两种真菌医院感染危险因素的荟萃分析

目的 通过荟萃分析对应用广谱抗菌药物>2周及原发性肺部疾病作为真菌医院感染的危险因素给予评价.方法 从中国期刊全文数据库中检索真菌医院感染的危险因素进行回顾性病例对照研究,对上述两个危险因素采用固定效应模型或随机效应模型进行数据统计分析.结果 共有3项回顾性病例对照研究入选;在院内真菌感染的危险因素中,原发性肺部疾病的暴露率显著高于对照组(P<0.05,采用固定效应模型:OR值5.66,95%CI 3.90～8.19);广谱抗菌药物>2周暴露率差异无统计学意义(P<0.01,采用随机效应模型:OR值1.01,95%CI 0.73～1.42).结论 应用广谱抗菌药物>2周不能作为危险因素,具有原发性肺部疾病可作为真菌医院感染的危险因素.     

肺癌合并医院获得性肺炎患者死亡的危险因素分析

目的 评价与肺癌合并医院获得性肺炎患者死亡相关的危险因素,探讨有效的预防措施.方法对312例肺癌合并医院获得性肺炎患者的临床资料进行了回顾性分析.结果其中87例死亡,225例感染治愈;其相关的危险因素包括:年龄≥62岁(OR值1.75,95%CI 1.06～2.98)、肿瘤分期(Ⅳ期)(OR值9.24,95%CI5.21～16.17)、细菌/真菌感染(OR值2.31,95%CI 1.15～4.67)、低血清白蛋白浓度(OR值1.87,95%CI1.08～3.13).结论年龄较大、肿瘤转移、双重感染及血清白蛋白较低是肺癌患者合并医院获得性肺炎的死亡相关危险因素.     

公安民警代谢综合征影响因素的配对病例对照研究

目的 探讨公安民警代谢综合征(MS)发病的遗传、生活行为和职业影响因素.方法 采用1∶4配比病例对照研究方法,以天津市公安民警2010年体检资料为基础,根据2004年中华医学会糖尿病分会制定的MS工作定义(CDS标准),随机抽取新确诊的708名MS患者为病例组;按性别、年龄(±1岁)随机选取2007至2010年体检均正常的2832名健康公安民警作为对照组.对既往各种可能的危险因素暴露史进行流行病学调查,相关资料应用条件logistic回归模型分析.结果 单因素条件logistic回归分析发现15个因素与MS发病有关.多因素条件logistic回归结果,高血压家族史(OR=2.406,95%CI∶1.946～2.975)、糖尿病家族史(OR=1.301,95%CI∶1.043～1.623)、吸烟(OR=1.357,95%CI:1.010～1.823)、打鼾(OR=1.268,95%CI∶1.043～1.543)、高工作强度(OR=4.603,95%CI∶3.767～5.623)、职业应激事件(OR=1.524,95%CI∶1.209～1.922)、警种为治安警(OR=1.453,95%CI∶1.127～1.872)和警种为刑侦警(OR=2.792,95%CI∶2.168～3.596)是MS独立的危险因素,而奶制品(OR=0.782,95%CI∶0.619～0.989)是MS的保护因素.人群归因分值结果,若依次控制MS的危险因素吸烟、打鼾、高工作强度和职业应激事件,MS发病可分别减少16.26%、11.71%、56.87%和8.97%.结论 MS已成为影响公安民警健康的重要的公共卫生问题,应尽早针对相关的行为和生活方式、职业因素采取预防控制措施,减少MS的发病,提高公安民警的健康水平.     

成人麻疹发病危险因素病例对照研究meta分析

目的探讨成人麻疹发病的危险因素,为麻疹防控提供科学依据。方法通过文献检索2005-2017年4月以来国内外公开发表的有关成人麻疹发病危险因素研究文献,采用Stata 14.0软件进行meta分析。结果共纳入19篇病例对照研究文献,病例2 807例,对照4 989例。Meta分析结果显示,无免疫史(OR=5.182,95%CI:4.136～6.493)、病例接触史(OR=5.953,95%CI:3.486～10.167)、医院暴露史(OR=5.395,95%CI:3.925～7.416)、外出史(OR=2.877,95%CI:1.469～5.634)、流动人口(OR=3.278,95%CI:2.727～3.939)、经济收入低(OR=2.321,95%CI:1.753～3.073)、文化程度低(OR=1.400,95%CI:1.057～1.855)是成人麻疹发病的危险因素,而性别与发病无关联(OR=1.430,95%CI:0.533～3.836);敏感性分析显示,除文化程度与性别外,其余因素合并结果较为稳定。Egger′s检验显示该meta分析不存在发表偏倚。结论成人麻疹发病与多种因素有关,无免疫史、病例接触史、医院暴露史、外出史、流动人口及经济收入低是影响成人麻疹发病较为可靠的危险因素。     

杭州市戊型肝炎流行特征及危险因素研究

目的了解杭州市戊肝疫情特征及发病的危险因素。方法对杭州市2006-2010年戊肝病例进行描述性流行病学分析。采用病例对照调查方法,选取实验室确诊戊肝病例作为病例组,同期在同所医院就诊,血清戊肝抗体阴性的非感染性疾病患者作为对照组。制定统一的调查表进行调查,资料采用SPSS 13.0单因素和多因素非条件logistic回归分析。结果 2006-2010年,杭州市共报告戊肝病例2 063例,年平均发病率为5.51/10万,年发病率逐年上升,疫情以散发病例为主。多因素logistic回归分析结果显示,在外就餐(OR=1.554;95%CI:1.234～1.958)及与他人共用水杯(OR=1.889;95%CI:1.120～3.184)是危险因素,饭前有洗手习惯(OR=0.370;95%CI:0.184～0.745)是保护因素。结论杭州市戊肝发病呈逐年上升趋势,接触及食源性传播是主要的传播方式,开展餐饮从业人员戊肝检测很有必要。     

安徽省淮河流域重点地区胃癌危险因素病例对照研究

目的 探索淮河流域重点地区胃癌患者的危险因素,为淮河流域胃癌的一级防控提供依据。方法 从当地区(县)肿瘤登记系统选取确诊时间在2020年1月1日—2021年7月31日期间肿瘤诊断ICD-10编码为C16的胃癌新发病例作为病例组,按照1∶2的配对原则选择与患者同地区、同性别、无既往恶性肿瘤病史、年龄±5岁的人群作为对照组,对两组人群进行问卷调查和身体测量,共纳入胃癌病例240例,对照480例。采用SAS统计软件进行logistic回归分析胃癌发生的危险因素。结果 多因素logistic回归分析结果显示,饮食口味偏咸(OR=2.161,95%CI:1.141～4.095)、喜食辛辣食物(OR=1.773,95%CI:1.057～2.975)、接触二手烟(OR=1.963,95%CI:1.168～3.299)、经常爱生气(OR=8.704,95%CI:3.582～21.147)和消化系统疾病史(OR=2.302,95%CI:1.329～3.988)是胃癌发生的危险因素;BMI(OR=0.697,95%CI:0.639～0.761)、文化程度高(OR=0.454,95%CI:0.248～0.8...     

深圳市宝安区8月～7岁儿童麻疹发病危险因素研究

目的 探讨深圳市宝安区21007年麻疹高发的原因,以制订针对性的麻疹控制措施.方法 选取8月～7岁龄儿童,采用病例对照研究方法,研究病例组和对照组在医院暴露史、麻疹患者接触史、疫苗接种史和人口信息等可能的影响因素上的差异,分析宝安区麻疹发病的危险因素.结果 医院暴露和麻疹病例接触是宝安区麻疹高发的危险因素,OR值的95%CI分别为1.85～5.77、1.75～13.6,疫苗接种是保护因素.OR值的95%CI为0.07～0.27.分层分析显示:医院暴露和麻疹病例接触有交互效应;医院暴露和未接种麻疹疫苗有交互效应;医院暴露次数越多,OR值越大;疫苗接种次数越多,OR值越小. 结论 医院暴露、麻疹病例接触史和未接种麻疹疫苗足宝安区麻疹高发的主要危险因素.     

老年人产超广谱β-内酰胺酶细菌医院获得性肺炎的危险因素分析

目的对老年人产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌医院获得性肺炎的危险因素进行探讨,以便积极采取有效的预防措施。方法收集2003-2006年的41例ESBLs阳性大肠埃希菌和肺炎克雷伯菌医院获得性肺炎老年病例,同时选取60例ESBLs阴性大肠埃希菌和肺炎克雷伯菌医院获得性肺炎老年病例为对照。对两组患者的危险因素进行病例对照研究,采用多因素非条件Logistic回归分析。结果多因素非条件Logistic回归分析表明,患有肾病(OR=26.272,95%CI为1.940～355.733)、使用三代头孢菌素(OR=9.187,95%CI为2.110～39.997)、动静脉置管(OR=7.714,95%CI为2.123～28.022)、使用氟喹诺酮类抗菌药物(OR=5.524,95%CI为1.417～21.534)、使用抗酸剂(OR=3.609,95%CI为1.054～12.360)和使用激素(OR=3.464,95%CI为1.051～11.412)是老年人产ESBLs细菌医院获得性肺炎的独立危险因素。结论应根据危险因素采取有效措施来减少老年患者中ESBLs细菌的感染。     

超广谱β-内酰胺酶细菌致医院内感染危险因素的病例对照研究

目的　探讨医院内产生超广谱 β 内酰胺酶 (ESBLs)细菌感染的危险因素。 方法　收集浙江省 1 999年 5月至 2 0 0 0年 5月 6所医院收治的 1 85例ESBLs阳性细菌医院内感染病例 ,男 1 0 8例 ,女 77例 ;平均年龄 (55± 1 7)岁 ;1 85例中呼吸道感染 59例 ,泌尿道感染 71例 ,血液感染 1 0例 ,创口感染 30例 ,其他部位感染 1 5例。同时选取 77例ESBLs阴性细菌医院内感染者为对照 ,男 54例 ,女 2 3例 ,平均年龄 (54± 2 0 )岁。其中呼吸道感染 38例 ,泌尿道感染 2 0例 ,血液感染 6例 ,创口感染 8例 ,其他部位感染 5例。对两组病人的危险因素进行病例对照研究 ,采用非条件logistic回归分析和主成分分析进行研究。结果　多因素非条件logistic回归分析结果表明 ,三代头孢菌素应用 3d以上 (OR =4 52 ,95 %CI为 2 30～ 8 89)、联合应用抗生素 (OR =2 86 ,95 %CI为 1 51～ 5 43)、喹诺酮类抗生素使用 3d以上 (OR =2 44,95 %CI为 1 1 8～ 5 0 4 )、应用肾上腺皮质激素 (OR =2 1 6 ,95 %CI为 1 0 8～4 31 )及给氧 (OR =2 56 ,95 %CI为 1 1 4～ 5 72 )是产生ESBLs的细菌医院内感染的独立危险因素 ;从1 4个产生ESBLs的细菌医院内感染危险因素中提取了 5个主成分进行分析 ,其方差累积贡献率达60 2 %。 5个主成分     

广东省传染性非典型肺炎感染危险因素病例对照研究

目的了解SARS感染的危险因素。方法选择2002年11月16日至2003年6月30日广东省报告的符合“卫生部《传染性非典型肺炎临床诊断标准(试行)》”的病例,在病例的邻居中选择与病例年龄相差不超过5岁,性别相同,无接触史且无发病者作为对照,采用回顾性调查方法,调查内容包括一般情况、流行病学史、家庭环境、工作场所环境、个人饮食和卫生情况。采用单因素和多因素Logistic回归分析方法进行比较。结果共调查病例809例、对照331例。多因素条件Logistic回归分析结果表明,发病前20 d有外县旅行史(OR=1.82,95%CI为1.05~3.17)、去过医院(OR=1.59,95%CI为1.06~2.39),有SARS/可疑SARS病例接触史(OR=1.66,95%CI为1.33~2.08)和有动物接触史(OR=1.53,95%CI为1.05~2.24)是SARS感染的危险因素,工作场所通风良好(OR=0.56,95%CI为0.41~0.76)是SARS感染的保护因素。结论接触SARS或可疑SARS病例、去过医院、有外县旅行史和有接触动物史是SARS感染的危险因素。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.