脑梗死患者医院感染特点及危险因素

目的探讨脑梗死患者医院感染特点及其危险因素。方法选取2016年1月-2019年12月鹰潭市人民医院神经内科合并医院感染的脑梗死患者74例作感染组,收集患者临床疾病资料、检查资料及病原学资料,总结脑梗死患者医院感染特点;另选取同期未发生医院感染的脑梗死患者65例作无感染组,以非条件Logistic模型,分析脑梗死患者发生医院感染的危险因素。结果脑梗死医院感染患者中≥60岁占87.84%,感染部位以下呼吸道为主(66.22%),病原菌培养阳性率为77.03%,共分离出65株病原菌,以革兰阴性菌为主(58.46%),常见革兰阴性菌对万古霉素、美洛培南及亚胺培南耐药率低。Logistic回归分析显示,年龄(OR=1.545)、吞咽困难(OR=1.435)、既往肺部疾病(OR=1.425)、糖尿病(OR=1.684)、入院美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.799)、住院时间(OR=1.919)及侵入性操作(OR=1.751)是脑梗死患者发生医院感染的独立危险因素(P0.05)。结论老年脑梗死患者是医院感染的易感人群,多为下呼吸道感染,病原菌以革兰阴性菌为主,其发生医院感染的影响因素较多,需针对性制定相应预防及干预对策,以降低脑梗死患者医院感染发生率。     

泌尿系统恶性肿瘤患者化疗后感染调查与影响因素分析

目的 探讨泌尿系统恶性肿瘤患者化疗后感染调查和影响因素,为采取针对性的预防干预措施提供参考依据.方法 收集泌尿外科2011年2月-2013年2月收治的290例泌尿系统恶性肿瘤患者临床资料,根据泌尿系统恶性肿瘤患者有无感染,分为感染组与非感染组,运用SPSS19.0统计软件进行描述性统计和二分类logistic回归分析泌尿系统恶性肿瘤化疗后感染影响因素.结果 290例患者中发生感染31例,感染率为10.69％,以呼吸道感染为首15例,占48.39％,多因素logistic回归分析发现,侵入性操作多(β=3.084,OR=21.847)、外周血白细胞数低(β=3.188,OR=24.244)和住院时间＞30 d(β=2.608,OR=13.574)是泌尿系统恶性肿瘤患者化疗后感染的影响因素,专科护理人员护理(β=-2.849,OR=0.058)是泌尿系统恶性肿瘤患者化疗后感染的保护因素.结论 泌尿系统恶性肿瘤患者化疗后感染率较高,其受多方面因素影响.     

呼吸内科患者医院感染的危险因素分析

目的探讨呼吸内科患者发生医院感染的危险因素,为可行的预防措施提供依据。方法回顾性分析2008年1月-2012年1月医院呼吸内科收治的843例住院患者临床资料,对可能导致感染发生的影响因素进行非条件logistic回归分析,确定影响呼吸内科患者发生术后感染的危险因素,采用SPSS15.0软件对数据进行统计处理,计数资料采用χ2检验。结果 843例住院患者中61例发生医院感染,感染率为7.2%;感染部位以下呼吸道为主23例占37.7%;单因素分析显示,年龄≥60岁、住院时间>2周、有侵入性操作、激素应用和合并基础疾病的患者医院感染发生率较高,分别为9.6%、9.4%、11.1%、9.4%、10.2%,差异有统计学意义(P<0.05);多因素logistic回归分析的结果显示,年龄(β=1.35,OR=2.55)、住院时间(β=1.57,OR=4.57)、侵入性操作(β=1.78,OR=5.81)、合并基础疾病(β=1.56,OR=2.94)与呼吸内科患者医院感染的发生有着密切关系,是其独立危险因素(β>0,OR>1)。结论呼吸内科患者的医院感染发生率较高,临床工作中应重视对影响其发生的危险因素,并采用合理的措施对其进行预防。     

结直肠癌患者术后感染病原菌分布及影响因素分析

目的探究并分析结直肠癌患者术后感染病原菌分布及影响因素,为采取针对性预防干预措施提供参考依据。方法收集医院2008年2月-2012年2月收治的459例结直肠癌患者临床资料,运用SPSS17.0统计软件进行描述性统计和二分类logistic回归分析,找出结直肠癌患者术后感染状况及影响因素。结果 459例结直肠癌患者术后发生医院感染82例,感染率为17.86%,以手术部位感染最多见,占65.85%;主要感染病原菌以革兰阴性杆菌为主,占63.95%;多因素logistic回归分析显示,高龄(OR=3.795,P=0.001)、Dukes分期为D期(OR=8.505,P=0.001)、侵入性操作>3种(OR=3.901,P=0.001)、陪护感染(OR=6.682,P=0.001)和手术持续时间>4h(OR=9.626,P=0.001)是结直肠癌患者术后感染的危险因素。结论结直肠癌患者术后感染发生率较高,感染病原菌以革兰阴性杆菌为主,其发生受多方面因素影响,应采取针对性预防干预措施来减少结直肠癌患者术后感染的发生,加快术后患者病情恢复,改善患者的生活质量及预后。     

妇产科术后医院感染相关危险因素分析及对策

目的 探讨妇产科患者发生术后医院感染的危险因素和相关对策,为控制和预防感染提供科学依据.方法 收集2009年1月-2011年12月在妇产科行手术治疗的786例患者的临床资料,观察医院感染发生情况,对感染相关危险因素行单因素分析后进入logistic多因素回归分析.结果 786例患者中发生医院感染43例,感染率5.47％,感染部位以泌尿道为主,占27.91％,其次为腹部切口、阴道、呼吸道、皮肤黏膜,分别占23.26％、16.28％、13.95％、11.63％;单因素分析发现医院感染与年龄、手术时间、合并基础疾病、侵入性操作、术后留置导管时间、手术方式、预防性应用抗菌药物等因素有相关性(P＜0.05);logistic多因素回归分析发现年龄((OR=3.812,P=0.037)、侵入性操作(OR=2.547,P=0.012)、手术时间(OR=2.804,P=0.041)和合并基础疾病(OR=3.758,P=0.023)是医院感染发生的独立危险因素.结论 妇产科术后医院感染是多因素综合作用的结果,其发生率较高,应根据相应的情况,采取有针对性的诊疗措施,密切监测高龄患者,减少侵入性操作,严格无菌操作,预防和降低医院感染的发生.     

呼吸机相关性肺炎危险因素的研究

目的 探讨引起呼吸机相关性肺炎的相关因素及预防对策.方法 2008年1月-2010年12月医院采用机械通气治疗患者160例,以呼吸机相关性肺炎患者作为观察组,无呼吸机相关性肺炎者作为对照组,比较两组可能相关因素上的差异,进行单因素检验及logistic回归分析.结果 160例患者中发生呼吸机相关性肺炎50例,发生率为31.25％;单因素检验12个变量是影响呼吸机相关性肺炎的危险因素(P＜0.05) ;logistic回归分析显示独立危险因素为:APACHEⅡ评分高(OR=4.56)、机械通气时间长(OR=3.23)、头部仰卧位置(OR=3.02)、年龄大(OR=2.98)、应用抗酸剂(OR=2.23).结论 呼吸机相关性肺炎发生率较高,应针对上述因素实施相应的对策以减少呼吸机相关性肺炎的发生.     

产妇发生医院内呼吸道感染的易患因素观察及对策

目的 探讨产妇发生医院内呼吸道感染相关因素及其护理对策,为临床降低产妇发生医院内呼吸道感染提供依据.方法 对2010年6月-2012年6月321例合并呼吸道感染的产妇临床资料进行了回顾性分析,对产妇发生医院内呼吸道感染的因素采用logistic回归分析进行统计分析.结果 季节(OR=2.634,95％CI:0.453～5.323)、生育高峰期(OR=2.432,95％CI:0.343～4.564)、住院时间(OR=3.453,95％CI:0.644～5.343)是产妇发生上呼吸道感染的危险因素,而室内每天通风(OR=4.453,95％CI:0.563～5.345)是产妇发生上呼吸道感染的保护性因素.结论 应当保持病室内空气流通、减少探视人员、减少产妇住院时间是降低产妇发生呼吸道感染的必要措施.     

甲状腺癌患者术后医院感染因素分析

目的探讨分析甲状腺癌患者术后发生医院感染的相关因素,为医院预防和控制医院感染提供依据。方法回顾性分析2007年3月-2012年8月医院收治的52例术后发生医院感染的患者作为感染组,同期住院的52例术后未发生感染的患者作为对照组;对两组患者进行单因素和非条件多因素logistic回归分析,找出导致患者医院感染的危险因素。结果单因素分析结果显示,年龄、肿瘤的病理分型、肿瘤发生转移的情况、住院时间、术前使用抗菌药物及气管切开情况的差异两组间比较差异有统计学意义(P<0.05);非条件多因素logistic回归分析结果显示,高龄(β=1.369,OR=3.391)、低分化癌(β=1.431,OR=4.108)、长时间住院(β=1.594,OR=4.923)、术前未使用抗菌药物(β=1.157,OR=3.180)、气管切开(β=1.639,OR=5.150)是甲状腺癌患者术后发生院感染的危险因素。结论对存在易感染因素的甲状腺癌患者术后应加强规范化护理操作,合理用药,降低感染的发生。     

高血压患者发生急性脑梗死的影响因素分析

目的研究高血压患者发生急性脑梗死(ACI)的影响因素,为临床各级预防提供依据。方法选取2014年5月1日至2016年10月1日在天津市红桥医院住院的高血压患者248例,按照是否合并急性脑梗死分为脑梗死组(128例)和非脑梗死组(120例),记录性别、年龄、吸烟饮酒状况、高血压发病年龄、高血压病程、高血压分级、高血压控制达标情况、心脑血管病史、心血管风险分层等基本资料,测定动态血压、相关血清学指标和颈动脉斑块形成情况。采用SPSS 20.0统计软件进行t检验、方差分析、秩和检验和χ2检验,用单因素和多因素logistic回归分析脑梗死的影响因素。结果单因素分析筛选出22个具有统计学意义的脑梗死相关因素。多因素logistic回归分析结果显示,血压晨峰(OR=2.269)、颈动脉斑块形成(OR=1.546)、夜间平均收缩压(OR=1.054)、白昼血压负荷值(OR=1.020)和低密度脂蛋白胆固醇(OR=1.588)是急性脑梗死的危险因素,血压控制达标(OR=0.074)和杓型血压(OR=0.121)是急性脑梗死的保护因素。结论应重点关注血压晨峰、颈动脉斑块形成、夜间平均动脉压、白昼血压负荷值和低密度脂蛋白胆固醇水平较高的高血压患者,积极预防,降低发生脑梗死的风险。     

鲍氏不动杆菌院内感染危险因素剂量反应关系分析

目的 了解重症监护病房(ICU)下呼吸道鲍氏不动杆菌院内感染的流行情况及危险因素,为下呼吸道鲍氏不动杆菌的院内感染控制提供依据.方法 采用回顾性病例对照研究,以2011年ICU 103例下呼吸道鲍氏不动杆菌感染病例为研究对象,病例组为院内感染下呼吸道鲍氏不动杆菌的47例患者,同期分离的院外下呼吸道鲍氏不动杆菌的病例56例为对照组,分别采用单因素t检验、检验、多因素logistic回归分析危险因素及趋势分析剂量反应关系.结果 ICU下呼吸道鲍氏不动杆菌感染病例共103例,其中院内感染47例占45.63％;男性83例,女性20例,平均年龄(61.45±20.87)岁;单因素分析发现年龄、性别、抗菌药物联用、机械通气和中心静脉插管与下呼吸道鲍氏不动杆菌院内感染有关;经多因素logistic回归分析只有年龄(OR=1.051)和机械通气(OR=2.937)是下呼吸道鲍氏不动杆菌院内感染的重要危险因素;年龄、机械通气的天数均与ICU下呼吸道感染鲍氏不动杆菌之间存在剂量-反应关系.结论 年龄越大、机械通气天数越长,发生下呼吸道鲍氏不动杆菌院内感染的风险越大,加强重点人群监测,规范各类侵入性操作,减少插管时间,将有利于减少下呼吸道鲍氏不动杆菌院内感染的发生.     

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.     

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.     

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.     

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.     

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.