肾移植手术患者下呼吸道医院感染经济损失

目的了解肾移植手术患者发生下呼吸道感染的经济损失。方法调查某三级甲等医院2008-2012年所有进行肾移植手术的患者,将发生医院下呼吸道感染的45例患者设为感染组,同期未发生医院感染的266例患者设为对照组,比较两组患者住院费用和住院天数的差异。结果纳入研究的患者共383例,其中下呼吸道医院感染发生率为11.75%（45例）。感染组的住院费用中位数为79 291.82元,对照组为72 185.14元,两组差异无统计学意义（P＞0.05）。感染组患者住院费用增加最多的是西药费（增加5 429.82元）,其西药费（39 123.17元）和检查费（702.52元）与对照组（分别为33 693.35元和 593.73元）比较,差异有统计学意义（均P＜0.05）。感染组患者住院天数中位数为28.38 d,对照组为21.47 d,两组比较,差异有统计学意义（P＜0.05）。结论肾移植术后患者发生下呼吸道感染会加重经济负担,延长住院时间,应采取措施防止肾移植术后患者发生下呼吸道感染,节约有限的医疗资源。     

脑卒中患者医院感染不同部位直接经济损失调查与分析

目的 通过对医院脑卒中患者医院感染不同部位进行前瞻性目标监测,分析患者不同感染部位的医院感染所造成的经济损失,为卫生决策部门制定相关政策提供依据。方法 采用整群抽样的方法,抽取医院2012年1月1日-2013年12月31日神经内科病房的552例脑卒中患者为研究对象,将发生医院感染的123例患者作为病例组,同期未发生感染的429例患者为对照组,比较两组患者住院费用的差异,采用SPSS17.0进行统计分析。结果 552例脑卒中患者感染123例、133例次,感染率为22.28%、例次感染率24.09%;多部位感染患者住院费用增加的最多,相比对照组患者住院费用中位数差值为6 766.88元;下呼吸道感染的患者住院费用中位数差值为3 234.46元;上呼吸道感染的患者住院费用中位数差值为3 192.15元,泌尿道感染的的患者住院费用中位数差值为2 495.07元。结论 不同医院感染部位导致脑卒中患者住院费用不同程度的增加,加强对脑卒中患者不同部位的医院感染控制力度,及时采取预防措施,可降低住院费用、减轻经济负担、避免医疗资源浪费。     

肾移植术后患者不同部位医院感染经济负担统计分析

目的分析某三级甲等医院器官移植病房肾移植术后患者因医院感染所造成的直接经济负担。方法采用前瞻性目标监测的方法,选取某三级甲等医院2008年1月1日-2012年12月31日在器官移植病房进行肾移植手术的患者为研究对象,使用自行设计的调查表比较两组(感染组和对照组)患者总住院费用及住院天数的差异。结果不同部位感染患者的经济负担不同;发生多部位感染患者较其他单一部位感染患者的住院费用高,住院天数长,经秩和检验,差异有统计学意义(P0.05);有无医保、多部位感染患者间住院费用的差异无统计学意义(P0.05)。结论肾移植术后患者发生医院感染导致患者住院费用增加,住院时间延长,且因患者医院感染部位的不同而有所差异,因此医院相关部门和医务人员应该采取积极有效的预防措施,避免肾移植术后的患者发生医院感染,以减轻国家与患者的经济负担。     

手术部位感染直接经济损失的病例对照研究

目的　了解手术部位感染所造成的直接经济损失。方法　采用 1∶1配比病例对照方法对患者进行研究。结果　病例组住院费用的中位数是 12 0 85元 ,对照组为 74 4 7元 (P <0 0 0 1) ,手术部位感染的直接额外费用是3419元 ,病例组术后住院日的中位数是 18 5d ,对照组为 10d(P <0 0 0 1) ,手术部位感染引起的额外术后住院日是 8d ,手术部位感染经济损失因科室、疾病不同而异。结论　手术部位感染的直接经济损失十分可观 ,有效地监控计划可以减轻患者和医院的经济负担     

ICU病房不同部位的经济学损失研究

目的:研究ICU病房住院患者不同部位医院感染所造成的直接经济损失。方法:采用回顾性调查和前瞻性监测的方法,调查2004年1月1日至2010年12月31日某省级医院ICU病房的住院患者,共收集病例2 060例。按条件1:1配比,发生医院感染的患者为病例组,未发生医院感染的患者为对照组,比较不同部位医院感染所增加的住院费用和住院天数的差别。结果:多部位感染所造成的经济损失中位数为168 998.33元/例,占据首位,其次为呼吸道感染所造成的经济损失中位数为48 472.17元/例,手术切口感染和泌尿道感染的经济损失中位数分别为42740.31元/例和26 324.46元/例,消化道感染的经济损失中位数最少为3 820.65元/例:多部位感染延长住院天数中位数为26天,呼吸道感染延长住院天数中位数为8天,手术切口感染和泌尿道感染延长住院天数中位数均为10天,消化道感染延长住院天数中位数为3天。结论:医院感染不同部位所造成的经济损失和延长的住院天数各不相同,按照经济损失的大小依次为多部位感染、呼吸道感染、手术切口感染、泌尿道感染和消化道感染。     

高血压脑出血老年患者医院感染经济损失调查与分析

目的分析老年高血压脑出血患者医院感染所造成的直接经济损失,降低经济损失,提高患者满意度。方法回顾性调查2014-2016年因高血压脑出血入院并且年龄≥65岁的发生医院感染患者115例,采用1∶1配比病例对照研究的方法,匹配病例组和对照组,各115例,比较其住院费用和住院时间的差异,分析老年高血压脑出血患者相关特点,计算由医院感染发生所导致的直接经济损失。结果病例组患者平均住院总费用中位数为4 7655.88元,对照组为32 413.07元,差异有统计学意义(P<0.05);在比较不同医院感染部位病例组和对照组住院时间中,所有部位的住院时间病例组中位数均高于对照组,差异均有统计学意义(P<0.05)。结论老年高血压脑出血患者发生医院感染后导致住院时间延长、住院费用增加,所致不良后果严重及直接经济损失很大,因此应目标性监测此类人群,降低其医院感染的发生。     

外科患者手术后医院感染直接经济损失评价

目的 探讨外科患者手术后医院感染所造成的直接经济损失及特点,为医院感染管理部门决策提供科学依据。方法 选择2016年1月1日-2018年12月31日某三级甲等综合性医院外科手术后发生医院感染的100例患者为病例组,采用1：1配对病例对照研究方法,选择100例手术后未发生医院感染的患者为对照组,采用配对设计的秩和检验方法,比较两组患者直接经济损失及住院日数差异。结果 病例组与对照组比较,住院费用（中位数）增加19 866.3元（Z=-8.338,P<0.01）,住院日数（中位数）增加8.0 d（Z=-6.857,P<0.01）;住院费用增加前三的手术为同种异体肾移植术、神经系统手术及泌尿系统手术,住院日数增加前三的手术为胆囊切除术、椎间盘破坏或切除术、泌尿系统手术,两组比较差异均有统计学意义（均P<0.05）;住院费用增加前三的感染为多部位感染、下呼吸道感染及腹腔内组织感染,住院日数增加前三的感染为多部位感染、深部切口感染及表浅切口感染,两组比较差异均有统计学意义（均P<0.05）。结论 外科患者手术后发生医院感染可导致巨大的直接经济损失,医院感染控制部门应采取有效的防控措施,减少外科多部位感染、下呼吸道感染及手术部位感染等感染的发生,减轻患者经济负担。     

脑卒中手术患者医院感染发生率及经济负担分析

目的调查脑卒中手术患者医院感染发生率及经济负担,为卫生决策部门制定相关政策提供依据。方法对2016年1月1日-2017年12月31日某三级甲等医院神经外科病房脑卒中手术患者医院感染情况进行调查,并采用1∶1病例对照研究方法,运用秩和检验比较感染组和非感染组的住院费用和住院天数,计算医院感染造成的经济负担。结果纳入的466例脑卒中手术病人中,133例发生医院感染,感染发生率为28.54%。感染组患者住院费用中位数为126280.08元,非感染组为72333.87元,两组比较差异有统计学意义(Z=-6.698,P0.001),医院感染的直接经济负担为53946.21元;感染组住院天数中位数为19d,非感染组为13d,两组比较差异有统计学意义(Z=-6.726,P0.001),医院感染延长病人住院6d;造成的间接经济负担为2055.6元,合计医院感染经济负担为56001.81元。结论脑卒中手术患者发生医院感染后住院费用增加,住院时间延长,给患者造成巨大的经济负担。     

住院患者医院感染直接经济损失的统计与分析

目的 研究住院患者医院感染所造成直接经济损失及其增长情况.方法 回顾调查2008-2010年发生医院感染并对出院的300例医院感染病例,采用1∶1病例配比对照方法,统计分析医院感染组住院费用、直接经济损失的增长情况.结果 2008年每例医院感染患者造成的直接经济损失为11679元,2009年为13426元,2010年为15696元;2009年每例医院感染患者较上一年直接经济损失增加1747元,增长率为14.96％,2010年每例医院感染患者较上一年直接经济损失增加2270元,增长率为16.91％,医院感染患者直接经济损失年平均增长2008元,增长率为15.94％.结论 医院感染给住院患者造成的经济损失严重,年增幅较大,应采取有效管理方法,控制医院感染.     

肾移植术后泌尿道感染患者的经济负担分析

目的:分析肾移植术后患者发生泌尿道感染所造成的经济负担,为卫生行政部门制定政策提供科学依据。方法:采用整群抽样的方法,对某三甲医院2008年1月1日至2012年12月31日所有入住器官移植科进行肾移植手术并符合纳入标准的患者共339例进行研究。采用病例对照研究的方法,将肾移植术后发生泌尿道感染的80例患者作为感染组,同期未发生医院感染的259例患者作为对照组,比较两组患者的住院费用及住院天数差异。结果:感染组患者住院费用高于对照组,两者中位数差值为23 307元,差异有统计学意义(P0.01)。在感染组患者的各项住院费用中,增加最多的是治疗费和西药费,其次为化验费。感染组和对照组住院费用中构成比占最多的均为西药费和治疗费。感染组患者较对照组患者延长住院天数6天,差异具有统计学意义(P0.05)。结论:肾移植术后患者发生泌尿道感染后经济负担较重,造成了患者、医院和国家医疗资源的浪费,因此应减少肾移植术后患者泌尿道感染的发生率,节约有限的医疗资源。     

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.