天津市某医院职工健康检查异常检出结果

目的了解医院职工的身体健康状况,为有针对性地采取预防保健和干预措施提供依据。方法2011年4月对天津市某医院1473名职工进行健康检查,包括临床常规项目（20余项）和加检项目检查（35岁以上人员加检血糖、血脂、血流变、。肾功能,男性加检泌尿系B超,女性加检妇科检查、妇科B超、乳房检查、宫颈图片检查）,并对检查结果进行统计分析。结果受检者异常总检出率为79．4％,其中男性检出率79．9％,女性检出率78．8％。检出率较高的前3种疾病依次为总胆固醇偏高占22．06％,高血压占14．80％,甘油三酯偏高占9．44％;男性检出率最高的是高血压,女性是高胆固醇。除了血脂异常和高血压,49岁以下人群脂肪肝检出率最高,50岁以上眼底动脉硬化检出率最高。结论代谢疾病是危害该院职工健康的主要问题,男性和中年职工是患病的高危人群。健康检查是早期发现疾病的根本途径,因此,做好健康检查管理和健康教育工作,对预防相关慢性病的发生有重大意义。     

北京市海淀区某高校教职工慢性肾脏病流行病学调查

目的 获取北京市海淀区某高校教职工慢性肾脏病流行病学数据,有助于慢性肾脏疾病的早期发现、早期诊断、早期治疗及国家公共卫生政策的制定提供依据。方法 采用普查法对北京市海淀区某高校中4 699名教职工进行问卷调查并检测肾脏损伤指标及相关危险因素,包括体格检查、尿常规、尿潜血、scr、BUN、血尿酸、血胆固醇(Cho)、血三酰甘油(TG)及肾脏B超等。结果 在4 401例资料完整的教职工中,白蛋白尿、肾功能下降、单纯镜下血尿及肾脏B超异常的患病率分别为7.02%、3.07%、15.57%及14.78%,该人群中CKD患病率30.72％。多因素logistic回归提示,CKD的最强烈危险因素为年龄,其余为男性。结论 在北京海淀某高校教职工人群中,CKD患病率为30.72％。CKD的危险因素为年龄和男性。     

某冶炼企业作业工人尿砷和血铅检测及临床观察

目的通过检测企业职工的尿砷和血铅含量及对超标者进行临床观察、治疗,了解工作环境中砷、铅对职工身体健康状况的影响。方法采集某冶炼厂一线作业工人的169份尿液和血液,用湿法消解-原子荧光法和石墨炉原子吸收光谱法分别进行尿砷和血铅含量捡测。结果 169名工人中,有25例尿中砷含量增高,45例血中铅含量增高,其中14例尿砷和血铅检测结果同时增高,分别占体检人数的14.79%、26.63%、8.28%。且男性血铅异常百分率明显高于女性(P0.01)。部分砷、铅超标工人出现头昏、腰背酸痛、全身乏力、精神睡眠差、胃肠消化道症状及血、尿常规、肝功异常。结论该企业生产环境中砷、铅已对职工身体健康造成一定影响,应加强作业环境监测,改善劳动条件,提高工人的职业防护意识。     

烟台市812名食品从业人员戊型肝炎病毒感染状况调查

目的调查烟台市食品从业人员（包括食品生产加工、餐饮服务及公共场所）戊型肝炎病毒（HEV）感染情况,为从业人员健康检查标准制定和从业人员戊肝（HE）的预防和控制提供依据。方法对2010年6—7月份进行预防性健康检查的食品生产加工、餐饮服务及公共场所从业人员调查既往戊肝患病史,采集5 m l静脉血,分离血清,检测丙氨酸转氨酶、抗HEV-IgG、抗HEV-IgM。结果调查812人,HEV感染率为24.01%,丙氨酸转氨酶均在正常范围内,抗HEV-IgG阳性率为22.78%,女性高于男性,40岁~年龄组高于其他年龄组。食品生产加工从业人员高于餐饮服务人员和公共场所服务人员。抗HEV-IgM阳性率1.23%。结论提示烟台市食品从业人员存在HEV排毒,可能威胁公共健康安全,建议应对从业人员健康检查的标准进行修订。     

某汽车公司职业健康体检结果分析

目的通过对某汽车公司职工进行职业健康体检,了解职工身体健康状况,确定危害职工健康潜在危险因素,为制定职业性有害因素预防控制提供依据。方法收集从事接触苯、粉尘、溶剂汽油的生产工人的职业健康体检资料,对体检结果进行对比分析。结果某汽车公司体检人数908人,目标疾病检查异常人数为28人,异常率为3.1%。非目标疾病检查异常人数299人,其中以血压增高、脂肪肝、心电图异常为主。结论职工健康状况令人担忧,应加强健康教育,提高自我保健意识,并定期体检。     

北京市西城区在职人群常见慢性病患病现状及危险因素分析

目的探讨北京市西城区在职人群常见慢性病患病现状及其相关危险因素,为在职人群慢性病防治提供科学依据。方法采用多阶段分层整群随机抽样方法对辖区15岁以上常住居民进行抽样调查。回收有效问卷33936份。本研究利用上述数据对其中12980名18--60岁在职人员进行分析。结果在职人群主要慢性病患病前8位的疾病依次为高血压、血脂异常、糖尿病、慢性骨关节病、冠心病、慢性阻塞性肺疾病（COPD）、慢性肾炎、脑卒中,患病率依次为11．20％、5．37％、2．43％、1．59％、1．19％、0．96％、0．71％和0．29％。以是否患有高血压、血脂异常或糖尿病为因变量进行多因素非条件logistic回归分析,发现体质指数（BMI）、年龄、男性、吸烟、饮酒、高盐饮食和不良情绪是在职人群三类慢性病患病的危险因素。结论高血压、血脂异常和糖尿病是危害在职人群健康的主要慢性病,应加强对在职人群的健康教育和行为干预,积极探索在职人群的健康管理模式。     

糖尿病因素对医院感染特征的影响 FREE

目的分析糖尿病因素对医院感染特征的影响。方法选择2006年7月-2008年6月某院内科医院感染病例为研究对象,以是否存在糖尿病因素分为研究组（有糖尿病）和对照组（无糖尿病）,分析两组基础疾病、感染部位、易感因素、侵袭性因素和病原菌分布情况的异同。结果研究组较少合并肿瘤疾病(P=0.00),较多发生泌尿道感染(P=0.00,OR=1.61),较少有化学治疗(P=0.01)、使用肾上腺糖皮质激素(P=0.00)和免疫抑制剂(P=0.01)易感因素,较多进行血液透析(P=0.00, OR=2.82)和发生肠球菌属感染(P=0.01, OR=2.06)。结论糖尿病因素对医院感染特征有一定影响,提示在关注所有医院感染易感因素时,对于糖尿病患者尤其要注重血液透析的管理和预防肠球菌泌尿道感染的发生。     

Improving physician compliance with a health maintenance protocol

A two-year prospective study was conducted to determine whether specific educational, organizational, and behavior reinforcing interventions could improve physician performance of selected health maintenance procedures in the private practice setting. The procedures studied included history of tobacco use, blood pressure determination, history of alcohol use, fecal occult blood testing for colon cancer, Pap smears, and physician breast examinations. Overall compliance with these procedures improved from 58 percent to 72 percent. There were marked differences in compliance among the procedures, ranging from 99 percent of patients having their blood pressure recorded to 51 percent having a fecal occult blood screening for colon cancer. Compliance with use of a screening flow sheet was much less than compliance with specific procedures. The screening flow sheet was completed on only 29 percent of patients' charts.     

4种类型医院感染的经济损失病例对照研究 FREE

目的从卫生经济学角度,分析医院上呼吸道、下呼吸道、泌尿道、手术部位感染所造成的经济损失。方法采用1∶1配对的方法,调查100对患者［发生上述医院感染的患者（病例组）与同期类似住院未发生医院感染的患者（对照组）］的卫生资源消耗并进行比较,对医院感染进行经济学评价。结果病例组住院总费用中位数每例为22 379.01元,对照组为7 611.52元,病例组显著高于对照组（Z=-6.72,P=0.00）;医院感染经济损失因感染部位的不同而异,下呼吸道感染经济损失最大,为21 701.03元,其次为泌尿道感染6 374.52元、手术部位感染5 849.04元、上呼吸道感染3 598.00元;患者住院费用的增加主要是药费、检验费、材料费、治疗费、处置费;病例组中位数每例患者住院时间为24.51 d,对照组为11.00 d,两组间差异有统计学意义（Z=-7.84,P＝0.00）。结论医院感染造成的经济损失较大,经济损失因感染部位的不同而异;同时,由于发生医院感染而延长了患者的住院时间。     

尿液分析仪与显微镜法在尿潜血检验中的应用

目的:探析尿液分析仪以及显微镜法在尿潜血检验中的临床应用价值。方法:纳入2018年2月~2019年2月本院检验科收治的接受尿潜血检验的患者55例为观察对象,所有患者均给予尿液分析仪检查和显微镜法检查,对两种尿潜血检查方法的临床应用价值进行分析与比较。结果:尿液分析仪检查尿潜血的阳性率为65.5%;显微镜法检查尿潜血的阳性率为67.3%,尿液分析仪检查尿潜血阳性率与显微镜法无明显差异(P>0.05)。结论:在检查尿潜血的过程中尿液分析仪检查与显微镜法检查的阳性率大致相同,两种检查方法均可以作为尿潜血的理想检查方法,各自具有自己的优势,而在实际的临床检查过程中可以联合两种检查方法的结果进行病情诊断,以提高诊断的准确性,为患者的及时、有效治疗提供基础。     

头孢地秦钠粉针剂治疗呼吸系统和泌尿系统感染的临床研究

目的评价头孢地秦钠粉针剂(康丽能)治疗呼吸系统和泌尿系统感染的临床有效性与安全性. 方法采用多中心随机双盲平行对照的试验方法, 试验药组和对照药组各72例,总病例数为144例(呼吸系统感染96例和泌尿系统感染48例),进入PP分析的例数为 129例(呼吸系统感染84例,泌尿系统感染45例);治疗方案为每次2g静脉滴注,2次/d,疗程均为5～14 d. 结果头孢地秦钠治疗呼吸系统感染患者的痊愈率为79.07%、有效率为86.05%,细菌阴转率和细菌消除率为100.00%;治疗泌尿系统感染患者痊愈率为81.82%、有效率为95.45%,细菌阴转率为88.89%、消除率为100.00%;不良反应发生率为5.56%. 结论头孢地秦钠粉针剂对敏感菌所致的呼吸道和泌尿道感染,临床疗效肯定,不良反应轻,值得在敏感细菌感染的治疗中推广应用.     

An occupational health physician's report on the improvement in the sleeping conditions of night shift workers

This paper reviews briefly our research findings on sleep and health for shift workers at a bakery and a dish factory and aims to give some information on health protection with improved sleep. Our medical examinations revealed that rises in blood pressure (BP) were frequently observed in male bakery workers on the fixed night shift. They took a two-hour nap from 1:00 to 3:00 during the night shifts according to our advice. As a result, their diastolic BP significantly decreased in subsequent years. Women working shifts before 3:00 at a dish factory seemed to show more sleep disturbance, higher daytime sleepiness, and more fatigue than those working shits from 3:00. Total sleep hours taken during the daytime was similar between two groups. Among the dish, factory workers who switched to midnight or night shifts, 70% reported slow recovery from fatigue and 30% felt deteriorated health. These women also reported increased efforts to obtain a deep sleep, probably making up for shortened sleep. Occupational physicians can act to improve shift work conditions through monitoring the health of workers, applying naps, and designing possible schedules to secure deep, sufficient sleep.     

Inequality in the health status of workers in small-scale enterprises

BACKGROUND: Small-scale enterprises (SSEs) usually share poorer resources for promoting occupational health. AIM: To investigate inequality of health status among SSEs in Japan. METHOD: A cross-sectional, multiple-centred study was carried out using the periodical health check-up data for the fiscal year 2000 to compare the age-adjusted proportions of workers with hypertension (HT), hyperlipidaemia, impaired glucose tolerance (IGT) and obesity and of current smokers by size of enterprise, i.e. or=1000 employees in Japan. RESULTS: From five leading occupational health organizations, data were collected for 9833 enterprises with a total of 436 729 subjects, 302 383 males and 134 346 females. The proportions of workers in SSEs with or=50 male employees. The prevalence of smokers in SSEs with or=50 male employees. These proportions showed a significantly increasing tendency with decreasing size of male workforce. CONCLUSION: Despite the cross-sectional design and only adjusting age as a potential confounder, higher proportions of HT, IGT, obesity and smoking in male workers were found in SSEs compared to larger organizations.     

Insights from a large rural population laboratory. Health census '89 and '99

PURPOSE: Data are limited on health status behaviors and use of health services for rural residents. Yet rural areas now have higher rates of chronic diseases, such as coronary heart disease, than urban areas.METHODS: A population laboratory (Health Census) was established in rural Central NY (Otsego County) to study these variables in this population. HC '89 was a door-to-door enumeration of all permanent households in the country. In 1989, 44,500 adults in 18,000 households provided data on individual health screenings, cancer and cardiovascular risk factors, health behaviors, chronic disease, access to care, preventive services use, health insurance and emergency department utilization. Data collection for HC '99 will identify 10-year trends; it also includes baseline data for children. Also, households in six surrounding rural counties (N = 10,000) were sampled; cost benefits of different survey methods were assessed. Questions about perceived health status, and special health and pediatric preventive care needs were included. After 10 years of social change, many limitations of traditional survey methods became apparent; much more varied and frequent types of follow-up were needed to achieve adequate response rates.RESULTS: The HC '89 final response rate was 86%. There were significant socioeconomic gradients in use of preventive services (blood pressure screening, rectal exams, mammograms and Pap smears). Adults without health insurance or Medicaid had much lower utilization rates of screening tests and higher rates of cigarette smoking and obesity. Several community intervention programs were implemented as a result of HC '89. HC '99 provides additional analyses to examine change in preventive service use, self-reported chronic disease, and health services use; it will likely verify the persistence of socioeconomic gradients. Response rates are similar to '89, but achieved only with more intensive reinforcement.CONCLUSIONS: HC '89 confirmed a lag in positive health indices in rural populations in Central NY. Both newer methodologies now needed and results of HC '99 will serve as guides for smaller rural counties to develop affordable local health surveys and plan intervention strategies.     

Colorectal cancer prevention. An approach to increasing compliance in a faecal occult blood test screening programme

STUDY OBJECTIVE: The assessment of the uptake of colorectal cancer screening offered in a workplace setting. DESIGN: Employees were offered a free faecal occult blood test (Haemoccult). A repeat letter was sent two months later to non-responders. Those with positive tests were invited for colonoscopy. Compliance was measured according to age, sex, and occupational group and the effects of reinviting non-compliers investigated. SETTING: Leicester General Hospital, a large university teaching hospital. PARTICIPANTS: 990 employees aged 41 to 65 years. MAIN RESULTS: Total compliance was 46% with women participating more than men (49% v 34%, chi 2 = 12.2, p < 0.001). The difference was mostly because of women aged 41 to 50 years complying more than their male counterparts (48% v 24%, chi 2 = 15.5, p < 0.0001). Participation was highest in clinical support staff (56%), nurses (52%), and clerical workers (46%). Uptake by doctors (26%) and managers (26%) was significantly lower than by clinical support staff and nurses (chi 2 > 5.5, p < 0.02). Remailing raised compliance slightly from 43.6% to 46.3%. Four employees (1%) had positive faecal occult blood tests but three were negative on repeat testing with dietary restrictions. CONCLUSIONS: The government favours the development of health promotion programmes as stated in its document "Health at work in the NHS". The response in this study, showed methods to increase compliance must be developed if such programmes are to be successful. As uptake was similar to that in several community based programmes in general practice, workplace based programmes could offer a complementary method of delivering screening.     

南京市浦口区482名机关人员健康状况分析

目的了解机关人员健康相关行为与常见慢性病的状况,以便有针对性地开展健康干预。方法采用问卷调查和体格检查、血液生化检验等方法,对研究对象健康相关行为与慢性病现况进行调查、分析。结果482名机关人员中,吸烟、饮酒、高盐/高脂饮食、运动不足、睡眠不足等5种行为流行率分别为51.66%、56.64%、36.51%、44.61%和36.10%;无危害健康行为的人数占11.20%,存在1种、2种、3种、4种及以上危害健康行为的人数分别占23.86%、28.84%、26.56%和9.54%。5种慢性病总患病率为30.71%,高血压、糖尿病、冠心病、慢性支气管炎、其他慢性病患病率分别为25.93%、6.85%、1.45%、0.62%和0.62%,其中高血压、糖尿病的患病率高于当地18岁以上居民的患病率水平（分别为17.70%、4.80%）。结论机关人员危害健康行为流行率高、慢性病患病率高,应列为重点干预对象,开展慢性病健康干预。     

泌尿生殖系标本支原体培养及药敏分析

目的了解某院泌尿生殖系感染患者的支原体感染及药敏情况，为临床合理治疗提供依据。方法采用板条培养药敏试剂法对所取标本进行解脲支原体（Uu）和人型支原体（Mh）检测，并对阳性标本进行11种抗菌药物的药敏测定。结果共检测1048份送检标本，支原体总阳性率为38．26％（401／1048），其中单一Uu感染302例，单一Mh感染19例，Uu合并Mh感染80例。女性支原体阳性检出率为42．78％，男性为29．49％，前者显著高于后者（χ^2=13．618，P〈0．01）。支原体对交沙霉素、美满霉素、多西环素敏感率较高，分别为99．25％、98．00％、97．51％；对环丙沙星的敏感率最低，为16．21％。结论泌尿生殖系支原体感染主要以Uu为主，应重视培养、鉴定及药敏结果，以合理选择敏感药物进行治疗。     

Cancer screening by primary care physicians. Can we explain the differences?

BACKGROUND. Physicians perform cancer screening tests less often than recommended. METHODS. Forty primary care physicians were surveyed to assess their knowledge, attitudes, and experiences regarding cancer and cancer screening, and patients' medical records were reviewed to measure physicians' screening rates. RESULTS. Over 80% of physicians believed doctors should urge screening. On average, 23% of their patient visits were scheduled primarily for preventive care interventions. Screening performance scores expressed the percentage of compliance with the American Cancer Society's recommendations and demonstrated the low levels of compliance for six out of seven tests; however, there was substantial variance in performance among physicians. The best predictors of screening performance were (1) the percentage of visits scheduled primarily for prevention (mammography, and pelvic and breast examinations [P less than .05]); and (2) the number of medical journals read regularly (stool occult blood test [P less than .01], sigmoidoscopy [P less than .01], and Papanicolaou smear [P less than .02]). Also, female physicians performed more Papanicolaou smears (P less than .05) and scheduled more visits for preventive care (P less than .001). CONCLUSIONS. A small group of predictors explain large portions of the variance in cancer screening performance.     

北京市昌平区76654名公共卫生从业人员传染病检出现状

目的了解北京市昌平区公共卫生从业人员传染病感染现况。方法采用北京市公共卫生信息管理系统对昌平区2009年1-12月公共卫生从业人员健康体检结果进行统计分析。结果共调查76 654名从业人员,乙型肝炎表面抗原(HBsAg)阳性率为1.83%,其中食品与公共场所从业人员分别为1.51%(920/61 032)、3.09%(482/15 622);本地与外埠从业人员HBsAg检出率分别为0.74%(139/18 749)、2.18%(1 263/57 905);男、女性从业人员HBsAg检出率分别为2.25%(729/32 397)、1.52%(673/44 257);上述HBsAg阳性率组内比较,差异均有显著性(均P0.01)。活动性肺结核检出率为0.12%,其中本地与外埠从业人员检出率分别为0.05%(9/18 749)、0.15%(86/57 905),两者比较,差异有显著性(P0.01)。丙型肝炎抗体阳性率为0.02%,戊型肝炎抗体阳性率为0.01%;化脓性或渗出性皮肤病检出率为0.03%;未检出伤寒/痢疾。结论在所监测的传染病中,HBsAg携带检出率居首位,肺结核、化脓性及渗出性皮肤病等检出率较低。对公共卫生从业人员应坚持每年1次的健康体检,加强对外埠从业人员的管理,开展疫苗接种工作。     

血清降钙素原水平在尿路感染中的定位作用研究

目的探讨血清降钙素原（PCT）在尿路感染中的定位作用。方法选取尿路感染患者106例，同期健康体检者100例，用化学发光免疫法测定血清中的PCT和C-反应蛋白（CRP）水平，同时检测患者外周血白细胞计数（WBC）。结果上尿路感染组患者血清PCT水平明显高于下尿路感染患者组（P〈0．01），PCT对上尿路感染诊断的敏感性为81．1％，特异性为85．5％，阳性预测值为80．3％，阴性预测值为92．5％，均高于CRP和WBC。结论血清PCT水平的测定对尿路感染有定位作用。