肺癌化疗患者癌因性疲乏与生存质量、血清皮质醇激素的相关性研究

目的探讨肺癌化疗患者癌因性疲乏(CRF)与生存质量、血清皮质醇激素的关系。方法 160例肺癌化疗患者根据Piper疲乏量表分为无RF组(37例)、轻度组(41例)、中度组(40例)、重度组(42例)。采用生存质量调查测定(FACT-L)量表评估肺癌化疗患者生存质量,采用电化学发光法检测血清皮质醇水平,采用酶联免疫吸附检测促肾上腺皮质激素(ACTH)水平。比较各组生存质量、血清皮质醇和ACTH水平,并分析CRF与生存质量、血清皮质醇和ACTH水平的相关性。结果不同CRF患者生存质量评分及血清皮质醇、ACTH水平均存在显著性统计学差异(P<0.05),随着CRF严重程度加重,生存质量评分及血清皮质醇水平明显降低(P<0.05),而血清ACTH水平明显升高(P<0.05);躯体疲乏、情感疲乏、认知疲乏及疲乏总分与生理状况、社会/家庭状况、情感状况、功能状况、附加的关注情况等生存质量均呈负相关性关系(P<0.05);躯体疲乏、情感疲乏、认知疲乏及疲乏总分与血清皮质醇水平呈负相关性关系(P<0.05),与血清ACTH水平呈正相关性关系(P<0.05)。结论肺癌化疗患者CRF与生存质量、血清皮质醇激素均具有明显相关性,而血清皮质醇和ACTH可作为评估肺癌化疗患者CRF严重程度的实验室指标,在CRF治疗方面也具有一定的价值。     

老年高血压患者心理健康、生存质量及家庭关怀度调查及相关性分析

目的调查分析老年高血压住院患者心理健康状况、生存质量、家庭关怀度及其相关性。方法 2020年10月至12月,采用整群抽样法抽取南通市3家三级医院老年高血压住院患者342例为研究对象,运用"综合性医院焦虑抑郁量表""简明健康调查问卷""家庭关怀度量表"对研究对象进行调查分析。结果不同性别、退休前职业、学历、月收入、合并慢性病种类老年高血压患者家庭功能得分差异有统计学意义(P0.05)。焦虑与抑郁呈正相关;焦虑、抑郁与生理机能、总体健康、社会功能、情感职能呈低度负相关(P0.05)。生存质量除生理机能外的各维度与家庭关怀度呈正相关,与健康变化呈负相关(P0.05)。结论老年高血压患者负性情绪较高,家庭功能不足,生存质量较低,焦虑、抑郁与生存质量、家庭关怀度呈负相关。由此可见在老年护理过程中,需以患者为中心,医院-社区-家庭、多学科联合协作干预,有效地提高老年高血压患者家庭功能、生存质量,减轻患者负性情绪。     

肺癌病人生存时间与生存质量的相关分析

[目的]探讨肺癌患者生存时间与生存质量(quality of life,QOL)的关系,评价不同生存时间的QOL.[方法]应用FACT-L(4.0)中文版QOL调查表,对不同生存时间的164例肺癌患者的QOL进行测评,采用相关分析法分析生存时让与QOL的关系,并应用多元回归方法筛选其QOL主要影响因素. [结果]生存时间与QOL的生理状况和附加关注显著负相关(P<0.05),与社会/家庭状况、功能状况及总体QOL之间显著正相关(P<0.05);治疗方法和生存时间是影响QOL总分的重要因素;手术治疗肺癌患者的生理状况、社会/家庭状况和QOL总分均高于非手术治疗患者(P<0.05);不同生存时间非手术治疗肺癌患者QOL的6个领域得分差异均无统计学意义,但QOL总分生存1年以上的患者高于1年以下患者,而随着生存时间的延长,手术治疗肺癌患者QOL的生理状况、社会/家庭状况、功能状况和总量表得分升高(P<0.05). [结论]肺癌患者的生存时间与QOL显著相关,手术治疗后长期生存者具有较好的QOL.     

郑州市不同养老模式老年人生存质量及影响因素

目的了解河南省郑州市不同养老模式老年人生存质量及其影响因素,为老年人选择适宜的养老模式、提高其健康水平和生存质量提供参考依据。方法采用分层随机抽样方法在河南省郑州市抽取5个区共1 630名≥60周岁老年人进行问卷调查。结果郑州市家庭养老、机构养老和社区养老3种不同养老模式老年人生存质量得分比较,不同养老模式老年人生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、社会功能(SF)、情感职能(RE)和综合评分间差异均有统计学意义(P=0.000);相关分析结果表明,住房面积和退休工资与家庭养老模式老年人生存质量综合评分呈正相关(P<0.05),年龄、文化程度、职业和患病种数均与家庭养老模式老年人生存质量综合评分均呈负相关(P<0.05);文化程度、退休工资和患病种数均与机构养老模式老年人生存质量综合评分呈正相关(P<0.05),性别、年龄和住房面积均与机构养老模式老年人生存质量综合评分呈负相关(P<0.01);文化程度和职业均与社区养老模式老年人生存质量综合评分呈正相关(P<0.05),性别和年龄均与社区养模式老年人生存质量综合评分呈负相关(P<0.05)。结论郑州市不同养老模式老年人生存质量不同,性别、年龄、文化程度、职业、住房面积、退休工资、患病种数和养老费用是郑州市老年人的影响因素。     

尿毒症患者的生活质量调查及护理对策

目的 探讨尿毒症患者生活质量及其影响因素,分析相关护理对策.方法 对本院60例患者随机分为对照组和实验组,对患者所获得的护理支持和生活质量进行问卷调查.结果 实验组患者的生活质量明显高于对照组(P<0.01),患者在躯体功能、心理、社会参与度等生活质量方面与其得到的护理支持呈正相关.结论 通过护理人员的努力,可帮助患者得到更多支持,提高生活质量.     

家庭因素对重庆市中小学生视力相关生存质量的影响分析

目的了解中小学生视力相关生存质量的家庭影响因素。方法采用分层整群抽样的方法,选取重庆主城两个区县的中小学各2所共8所学校,采用《中小学生视力相关生存质量量表》和家庭因素问卷(包括父母亲的文化程度、职业、是否近视、家庭经济水平等)分别对4096名学生及其家长(3740名)进行调查。结果学生视力相关生存质量得分比较结果:男生(92.13±12.50)>女生(90.08±12.82)(t=6.18,P<0.05),小学生(96.39±9.72)>初中生(90.35±12.07)>高中生(83.45±13.46)(F=432.70,P<0.01),乡村学生(91.46±12.87)>城市学生(90.84±12.54)(t=-1.534,P>0.05)。单因素分析显示:父母亲文化程度、眼距电视的距离、是否鼓励孩子运动对视力相关生存质量得分有影响。进一步多元回归分析显示:母亲文化程度、眼距电视距离是视力相关生存质量主要的家庭影响因素,父亲文化程度对学生生理功能维度有影响。结论家庭因素是中小学生视力相关生存质量的重要影响因素,视力相关生存质量干预应将家庭作为重要场所之一。     

食管癌术后远期生存患者的生存质量调查

目的探讨和提高食管癌切除术后远期生存患者的生存质量。方法对176例术后生存超过5年的食管癌切除术后患者,通过门诊随访及信访,补充以电话访问,检查患者术后一般的身体状况,调查患者术后的消化功能,行化验检查,与患者术前或出院时状况进行比较。结果切除术后患者的食管功能有了明显的好转,在吞咽功能方面的改善尤为明显。量表观测表明术后躯体功能比正常人群下降,生命力也受到影响,然而,心理健康上却得到了改善(P<0.05)。结论食管癌切除术后远期总的生存质量较为满意,手术治疗有利于生存质量的提高。探讨术后生存质量的评价方法及其影响因素,有利于改善患者的生存质量。     

急性阑尾炎手术患者术后心理症状的调查及其对疗效的影响

目的探讨急性阑尾炎手术患者术后的心理症状,分析患者心理症状对手术疗效的影响。方法以我院2015年1月至2016年12月收治的100例急性阑尾炎手术患者为研究对象,调查影响患者术后心理症状的相关因素,并比较不同心理症状患者的疗效差异。结果患者术后住院期间的躯体化、抑郁、焦虑等SCL-90量表因子评分相对较高,其中心理症状阳性患者38例,阴性患者62例。文化程度低、家庭关系较差、家庭月收入<2 000元、术后疼痛、合并穿孔或坏疽及术后并发症患者的SCL-90量表总分更高,差异有统计学意义(P<0.05)。心理症状阳性患者的住院时间显著长于阴性患者,差异有统计学意义(P<0.05)。结论急性阑尾炎手术患者术后心理症状的主要危险因素为文化程度低、家庭关系较差、家庭月收入低、术后疼痛、合并穿孔或坏疽及术后并发症。心理症状不利于患者的健康恢复,影响治疗效果,应针对危险因素采取相关措施,预防或缓解患者的术后心理症状,促进患者的恢复。     

癌症伴高死亡焦虑患者生存质量与死亡焦虑的相关分析

目的:探讨癌症患者死亡焦虑水平及伴高死亡焦虑患者的生存质量,并分析两者之间的相关性.方法:采用死亡焦虑量表和肿瘤患者生命质量核心量表对279例住院癌症患者进行调查,分析高死亡焦虑患者的生存质量及其与死亡焦虑水平的相关性.结果:癌症患者死亡焦虑总体得分为6.48±3.19分.其中高死亡焦虑142例.癌症伴高死亡焦虑患者的总体生存质量、躯体功能、角色功能、情绪功能、社会功能、疲乏、恶心呕吐、食欲丧失八个维度均低于低死亡焦虑组(P<0.05);其总体生存质量、情绪功能、认知功能、社会功能领域与死亡焦虑得分呈负相关(P<0.05),恶心呕吐、呼吸困难、便秘领域得分与死亡焦虑成正相关(P<0.05).结论:癌症伴高死亡焦虑患者的死亡焦虑水平明显影响该类患者的生存质量.     

不同年龄直肠癌结肠造口患者生命质量研究

目的了解不同年龄段大肠癌永久结肠造口患者的生命质量及影响因素,为不同年龄段患者提供健康教育方案。方法采用欧洲癌症研究与治疗组织生命质量核心问卷(EORTC QLQ-C30)对145例不同年龄段结肠造口患者生命质量进行调查。结果不同年龄段结肠造口患者总体生命质量与常模得分比较差异无统计学意义(均P0.05),≤50岁组、50~60岁组角色、社会功能、经济困难、腹泻、气促、疲倦得分与常模比较,差异有统计学意义(均P0.05),≤50岁组疼痛、50~60岁组失眠、食欲丧失得分与常模比较,差异有统计学意义(均P0.05);60~70岁组社会功能、便秘、经济困难、腹泻、气促、疲倦、食欲丧失得分与常模比较,差异有统计学意义(均P0.05),70~80岁组社会功能、躯体功能、失眠、疼痛、便秘、经济困难、腹泻得分与常模比较,差异有统计学意义(均P0.05)。多元回归分析结果显示心理状态、术后时间、排便规律性、健康教育分别为不同年龄段患者生命质量的影响因素。相关性分析结果显示年龄与躯体、认知功能呈负相关(均P0.05),与角色、情感、社会功能及总体QOL评分呈正相关(均P0.05);心理状态、术后时间与生命质量各维度呈正相关(均P0.05)。结论医务人员应采取多种措施关注直肠癌患者社会功能、腹泻症状、心理状态的恢复,重点关注≤50岁、50~60岁组角色功能恢复,50~60岁组排便规律性技巧,60~70岁组便秘症状,70~80岁组躯体功能恢复,减轻疼痛、失眠、便秘症状。     

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.     

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.     

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.