老年脑卒中患者并发肺部感染病原学及危险因素分析

目的探讨分析老年脑卒中患者并发肺部感染的病原学及危险因素,为有效降低老年脑卒中患者发生院内肺部感染提供参考。方法选择2006年7月-2013年7月医院收治的急性脑卒中老年患者325例,采用单因素以及多因素logistic回归分析,对可能影响患者并发肺部感染的各因素进行分析。结果 325例患者中,并发肺部感染患者80例,肺部感染率为24.62%;80例合并肺部感染患者共检出病原菌106株,其中革兰阴性菌75株占70.75%、革兰阳性菌24株占22.64%、真菌7株占6.61%;单因素分析结果显示,年龄、卒中类型、合并基础疾病、意识障碍、吞咽障碍、长期吸烟史、侵入性操作、卧床时间≥14d与老年脑卒中患者肺部感染的发生具有相关性(P<0.05);logistic回归分析显示,合并基础疾病、年龄大、侵入性操作、卧床时间≥14d及意识障碍为影响老年脑卒中患者肺部感染的独立危险因素。结论合并基础性疾病、高龄、侵入性操作、长期卧床以及合并意识障碍是老年脑卒中患者并发肺部感染的独立危险因素,需要引起临床工作者的重视。     

98例老年护理院肺部感染病人临床分析

目的初步探讨老年护理院病人肺部感染易感因素、病原菌流行情况、抗生素治疗的经验及健康教育策略。方法对老年护理院98例肺部感染患者的基础疾病情况、痰细菌培养及药物敏感结果进行统计分析。结果冬春季发病者72例(73.5%),脑卒中后遗症长期卧床发病者84例(85.7%)。原患有l～3种慢性病者94例(95.9%),其中慢性支气管炎72例(73.5%),心血管病45例(45.9%),糖尿病59例(60.2%),其他4例(4.49%)。该组患者共培养出致病菌14种,菌株111株,革兰阴性杆菌占60.37%,革兰阳性球菌占35.39%,真菌占4.24%。药物敏感试验显示,致病菌对第二、三代头孢菌素、第二代喹诺酮类多敏感,金葡菌对万古霉素、铜绿假单胞菌对妥布霉紊也都显示了较高的敏感率。结论老年护理院病人长期卧床,合并多种基础疾病,季节变化为肺部感染的易感因素。积极控制基础疾病可减少老年护理院病人肺部感染的发生率。     

老年阿尔茨海默病患者肺部感染的病原菌分布及危险因素分析

目的分析阿尔茨海默病患者中阿尔茨海默病合并肺部感染的病原菌分布、耐药性及相关危险因素,为临床老年阿尔茨海默病患者的预后提供参考依据。方法选取2010年7月-2016年2月医院收治的老年阿尔茨海默病合并肺部感染痰培养阳性患者66例,对患者进行细菌培养及药敏试验,分析感染患者的病原菌分布、耐药性及相关感染影响因素。结果 66例痰培养阳性患者共分离病原菌106株,其中革兰阴性菌82株,占77.36%,以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主,分别占38.68%、11.32%、11.32%,革兰阳性菌18株,占16.98%,以金黄色葡萄球菌、沃式葡萄球菌为主,分别占6.60%和4.72%,真菌6株,占5.66%;革兰阴性菌对亚胺培南、美罗培南的耐药率均<9.00%,革兰阳性菌对万古霉素耐药率为0;单因素及多因素分析结果显示,年龄>70岁、伴有糖尿病、长时间卧床、住院时间>1个月、较长的病程时间及伴有吸烟史均是引发阿尔茨海默病合并肺部感染的危险因素。结论老年阿尔茨海默病合并肺部感染患者除了肺部功能降低外,还可导致慢性脑部缺氧性疾病,脑皮质血管受损,大脑对呼吸的调控能力下降,也是细菌不易从肺部清除的重要原因;对于老年阿尔茨海默病合并肺部感染者的病原菌分布、耐药性及感染危险因素的分析,对患者的预后具有重要的临床意义。     

老年心力衰竭患者合并肺部感染及预后影响因素

目的分析心力衰竭(HF)合并肺部感染老年患者病原菌分布及预后影响因素。方法选择2015年1月-2019年12月遵义市第一人民医院收治的100例HF合并肺部感染老年患者作为感染组,选择同期收治的100例HF未合并肺部感染老年患者作为对照组。对感染组患者采集痰液标本进行病原菌鉴定,分析并筛选老年HF患者合并肺部感染的影响因素。比较两组住院治疗效果,并分析老年HF患者合并肺部感染预后不良的影响因素。结果 100例HF合并肺部感染患者共分离出病原菌112株,其中革兰阴性菌62株(55.36%),革兰阳性菌44株(39.29%),真菌6株(5.36%);年龄、心功能分级、吸烟史、糖尿病、合并呼吸道疾病、侵入性操作及卧床时间是老年HF患者合并肺部感染的影响因素;感染组治疗后预后良好(显效+有效)患者占比(78.00%)显著低于对照组(94.00%),两组比较差异有统计学意义(χ²=2.680,P=0.007),住院时间较对照组显著延长(t=10.631,P<0.001);单因素分析及多因素Logistic回归分析结果显示,年龄、心功能分级、合并呼吸道疾病是老年HF合并肺部感染患者预后不良的影响因素。结论老年HF患者合并肺部感染的主要病原菌为革兰阴性菌,需针对影响因素,积极控制高危患者的病情进展,改善患者预后。     

老年患者经皮椎体成形术后肺部感染的临床分析

目的探讨老年压缩性骨折患者经皮椎体成形术后发生肺部感染的危险因素,为术后肺部感染的预防提供依据。方法回顾性分析2012年1月-2014年6月进行经皮椎体成形术的102例压缩性骨折老年患者临床资料,对可能发生术后肺部感染的相关因素采用SPSS 16.0软件进行分析。结果 102例压缩性骨折老年患者术后发生肺部感染9例,感染率8.82%;痰细菌培养出革兰阴性菌6株、革兰阳性菌2株、真菌1株,分别占66.37%、22.22%、11.11%;年龄>80岁、全身麻醉、术前合并慢性阻塞性肺疾病、糖尿病和ASA分级过高是老年患者全麻术后发生感染的危险因素(P<0.05)。结论老年压缩性骨折患者经皮椎体成形术后可发生肺部感染,针对存在多个危险因素的患者,在术前进行仔细评估,术后加强护理,进一步降低术后肺部感染的发生率。     

老年肺部感染患者病原菌分布及耐药性研究

目的分析老年肺部感染患者病原菌分布特点及耐药性,旨在为临床合理用药提供参考依据。方法对2011年12月-2012年12月158例老年肺部感染患者的痰标本进行细菌培养、鉴定、药物敏感试验,试验菌株均采用全自动微生物鉴定分析仪进行鉴定,药敏试验采用纸片扩散法(K-B),数据采用SPSS16.0统计软件进行分析。结果 158例老年肺部感染患者的痰标本检出144株病原菌,其中革兰阴性菌102株占70.83%,革兰阳性菌40株占27.78%,真菌2株占1.39%;革兰阴性杆菌对亚胺培南/西司他丁耐药率最低为1.96%,其次为美罗培南、哌拉西林/他唑巴坦,耐药率分别为3.92%、13.73%,革兰阳性球菌对青霉素G、红霉素、氧氟沙星的耐药率较高,分别为87.50%、80.00%、77.50%。结论及时了解病原菌的分布及耐药趋势有利于合理选择抗菌药物,制定有效治疗方案,不仅可降低老年患者感染的发生及病死率,而且能够减少耐药菌株的产生。     

脑卒中合并肺部感染患者病原体分布及抗生素应用研究

探讨脑卒中患者并发肺部感染的病原体分布特点及抗生素类药物应用情况,为临床合理使用抗生素类药物提供依据。分析2013年1月至2015年6月,首都医科大学康复医学院北京博爱医院收治的脑卒中合并肺部感染患者102例,并对其病原体特点及临床抗生素药物应用情况进行研究。结果显示,102例脑卒中肺部感染患者的样本中共分离出116株病原体,其中革兰阴性菌78株(67.24%),革兰阳性菌22株(18.97%)。在革兰阴性菌中,前三位分别为铜绿假单胞菌23株(19.83%),肺炎克雷伯菌16株(13.79%),大肠埃希菌12株(10.34%);在革兰阳性菌中,以金黄色葡萄球菌为主,10株(8.62%)。致病菌普遍呈多重耐药性,应及时进行细菌培养及耐药性检测,根据药敏试验结果制订合理的用药方案。     

老年髋部骨折术后肺部感染病原菌与影响因素

目的 探究老年髋部骨折术后肺部感染病原菌分布情况及其影响因素。方法 回顾性选取2018年1月-2020年9月于临安区第一人民医院行髋部骨折手术的335例老年患者为研究对象，全部患者于术后随访30 d,无失访病例，患者按术后是否发生肺部感染分为肺部感染组(30例)和非肺部感染组(305例);分析肺部感染组患者病原菌分布情况，通过单因素及多因素分析法分析老年髋部骨折术后肺部感染的危险因素。结果 老年髋部骨折术后肺部感染的发生率为8.96%,肺部感染组分离出病原菌30株，其中革兰阴性菌18株(60.00%),革兰阳性菌8株(26.67%),真菌4株(13.33%);年龄>70岁、有慢性阻塞性肺疾病史、超敏C-反应蛋白(hs-CRP)水平高为老年髋部骨折术后肺部感染的危险因素(P<0.05)。结论 老年髋部骨折术后肺部感染发生率较高，病原菌多以革兰阴性菌居多，其发生与患者年龄、慢性阻塞性肺疾病史、hs-CRP水平密切相关，临床需针对性地做好相应预防措施，以降低老年髋部骨折术后肺部感染的发生风险。     

老年急性胆道感染细菌培养及药敏分析的临床研究

目的分析老年急性胆道感染患者胆汁细菌培养的临床特征,为临床合理使用抗菌药提供参考。方法采集189例老年急性胆道感染病人进行细菌培养加药敏试验。结果189株胆汁培养结果,革兰阴性菌128株67.7%,革兰阳性菌56株29.67%,真菌5株(2.6%)。药敏结果表明老年急性胆道感染中主要病原菌对亚胺培南,头孢他啶,阿米卡星耐药率低。对环丙沙星,庆大霉素,呱拉西林,氨苄西林耐药率高。结论老年急性胆道感染中革兰阴性菌居主导地位,对亚胺培南,头孢他啶,阿米卡星有较高敏感性。     

老年大面积脑梗死患者肺部感染病原菌与相关因素分析

目的探讨老年大面积脑梗死患者肺部感染病原菌与相关因素,探究相应的防治对策。方法回顾性分析2015年1月-2017年1月医院收治的老年大面积脑梗死患者594例的临床资料,对病原菌进行分析,分析患者年龄、性别等临床资料,归纳老年大面积脑梗死患者肺部感染的相关因素。结果 594例脑梗死患者住院期间发生肺部感染61例,感染率10.27%;共培养分离病原菌69株,其中革兰阴性菌43株占62.32%,以肺炎克雷伯菌和铜绿假单胞菌为主;革兰阳性菌21株占30.43%,以金黄色葡萄球菌为主;真菌5株占7.25%。年龄、糖尿病、既往肺部基础疾病史、意识障碍、吞咽困难是老年大面积脑梗死患者肺部感染的相关因素(P0.05)。结论脑梗死患者是医院肺部感染的高发人群,且发病与临床多种因素密切相关。临床应针对相关因素采取有效预防措施,降低肺部感染率。     

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.     

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.