3年间医院内侵袭性真菌感染的病原菌分布及临床分析

目的了解医院内侵袭性真菌感染的发病率和菌种分布特点，为减少真菌感染提供依据。方法对3年间住院患者真菌培养阳性的病例进行了分析，从患者年龄、疾病种类、标本、菌种分布、科室等方面进行了分析研究。结果医院内侵袭性真菌感染的发病率为4．32％，患者年龄在7～96岁，以男性老年患者最多，均患有基础疾病；感染部位以下呼吸道最多，其次为泌尿道、消化道；检出的真菌种类以假丝酵母菌属为主，约占93．38％；且白色假丝酵母菌居多，占66．19％，丝状真菌占6．62％。结论白色假丝酵母菌仍是医院内侵袭性真菌感染的主要病原菌；侵袭性真菌感染的流行病学正在发生改变，非白色假丝酵母菌和曲霉菌属引起的感染正在逐年增加。     

医院内深部真菌感染的临床分析

目的 了解医院内真菌感染的临床分布及其危险因素,为预防及治疗院内真菌感染提供依据.方法 回顾性分析2008年1月-2009年1月真菌感染患者的临床资料.结果 医院内真菌感染部位以呼吸道为主,占72.2%,其次为血液和尿路感染;最常见的真菌感染病原菌是白色假丝酵母菌,占53.3%;高龄患者、严重基础疾病、经验性广谱抗菌药物小规范应用、激素、化疗放疗及侵入性操作等是感染的危险因素.结论 应重视医院内真菌感染,通过加强真菌的检测指导临床合理用药,从而有效预防与控制院内真菌感染.     

肿瘤患者真菌医院感染情况及耐药性分析

目的 研究肿瘤患者深部真菌感染的病原菌构成特点及抗菌药物敏感性分析,为临床合理应用抗菌药物提供较为科学的依据.方法 对205例真菌感染的肿瘤患者进行回顾性分析,真菌的培养和药敏试验严格按照《全国临床检验操作规程》进行.结果 肿瘤患者真菌医院感染以呼吸道为主,占81.4％,其次是泌尿生殖道,占11.2％;真菌感染以白色假丝酵母菌为主,占75.6％,其次为热带假丝酵母菌,占6.4％;真菌药敏试验结果表明,真菌对于两性霉素B和制霉菌素的敏感性最好,对咪唑类药物的敏感性相对较低.结论 重视肿瘤患者真菌感染的病原学检查和药敏试验,能有效控制感染.     

消化道肿瘤患者真菌感染的临床特点及耐药性分析

目的探讨消化道肿瘤患者真菌感染的种类分布及耐药性,为其预防及诊治提供理论依据。方法回顾性分析2013年1-12月消化道肿瘤患者真菌感染的种类分布及耐药性,病原菌培养、鉴定和药敏试验严格按照《全国临床检验操作规程》进行,采用WHONET5.6软件对数据进行统计分析。结果 87例真菌感染患者感染部位以下呼吸道为主,占80.5%,其次为消化道占17.2%;送检标本中共检出真菌90株,其中以白色假丝酵母菌为主,占64.4%,其次为热带假丝酵母菌、光滑假丝酵母菌,分别占13.3%、11.1%;真菌感染患者中53例发生二重感染,发生率60.9%,发生二重感染的细菌主要以肺炎克雷伯菌和鲍氏不动杆菌为主,分别占28.3%、24.5%;克柔假丝酵母菌、光滑假丝酵母菌对伊曲康唑的耐药率较高,分别为71.4%、60.0%,白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌对伏立康唑、两性霉素B的敏感性高,无耐药菌检出。结论消化道肿瘤患者以下呼吸道真菌感染最多见;二重感染的发生率较高,检出真菌主要为白色假丝酵母菌,细菌主要肺炎克雷伯菌;对晚期肿瘤下呼吸道感染患者应及时进行病原学检测,根据检验结果合理应用敏感抗菌药物进行治疗,有效地控制医院感染。     

医院真菌感染现状分析

目的分析医院真菌感染的现状,加强感染的防治。方法回顾性分析2008-2009年206例住院患者真菌感染的病例资料。结果真菌感染以呼吸道为主,感染率为0.96%;真菌种类白色假丝酵母菌占首位,为70.90%;高龄、抗菌药物的滥用、侵入性操作、激素的应用、放疗、化疗是真菌感染的危险因素。结论控制感染的危险因素、合理使用抗菌药物、减少侵入性操作是预防和控制医院真菌感染的关键。     

恶性肿瘤患者医院感染的临床分析

目的 分析医院恶性肿瘤患者医院感染的临床特点.方法 回顾性分析医院6967例恶性肿瘤患者医院感染的临床资料.结果 409例患者并发医院感染,感染率为5.87%;感染部位以呼吸道为主,占57.95%,其次是消化道,感染率为18.83%;引起感染的病原菌种类以革兰阴性菌为主,占43.22%;真菌感染也占较大比例,占36.91%,真菌感染以假丝酵母菌属为首;感染与年龄、抗肿瘤治疗、侵入性操作和滥用抗菌药物等危险因素有关.结论 恶性肿瘤易导致医院感染,必须加强医院感染的管理,控制易感因素,规范抗菌药物的使用,减少医院感染的发生.     

心脏直视术后肺部真菌感染临床分析

目的 探讨心脏手术后肺部真菌感染的相关因素及治疗.方法 回顾2004年1月-2006年12月324例心脏直视手术后发生医院感染病例的临床资料.结果 共发生肺部真菌感染61例,占同期医院感染的18.8%,患者均病情危重且使用过广谱抗菌药物及糖皮质激素,36例患者机械通气时间＞1周;白色假丝酵母菌最多见,其次为光滑假丝酵母菌,药敏结果显示,氟康唑、伊曲康唑及5-氟胞嘧啶等具有良好的抗菌活性.结论 心脏手术后肺部真菌感染呈增加趋势,其发病与基础疾病严重、长时间机械通气、使用广谱抗菌药物等密切相关.     

228例医院真菌感染患者调查分析

目的了解医院真菌感染情况,探讨诱发感染的危险因素,以采取有效预防控制措施。方法对某院228例医院真菌感染患者进行回顾性调查分析。结果医院真菌感染率0.49%;>60岁患者占70.6%,营养不良患者占71.1%;感染部位以呼吸系统为主,占73.4%;主要病原菌为白色假丝酵母菌,占63.5%;88.6%的患者接受抗菌药物治疗,广谱抗菌药物使用频率最高;接受侵入性治疗患者占32.9%。结论临床上应规范抗菌药物的使用,对于高龄、严重基础疾病、营养不良及接受侵入性治疗患者应加强病原菌监测,并采取适当预防措施,真正达到控制医院真菌感染的目的 。     

肿瘤医院医院深部真菌感染分析

目的探讨肿瘤医院住院患者医院深部真菌感染情况。方法采用前瞻性及回顾性调查方法,调查某肿瘤医院2008年1-12月间医院感染病例资料521份。结果 521例医院感染病例中发现深部真菌感染者179例(34.36%),其中60岁者占59.22%(106例);恶性肿瘤患者居多,占94.41%(169例);感染部位以呼吸道最常见,占53.07%(95例);分离真菌以白假丝酵母菌为主,占57.54%(103株),其次为光滑假丝酵母菌(43株,24.02%)、热带假丝酵母菌(23株,12.85%)、克柔假丝酵母菌(9株,5.03%)、毛孢菌属(1株,0.56%)。结论肿瘤医院的医院深部真菌感染情况较严重,以高龄、恶性肿瘤患者多见。增强患者免疫功能,合理使用抗菌药物是预防肿瘤医院住院患者医院深部真菌感染的关键措施。     

EICU侵袭性真菌感染临床特点及病原学分析

目的 探讨急诊重症监护病房(EICU)重症患者真菌感染的临床特点.方法 对2009年1月-2010年12月入住医院EICU的106例侵袭性真菌感染重症患者,进行回顾性调查分析.结果 106例真菌感染患者中分离菌株117株,白色假丝酵母菌72株占61.5％,非白色假丝酵母菌45株占38.5％,主要感染部位为呼吸道、泌尿道及血液为主,其主要诱因为不合理使用抗菌药物、长期使用激素、中心静脉置管、人工机械通气及留置导尿管等,非白色假丝酵母菌与白色假丝酵母菌感染死亡率比较,差异有统计学意义(P＜0.01).结论 EICU重症患者真菌感染以白色假丝酵母菌最常见,感染部位以呼吸道为主,其中不合理使用抗菌药物、长期使用激素、中心静脉置管、人工机械通气及留置导尿管为高危因素,真菌感染死亡患者多为非白色假丝酵母菌感染.     

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.