医务人员血源性职业暴露原因分析及对策

目的 了解医务人员工作中血源性职业暴露的特点,并探讨对策.方法 调查2011年1月～2013年6月发生的62例次医务人员血源性职业暴露,分析医务人员职业、暴露物品、暴露过程、处理方式及随访结果.结果 血源性职业暴露发生于护士42例次（67.74％）、医师16例次（25.81％）、工勤人员4例次（6.45％）.职业暴露以针刺伤为主,拔针、拔针后放置不当及针头用后处置是针刺伤的高危环节.结论 医务人员血源性职业暴露以针刺伤为主.制定严格的规章制度,加强职业安全培训、规范操作行为、加强锐器及医疗废物的管理、改善护士和医师工作环境等可能有助于减少医务人员血源性职业暴露.     

北京郊区医务人员艾滋病职业暴露与防护现况

目的了解北京郊区医务人员艾滋病职业暴露及防护情况。方法采取现况调查的方法,按多阶整群抽样的原则,于2005年12月-2006年1月抽取北京郊区的医务人员进行问卷调查。结果2 021名医务人员中有21.8%参与过艾滋病诊疗服务,5.6%一年内接触过HIV阳性病人,38.9%一年内曾被医疗器械(皿)刺破皮肤,52.0%一年内经常接触引起血液、体液飞溅的操作;职业暴露防护不规范率为12.3%~62.1%;职业暴露后局部处理、预防性用药知识知晓率分别为4.6%、15.3%。结论北京郊区医务人员普遍存在艾滋病职业暴露危险,防护相关行为有待进一步培训、规范,推广普遍性防护原则势在必行。     

医务人员职业暴露原因分析与干预策略

随着新发传染病的增多、新的化学药物和高新技术的推广应用，医务人员常暴露于多种危害中，在诊疗护理技术操作过程中，若不注意职业安全防护，容易造成职业损伤，严重威胁医务人员的身心健康。职业安全防护是近年来医护人员日益关注的重要问题，因此，正确对待各种职业暴露的危险因素，制定有效的干预策略，预防职业风险非常重要。     

北京市两家三级综合医院医务人员艾滋病职业暴露防护知识调查与影响因素分析

目的了解医务人员艾滋病知识以及艾滋病职业防护知识知晓现状,为开展医务人员艾滋病相关培训提供依据。方法采用整群抽样方法,于2013年11月对北京市两家三级综合医院的医务人员进行艾滋病基础知识和职业暴露相关知识知晓情况问的卷调查,分析医务人员艾滋病职业暴露知识的影响因素。结果两家医院共获取有效问卷1077份,对艾滋病职业暴露相关知识知晓率为57.9%（624/1077）,发生职业暴露后伤口处理措施和艾滋病病毒（HIV）职业暴露后抗体检测时间的知晓率分别为29.3%（316/1077）和35.0%（377/1077）。以前接受过艾滋病相关培训、职称、学历、工作年限等因素影响医务人员对艾滋病职业暴露防护知识的了解,其中接受过艾滋病相关培训对知晓率的影响最大[比值比（OR）=2.32,95%可信区间（CI）1.80-2.99]。结论此两家综合医院医务人员的艾滋病职业暴露知识知晓率偏低,应加强对新入职、学历低的医务人员的艾滋病及职业暴露防护知识的相关培训。     

北京市两所三甲医院医务人员血液和体液职业暴露及HIV相关防护知识调查

目的了解北京市两所三甲医院医务人员的血(体)液艾滋病病毒(HIV)职业暴露情况,防护知识、态度情况,培训情况及培训意愿。方法采用方便抽样的方法,对两所医院的392名医务人员采取自填式问卷调查。结果有81.2%(311/383)的医务人员被锐器刺伤过,有62.7%(240/383)被病人的血(体)液溅到过黏膜或破损皮肤。近一年内暴露密度中位数为1.0次/人年;相关防护知识的知晓率在51.4%～95.4%之间。42.3%(166/392)的医务人员接受过HIV职业暴露防护培训,94.6%(368/389)表示希望得到HIV职业暴露防护培训。结论医务人员HIV相关暴露普遍存在,防护知识缺乏,相关部门应加大培训力度,为医务人员创造良好的防护环境。     

清远市清新区预防接种门诊医务人员丙肝职业暴露认知现况分析

目的了解清远市清新区预防接种门诊医务人员丙型肝炎职业暴露认知现况,并对其分析,为今后防控工作提供依据。方法采用普查方法,对广东省清远市清新区16个预防接种门诊医务人员进行问卷调查。结果共调查16个预防接种门诊154名医务人员,丙肝职业暴露认知知晓率为44.18%;23～29岁年龄组、中专及以下文化程度组和1～5年工作年限组知晓率低于其他组别;≥40岁组知晓率为最高80.95%,知晓率随年龄增加而增加(χ~2=5.72,P<0.05);本科及以上组知晓率为最高81.82%,文化程度越高水平知晓率越高(χ~2=9.34,P<0.05);≥16年组知晓率为最高90.00%,随工作年限越长知晓率越高(χ~2=9.81,P<0.05)。结论清远市清新区预防接种门诊医务人员丙型肝炎职业暴露认知不高,相关知识比较缺乏,存在不安全注射、诊断及治疗不到位等风险。今后,应因地制宜、精准施策开展教育培训工作,是下一步教育培训工作重点。     

12例HIV职业暴露情况分析

近年来随着艾滋病毒（HIV）感染人数的增加,医务人员发生HIV职业暴露的人数也逐渐增加。为了避免HIV职业暴露的发生,分析HIV职业暴露的原因、方式及危险性,探讨防治措施十分必要。现将布拖县人民医院2004年10月-2008年3月所发生的12例医务人员HIV职业暴露的情况分析如下。1资料来源布拖县人民医院医务人员HIV职业暴露个案登记表。     

产科医务人员艾滋病职业暴露的危险因素及防护策略

阐述产科医务人员发生艾滋病职业暴露的原因、方式、危险因素及暴露后的应急处理措施,探讨防范策略。旨在引起产科医务人员对发生艾滋病职业暴露的重视,以便加强防护有效减少职业暴露,确保产科医务人员的身心健康和工作的顺利高效。     

喀什地区HIV职业暴露情况分析

目的了解喀什地区艾滋病病毒(HIV)职业暴露现状和职业暴露后应急预防处理的情况,完善预防HIV职业暴露感染的防控措施。方法收集喀什地区2010-2013年报告的HIV职业暴露案例,分析其发生的原因、应急处理情况、预防用药及时性及预防效果。结果喀什地区2010-2013年共计报告68例HIV职业暴露者,医务人员52例(占76.47%),公安人员16例(占23.53%)。暴露方式针刺占70.59%。暴露级别Ⅰ级为61例,Ⅱ级7例。75.00%(51/68)的人进行了预防性服药,服药者中68.63%(35/51)的人采取了合理的服药方案。所有病例医学观察6个月后,均未发现HIV抗体阳转。结论医务人员和公安人员是HIV职业暴露的高发人群,应加强HIV职业暴露的宣传和防护;目前执行的职业暴露应急措施安全、有效。     

Occupational Hydrocarbon Exposure and Diabetic Nephropathy

Exposure to hydrocarbons has been implicated in the pathogenesis of glomerulonephritis but its role in the development of diabetic nephropathy remains unknown. Three groups of patients with Type 1 diabetes of over 10 years duration were studied. Group 1 comprised 45 patients (23 F) with no diabetic nephropathy (urinary albumin excretion (AER) –30 mg 24 h^?1), group 2 comprised 37 patients (17 F) with incipient diabetic nephropathy (AER between 30–300 mg 24 h^?1), and group 3 comprised 31 patients (15 F) with overt diabetic nephropathy (AER >300 mg 24 h^?1). The groups were comparable for age, sex, duration of diabetes, recent glycaemic control, social class, and residential area. Patients were assessed blindly by a validated questionnaire and interview for hydrocarbon exposure, consumption of tobacco, analgesic agents, and alcohol. Exposure scores to hydrocarbons derived from the questionnaire were significantly higher in patients with incipient and overt diabetic nephropathy with smoking adjusted odds ratios of 3.6 and 5.2, respectively. The consumption of alcohol, analgesic agents, tobacco, and smoking habits were similar in the three groups. In conclusion, hydrocarbon exposure may be a key environmental factor in the development of diabetic nephropathy in patients with Type 1 diabetes.     

Occupational Lung Disease Caused by Exposure to Polytetrafluoroethylene

We herein report a 45-year-old-man with multiple foreign body granulomas in the lungs caused by polytetrafluoroethylene (PTFE). A mass in the right lower lobe of the lung and bilateral centrilobular lung nodules were found unexpectedly during the patient''s visit to a hospital for a respiratory infection. The patient''s occupation for 26 years involved spraying PTFE. A lung biopsy using bronchoscopy revealed granulomatous lesions and giant cells. The presence of fluorine in the granulomatous lesions was confirmed using an electron probe microanalyzer with wavelength dispersive spectrometer. Fluorine is a component of PTFE and is not found in normal lung tissue.     

Hematogenous candida vertebral osteomyelitis treated with ketoconazole

Summary Candida vertebral osteomyelitis was diagnosed in a patient with systemic lupus erythematodes following X-ray evidence of osteomyelitis and the repeated culturing ofCandida albicans from material obtained by needle biopsies from the third lumbar vertebra. The patient had been on glucocorticosteroids and parenteral nutrition six months previously. At that time, a yeast was cultured from the blood and the tip of the subclavian catheter which had been removed. After candida vertebral osteomyelitis was diagnosed, she was treated with ketoconazole for seven months. Recovery was impressive, as judged by the clinical and radiographic findings. At the time of writing this paper — 12 months after the withdrawal of ketoconazole — the patient showed no signs of recurrence.

---

Behandlung einer hämatogenen Candida-Wirbelosteomyelitis mit Ketoconazol

Zusammenfassung Bei einer Patientin mit systemischem Lupus erythematodes wurde röntgenologisch eine Wirbelosteomyelitis diagnostiziert. In Material, das durch Punktur des dritten Lendenwirbelkörpers gewonnen wurde, ließ sich kulturell wiederholtCandida albicans nachweisen. Sechs Monate vorher war die Patientin mit Kortikosteroiden behandelt und parenteral ernährt worden. Zu dieser Zeit wurden aus dem Blut und von der Spitze des entfernten Subclavia-Katheters Hefen kultiviert. Nachdem eine Wirbelosteomyelitis durchCandida diagnostiziert worden war, wurde die Patientin sieben Monate lang mit Ketoconazol behandelt. Entsprechend den klinischen und röntgenologischen Befunden kam es zu einem eindrucksvollen Heilungsverlauf. Zwölf Monate nach Beendigung der Ketoconazolbehandlung — zum Zeitpunkt der Manuskripterstellung — waren bei der Patientin keine Zeichen für einen Rückfall festzustellen.

     

Occupational Exposure Influences on Gender Differences in Respiratory Health

Background  

The aim of this study was to evaluate gender differences in the respiratory health of workers exposed to organic and inorganic dusts.     

Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS.

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.     

Recently Graduated Medical Students Lack Exposure to and Comfort with Chronic Liver Diseases

Digestive Diseases and Sciences - The prevalence of chronic liver disease (CLD) is rising, but it remains unclear if medical school curricula are emphasizing CLD to reflect its growing...     

Survival analysis of 118 patients with systemic sclerosis

Abstract. Life-table analysis based on the survival statistics of 118 Hungarian patients with systemic sclerosis suggests that the presence of skin hypo- and/or hyperpigmentation indicates a poor prognosis. Furthermore, truncal skin involvement, lung, cardiac, and renal manifestations, older age at the onset of disease, anaemia, hand deformity, and elevated erythrocyte sedimentation rate values, predict an unfavourable prognosis, whilst patients with exposure to chemicals shows a relatively favourable disease outcome.