早期干预妊娠期糖尿病对新生儿并发症的影响研究

目的 研究早期干预妊娠期糖尿病(GDM)对新生儿并发症的影响.方法 将我院确诊的84例GDM患者分为干预组45例和对照组39例,干预组给予饮食控制、适当运动及必要情况下的皮下注射胰岛素干预治疗,力求控制血糖在正常范围.记录并比较两组患者及新生儿并发症发生情况.结果 干预组患者妊娠期感染、羊水过多及子痫前期发生率均显著低于对照组(P＜0.05)；两组新生儿中,干预组新生儿巨大儿、低血糖、高胆红素血症、红细胞增多症、窒息及羊水污染发生率显著低于对照组(P＜0.01).结论 早期干预妊娠期糖尿病可显著降低新生儿并发症发生率,临床上要加强孕妇保健,早期发现和诊断妊娠期糖尿病,以减少GDM对母婴的不良影响.     

早期干预对妊娠期糖尿病母儿结局的影响

目的 探讨早期干预对妊娠期糖尿病（GDM）母儿结局的影响.方法 选择2007年1月～2010年6月笔者所在医院进行系统产前检查并行早期干预住院分娩的妊娠期糖尿病孕妇60例为观察组,选择同期未进行系统产前检查,入院时才确诊的妊娠期糖尿病孕妇60例为对照组,比较两组的母儿妊娠结局.结果 通过在孕期对GDM孕妇采取早期干预措施,孕产妇及围产儿预后均有明显改善,两组孕妇及围产儿并发症有统计学意义（P＜0.05）.结论 应及时发现妊娠期糖尿病并尽早实施早期干预,以降低产科并发症,改善母儿预后.     

妊娠期糖尿病饮食治疗依从性对妊娠结局的影响

目的探讨妊娠期糖尿病患者饮食治疗管理后对妊娠结局的影响。方法 94例妊娠期糖尿病（GDM）患者均经营养医师配制糖尿病食谱,64例患者遵医嘱定期到营养门诊复诊为观察组,30例患者未复诊为对照组,分析2组患者产时产科并发症、新生儿并发症的发生情况。结果复诊组GDM妊娠时间比未复诊组长,差异有统计学意义（P〈0.05）,胎膜早破、早产和低出生体重儿的发生率显著低于未复诊组GDM者（P〈0.05）。结论加强GDM的饮食管理,提高患者对治疗的依从性可以显著改善妊娠结局,提高母儿生活质量。     

妊娠期糖尿病相关因素的临床对照研究

目的：探讨妊娠期糖尿病（GDM）诊断与治疗方法。方法对2012年1-12月衢州市妇幼保健院门诊建卡的2388名孕妇进行葡萄糖耐量实验（OGTT）筛查，根据结果分为糖尿病组和对照组，比较两组分娩情况；再按血糖控制情况将糖尿病组分为血糖控制正常组和未正常组，比较两组分娩方式及新生儿并发症发生情况。结果 GDM发生率与孕期体重指数相关；糖尿病组与对照组孕妇剖宫产率分别为57.56％和47.79％，两者差异有统计学意义（P＜0.05）；血糖控制正常组的新生儿并发症发生率14.97％，明显低于血糖未控制正常组的46.15％（P＜0.05），新生儿并发症发生率与血搪控制情况有直接关系。结论 GDM对母儿的影响与血糖控制水平密切相关，因此及时做好妊娠期糖尿病筛查，早期诊断并综合规范治疗，能明显减少母儿并发症发生。     

妊娠期糖尿病患者孕期合理管理对母儿结局的影响

目的:探讨妊娠期糖尿病(GDM)患者在孕期进行合理管理的意义.方法:在95例GDM患者中随机选择60例经规范化管理作为观察组,同期未经过合理管理的35例GDM患者作为未治组,同期分娩血糖正常的孕妇50例为对照组,比较3组母婴并发症的发生率.结果:观察组中46例(76.7％)经饮食控制与适当锻炼后血糖控制良好,5例需加用胰岛素治疗;其母婴并发症中除早产发病率及剖宫产率高于对照组(P＜0.05)外,其他观察项目发生率与对照组比较差异无统计学意义(P＞0.05).未治组其母婴并发症各项均明显高于对照组(P＜0.05).结论:加强妊娠期糖尿病的管理,可有效减少母婴并发症的发生,甚至接近正常孕妇水平.     

妊娠期糖尿病孕妇并发甲状腺功能减退对妊娠结局的影响

目的探讨妊娠期糖尿病孕妇并发甲状腺功能减退对妊娠结局的影响,为临床母儿保健及诊治提供帮助。方法选取2016年2月-2017年2月行产前检查并分娩的妊娠妇女通过OGTT试验及甲状腺功能检查共计纳入妊娠期糖尿病(GDM)组患者47例、甲状腺功能减退(HT)组61例、GDM并发HT组53例以及正常对照组45例,比较各组孕妇妊娠结局和新生儿结局。结果 GDM并发HT组妊娠期高血压疾病与产后出血的发病率高于对照组及HT组,差异有统计学意义(P<0.05),而早产、胎膜早破、胎盘早剥的发生率与对照组差异无统计学意义(P>0.05)。GDM组新生儿低出生体重的发生率高于对照组及GDM组,差异有统计学意义(P<0.05),而其他各组的新生儿低血糖及新生儿窒息的发生率与对照组差异无统计学意义(P>0.05)。结论妊娠期糖尿病并发甲状腺功能减退组孕妇妊娠期并发症以及新生儿不良结局高于健康对照组以及单纯妊娠期糖尿病或单纯甲状腺功能减退组,在临床诊治中应注意监测并及时给予相应干预措施。     

妊娠糖耐量受损140例临床研究

[目的]探讨妊娠糖耐量受损(GIGT)对母儿结局的影响。[方法]对2515例孕妇进行口服50g葡萄糖筛查试验,对异常者,再空腹口服75g葡萄糖进行糖耐量试验(OGTT)以确诊妊娠期糖尿病(GDM)及妊娠糖耐量受损。并分正常组、GIGT组及GDM组进行比较母儿结局。[结果]孕期及分娩过程中的合并症,难产率及围产儿患病率中,在正常组、GIGT组、GDM组的妊娠期高血压疾病、早产、胎膜早破、羊水过多、新生儿窒息、新生儿低血糖、剖宫产、巨大儿差异有统计学意义(P﹤0.01)。而胎膜早破的并发症差异无统计学意义(P﹥0.05);在GDM组与GIGT组中,妊娠期高血压疾病、新生儿窒息、新生儿低血糖、剖宫产、巨大儿明显高于正常组(P﹤0.01﹤0.017),但早产、胎膜早破、羊水过多的并发症差异无统计学意义(P﹥0.05﹥0.017);GDM与GIGT组之间新生儿窒息的并发症明显高于GIGT组(P﹤0.001﹤0.017);但GDM与GIGT组之间的妊娠期高血压疾病、早产、胎膜早破、羊水过多、新生儿低血糖、剖宫产、巨大儿差异无统计学意义(P﹥0.05﹥0.017)。[结论]对GIGT及时治疗,可提高孕期糖代谢异常母儿的预后。     

妊娠期糖尿病孕期系统化管理对妊娠结局的影响分析

目的:探讨妊娠期糖尿病(GDM)孕期系统化管理对母婴妊娠结局的影响.方法:选取65例在妇保科实施孕期系统化管理的GDM孕妇作为管理组,同时随机选取同期确诊为GDM但未接受孕期系统化管理的65例孕妇作为对照组,比较两组孕妇的GDM知识知晓率、相关行为率及并发症发生率.结果:管理组的GDM相关知识知晓率、遵医行为率、饮食控制率、定期血糖监测率等均明显高于对照组(P＜0.01);管理组的妊娠期高血压、羊水过多、产后出血、产褥感染等并发症发生率均明显低于对照组(P＜0.05);管理组的早产、巨大儿、新生儿窒息、新生儿低血糖等围产儿并发症发生率均明显低于对照组(P＜0.05).结论:GDM孕妇实施孕期系统化管理,可提高GDM知识和遵医行为,加强定期血糖监测,降低母婴并发症发生率,从而改善母婴妊娠结局.     

妊娠期糖尿病的规范化诊治对母婴结局的影响

目的 探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）的规范化诊治对母婴结局的影响.方法 将本院70例妊娠期糖尿病患者,在孕24～32周内确诊并接受规范化诊治,血糖水平控制满意者为Ⅰ组,选择司期未及时发现或不配合治疗血糖控制不满意42例（确诊时间超过孕32周）为Ⅱ组,比较两组妊娠期糖尿病的母婴结局.结果 Ⅰ组妊娠期高血压疾病、羊水过多、早产、剖宫产率、产褥病率及巨大儿新生儿低血糖发生率低于Ⅱ组（P＜0.05或P＜0.01）.结论 妊娠期糖尿病产妇母儿并发症发生事件增加,早期筛查,及时规范化诊治能降低母婴并发症发生、改善妊娠结局.     

妊娠期糖尿病不同治疗方式对妊娠结局的影响

目的分析用不同治疗方式治疗妊娠期糖尿病(GDM)孕妇对妊娠结局的影响。方法选取我院2017年1月-2019年5月间的114例GDM孕妇进行回顾性分析,根据治疗方式的不同分为饮食运动干预组和干预加胰岛素治疗组,对比分析两组产妇的血糖值和妊娠结局以及新生儿并发症情况。结果干预加胰岛素治疗组的孕妇血糖值、不良妊娠结局、新生儿并发症发生率均显著低于饮食运动干预组(P0.05)。结论饮食运动干预加胰岛素治疗对于妊娠期糖尿病有更好的疗效。     

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.