某院住院患者感染及抗菌药物使用横断面调查

目的调查某院住院患者医院感染现患率及社区感染情况,为医院感染防控提供依据。方法采用床旁调查与查阅病历相结合的方法,调查2011年9月26日0∶00- 24∶00该院所有住院患者。结果应调查住院患者1 331例,实际调查1 309例,实查率为98.35%。发现感染患者237例,其中医院感染57例（4.35%）,60例次（4. 58%）;社区感染181例（13.83%）,183例次（13.98%）;同时存在医院和社区感染者1例。医院感染部位居前3位的是下呼吸道（48.33%）、器官腔隙（16.67%）和泌尿道（8.33%）。社区感染率居前3位的科室分别为：呼吸科（84.44%）、儿科（71.43%）、重症监护室（50.00%）;感染部位以下呼吸道（45.36%）和皮肤软组织（15.30%）多见。共分离病原体65株,其中医院感染33株,社区感染32株;其中铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌合计分别占医院感染和社区感染的72.73%（24/33）、78.13%（25/32）。抗菌药物日使用率为27.43%（359 例）,其中预防用药占52.92%,治疗用药占43.45%,预防+治疗用药占3.62%;以单一用药为主,占88.02%,二联用药占11.98%。病原学送检率为61.54%（104/169）。结论感染现患率调查有助于全面了解医院感染及社区感染现状和抗菌药物使用情况,有利于针对性地开展监测。     

某院住院患者医院感染和社区感染横断面调查

目的了解某院住院患者医院感染和社区感染现状,为更好地预防和控制医院感染提供依据。方法采用床旁调查和查阅病历相结合的方法,对某院2014年9月11日0:00—24:00所有住院患者进行医院感染横断面调查。结果本次调查应查住院患者2 470例,实查住院患者2 470例,实查率为100.00%;发生医院感染89例(93例次),医院感染现患率为3.60%(例次现患率为3.77%);发生社区感染574例(617例次),社区感染现患率为23.24%(例次现患率为24.98%)。医院感染和社区感染部位均以下呼吸道为主,分别占50.53%和46.19%。医院感染现患率居前5位的科室依次为重症医学科、急诊(创伤)外科、神经外科、胃肠外科、心胸外科;社区感染现患率居前5位的科室依次为儿科、呼吸内科、急诊内科、血液内科及风湿免疫科。医院感染和社区感染病原体均以革兰阴性菌为主,分别占78.38%和49.54%。抗菌药物使用率为31.09%,以治疗用药为主(82.29%);抗菌药物联合用药以一联为主(94.66%);治疗性使用抗菌药物病原体送检率为65.19%。结论医院感染和社区感染横断面调查有助于了解医院感染和社区感染现状;有利于加强对重点科室、重点部位医院感染管理。     

某妇幼保健院医院感染横断面调查

目的了解某妇幼保健院医院感染现况，对引起医院感染的相关因素进行调查与分析。方法采用横断面调查方法，床旁调查与查阅病历相结合，对该院2012年4月11日0︰00-24︰00所有住院患者进行调查。结果应查人数769例，实查769例，实查率100.00%。发现医院感染12例，医院感染现患率为1.56%；现患率居前3位的科室分别为产科重症监护室（8.33%）、儿内科（5.08%）及新生儿重症监护室(3.08%）。调查日抗菌药物使用率为44.10%（351/796），其中治疗用药者病原学送检率为60.90%（81/133），医院感染患者病原学送检率为66.67%（8/12）。检出1株产超广谱β 内酰胺酶大肠埃希菌和1株多重耐药菌。241例预防性使用抗菌药物者中，233例（96.68%）术前用药控制在0.5～2 h，8例（3.32%）术前用药时间＞2 h。结论医院感染现患率调查，有利于了解医院感染发生情况和采取相应控制措施。该院检出了多重耐药菌，需引起高度重视。     

Upper-extremity Musculoskeletal Disorders in Keyboard Operators in Brazil: A Cross sectional Study

Abstract

This study sought to determine the prevalenee of upper extremity musculoskeletal disorders (UEMSDs) among keyboard operators in Sao Paulo, Brazil, and to compare this prevalence with that among other office workers. One hundred and thirty keyboard operators (mean age 33 years, 60 male/70 female) and 138 office workers (mean age 35 years, 82 male/66 female) from two computing centers were interviewed by a research assistant using a standardized questionnaire. Symptomatic subjects, defined as those who reported upper extremity pain or lost work time due to pain in the preceding 12 month, were examined by a rheum-tologist. Mean (SD) lengths of employment were 9 (6) years for keyboard operators and 8 (6) years for office workers. Upper-extremity pain during the preceding seven days was reported by 66 keyboard operators (51%) and by 18 office workers (13%) (p < 0.0001); during the preceding 12 months, by 90 keyboard operators (69%) and by 26 office workers (19%) (p < 0.0001). UEMSDs were diagnosed following physical examination in 50 keyboard operators and in 12 office workers (9%) (p < 0.0001). Tenosynovit is was the most common disorder diagnosed among the keyboard operators (n = 23). Among the keyboard operators the prevalence of UEMSDs was significanlly lower for males (p = 0.017, OR = 0.38, 95% CI = 0.17–0.86. The presence of a diagnosed UEMSD was significantly associated with duration of employment (p = 0.005) and lack of or insufficient rest breaks (p = 0.012). Keyboard operators had significantly more UEMSDs than did office workers. Strategies aimed at the reduction of repetitive strain injuries among keyboard operators, such as the provision of adequate work breaks, should be evaluated.     

2015年云南省116所医院医院感染横断面调查

目的了解云南省2015年医院感染现状,为制订医院感染预防与控制措施提供依据。方法采用床旁调查和病历调查相结合的方法,调查云南省116所医院医院感染现患率、抗菌药物使用情况及病原学送检情况。结果共调查住院患者64 386例,发生医院感染1 357例,1 476例次,医院感染现患率为2.11%,例次现患率为2.29%。不同床位数医院医院感染现患率、抗菌药物使用率和治疗使用抗菌药物病原学送检率比较,差异均有统计学意义（均P＜0.01）。医院感染居前3位的科室依次为重症监护病房（20.99%）、烧伤科（8.00%）及血液科（7.34%）;感染部位以下呼吸道为主（占42.68%）;医院感染病原菌以革兰阴性菌为主（占69.28%）,主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等。调查日抗菌药物使用率为35.62%,治疗性使用抗菌药物病原学送检率为59.56%。结论本次医院感染横断面调查有助于了解全省医院感染现况,计算出各指标的百分位数分布,便于各医院进行医院感染相关工作的自我评价。     

2011年四川省248所医院医院感染横断面调查

目的了解四川省医疗机构2011年医院感染基本情况,建立医院感染相关指标的参照体系。方法2011年9月1-30日,四川省248所二级及二级以上医院参与医院感染现患率调查。参与调查的各医院自行确定调查日,采取床旁调查和查阅住院病历相结合的方法,对248所医院调查日（0∶00-24∶00）所有住院患者进行调查。结果248所医院应查人数75 822例,实查74 457例,实查率98.20%。发生医院感染1 966例,2 001例次,医院感染现患率为2.64%,例次现患率为2.69%。不同规模医院医院感染现患率比较,差异有统计学意义（χ2=46.70,P＜0.01）,随着医院规模的增大,医院感染现患率升高。医院感染部位居前3位者依次为呼吸道(55.77%)、泌尿道(12.79%)和手术切口(11.99%);医院感染现患率较高的科室依次为：肿瘤科（4.52%）、外科（3.28%）和内科（3.02%）;医院感染患者病原学送检率为42.13%（843/2 001）;调查当日共39 440例患者使用抗菌药物,医院抗菌药物使用率为52.97%,其中11 209例（15.05%）患者预防用药,28 231例（37.92%）患者治疗用药。医院治疗用抗菌药物者送细菌培养率为21.63%（6 105/28 231）。结论此次调查有助于了解四川省各医院医院感染的基本情况,建立各指标的参照体系,供各医院参考比对,可指导医院感染防控工作。     

Cross sectional and longitudinal study on selenium, glutathione peroxidase, smoking, and occupational exposure in coal miners

OBJECTIVES—To understand the variations of selenium (Se) concentration relative to changes in occupational exposure to coal dust, taking into account age and changes in smoking habits in miners surveyed twice, in 1990 and 1994. To better understand the relation of Se concentration with glutathione peroxidase activities (GSH-Px) in these miners.
METHODS—In 1994, blood samples were obtained from active (n=131) and retired (n=40) miners without coal worker''s pneumoconiosis, in whom Se concentration was available at both surveys and in whom International Labour Organisation (ILO) profusion grade had not been changed. Active miners were exposed to high dust concentrations (n=48) or low dust concentrations (n=83). Miners were classified into three subgroups according to their estimated cumulative exposure to dust, and into three subgroups according to their smoking habits.
RESULTS—Selenium concentration and GSH-Px activities were significantly lower in active than in retired miners (Se adjusted means: 62.6 v 72.2 ng/ml p=0.01). Moreover, Se concentration was lower in miners exposed to high compared with those exposed to low dust concentrations (adjusted means: 59.4 v 65.8). In miners exposed to high dust concentrations, Se concentration was significantly lower whereas erythrocyte GSH-Px activity was significantly higher in the subgroup with estimated cumulative exposure >68 mg/m³.y. In all miners, plasma GSH-Px activity was correlated with Se concentration (r=0.22, p<0.005). The 4 year Se changes were negatively related to exposure to high dust concentrations and positively related to change in exposure from high to retirement and to change from smoker to ex-smoker (p=0.01).
CONCLUSION—The variations of Se concentration in relation to changes in occupational exposure to coal dust and in smoking habits, and the close correlation found between plasma Se concentration and GSH-Px activity suggest that both are required in antioxidant defence. These results agree well with the hypothesis that the decrease in Se concentration reflects its use against reactive oxygen species generated by exposure to coal mine dust and by smoking.


     

Use of health services and home care before and after conversion of nursing home residences into private flats: Cross sectional consumer health surveys

The aim of this article is to describe the attitude to a changeof nursing home residences into private flats and the use ofservices by elderly persons before and after a major intervention(in 1986) in the service-delivery organization in the DanishMunicipality of Skaevinge. In this intervention, the rooms ofa nursing home were converted into health care centre flats.Former nursing home residents were again living in private flats.Their pensions, which formerly paid for their upkeep in thenursing home, were now paid directly to them. The study is basedon cross-sectional consumer health surveys. A total of 155 elderlypersons participated in ‘before and after’ interviewswhich took place in 1985 and 1987. During the first survey,52% of the elderly persons were positive towards conversionof the nursing home; in the second survey, this figure roseto 76%. There was a significant increase in provision of homehelp from 10 to 37%, home nursing from 11 to 30% and healthadvice in general. Due to the integration of the former nursinghome staff with the home care area, staff now work as interdisciplinaryteams both inside and outside the new health care centre.     

2014年贵州省苗族侗族自治州医院感染横断面调查

目的了解贵州省苗族侗族自治州医院医院感染现状,为医院感染防控措施的制定提供依据。方法按照全国医院感染监测网的统一部署,采用横断面调查方法,调查贵州省苗族侗族自治州26所医院医院感染现患率、抗菌药物使用情况及细菌培养送检率。结果共调查3所三级医院、23所二级医院7 799例住院患者,发生医院感染198例、205例次,医院感染现患率为2.54%,例次现患率为2.65%。综合重症监护病房（ICU）医院感染现患率最高,为29.63%;医院感染部位以下呼吸道为主（占44.44%）;医院感染病原体以革兰阴性（G-）菌为主,主要为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌等。抗菌药物使用率为45.66%,二级医院抗菌药物使用率为53.65%,高于三级医院的31.14%（χ2=148.53,P<0.001）。治疗用药占74.02%,预防用药占19.77%,预防+治疗用药占6.21%;抗菌药物单一用药比率占81.02%,二联占17.21%,三联及以上占1.77%;治疗用药及治疗+预防用药患者细菌培养送检率为29.37%。结论该地区医院感染现患率低于全国平均水平,抗菌药物使用率低于国家标准,应加强医院感染重点科室、重点部位的管理,合理使用抗菌药物,尤其是二级医院。     

Human papillomavirus vaccination and sexual behaviour: cross-sectional and longitudinal surveys conducted in England

Objective

To examine whether HPV vaccination influences sexual behaviour in adolescent girls, either by giving them a ‘green light’ to have sex, or because perceived protection afforded by the vaccine permits compensatory risky sexual behaviour.

Design

Cross-sectional and longitudinal surveys.

Setting

Seven English schools.

Main outcome measures

Self-reported sexual behaviour.

Participants

The cross-sectional survey included 1053 girls (mean age 17.1 years) who had (n = 433 recruited in March 2010) or had not (n = 620 recruited in March 2009) been offered the HPV vaccine. The longitudinal survey included 407 girls (mean age 17.5 years) who had been offered HPV vaccination and had either received at least one dose (n = 148) or had not received any doses (n = 259).

Results

In the cross-sectional survey, the group of girls who had been offered the HPV vaccine were no more likely to be sexually active than the group of girls who had not been offered the HPV vaccine. In the longitudinal survey, the vaccinated group were no more likely to have changed their condom use or increased their total number of sexual partners than the unvaccinated group.

Conclusions

Neither being offered the HPV vaccine nor receiving it affected sexual behaviour.     

A review of enteric outbreaks in child care centers: effective infection control recommendations

Child care environments facilitate the spread of enteric infections because of diapering, confined spaces, and children's unhygienic habits. This study reviews documented outbreaks of enteric illness in daycare centers (DCCs) to identify infectious agents, modes of transmission, morbidity/mortality, ages, secondary cases, and practices found effective by investigators. A systematic review of the literature, including peer-reviewed journals and public health records, identified reports of DCC enteric outbreaks published in English occurring between January 1996 and November 2006. In the 75 studies reviewed, 1,806 children were reported ill and 104 were reported hospitalized (mainly associated with Escherichia coli O157:H7). For bacterial outbreaks, the modes of transmission were person-to-person (43%), food (29%), and animal contact (11%). The mode of transmission was largely unknown (51%) for viral outbreaks. One hundred twenty-six staff cases and at least 212 additional ill household contacts were identified. The most frequently identified effective management practices included management of symptomatic cases, enhanced hand hygiene, safe food handling practices, and improved environmental cleaning. Although most children recover quite uneventfully from enteric illness, some can be seriously affected, especially by E. coli O157:H7. Staff, family members, and the community may become ill from secondary spread; therefore, it is important for DCCs to have effective infection control procedures in place to prevent and control outbreaks.     

Nutritional situation among Syrian refugees hosted in Iraq,Jordan, and Lebanon: cross sectional surveys

Background

Ongoing armed conflict in Syria has caused large scale displacement. Approximately half of the population of Syria have been displaced including the millions living as refugees in neighboring countries. We sought to assess the health and nutrition of Syrian refugees affected by the conflict.

Methods

Representative cross-sectional surveys of Syrian refugees were conducted between October 2 and November 30, 2013 in Lebanon, April 12 and May 1, 2014 in Jordan, and May 20 and 31, 2013 in Iraq. Surveys in Lebanon were organized in four geographical regions (North, South, Beirut/Mount Lebanon and Bekaa). In Jordan, independent surveys assessed refugees residing in Za’atri refugee camp and refugees residing among host community nationwide. In Iraq, refugees residing in Domiz refugee camp in the Kurdistan region were assessed. Data collected on children aged 6 to 59 months included anthropometric indicators, morbidity and feeding practices. In Jordan and Lebanon, data collection also included hemoglobin concentration for children and non-pregnant women aged 15 to 49 years, anthropometric indicators for both pregnant and non-pregnant women, and household level indicators such as access to safe water and sanitation.

Results

The prevalence of global acute malnutrition among children 6 to 59 months of age was less than 5 % in all samples (range 0.3–4.4 %). Prevalence of acute malnutrition among women 15 to 49 years of age, defined as mid-upper arm circumference less than 23.0 cm, was also relatively low in all surveys (range 3.5–6.5 %). For both children and non-pregnant women, anemia prevalence was highest in Za’atri camp in Jordan (48.4 % and 44.8 %, respectively). Most anemia was mild or moderate; prevalence of severe anemia was less than or equal to 1.1 % in all samples of children and women.

Conclusions

Despite the ongoing conflict, results from all surveys indicate that global acute malnutrition is relatively low in the assessed Syrian refugee populations. However, prevalence of anemia suggests a serious public health problem among women and children, especially in Za’atri camp. Based on these findings, nutrition partners in the region have reprioritized response interventions, focusing on activities to address micronutrient deficiencies such as food fortification.

     

Review of enteric outbreaks in prisons: effective infection control interventions

Objectives

To identify documented outbreaks, worldwide, of enteric illness in correctional facilities over the last 10 years to understand the epidemiology of the outbreaks and explicitly identify effective infection control measures.

Study design

Review of literature and outbreak investigation reports.

Methods

Computer-aided searches of literature databases and systematic searches of government websites were completed to identify relevant outbreak reports. Reference lists were hand-searched to validate the electronic search methodology. Reports identified through personal communications with public health officials were also included.

Results

Of the 72 outbreaks meeting the inclusion criteria, 76% and 21% were associated with bacterial agents and viral agents, respectively. The majority of outbreaks were associated with Salmonella (n = 20), Clostridium perfringens (n = 14), norovirus (n = 14), pathogenic Escherichia coli (n = 10) and Campylobacter spp. (n = 5). Transmission was primarily foodborne (67%). During an outbreak, the most common control measures included limiting movements of ill inmates and staff, and their exclusion from kitchen duty. The most common retrospectively reported preventative recommendations included monitoring food temperatures and effective infection control procedures.

Conclusions

It is essential to monitor food temperatures to prevent enteric outbreaks in prisons. Training in safe food handling should be offered to inmates who work in the kitchen. Enteric outbreaks are best controlled by effective infection control practices, while active surveillance and early diagnosis may prevent further spread of illness.     

Influenza pandemic: perception of risk and individual precautions in a general population. Cross sectional study

Background  

An influenza pandemic may have considerable impact on health and societal functioning. The aim of this study was to explore people's reflections on the consequences of a pandemic.     

苏州市牙科手机清洗质量横断面调查分析

目的了解苏州市各级各类医疗机构牙科手机的清洗现状和清洗质量。方法采用横断面调查的方法,按照等比例系统抽样原则,2015年10月26—31日对全市范围内口腔诊疗机构进行抽样检查,采用ATP生物荧光检测法检测各单位手机清洗质量。结果在全市10个行政区范围内共抽检医疗机构72所,检测手机201支,样本402份,其中有42份不合格,不合格率为10.45%。手机表面清洗不合格率为17.91%,高于手机水路的不合格率(2.99%),差异有统计学意义(P0.05)。不同等级医疗机构清洗质量比较,差异有统计学意义(P0.05),三级医院全部合格,无等级医疗机构手机清洗不合格率达14.45%。按不同医疗机构名称分类,清洗质量比较差异有统计学意义(P0.05),公立医院口腔科的手机清洗效果最好(不合格率4.31%),私营口腔诊所的清洗效果最差(不合格率13.81%)。结论应加强对全市牙科手机清洗的教育培训,尤其是低等级、私营口腔诊所牙科手机清洗质量的监督管理。     

Cross sectional study of performance indicators for English Primary Care Trusts: testing construct validity and identifying explanatory variables

Background  

The performance of Primary Care Trusts in England is assessed and published using a number of different performance indicators. Our study has two broad purposes. Firstly, to find out whether pairs of indicators that purport to measure similar aspects of quality are correlated (as would be expected if they are both valid measures of the same construct). Secondly, we wanted to find out whether broad (global) indicators correlated with any particular features of Primary Care Trusts, such as expenditure per capita.