产后盆底康复治疗100例临床疗效观察

盆底功能障碍性疾病(PFD)是影响女性生活质量的常见疾病,主要包括压力性尿失禁、盆腔器官脱垂[1]等,妊娠分娩导致盆底肌肉功能受损被认为与PFD的发生有关.湖北省妇保院采用盆底康复综合性治疗方法治疗产后盆底功能障碍性疾病,取得较好疗效,现报道如下.     

产后妇女盆底功能障碍性疾病的盆底肌力特点

目的分析产后妇女盆底功能障碍性疾病(PFD)盆底肌收缩力特点,探讨该疾病的危险因素。方法选取2017年就诊于该院盆底康复中心的产后1～3月妇女975例,1种PFD组、多种PFD组及无PFD (对照组)分别为364例、382例和229例,患有单纯盆底肌疼痛(MFPP组)、盆底器官脱垂(POP组)分别为205例和131例,以问卷调查形式记录患者一般情况,采用手检和盆底表面肌电检测进行盆底肌力评估。结果产后妇女手检肌力为(1. 37±0. 75)级,Ⅰ类肌力为(1. 28±0. 85)级,Ⅱ类肌力为(1. 82±0. 95)级。各级肌力分布情况如下:肌力0级78例(8%),肌力1级538例(55. 18%),肌力2级291例(29. 95%),肌力3级60例(6. 15%),肌力4级8例(0. 82%),肌力5级0例。1种PFD组、多种PFD组、MFPP组的手检肌力和电反馈信号明显低于对照组(均P<0. 05); POP组和对照组比较手检肌力降低(P<0. 05),但电反馈信号两组间差异无统计学意义(P>0. 05); 1种PFD组和多种PFD组之间、MFPP组和POP组之间手检肌力和电反馈信号比较,差异均无统计学意义(均P>0. 05)。结论产后妇女盆底肌收缩力明显下降;产后PFD与盆底肌收缩力下降有关,但无论是盆底肌手检肌力值还是盆底表面肌电值在产后PFD分型和分度诊断中未发现明显优势。     

鲁南地区3052名产妇对盆底功能障碍性疾病的认知现状调查

女性盆底功能障碍性疾病(pelvic floor dysfunction,PFD)是各种病因导致盆底支持薄弱,进而盆腔脏器移位连锁引发其他盆腔器官的位置和功能异常,主要包括盆腔器官脱垂(pelvic organ prolapse,POP)、压力性尿失禁(stress urinary incontinence,SUI)及性功能障碍。为了解鲁南地区产妇对盆底功能障碍性疾病认知情况,以便寻找一定的方法提高产妇对产后进行盆底肌康复重要性的认知,达到早期预防、早期检查和早期治疗的目的,我们于2011年1—4月对在我院住院分娩的3 168名产妇采用自拟问卷调查表进行PFD认知水平的调查,现将结果报告如下:     

产后盆底康复训练的研究现状

盆底功能障碍性疾病(pelvic floor dysfunction,PFD)是指由于各种原因而导致的盆底支持结构损伤、盆腔脏器移位,继而引发其他盆腔脏器的位置、功能的异常,它主要包括盆腔器官脱垂(POP)、压力性尿失禁(SUI)等[1].它是影响女性生活质量的常见病.在我国已婚已育的女性中,有45％的女性有不同程度的盆底功能障碍.妊娠和分娩对女性的盆底肌肉的损害受到越来越多的关注.一些产科的因素如分娩次数的增加、第二产程的时间过长、胎儿体重过重、胎儿的头围偏大以及会阴的裂伤等情况都可以导致产妇盆底肌肉的损伤和尿道横纹肌的部分去神经作用,导致其发生盆底功能障碍[2].而在产后早期开展盆底康复训练,可以提高盆底肌肉的张力、降低尿失禁的发生率,并有改善阴道前壁脱垂的作用,能够较好的预防女性盆底功能障碍性疾病的发生.     

高龄产妇盆底康复治疗研究现状

目的随着中国人口老龄化以及全面二孩政策的实施,高龄妇女二胎妊娠和分娩对盆底肌肉和神经的影响已凸现出社会卫生经济学问题,使得盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的发病率有所升高。本文就高龄妇女妊娠和分娩对盆底组织的影响,产后早期最佳治疗时机进行盆底肌肉锻炼、生物反馈及电刺激等盆底康复治疗进行阐述,以期为临床工作者和产妇树立个体化的产后盆底康复治疗的观念,改善早期PFD的症状,防治远期PFD的发生。     

邢台市企业女工盆底功能障碍性疾病相关因素调查

女性盆底功能障碍性疾病(PFD)表现为盆腔器官膨出(POP)和压力性尿失禁(SUI),是妇女常见疾病,发病率较高.我们对邢台市30岁以上企业女工进行调查,以了解PFD发病情况及POP与SUI二者之间的关系.现报告如下.     

探讨Kegel训练及盆底电刺激对产妇盆底功能的保护作用

目的探讨Kegel训练及盆底电刺激对产妇盆底功能的保护作用。方法选择在昆山市妇幼保健所产后检查的299例顺产经产妇作为观察对象,其中152例(实验组)在初产后均进行了Kegel训练加盆底电刺激,在两次产后分别评估盆底功能障碍性疾病(PFD)及进行盆底肌综合肌力检测;147例(对照组)在初产后未干预,在第2次产后评估PFD及进行盆底肌综合肌力检测。分析两组产妇发生盆底功能障碍性疾病(PFD)及手测盆底肌综合肌力等情况。结果实验组产妇第1、2次产后PFD发生率分别为55.26%、58.55%,差异无统计学意义(P=0.563),盆底肌综合肌力3级,分别占89.47%、78.95%,差异有统计学意义(P=0.01);实验组、对照组产妇第2次产后发生PFD(58.55%、83.67%)、盆底肌综合肌力3级(78.95%、91.16%)间差异均有统计学意义(P值均0.05)。结论顺产后进行Kegel训练及盆底电刺激的产妇经产后PFD的发生率减少、盆底肌综合肌力好,该方法对顺产产妇盆底功能有保护作用。     

不同分娩方式对产妇产后早期盆底肌力的影响

目的通过盆底功能评估产后妇女盆底功能障碍状况,分析比较剖宫产与正常产两种分娩方式对产后盆底功能的影响,为盆底功能障碍性疾病(PFD)的防治提供理论依据。方法选取2014年4月-2015年10月在该区妇幼保健院妇女保健中心进行产后复查的产妇10 540例,根据其分娩方式的不同分为剖宫产组(4 490例)和正常产组(6 050例),比较观察两组产妇PFD的发生情况及其对盆底肌力的影响。结果正常产组盆底疲劳度异常、肌力损伤、肌力收缩失调、压力性尿失禁(SUI)、盆腔器官脱垂(POP)、腹直肌分离及阴道闭合不全等情况的发生率高于剖宫产组,差异均有统计学意义(P0.05)。正常产组产妇两类肌纤维肌力受损情况均高于剖宫产组产妇(P0.05)。结论两种分娩方式均对盆底肌力有影响,但是剖宫产对产妇早期盆底肌力的影响小于正常产,为提高盆底肌力,产妇产后应早日进行康复锻炼。     

从盆底筛查来提高对盆底功能障碍性疾病的认识

目的:探讨在健康体检行盆底筛查提高妇女对自身盆底功能的了解,为妇女保健提供依据。方法:回顾性总结唐山市妇幼保健院2012年健康查体中行盆底筛查检查的2 216例已育妇女检查结果,以提高对盆底功能障碍性疾病的认识。结果:在2 216例已育妇女中,共检出阴道前壁、后壁膨出789例和428例,各占35.6%和19.3%;子宫脱垂364例,占16.4%;子宫脱垂同时并发阴道前、后壁膨出296例,占13.4%;合并压力性尿失禁783例,占35.3%。结论:已婚已育妇女是盆底疾病的高危人群,盆底筛查可提高早期盆底功能障碍性疾病的检出,加强妇女保健意识,提高其终生的生活质量水平。     

产后盆底肌肉生物反馈训练加电刺激治疗临床观察

<正>妊娠期母体将发生一些变化,以最大限度地适应胎儿的生长发育和代谢。妊娠和分娩会对盆底肌肉造成不同程度的损伤,导致盆底功能障碍性疾病,表现为压力性尿失禁、盆腔脏器脱垂等一系列盆底损伤与缺陷。目前发现,妇女常见的复发性阴道炎、器官下垂、尿失禁、夫妻生活不和谐等与其相关[1]。本院对正常分娩产后42d盆底筛查肌力≤Ⅲ级妇女进行生物反馈电刺激治疗,取得较好疗效,报告如下。1资料与方法     

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.