非营养性吸吮联合抚触干预早产儿胃管喂养的临床研究

【目的】 评价非营养性吸吮联合抚触两种干预方式在早产儿胃管喂养中的临床应用价值。 【方法】 68例早产适于胎龄儿,生后即给予鼻胃管喂养,随机平均分为两组:干预组和常规喂养组,干预组早产儿在常规喂养的情况下同时给予非营养性吸吮和抚触干预,观察两组早产儿胎便持续时间、生理性体重下降持续天数、胃管留置时间、经口喂养后喂养不耐受的发生率、并发症的发生率、住院天数等指标。 【结果】 干预组早产儿胎便持续时间、生理性体重下降天数、胃管留置时间、住院天数均短于常规喂养组,差异均有统计学意义(P<0.05);喂养不耐受和并发症的发生率干预组明显低于常规喂养组,差异有统计学意义(P<0.05)。两组早产儿并发症中,高胆红素血症发生率居首位,常规喂养组发生率为44.1%,干预组发生率为14.7%,两组差异具有统计学意义(P<0.05)。两组早产儿在纠正胎龄40周时进行体重、身长、头围的比较,干预组明显优于常规喂养组,差异具有统计学意义(P<0.05)。 【结论】 非营养性吸吮联合抚触两种干预方式在早产儿喂养中起到良好促进作用。     

非营养性吸吮联合腹部抚触对极低出生体重儿体重增长的影响研究

目的探讨非营养性吸吮联合腹部按摩对极低出生体重儿体重增长的影响。方法将舟山市妇幼保健院NICU收治的48例需经鼻胃管喂养的极低出生体重儿随机分成两组。对照组（24例）给予单纯经鼻胃管喂养,实验组（24例）在经鼻胃管喂养的基础上辅以非营养性吸吮加腹部抚触,两组均给予同一种早产儿特殊配方乳喂养。观察记录两组胃内残留发生率、鼻胃管留置时间、达到完全肠道营养时间、胎粪完全排尽时间、恢复出生体重时间、体重增长速度、睡眠时间。结果与对照组比较,实验组鼻胃管留置时间较短,达到完全肠道营养时间短,胎粪完全排尽时间短,胃内残留奶量少,恢复出生体重时间及体重增长速度快,睡眠时间相对延长。结论极低出生体重儿在鼻胃管喂养期间辅以非营养吸吮伴腹部抚触的方法,能有效促进胃排空,对其胃肠功能发育及体重增长有促进作用。     

喂养方式对早产儿营养状况及生长发育的影响

目的:探讨不同喂养方式对早产儿营养状况及生长发育的影响。方法:将63例早产低出生体重儿(出生体重1250～2150g)分为自吮奶组和胃管喂养组,后者根据是否辅以非营养性吸吮随机分为单纯胃管喂养组和非营养性吸吮组,所有早产儿均采用同一种配方奶粉喂养,记录喂养2周后早产儿生长发育指标的变化及恢复出生体重的时间;记录奶量、热能、鼻胃管留置时间。结果:自吮奶组和非营养性吸吮组恢复出生体重时间较单纯胃管喂养组显著缩短(P<0.05);1周后自吮奶组体重增加明显高于单纯胃管喂养组和非营养性吸吮组,2周龄时身长明显增加,差异有显著性(P<0.05);非营养性吸吮组鼻胃管留置时间缩短了5天。结论:若早产儿消化道能适应胃肠道营养,应尽早给予奶瓶喂养;对吸吮、吞咽功能不协调者,在鼻胃管喂养期间辅以非营养性吸吮是一种适宜的辅助喂养方法。     

非营养性吸吮对早产儿营养及生长发育的影响

目的:探讨非营养性吸吮(NNS)对早产儿营养、生长发育及喂养相关并发症的影响。方法:将60例需经鼻胃管喂养(INGF)的健康早产适于胎龄儿,根据是否辅以非营养性吸吮随机分成单纯鼻胃管喂养组和非营养性吸吮组,均用瑞士雀巢公司提供的雀巢早产儿配方奶,记录喂养2周生长发育指标(体重、身长、头围)的变化及恢复出生体重的时间、达自行吮母乳时间、喂养相关并发症。结果:非营养性吸吮组恢复出生体重时间(8.8±1.8)天,较单纯鼻胃管喂养组(10.1±1.3)天,显著缩短(P<0.01);达自行吮母乳时间(8.1±0.9)天,较单纯鼻胃管喂养组(9.5±1.3)天,显著缩短(P<0.01);喂养2周后两组的体重、身长差异有显著性(P<0.05),头围差异无显著性(P>0.05);非营养性吸吮组胃残留、呕吐、腹胀并发症的发生率较单纯鼻胃管喂养组的发生率显著减少(P<0.05)。结论:早产儿早期非营养性吸吮可促进胃肠道的发育和功能成熟、降低喂养不耐受的发生率、促进体质量增长、有利于改善早产儿营养状况,加快早产儿生长发育。     

乳糖酶联合非营养性吸吮对早产儿喂养不耐受和早期生长发育的影响

目的 探讨乳糖酶联合非营养性吸吮对早产儿喂养不耐受和早期生长发育的影响。方法 选取2020年1月—2021年6月在杭州市富阳区妇幼保健院分娩的120例早产儿，采取随机数字表法分为两组，分别为对照组(60例)和观察组(60例)。两组均采用常规干预措施，在此基础上，对照组接受非营养性吸吮，观察组接受乳糖酶联合非营养性吸吮干预，两组均持续干预2周。记录并比较两组早产儿症状缓解及恢复情况(每日进奶量、达全量肠内营养时间、体质量恢复时间、初次排便时间、胎粪排空时间)、早期生长发育情况(体质量、身长、头围、腹围增长情况);在干预前和干预2周时，比较两组胃肠激素(血清胃动素、胃泌素)水平；记录并比较两组喂养不耐受发生情况。结果 观察组每日进奶量为(103.82±6.69)ml,体质量恢复时间为(9.25±2.59)d,达全量肠内营养时间为(9.01±1.81)d,胎粪排空时间为(3.46±0.65)d,初次排便时间为(17.49±3.71)h;对照组每日进奶量为(94.44±5.14)ml,体质量恢复时间为(10.37±3.04)d,达全量肠内营养时间为(10.24±1.95)d,胎粪排空时间为(4...     

非营养性吸吮在早产儿喂养中的观察及护理

目的探讨非营养性吸吮（NNS）在早产儿喂养中的应用效果及护理。方法将98例早产儿常规分为两组,N—NNS组49倒,给予胃肠外营养联合早期微量喂养,不给予非营养性吸吮;NNS组除给予上述常规处理外,还给予非营养性吸吮。结果除呕吐外,NNS组早产儿喂养不耐受的发生率明显低于N—NNS组（P〈0．05）,喂养不耐受改善所需时间明显少于N—NNS组（P〈0．05）。结论在早产儿喂养护理中应用非营养性吸吮,能提高胃肠道喂养的耐受能力,促进改善喂养不耐受状况,缩短过渡到经口进食的时间,是一种安全、经济、方便,无不良反应的有效方法。     

鼻饲辅以安慰奶嘴吸吮对早产儿喂养不耐受的疗效观察

目的:探讨早产儿早期给予安慰奶嘴吸吮对其喂养及生长发育的影响。方法:将50例早产儿随机分为观察组25例和对照组25例,观察组在鼻胃管喂养时吸安慰奶嘴(无孔橡皮奶头),对照组单纯给予鼻胃管喂养,两组均给予部分静脉营养。观察两组早产儿体重、喂养耐受情况、胎粪排出时间和排尽时间、完全经口喂养时间、静脉营养时间。结果:观察组恢复出生体重时间较对照组缩短(P0.01),体重下降最大限度两组间比较差异无统计学意义;观察组胃潴留发生率(12.00%)较对照组发生率(40.00%)明显降低;观察组胎粪排尽时间、完全经口喂养时间、静脉营养时间均较对照组缩短(P0.05)。结论:早产儿在鼻胃管喂养期间辅以安慰奶嘴吸吮是一种适宜的辅助喂养方法。     

不同喂养方式早产儿血胃动素、胃泌素及胃蛋白酶原浓度变化的研究

目的 动态监测早产儿开奶前、生后第3天、第7天及第14天血中胃动素、胃泌素及胃蛋白酶原的浓度变化,并予以三种不同的喂养方式干预,探讨早产儿血胃动素、胃泌素及胃蛋白酶原的动态变化及其与喂养方式的相关性,探讨合理的喂养方式.方法 需经间断鼻胃管喂养的胎龄34周以下的早产儿52例,随机分为三组,分别予以不同的喂养方式.放射免疫法批量监测血胃动素、胃泌素及胃蛋白酶原的水平.结果 （1）开奶前三组胃动素、胃泌素及胃蛋白酶原水平无明显差异,随喂养时间延长,非营养性吸吮组、滴服喂养组均高于单纯鼻胃管喂养组.非营养性吸吮组较明显,差异有显著意义.（2）早产儿血胃蛋白酶原的浓度变化与胃动素及胃泌素水平成正相关.（3）非营养性吸吮及滴服喂养组喂养不耐受的发生率减低,达全口喂养时间、黄疸持续时间及住院时间缩短.非营养性吸吮组更为明显.结论 早产儿血胃蛋白酶原的浓度变化与胃动素及胃泌素水平成正相关 非营养性吸吮及滴服喂养均可促进胃动素及胃泌素和胃蛋白酶原的分泌,促进胃肠功能的成熟,而非营养性吸吮作用更为明显.     

口腔按摩对非营养性吸吮和腹部按摩为干预基础的早期早产儿经口喂养能力的影响

目的 探讨口腔按摩对非营养性吸吮和腹部按摩为干预基础的早期早产儿经口喂养能力的影响。方法 选取2020年7月—2021年6月义乌市妇幼保健院收治的124例早期早产儿为研究对象,随机分为对照组和干预组,每组各62例,对照组早产儿留置胃管接受胃肠内营养,同时给予非营养性吸吮和腹部按摩,干预组早产儿在上述治疗基础上给予口腔按摩,观察两组早期早产儿喂养进程、喂养效率、喂养不耐受、不良反应及康复时间。结果 干预组早产儿留置胃管时间、开始经口喂养时间、过渡时间及完全经口喂养时间[(12.10±4.23)d、(10.04±3.58)d、(15.05±4.97)d及(21.50±4.75)d]均短于对照组[(15.32±5.10)d、(13.45±3.94)d、(18.32±5.05)d及(25.34±4.99)d],差异均有统计学意义(t=3.827、5.044、3.634及4.389,均P<0.05)。干预组早产儿开始经口喂养和完全经口喂养时的摄入奶量和喂养速率均高于对照组(均P<0.05)。干预组早产儿呕吐、胃潴留、腹胀及持续3 d实际摄入奶量不增加或减少等喂养不耐受发生率(9.68...     

非营养性吸吮对早产儿胃排空的影响

非营养性吸吮（NNS）对早产儿的有益作用尚存在不同意见，我们对无法经口喂养的早产儿，在给予胃管喂养的同时，给予吸吮空的橡皮奶头，称为非营养性吸吮（NNS）。NNS对早产儿的行为、生理、心理的发育具有重要作用。但有关NNS对胃肠功能的影响，许多方面尚存在争汉。本研究通过胃泌素（GAS）和胃动素（MOT）的测定，了解NNS对早产儿胃排空的影响。     

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.     

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.     

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.     

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.     

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.