老年良性前列腺增生症门诊患者自我效能水平及其影响因素分析

目的调查锦州市老年良性前列腺增生症门诊患者自我效能水平及影响因素。方法选择2014年1—8月在门诊体检的235例门诊老年良性前列腺增生症患者为调查对象,采用慢性非传染性疾病(慢性病)自我效能量表,国际前列腺症状评分量表(international prostate symptom score,IPSS)及一般资料调查表对患者进行调查。人口统计学及自我效能水平采用一般描述性分析,采用F检验,自我效能影响因素分析采用多重线性逐步回归分析,P0.05为差异有统计学意义。结果门诊老年良性前列腺增生症患者自我效能得分为(5.88±1.80)分,处于中等偏下水平,影响自我效能感的主要因素是文化程度、年龄、收入及饮食结构。结论门诊老年良性前列腺增生症患者自我效能水平为中等偏下水平,提示患者还有很高的提升空间,同时护理人员应该重视老年良性前列腺患者心理水平,并依据影响老年良性前列腺增生症患者自我效能因素而实施必要的护理,提高患者的生活质量。     

中老年维持性血液透析患者主要照顾者负担水平及其影响因素分析

目的调查中老年维持性血液透析(MHD)患者主要照顾者的负担现状,分析其相关的影响因素。方法采用便利抽样方法,选取2019年1月至6月吉林省某三级甲等医院血液净化中心中老年MHD主要照顾者115人为研究对象,采用一般人口学问卷、照顾者负担量表、社会支持量表、自我效能感量表进行调查分析,采用多元线性回归分析其影响因素。结果中老年MHD患者主要照顾者负担总分为(41.50±13.85)分,处于中等水平;社会支持得分(25.40±7.62)分,处于中低水平;自我效能得分为(20.40±5.62)分,处于中低水平。主要照顾者负担得分在年龄、文化程度、工作状态、家庭月总收入之间差异均有统计学意义(均P0.05)。回归分析结果显示社会支持、自我效能、家庭经济收入是中老年MHD患者主要照顾者负担的主要影响因素(P0.01)。结论中老年维持性血液透析患者主要照顾者负担处于中等水平,受自社会支持、自我效能、家庭经济收入影响。护理人员应及时评估主要照顾者负担的影响因素,扩大中老年维持性血液透析患者主要照顾者社会支持,提供相应的健康教育,最终提高患者及照顾者的生活质量。     

老年慢性心力衰竭患者症状管理自我效能对自我感受负担的影响

目的调查老年慢性心力衰竭患者自我感受负担、症状管理自我效能现状,探讨症状管理自我效能对自我感受负担的影响。方法选取2015年10月—2016年3月住院的老年心力衰竭患者102名进行问卷调查,使用症状管理自我效能量表(SESMs)、自我感受负担量表(SPBS)对患者的自我效能及自我感受负担进行测评。结果患者的自我效能得分为6.13±0.76,自我感受负担及各维度得分分别为32.79±8.52、10.41±2.53、15.66±5.53、6.72±1.75,自我效能得分与自我感受负担总分及各维度得分均具有负相关性(r=-0.564～-0.666,P0.05)。多元线性回归分析结果显示,在控制其他变量后,自我效能可增加回归模型对自我感受负担的预测力(ΔR~2=0.275)。结论老年心衰患者自我感受负担较重,自我效能是影响自我感受负担的重要因素。     

绵阳市涪城区城市老年慢性阻塞性肺疾病患者主观幸福感现状及影响因素

目的了解城市老年慢性阻塞性肺疾病(COPD)患者主观幸福感现状及其影响因素,为制定慢性病管理相关措施提供依据。方法采用一般资料量表、自我效能感量表、社会支持量表和纽芬兰纪念大学幸福度量表,对涪城区168名老年慢性阻塞性肺疾病患者进行调查。结果 168名老年慢性阻塞性肺疾病患者主观幸福感得分为28.47±7.16,4个维度得分分别为:正性情绪(PA)为7.25±2.67、负性情绪(NA)为4.49±2.32、正性体验(PE)为6.92±2.71、负性体验(NE)为5.21±2.45,其中81.5%患者主观幸福感处于中低水平。多元回归显示:婚姻状况、月均收入、患慢性病情况、自我效能感、社会支持是老年慢性阻塞性肺疾病患者主观幸福感的影响因素(P0.05)。结论城市老年慢性阻塞性肺疾病患者主观幸福感欠佳,提高老年慢性阻塞性肺疾病患者主观幸福感应考虑婚姻状况、月均收入、患慢性病情况、自我效能感及社会支持,并采取针对性干预措施,以提高患者主观幸福感。     

运动动机对参与运动疗法老年HFPEF患者运动自我效能的影响作用

目的分析参与运动疗法老年左心室射血分数保留的心力衰竭(HFPEF)患者运动动机与运动自我效能的相关性及运动自我效能相关影响因素。方法选取淮南市某三甲医院老年病科于2016年1月—2017年6月期间收治参与8周运动疗法的老年HFPEF患者98例作为调查对象,调查其基线资料、运动动机和运动自我效能,分析运动动机与运动自我效能的相关性及运动自我效能相关影响因素。结果 98例参与运动疗法老年HFPEF患者身体活动动机得分为121.02±10.57,运动自我效能得分为75.18±7.16,主观因素得分高于客观因素得分(80.63±7.26 vs 69.73±6.94,t=3.432,P0.01)。单因素比较显示,患者运动自我效能在性别、年龄、学历、居住地、配偶情况、子女情况和家庭人均收入方面和参与运动疗法时间的比较差异有统计学意义(P0.01)。参与运动疗法老年HFPEF患者能力动机、健康动机、社交动机均与主观因素及客观因素呈现显著正相关性(P0.05)。男性、年龄越低、学历越高、城市、有配偶、多子女、参与运动疗法时间越久及高健康动机、高能力动机及高社交动机的老年HFPEF患者的运动自我效能更高(P0.05)。结论运动疗法可能对老年HFPEF患者运动自我效能存在促进作用,参与运动疗法老年HFPEF患者能力动机、外貌动机和健康动机可以影响其运动自我效能。     

结核病患者自我效能感水平及其影响因素分析

目的了解结核病患者的一般自我效能感水平及其影响因素,为提高结核病患者一般自我效能感水平的对策制定提供依据。方法采用一般情况调查表和一般自我效能感量表对某省某三级甲等综合肺科医院结核病区住院的所有结核病患者进行面对面调查,分析结核病患者一般自我效能感水平及其影响因素。结果 402例结核病患者一般自我效能感平均得分为(20.4±4.2)分,其中14例(3.5%)表现出高水平的自我效能。自我效能感得分等级为偏低(10~)、中等(20~)、较高(30~)等级的患者分别为163例(40.5%)、225例(56.0%)、14例(3.5%)。对结核病患者自我效能感有较大影响的因素有患者的病程(P0.001)、居住地(P=0.012)、是否参加结核病教育讲座(P=0.034)、是否体育锻炼(P=0.053,逐步多元线性回归分析P=0.017)和职业状态(P=0.027),以及因结核病住院次数(P=0.002)、家庭经济状况(P=0.027)和文化程度(P=0.020)。结论结核病患者一般自我效能感水平偏低,医护人员对患者随访时应评估患者的一般自我效能感水平及其影响因素,根据患者的具体情况制定个体化的护理干预措施,以提高自我效能感水平。     

老年住院病人营养不良与慢性疾病的关系

[目的]调查住院老年病人营养不良与慢性疾病的关系。[方法]运用简易营养评价精法评估我院老年科住院老年人的营养不良的状况,选择同期住院营养正常的老年患者作对照,运用Logistic回归分析老年住院患者营养不良的慢性疾病性因素。[结果]共纳入148例患者,多因素分析显示总蛋白(P=0.000,OR=0.870)、厌食(P=0.018,OR=2.705)、吞咽困难(P=0.007,OR=3.743)及存在呼吸系统疾病(P=0.004,OR=3.159)均与住院老年患者营养不良相关。[结论]厌食、吞咽困难及呼吸疾病可能是老年人营养不良的独立危险因素,而较高的总蛋白水平可能有一定的保护作用,对这些因素的纠正/保护,可能预防老年人营养不良的发生。     

一般自我效能与患者用药依从性的相关性研究

[目的]调查患者用药依从性和自我效能现状,探讨两者之间的关系,为制定提高依从性健康干预策略提供科学依据。[方法]采用多阶段分层随机抽样方法,对杭州市784例患者进行自填式问卷调查。[结果]用药依从性量表得分为(1.66±1.37)分,依从性好的有106例(13.5%),依从性差的有678例(86.5%);自我效能量表得分为(25.21±5.77)分,自我效能高分组患者用药依从性得分高于自我效能低分组患者,差异具有统计学意义。多因素回归分析中,自我效能对患者用药依从性的影响最大,其次是年龄和文化程度。[结论]患者自我效能的高低影响用药依从性的好坏,在健康干预、健康教育中应该重视提高患者的自我效能。     

自我管理小组活动对糖尿病患者自我效能影响因素分析

目的评估糖尿病患者参加自我管理小组活动前后自我效能的改变情况,分析其影响因素,为完善自我管理小组活动效果提供相关依据。方法将参加中国糖尿病综合管理项目2014年社区糖尿病患者自我管理小组活动的所有糖尿病患者(1 509人)为研究对象,通过活动前后两次问卷调查了解患者的基本信息和自我效能得分情况,采用多重线性回归分析干预效果的影响因素。结果自我管理小组活动后,糖尿病患者自我效能总体得分(101.19±18.91)分高于活动前(85.88±20.99)分,差异有统计学意义(t=30.04,P0.01)。多因素分析结果显示,参加小组活动的次数(β=0.87)、有社区医生参加(β=5.69)及自觉所学知识和技能有用(β=7.16)与自我效能得分的提升呈正相关;自评活动内容较难理解(β=-3.84)与自我效能得分的提升呈负相关。结论自我管理小组活动可以提高糖尿病患者的自我效能,患者参加小组活动的次数、对活动内容的理解程度等是影响糖尿病患者自我效能提高的因素。     

舟山市老年高血压患者自我效能水平及影响因素研究

目的了解老年高血压患者自我效能水平及影响因素,探讨提高老年高血压患者自我效能水平的有效途径。方法于2016年采用分层随机抽样方法在舟山市抽取800例60周岁高血压患者,采用Morisky量表、高血压患者自我效能评价表进行问卷调查,采用Logistic回归模型分析自我效能水平的影响因素。结果实际调查738例老年高血压患者,自我效能平均得分为(34.13±5.17)分(满分44分);得分≤2分的人数占50%以上的项目为自我监测血压(86.99%)和坚持运动(50.95%)两项;健康行为维度的得分指标最高(90.04%),遵医行为维度的得分指标最低(63.93%)。Logistic回归分析结果显示,女性(OR=2.34,95%CI:1.55~3.53)、小学及以上文化程度(OR_(小学)=1.72,95%CI:1.09~2.69;OR_(初中)=2.25,95%CI:1.13~4.46;OR_(高中及以上)=2.46,95%CI:1.06~5.71)和服药依从性高(OR_(中等)=1.72,95%CI:1.09~2.69;OR_高=2.12,95%CI:1.38~3.26)的患者,其自我效能水平相对较高;不舒服时才测血压患者的自我效能水平相对较低(OR=0.22,95%CI:0.08~0.68)。结论舟山市老年高血压患者自我效能水平较高,服药依从性和血压测量频率是自我效能水平的重要影响因素。     

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.