374例血液科医院感染病例资料分析

目的探讨血液病患者医院感染特点及防治措施。方法采用前瞻性与回顾性相结合的方法对血液科374例医院感染病例监测资料进行分析。结果血液科2188例住院患者中发生医院感染374例、473例次,感染率为17.1%、例次感染率为21.6%;感染患者以恶性血液病者为主,占81.8%;感染部位中呼吸道占首位,为61.3%;病原菌中革兰阴性菌占41.0%、革兰阳性菌占19.3%、真菌占39.7%;中性粒细胞数与感染关系密切,感染时患者中性粒细胞计数≤2.0×109/L者占76.1%。结论血液病患者尤其是恶性血液病患者是医院感染的主要人群,中性粒细胞数低下是主要危险因素,呼吸道是重点监控部位,采取积极的全面综合性预防与针对性预防相结合的控制措施,对降低血液病患者医院感染发病率至关重要。     

急性白血病合并医院感染调查分析

目的 探讨急性白血病(AL)患者医院感染特点,分析引起医院感染的危险因素,为制定医院感染防治措施提供客观依据.方法 采用前瞻性与回顾性相结合的方法,对2008-2009年血液科612例AL患者监测资料进行统计分析.结果 血液科612例AL住院患者中发生医院感染207例、277例次,感染率为33.8％、例次感染率为45.3％;感染患者中以初治者、难治者及复发者为主,占64.3％;入院时住走廊及＞6例大房间者占66.7％;感染部位中呼吸道占首位,感染率为55.2％;病原菌中革兰阴性菌占35.2％、革兰阳性菌占25.9％、真菌占38.9％;感染时患者中性粒细胞计数≤2.0 × 109/L者占84.1％.结论 急性白血病患者中初治、难治及复发者是医院感染的主要人群;中性粒细胞数低下是主要危险因素;呼吸道是重点监控部位;控制加床数、缩短住院日、减少陪护与探视不可忽视,采取积极的全面综合性预防与针对性预防相结合的控制措施,对降低AL患者医院感染发病率、减轻经济负担、延长生存期有重要意义.     

119例多发性骨髓瘤医院感染的临床分析

目的　分析多发性骨髓瘤患者发生医院感染的情况。方法　对 119例多发性骨髓瘤患者发生的医院感染进行回顾性分析 ;将患者分为粒细胞缺乏组 (粒缺组 )和非粒细胞缺乏组 (非粒缺组 )。结果　 119例中 34例发生医院感染 ,感染率 2 8.5 7% ;医院感染率粒缺组 83.33% ,非粒缺组 2 2 .4 3% (P<0 .0 0 5 ) ,粒缺组死亡率 16 .6 7% ,非粒缺组 2 8.3% (P<0 .0 1) ;人均感染日粒缺组 10 .3d,非粒缺组 5 .75 d(P<0 .0 5 ) ;感染部位以下呼吸道为主 ;医院感染的病原菌以革兰阴性杆菌为主。结论　粒细胞缺乏是多发性骨髓瘤患者发生医院感染的主要危险因素 ,缩短白细胞减少的持续时间 ,有效的预防措施 ,早期、合理应用敏感的抗生素是减少医院感染的主要方法     

多发性骨髓瘤医院感染分析

目的 探讨多发性骨髓瘤(MM)患者医院感染的临床特点.方法 对1982年10月-2006年12月178例MM患者医院感染的临床资料进行回顾性分析.结果 85例患者发生医院感染,感染率为47.8%,感染部位以呼吸道为主;高龄、粒细胞缺乏、低蛋白血症、重度贫血及合并糖尿病是MM医院感染的易感因素;共检出91株病原菌,革兰阴性杆菌为主(45.1%),其次为真菌(37.4%)、革兰阳性球菌(17.6%);检出产ESBLs肺炎克雷伯菌、大肠埃希菌6株,耐万古霉素肠球菌4株;白色假丝酵母菌占真菌感染的首位.结论 MM患者医院感染率高,感染与多种因素有关,主要是自身免疫功能低下,应加强免疫保护及合理应用抗菌药物.     

多发性骨髓瘤患者化疗后医院感染病原菌分布及危险因素分析

目的 探讨多发性骨髓瘤(MM)患者化疗后医院感染病原菌种类及其危险因素,以降低感染率。方法 回顾性分析2010年3月-2013年3月80例多发性骨髓瘤患者临床资料,分析感染部位、感染病原菌种类以及化疗后感染影响因素。结果 80例患者中有21例化疗后发生感染,感染率为26.25%;其中感染部位主要是消化系统占42.85%,其次呼吸道、泌尿系统,分别占23.81%、19.05%;共分离出病原菌23株,其中革兰阳性菌5株占21.73%,革兰阴性菌16株占69.57%,革兰阳性菌中以金黄色葡萄球菌为主占13.03%,革兰阴性菌中以大肠埃希菌为主占26.09%;多因素分析显示,BMI高(β=3.085,OR=21.854)、Dukes分期高(β=3.189,OR=24.247)、合并有糖尿病(β=2.671,OR=25.221)是MM患者化疗后感染的影响因素。结论 多发性骨髓瘤患者化疗后容易导致各种病原菌感染,临床上需要加强患者的风险评估,对于合并有糖尿病、临床症状严重以及肥胖的患者应采取有效的预防和控制感染手段。     

2005-2010年急性白血病医院感染临床分析

目的分析急性白血病医院感染情况,探讨降低医院感染发病率的预防措施。方法回顾性调查分析2005年6月-2010年6月血液科就诊的急性白血病患者并发医院感染的临床特点,并对感染部位、病原菌以及易感因素进行分析。结果急性白血病医院感染的感染率为51.0%,例次感染率为65.1%;检出病原菌以革兰阴性杆菌为主,占45.1%;感染部位以呼吸道最多,占44.3%。结论医院感染与患者的年龄、外周血粒细胞计数、化疗以及住院时间有关。     

急性白血病患者医院感染病原菌分布及影响因素分析

目的研究急性白血病患者医院感染的临床特点、病原菌分布和影响因素。方法选取2013年12月-2017年2月医院收治的急性白血病患者274例作为研究对象,收集患者临床资料,分析感染患者的临床特点和病原菌分布,探究发生医院感染的影响因素。结果 274例急性白血病患者发生医院感染79例,感染率为28.83%,患者感染部位主要为呼吸道占44.30%,其次为消化道占11.39%;共检出82株病原菌,革兰阴性菌53株占64.63%,革兰阳性菌21株占25.61%,真菌8株占9.76%;单因素和多因素Logistic回归分析结果显示,住院天数、社区感染、应用免疫调节剂、进行化疗、中性粒细胞计数水平为患者发生医院感染的影响因素。结论急性白血病患者医院感染主要为呼吸道感染和消化道感染,感染主要病原菌为革兰阴性菌,患者发生医院感染的影响因素较多,临床工作中需采取针对性的干预措施进行防范,降低感染率。     

1350例医院感染病例的调查分析

目的 了解医院感染分布特点和病原菌类型,为预防和控制医院感染提供科学依据.方法 采用前瞻性监测为主,结合临床医师报告的方法,对2009年1-12月24 257例住院患者进行调查.结果 24 257例住院患者中,1111例发生医院感染,感染率为4.58％,感染1350例次,例次感染率为5.57％;感染部位居前2位的依次为呼吸道、泌尿道,分别占76.89％、5.48％;检出的病原菌以革兰阴性菌为主,占56.70％,革兰阳性球菌占11.46％,真菌占31.84％.结论 针对医院感染现状,在医院感染率高的部分科室开展目标性监测,严格执行医院感染标准操作规程,严格规范抗菌药物的使用,加强医院感染病原菌的监测.     

恶性肿瘤化疗患者医院感染的临床分析

目的 探讨恶性肿瘤患者化疗后医院感染特点及预防感染的措施,为其降低医院感染率提供指导依据.方法 回顾性分析786例恶性肿瘤患者化疗后发生医院感染患者的临床资料.结果 101例恶性肿瘤化疗患者并发医院感染,感染率为12.85％,感染部位以呼吸道感染为主,占55.45％;引起感染的病原菌以革兰阴性菌为主,占54.84％.结论 恶性肿瘤化疗后骨髓抑制,机体免疫力下降,易导致医院感染,应及时以粒细胞集落刺激因子升白细胞治疗和加强营养、支持治疗,提高机体免疫功能;并加强医院感染的管理,控制易感因素,规范抗菌药物的使用,减少医院感染和耐药菌的发生.     

急性白血病医院感染危险因素及防治对策

目的探讨急性白血病发生医院感染的危险因素以及采取的相对应防治对策,以期为其预防与控制医院感染提供可靠依据。方法采用回顾性与前瞻性研究方法对2007年6月-2013年6月医院治疗的108例初发急性白血病患者临床资料进行分析,分析其发生医院感染情况及危险因素。结果 108例急性白血病患者发生医院感染92例、94例次,医院感染率85.19%、例次感染率87.04%;感染部位以上呼吸道、下呼吸道、血液为主,分别占41.49%、19.15%、11.70%;共分离出病原菌94株,其中革兰阴性菌54株占57.45%,革兰阳性菌28株占29.79%,真菌12株占12.76%;年龄、住院时间、化疗持续时间、白细胞计数、粒细胞计数和抗菌药物预防性应用等因素是导致急性白血病患者发生医院感染的主要危险因素(P<0.05)。结论急性白血病患者医院感染率高,临床上应当针对患者年龄、住院时间、化疗持续时间、白细胞计数、粒细胞计数和抗菌药物预防性应用等相关危险因素采取积极的防治对策,减少医院感染的发生,以提高患者治疗水平,延长患者生存期。     

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.     

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.