120例二胎孕妇妊娠晚期压力调查及其影响因素和预防措施分析

目的调查120例妊娠晚期孕妇焦虑和压力及应对方式情况,并分析相关影响因素,提出合理的预防措施。方法采用焦虑自评量表和妊娠压力量表及简易应对方式问卷等对120例妊娠晚期孕妇进行调查,分析焦虑相关影响因素及焦虑与妊娠晚期压力、应对方式的相关性。结果 120例妊娠晚期孕妇中,发生焦虑者10例(8. 33%),焦虑得分为(39. 38±7. 22)分。120例妊娠晚期孕妇中,完全无压力者11例(9. 17%),轻度压力者99例(82. 5%),中度压力者10例(8. 33%)。二胎妊娠晚期孕妇积极应对方式得分明显高于常模,消极应对得分明显低于常模,差异均有统计学意义(均P0. 05)。社会支持总分为(45. 19±5. 69)分,其中客观支持为(10. 02±2. 68)分,主观支持(26. 95±3. 57)分。单因素分析结果显示,职业、家庭住房条件、与公婆间关系、产后是否有人照护、胎儿性别期望、睡眠状况、妊娠并发症、孕期是否服用药物是二胎妊娠晚期孕妇焦虑的影响因素(均P0. 05);焦虑得分与妊娠晚期压力、消极应对方式呈正相关关系,与积极应对方式、社会支持呈负相关关系(均P0. 05)。多因素分析结果显示,妊娠并发症、消极应对方式、主观支持、因子2、客观支持、睡眠状况、孕期是否服用药物是影响二胎妊娠晚期孕妇焦虑的独立危险因素(均P0. 05)。结论二胎妊娠晚期孕妇压力处于轻度状况,焦虑状况不显著。临床可加强对二胎妊娠晚期孕妇的社会支持,以减轻其压力,缓解焦虑状况,此外要积极改善孕妇睡眠状况,积极控制妊娠期并发症的发生。     

述情障碍与孕妇不良心理行为的相关性研究

目的 探讨不同情绪表达能力孕妇孕期焦虑症状、抑郁症状、自杀相关心理行为、自伤行为以及酗酒等不良心理行为,为孕期不同情绪表达能力孕妇有针对的心理行为干预提供依据.方法 使用多伦多述情障碍量表、流调中心用抑郁量表、焦虑自评量表、简易应对方式量表、生活事件问卷和自杀、自伤、酗酒等问卷,对1 789名孕妇进行调查.结果 不同文化程度孕妇描述情感能力、认识和区别情绪和躯体感受能力、外向型思维3个因子以及述情障碍总分差异均具有显著统计学意义(均P<0.05),均表现为随着文化程度的增高得分呈下降的趋势.述情障碍各因子得分及总分与消极应对方式、焦虑症状、抑郁症状得分呈显著正相关,而与积极应对得分呈显著负相关(均P<0.05).除外向性思维因子外,述情障碍其他3个因子均与孕妇轻度不良心理行为(自杀意念、自伤行为、酗酒行为)有关,而与严重的心理行为(自杀计划、自杀行为)关系不明显.结论 述情障碍与孕期轻度不良心理行为有关,孕期应加强对述情障碍孕妇不良心理行为的关注.     

161例孕妇情绪状态及心理保健需求分析

目的了解女性怀孕期间情绪状态及心理保健需求,以调整制定团体心理咨询的内容和方案。方法用自编问卷、焦虑自评量表(SAS)、抑郁自评量表(SDS)对161名孕妇进行调查。结果孕期焦虑、抑郁的发生率分别为15.53%、24.22%;孕妇对孕期及产后情绪对孩子影响认知的分值为(2.90±0.40);孕妇对孕期心理保健内容的需求是多样化的,需求最高的为交流妊娠相关问题及解决方法。结论针对孕妇需求,安排心理保健内容,采用团体心理咨询模式进行孕妇情绪管理。     

围产期焦虑/抑郁与分娩疼痛相关性的研究现状

围产期焦虑/抑郁是过度应激状态的不同表现形式,包括孕期焦虑/抑郁和产后焦虑/抑郁,它是指从妊娠开始至产后12个月这段时期女性对身体内外部压力事件的心身应激反应。若持续焦虑可能发展为过度焦虑,过度焦虑衰竭后,则可能发展为围产期焦虑/抑郁。围产期焦虑/抑郁的全球发病率为10%～21%,可增加女性产科疾病发生率,加重分娩疼痛,增加孕产妇自伤和自杀率等,还可能导致子代和家庭不良结局,造成严重社会负担,因此被临床日益重视。围产期焦虑/抑郁与多种因素相关,越来越多研究开始关注分娩疼痛(LP)与围产期焦虑/抑郁的关系。孕期焦虑/抑郁可能加重LP,也可能延续至产后,成为产后焦虑/抑郁,但是LP是否与产后焦虑/抑郁发生直接相关,则迄今尚存在争议。笔者拟从孕期焦虑/抑郁与LP的相关性、LP与产后焦虑/抑郁的相关性、孕期焦虑/抑郁与产后焦虑/抑郁的相关性这3方面入手,对围产期焦虑/抑郁与LP的最新研究现状进行阐述,旨在为相关临床研究提供参考。     

剖宫产瘢痕妊娠患者焦虑、抑郁现状与应对方式的相关性研究

目的探讨剖宫产瘢痕妊娠(CSP)患者焦虑、抑郁与其应对方式的相关性。方法选取2019年1月至2020年5月于南昌大学第一附属医院妇产科首次接受治疗的112例CSP患者作为研究对象,按照便利抽样法,采用医院焦虑抑郁量表(HADS)、医学应对方式问卷(MCMQ)对112例患者进行问卷调查。结果112例CSP患者焦虑发生率为44.6%,其中轻度焦虑与明显焦虑占比略高于国内常模;抑郁发生率为20.5%,略低于国内常模。应对方式中的屈服维度与焦虑分值呈正相关(r=0.382,P<0.001),而回避、面对维度与焦虑分值呈负相关(r=-0.263,P=0.003;r=-0.202,P=0.023)。屈服维度与抑郁分值呈正相关(r=0.219,P=0.014),而回避维度与抑郁分值呈负相关(r=-0.203,P=0.022)。结论CSP患者焦虑与抑郁状况呈中等水平,焦虑和抑郁易引起患者消极应对,护理人员应重视患者的心理护理,帮助其缓解焦虑与抑郁情绪。     

孕期抑郁情绪对妊娠并发症和围生结局的影响分析

目的 探究抑郁情绪对孕妇妊娠并发症、围生结局及产后抑郁的影响,以期为临床决策提供参考。方法 选取2021年1—12月在天津市北辰区15家社区卫生服务中心建档且分娩的孕妇1 050人作为研究对象。采用抑郁自评量表(PHQ-9)、爱丁堡产后抑郁自评量表(EPDS)于孕期及产后评估研究对象的抑郁情况。并根据PHQ-9的评估结果,将研究对象分为抑郁组和无抑郁组,观察并比较2组孕妇妊娠并发症、产后抑郁发生情况及围生结局。结果 2组研究对象妊娠并发症发生情况比较:抑郁组研究对象高血压、糖尿病发生率均高于无抑郁组,且差异均有统计学意义(P<0.05)。2组研究对象围生结局比较:抑郁组研究对象早产、低体质量儿、流产的发生率及剖宫产率均高于无抑郁组,顺产率则低于无抑郁组,差异均有统计学意义(P<0.05)。此外,抑郁组研究对象的产后抑郁发生率高于无抑郁组,差异亦有统计学意义(P<0.05)。结论 孕期抑郁情绪可影响孕妇妊娠并发症、产后抑郁的发生及围生结局。医疗机构应建立孕妇抑郁情绪筛查系统,对于孕妇的抑郁情绪应及时发现并及早干预,从而促进自然分娩,提高母婴心身健康水平。     

孕期心理干预对预防产后抑郁症的效果评价

目的探讨孕期心理干预对预防产后抑郁症的可行性。方法将600例孕妇随机分为2组并随访至产后2周。心理干预组分别对孕早期、孕中期和孕晚期进行3个阶段的心理干预,对照组只进行常规产前检查。孕期采用抑郁自评量表、焦虑自评量表调查,产后2周采用艾迪产后抑郁量表（EPDS）并增加本次有关妊娠、分娩前后的生活事件等内容进行调查。结果心理干预组孕妇临产前焦虑和抑郁情绪总粗分值分别为32.13±3.26和34.26±3.78,明显低于对照组,其产后抑郁症发生率为3.7%,亦明显低于对照组,有统计学差异（P〈0.01）;潜在心理背景分析表明：心理干预组的孕产妇在妊娠心境、产后育儿、与社会家人关系等得到明显改善（P〈0.01）,而对来自分娩周围环境、分娩疼痛等压力无明显改善,与非心理干预组比较无统计学差异（P〉0.05）。结论孕期心理干预可明显改善孕产妇的心理状况和降低产后抑郁症的发生率。     

孕妇焦虑和抑郁情绪对妊娠结局的影响

目的了解孕妇焦虑、抑郁现状,探讨孕妇焦虑、抑郁不良情绪与妊娠结局的关系。方法采用前瞻性队列研究方法,以2013年1—6月期间在海口市妇幼保健院进行孕期健康保健并有明确意向在该院分娩的孕妇作为研究对象,采用焦虑—状态特质量表(STAI)、流行病学调查用抑郁自评量表(CES-D)对研究对象的焦虑、抑郁和社会支持现状进行问卷调查,并追踪随访其妊娠结局,采用Spearman相关系数描述孕妇焦虑、抑郁与孕妇妊娠结局的相关关系,采用单因素χ2检验及多因素logistic回归模型分析影响孕妇不良妊娠结局发生的危险因素。结果322名孕妇中,存在焦虑情绪18人(5.6%),其中状态焦虑者13人(4.0%),特质焦虑者5人(1.6%);有95名(29.5%)孕妇存在抑郁情绪,有89名(27.6%)孕妇表现为有抑郁倾向。孕妇状态焦虑、特质焦虑与低出生体重之间存在正相关关系(P0.05)。孕妇不良妊娠结局影响因素的单因素分析结果显示,年龄、流产史、孕期感染史、孕期用药史、有状态焦虑、特质焦虑、抑郁情绪与孕妇不良妊娠结局的发生有关(P0.05);多因素logistic回归分析显示,影响孕妇发生不良妊娠结局的主要危险因素有高龄、孕期感染史、孕期用药史、孕期特质焦虑情绪、孕期抑郁情绪。结论孕妇孕期焦虑、抑郁等不良情绪普遍存,且与不良妊娠结局存在一定相关性,孕期特质焦虑情绪和抑郁情绪是发生不良妊娠结局的重要危险因素。     

二胎产妇分娩体验与抑郁情绪的相关性研究

目的了解二胎产妇的分娩体验、抑郁情绪并探讨两者的相关性。方法采用便利抽样法选取2016年8月-2017年3月在合肥两所三甲医院的产科病房分娩的204例二胎产妇为调查对象。于产后3 d内采用分娩体验问卷(CEQ2. 0)评估产妇的分娩体验,爱丁堡抑郁量表(EPDS)评估产后抑郁情绪。结果二胎产妇分娩体验的总分为(76. 58±7. 85)分,其中自身能力维度得分为(22. 13±3. 18)分,参与性维度得分为(16. 12±2. 44)分,专业支持维度得分为(21. 28±2. 56)分,安全感知维度得分为(17. 04±3. 35)分。二胎产妇产后抑郁情绪的发生率为38. 7%,EPDS得分为(8. 55±4. 18)分。二胎产妇分娩体验与抑郁情绪呈负相关(r=-0. 311,P0. 05),其中抑郁情绪与自身能力呈负相关(r=-0. 178,P0. 05),抑郁情绪与专业支持呈负相关(r=-0. 206,P0. 05),抑郁情绪与安全感知呈负相关(r=-0. 351,P0. 05)。结论高水平的分娩体验能够降低二胎产妇产后抑郁的风险,临床中医护人员应该给予专业、情感等支持以提高二胎产妇积极的分娩体验,预防二胎产妇产后抑郁情绪及产后抑郁的发生。     

孕妇情绪影响因素探讨

随机抽取１９９７年１～１１月决定在本院分娩的部分孕妇,采用医院焦虑及抑郁自评量表（ＨＡＤ）进行孕期情绪测定,其中以艾氏产后抑郁量表（ＥＰＤＳ）跟踪调查至产后７天内８６６例。结果：ＨＡＤ问卷中Ａ值总分、Ｄ值总分≥１１分的分别为５．１３％及４．３７％,随着Ａ值、Ｄ值分值的增高,ＥＰＤＳ阳性率也随之升高。并对孕期焦虑、抑郁的相关因素进行单因素和多元逐步回归分析,发现孕妇焦虑情绪与本人健康状况、孕妇企盼生     

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.