全程陪护对产后出血及剖宫产率的影响研究

目的：探讨助产士全程陪护对降低产妇分娩出血率和提高顺产率的效果。方法选择2012年7月至2013年7月期间收治的480例产妇为研究对象,并将其随机分为两组。对照组280例给予常规陪护;研究组200例给予助产士全程陪护,实施一对一人性化陪护。比较两组产妇的分娩方式、产程、分娩出血量及满意度。结果研究组的平均分娩时间为（7．31±0．98） h,明显少于对照组的（10．86±2．23）h（t＝16．513,P＜0．05）;研究组的剖宫产率为3．00％,明显低于对照组的16．79％（χ2＝22．573,P＜0．05）。研究组产妇的SAS评分为（46．39±2．65）分,明显少于对照组的（57．36±6．71）分（t＝13．402,P＜0．05）;研究组的产后出血率为3．50％,明显低于对照组的8．93％（χ2＝5．526,P＜0．05）;但两组新生儿Apgar评分比较无显著性差异（ P＞0．05）。研究组产妇的回访满意度为94．00％,明显高于对照组的76．43％,两组比较有显著性差异（χ2＝26．468,P＜0．05）。结论助产士全程陪护能够有效的缩短分娩时间,提高产妇的分娩质量,稳定产妇的情绪,降低产妇分娩出血率,值得临床推广。     

苦参碱联合顺铂对 SiHa细胞 TSLC1基因表达的影响

目的：探讨苦参碱联合顺铂抑制人宫颈癌SiHa细胞及对肺癌肿瘤抑制因子1（TSLC1）基因表达的效果。方法取对数生长期的SiHa分为对照组、苦参组、顺铂组和联合组,采用四甲基偶氮唑蓝比色法（ MTT）测定4组联合干预SiHa细胞2d后的抑制率;采用实时荧光定量（ RT－PCR）技术检测各组处理后TSLC1基因mRNA表达水平的变化。结果对照组、顺铂组、苦参碱组和联合组的SiHa细胞抑制率分别为0、61．24％、70．31％和74．20％,药物干预组均高于对照组（ t 值分别为14．21、17．44、11．20,均P＜0．05）,同时联合组高于苦参碱和顺铂单独干预（t值分别为4．47、3．21,均P＜0．05）,而顺铂和苦参碱组间差异无统计学意义（t＝0．71,P＞0．05）。对照组、苦参碱组、顺铂组和联合组干预SiHa细胞后TSLC1mRNA表达量分别为1．00±0．00μg／mL,23．53±0．01μg／mL,84．33±0．03μg／mL和90．23±0．01μg／mL,苦参碱组、顺铂组和联合组干预组明显高于对照组（ z值分别为9．41、10．72、13．23,均P＜0．05）,其中苦参碱组和联合组TSLC1mRNA表达量组间比较差异无统计学意义（z＝1．24,P＞0．05）,但均高于顺铂组（z值分别为6．04、5．47,均P＜0．05）;析因设计方差分析结果表明顺铂和苦参碱均为SiHa细胞抑制率和TSLC1基因表达的影响因素,而且两者存在交互作用,联合应用使效果增加。结论苦参碱联合顺铂能抑制人宫颈癌SiHa细胞增殖,提高TSLC1mRNA表达量。     

治疗绝经后骨质疏松症的临床分析

目的探讨阿法骨化醇联合阿仑膦酸钠治疗绝经后骨质疏松症的临床疗效。方法选取2010年2月至2012年2月间于万宁市妇幼保健院接受诊断和治疗的绝经后骨质疏松症患者84例,随机分为观察组与对照组,每组42例。对照组给予常规补钙治疗,观察组给予阿法骨化醇联合阿仑膦酸钠治疗。治疗周期6个月,比较两组患者骨密度值及临床疗效情况。结果观察组患者治疗后的骨密度值为（0．94±0．11）g/cm2,明显高于治疗前的（0．82±0．08）g/cm2和对照组的骨密度值（0．84±0．08）g/cm2（t值分别为9．131、8．441,均P＜0．05）。观察组治疗的显效率为66．67％,明显高于对照组的28．58％（χ2＝9．784,P＜0．05）;无效率为9．52％,明显低于对照组的35．71％（χ2＝8．561,P＜0．05）。结论阿法骨化醇联合阿仑膦酸钠治疗绝经后骨质疏松症临床疗效显著,值得推广应用。     

舟山群岛新区妊娠期糖尿病的临床特点和防治

目的：回顾性分析舟山群岛新区妊娠期糖尿病（ GDM）的临床特点和防治体会。方法搜集2013年1月至2014年12月舟山群岛新区GDM患者300例为研究对象，按照不同干预措施分为对照组（ n＝150）与观察组（ n＝150）。对照组给予常规的内科治疗，观察组在此基础上给予饮食干预及健康教育，随访两组患者的干预情况。结果观察组对GDM基础知识认知率、常见并发症知晓率和正常血糖值认知率均分别高于对照组，经比较差异均具有统计学意义（χ2值分别为57．960、75．505、100．259，均P＜0．05）。观察组饮食干预认知率、合理饮食率均分别高于对照组，经比较差异均具有统计学意义（χ2值分别为20．184、7．441，均P＜0．05）；观察组糖化血红蛋白水平为（4．9±1．3）％，低于对照组的（7．8±1．6）％，经比较差异具有统计学意义（t＝17．228，P＜0．05）。结论 GDM患者经营养门诊做出相应干预后，能有效提高对自身疾病的认识，树立健康新观念，促进对相关健康行为的执行。     

血管性介入治疗56例剖宫产瘢痕妊娠疗效分析

目的：观察剖宫产瘢痕处妊娠采用血管性介入治疗效果。方法研究对象共56例,根据病情分为研究组和对照组,研究组采用血管性介入治疗,对照组采用保守治疗,比较两组治疗效果及不良反应。结果研究组和对照组患者治疗后和各项指标均明显下降（P＜0．05）,且治疗后研究组血人绒毛膜促性腺激素（hCG）水平和孕囊平均直径较对照组下降更为明显（t值分别为28．83、8．37,均P＜0．05）,而子宫动脉阻力指数和搏动指数均较对照组显著升高（t值分别为8．99、8．00,均P＜0．05）。研究组下肢或臀部疼痛发生率显著低于对照组（χ^2＝4．51,P＜0．05）。结论血管性介入性治疗剖宫产瘢痕妊娠疗效确切、安全有效,值得在有条件医院临床推广。     

联合干预措施对促进自然分娩作用的研究

目的：通过导乐陪产联合干预措施为产妇提供心理和生理上的专业知识,使其树立自信,以利于缩短产程,降低剖宫产率,促进和支持自然分娩。方法按随机选择模式将2012年1至3月在洛阳市妇女儿童医疗保健中心住院分娩的产妇分为2组,对照组350例沿用常规产时服务模式,观察组328例实施导乐陪产、播放潜脑音乐、自控硬膜外镇痛等联合干预措施,观察2组的分娩方式、产后24小时出血及新生儿Apgar评分情况。结果观察组阴道分娩264例（80．5％）,剖宫产64例（19．5％）;对照组阴道分娩194例（55．4％）,剖宫产156例（44．6％）,两组比较差异有统计学意义（χ2＝48．51,P＜0．05）。对照组产后24小时出血1例（0．3％）,观察组产后24小时无出血病例,两者比较差异无统计学意义（P＝1．00＞0．05）。两组新生儿Apgar评分比较差异无统计学意义（χ2＝0．99,P＞0．05）。结论导乐陪产的顺产分娩率高,联合干预措施对促进自然分娩,提升服务质量有积极作用。     

抗生素联合硫酸镁治疗先兆早产的疗效研究

目的：探讨抗生素联合硫酸镁治疗先兆早产的疗效。方法选择妊娠28～33＋6周先兆早产孕妇117例，随机分成两组：研究组60例，连续使用抗生素以及硫酸镁治疗3天；对照组57例，硫酸镁治疗3天，未使用抗生素。检测治疗前、治疗3天后孕妇宫颈阴道分泌物中的胎儿纤维连接蛋白（ fFN）和血清中的C－反应蛋白（ CRP），并比较两组孕妇延长孕周成功率及CRP值的差异。结果①研究组延长孕周成功率为81．67％（49／60），对照组延长孕周成功率为52．63％（30／57），两组差异有统计学意义（χ2＝11．23，P＜0．05）；②研究组治疗前55例（91．67％）孕妇CRP值异常，治疗后9例（15．00％）异常；对照组治疗前52例（91．22％）孕妇CRP值异常，治疗后26例（45．61％）异常，研究组效果显著高于对照组（χ2＝7．02，P＜0．05）。结论抗生素联合硫酸镁治疗先兆早产疗效显著，可降低早产率，值得在临床上预防性使用。     

两种不同镇痛方式用于剖宫产术后镇痛的比较

目的：比较硬膜外自控镇痛和静脉自控镇痛两种术后镇痛方式用于剖宫产术后镇痛的疗效及对母乳喂养的影响,旨在选择一种适宜于产妇的术后镇痛方式。方法选择择期行剖宫产手术的患者100例,随机分为A、B两组,A组为硬膜外自控镇痛组（n＝50）,B组为静脉自控镇痛组（n＝50）。观察两组患者术后疼痛视觉模拟评分（VAS）、运动神经阻滞评分（Bromage评分）、不良反应（恶心呕吐、皮肤瘙痒、尿潴留）的发生情况、24h内哺乳次数、人工喂养添加率。结果 A组VAS评分在4h、6h、12h、24h时点明显低于B组（t值分别为4．17、2．80、4．21、18．24,均P＜0．01）。两组Bromage评分在2h、4h、6h、12h、24h、48h各时点均无明显差异（t值分别为0．00、0．51、1．25、0．28、0．39、0．56,均P＞0．05）。 B组恶心呕吐发生率高于A组（χ^2＝5．10,P＜0．05）,两组皮肤瘙痒和尿潴留发生率无明显差异（χ^2值分别为0．61、0．84,均P＞0．05）。 A组48h内母乳喂养次数明显多于B组（t＝3．04,P＜0．01）,人工喂养添加率低于B组（χ^2＝4．40,P＜0．05）。结论硬膜外自控镇痛为更适合于剖宫产的术后镇痛方式。     

早期综合康复干预对早产儿脑性瘫痪发生率及智能的影响

目的：观察早期综合康复干预治疗对降低早产儿脑性瘫痪发生率及智能影响的效果。方法选择2012年6月至2013年12月在彩虹集团公司彩虹医院儿保康复科就诊的158例无合并症的早产儿为研究对象,按照就诊编号和家长自愿的原则,73例早产儿从纠正胎龄40周开始进行早期医疗康复干预结合家庭干预（综合干预组）,85例早产儿只行常规的家庭干预（常规干预组）,两组患儿均在3、6、9、12个月用发育量表检查发育商,1岁时进行脑瘫诊断和排除诊断。结果从9月龄后,综合干预组儿童各能区得分均高于常规干预组儿童,且综合干预组儿童6月龄时的社交能力（ t＝2．53,P＜0．05）;9月龄时的社交能力（t＝2．50,P＜0．05）和语言能力（t＝2．04,P＜0．05）;12月龄时的大运动（t＝4．00,P＜0．05）、精细运动（t＝2．40,P＜0．05）、适应能力（t＝2．34,P＜0．05）和社会行为（t＝2．12,P＜0．05）得分都明显高于常规干预组。综合干预组儿童脑性瘫痪的检出率为4．1％（3/73）,明显低于常规干预组的12．9％（11/85）,χ2＝6．10,P＜0．05。结论早期综合康复干预对早产儿脑性瘫痪有显著的预防作用,对婴儿期智能发展具有明显的促进作用。     

子宫下段横形环状压迫缝合术治疗剖宫产子宫下段出血的临床分析

目的：探讨子宫下段横形环状压迫缝合术（ TACS）在治疗子宫下段剖宫产手术中子宫下段出血的疗效。方法回顾性分析2012年12月至2015年4月我院60例剖宫产术中出现子宫下段收缩不良出血、子宫下段胎盘剥离面渗血难以止血的患者。随机分为两组,研究组30例,采用子宫下段横形环状压迫缝合术止血;对照组为30例,在剖宫产术中采用欣母沛子宫下段注射方法止血,部分患者结合传统“8”字间断缝合联合止血。比较两组方法在手术时间、出血量、切除子宫率、节约社会资源等方面的优缺点。结果两组产妇的年龄、分娩孕周、分娩前血红蛋白以及新生儿出生体重比较均无显著性差异（ t值分别为0．759、0．000、0．679、0．156,均P＞0．05）。研究组手术时间、产后24小时出血量均显著低于对照组（ t值分别为－11．697、－4．057,均P＜0．05）,研究组术中输血率显著低于对照组（χ2＝9．017,P＜0．05）,两组子宫切除发生率无显著性差异（χ2＝2．069,P＞0．05）。结论子宫下段横形环状压迫缝合术在治疗子宫下段剖宫产手术中子宫下段出血简单、快速、有效、经济,值得推广应用。     

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.