产妇产褥期感染影响因素分析

目的分析影响产妇产褥期感染的可能因素,探讨临床预防控制对策,以期降低产褥期感染率。方法回顾性分析2017年2月-2020年1月在该院分娩且符合纳入条件的2 138例产妇的临床资料,按照其是否出现产褥期感染将其分为感染组(92例)和非感染组(2 046例)。参照相关文献资料及临床经验制定可能影响因素调查方案,分组统计调查因素并行组间比较,组间差异有统计学意义的指标可能与产褥期感染相关,并将其进行多因素Logistic回归分析,总结可能影响产褥期感染的危险因素。针对可能影响因素分析降低产褥期感染率的临床预防控制对策。结果 2 138例产妇产褥期感染92例,感染率为4.30%;感染部位以呼吸系统、生殖系统及手术切口为主。可能影响产妇产褥期感染的相关因素有:文化背景、居住地、多胎妊娠、围生期阴道侵入性检查、妊娠期慢性合并症、既往流产史、产前贫血、产前出血、合并生殖道炎症、胎膜早破、剖宫产、会阴侧切、产程时间8 h、助产、胎盘残留、产后出血、软产道损伤、卧床时间(P0.05);经多因素Logistic分析显示,可能影响产褥期感染的危险因素有:围生期阴道侵入性检查次数≥3次、妊娠期慢性合并症、贫血、助产、产程时间≥8 h、剖宫产、卧床时间≥7 d为产妇产褥期感染的可能危险因素。结论产妇产褥期感染可能影响因素较多,加强产妇健康宣教、合理制定围生期保健检查,尽可能降低感染风险因素,降低产褥期感染率,提高产妇产后健康水平率。     

胎膜早破产妇产褥期感染危险因素分析及氧化应激指标的预测价值

目的探讨胎膜早破产妇分娩后产褥期感染的危险因素及氧化应激指标、炎症因子早期预测价值。方法选择2018年1月-12月漯河医学高等专科学校第一附属医院及第三附属医院胎膜早破产妇58例的临床资料,分析胎膜早破后产褥期感染的危险因素,分析白细胞介素(IL)-6、IL-8、总抗氧化能力(TAC)、髓过氧化物酶(MPO),丙二醛(MDA)对产褥期感染预测价值。结果 58例患者18例发生感染,感染率31.03%。破膜时间长、阴道产者产程长、剖宫产、合并妊娠期高血压、合并妊娠期糖尿病、产后出血、合并生殖道感染者产褥期感染率较高(P<0.05)。多因素Logistic回归分析结果显示破膜时间、合并生殖道感染、合并妊娠期高血压、合并妊娠期糖尿病、产后出血是胎膜早破产褥期感染的独立危险因素(P<0.05)。感染组IL-6、IL-8、MPO、MDA水平高于未感染组,TAC水平低于未感染组,差异有统计学意义(P<0.05)。IL-6对胎膜早破产妇产褥期感染的预测价值,曲线下面积(AUC)为0.925,敏感度89.90%,特异度85.00%;TAC预测价值,AUC为0.943,敏感度94.44%,特异度82.50%;MPO预测价值,AUC为0.885,敏感度83.33%,特异度85.50%。结论破膜时间、合并生殖道感染、合并妊娠期高血压、合并妊娠期糖尿病、产后出血是胎膜早破后产褥期感染的独立危险因素。IL-6、TAC、MPO水平对预测产褥感染具有一定的临床价值。     

产妇产褥期感染病原学特点及危险因素分析

目的探讨产妇产褥期感染的病原学分布及感染的危险因素分析。方法选取2015年6月-2016年10月医院收治的产妇483例作为研究对象,调查产褥期感染的情况,对感染产妇进行分析,收集样本进行病原学检测,运用单因素及多因素logistic线性回归分析方法探讨发生感染的危险因素。结果 483例产妇共发生产褥期感染17例,感染率为3.52%,其中8例发生在会阴切口占47.06%;17例产妇共检出59株病原菌,其中革兰阴性菌24株占40.68%,革兰阳性菌30株占50.85%;单因素分析结果表明:产程(活跃期)延长(>8h)、破膜时间长(>12h)、剖宫产、医源性操作不当、产前产后出血、胎膜早破、合并慢性病、贫血的产妇出现感染的概率明显高于其他产妇,差异有统计学意义(P<0.05),logistic多因素结果显示:产程(活跃期)延长(>8h)、胎膜早破、医源性操作不当、产前产后出血是产妇产褥期感染的独立危险因素。结论产妇产褥期易受到多种病原菌感染,针对产褥期感染的病原菌使用相应的抗菌药物至关重要,但更为重要的是根据产褥期感染的危险因素采取针对性地预防措施,减少产褥期感染的发生率。     

产妇产褥期感染的相关影响因素与临床预防控制

目的了解产妇产褥期感染的相关影响因素,并分析其临床护理和预防控制策略,为降低产妇产褥期感染提供依据。方法选取2011年1月-2015年1月产科产褥期感染产妇72例,为观察组,选择同期未发生产褥期感染产妇160例,为对照组;统计感染产妇产褥期感染部位分布,对比两组产妇的临床资料进行产褥期感染相关危险因素的分析;采用SPSS11.0软件进行统计分析。结果 72例产褥期感染产妇主要感染部位为呼吸系统、生殖道、手术切口、泌尿系统及消化系统,分别占29.17%、26.39%、25.00%、13.89%、5.55%;剖宫产、经产妇、合并妊娠高血压、糖尿病、合并生殖道炎症、产后出血和胎膜早破与产妇产褥期感染具有相关性(P<0.05);观察组平均血红蛋白低于对照组,差异有统计学意义(P<0.05);观察组平均破膜时间、产程及卧床时间均高于对照组,差异有统计学意义(P<0.05)。结论产妇产褥期感染的影响因素多,临床应加强产褥期的预防控制及护理,以降低患者感染发生。     

产妇产褥期感染病原菌特点及影响因素分析

目的分析产妇产褥期感染的病原菌分布特点及影响因素。方法回顾性分析2014年2月-2016年3月于医院妇产科分娩的3 000例产妇的临床资料,其中发生产褥期感染产妇80例,分析感染部位的病原菌分布特点,统计分析产妇的临床资料,分析产妇产褥期感染发生的相关影响因素。结果 3 000例产妇中有80例发生产褥期感染,感染发生率为2.67%,产妇产褥期感染部位分布以呼吸系统23例占28.75%为主;80例产褥期感染产妇共检出90株病原菌,其中革兰阳性菌54株占60.00%、革兰阴性菌34株占37.78%、真菌2株占2.22%;多元Logistic回归分析结果显示,妊娠合并症、生殖道炎症、助产、产前贫血、产后出血、低血红蛋白水平、产程时间延长、营养不良、软肠道损伤、卧床时间均为导致产妇产褥期感染的影响因素。结论积极控制产妇产褥期发生感染的影响因素,并予以积极的产前、产后卫生宣教,强化产褥期护理,可降低产褥期感染发生率。     

剖宫产产妇产褥期感染发生情况及影响因素研究

目的 研究与分析剖宫产产妇产褥期感染发生情况及影响因素。 方法 选取2016年10月－2017年10月期间金华市中心医院的615例剖宫产产妇为研究对象,将其产褥期感染发生情况进行统计,并比较感染与未感染者的年龄、孕周、剖宫产时机、产后出血情况、妊娠期合并疾病情况、产前生殖道感染情况、胎膜早破情况、瘢痕子宫情况、产前血红蛋白及白蛋白水平者的产褥期感染发生率,同时以多因素logistic回归分析影响产褥期感染的因素。 结果 615例剖宫产产妇共发生27例产褥期感染,发生率为4.39%,感染与未感染者的年龄及孕周比较,差异无统计学意义(均P＞0.05)。感染与未感染者的剖宫产时机、产后出血情况、妊娠期合并疾病情况、产前生殖道感染情况、胎膜早破情况、瘢痕子宫情况、产前血红蛋白及白蛋白水平比较,差异有统计学意义(均P＜0.05)。多因素logistic回归分析显示,剖宫产时机(OR=1.697)、产后出血情况(OR=1.658)、妊娠期合并疾病情况(OR=1.674)、产前生殖道感染情况(OR=1.824)、胎膜早破情况(OR=1.645)、瘢痕子宫情况(OR=1.578)、产前血红蛋白(OR=1.587)及白蛋白(OR=1.709)水平均是产褥期感染的影响因素。 结论 金华市中心医院剖宫产产妇产褥期感染发生率并不低,且围术期影响因素较多,应根据影响因素进行针对性的干预。     

产褥感染的相关因素分析及预防措施

目的分析研究产褥感染的相关影响因素及预防措施,以达到有效控制产褥感染及促进康复的目的。方法选取2008年5月-2013年4月于医院生产的16 001例产妇为研究对象,统计产褥感染率,分析感染情况,将其中不同生产方式及是否伴有妊娠期并发症、胎膜早破、产前贫血、产后出血及孕期阴道炎产妇的感染率进行比较,所有数据采用SAS8.0软件进行统计分析。结果 16 001例产妇共发生产褥感染62例,感染率为0.39%,其中局部感染33例占53.23%,高于其他部位感染发生率,差异有统计学意义(P<0.05);剖宫产、有妊娠期并发症、胎膜早破、产前贫血、产后出血、孕期有阴道炎者的感染率为0.96%、3.91%、4.88%、1.56%、9.80%、4.67%,差异有统计学意义(P<0.05),其与发生产褥感染具有相关性。结论剖宫产、妊娠期并发症、胎膜早破、产前贫血、产后出血、孕期阴道炎是产褥感染的相关影响因素,可针对上述因素制定预防性措施。     

人工破膜对生殖道B族链球菌感染母婴风险评价

目的探讨人工破膜在生殖道B族链球菌(GBS)感染产妇中的应用及对母婴风险的影响。方法选择320例生殖道GBS感染产妇随机分为对照组与研究组。对照组自然破膜,研究组人工破膜,比较两组产妇产程、剖宫产率、新生儿Apgar评分及产妇围生期并发症发生情况。结果观察组产妇第一产程、第二产程、第三产程及总产程时间均短于对照组,差异有统计学意义(P<0.05)。研究组剖宫产率为4.38%,对照组产妇剖宫产率为11.25%,研究组剖宫产率低于对照组,差异有统计学意义(P<0.05)。研究组新生儿产后1 min Apgar评分高于对照组(P<0.05),产后5 min Apgar评分与对照组比较,差异无统计学意义(P>0.05)。研究组新生儿窒息、新生儿黄疸、新生儿肺炎及新生儿GBS感染发生率与对照组比较,差异无统计学意义(P>0.05)。研究组产妇胎盘绒毛膜羊膜炎、产褥期感染、产后出血发生率与对照组比较,差异无统计学意义(P>0.05)。结论人工破膜能够促进生殖道GBS感染产妇产程进展,降低剖宫产率,对母婴安全无明显影响。     

高危产妇剖宫产术后产褥期感染的危险因素及预测模型构建

目的 探讨高危产妇剖宫产术后产褥期感染的危险因素，构建风险预测模型并进行内部验证。方法 选择2019年2月-2021年3月三亚市妇幼保健院收治的252例行剖宫产高危产妇为研究对象，分析剖宫产术后产褥期感染危险因素及病原菌分布，并构建产褥期感染预测模型。结果 252例产妇依据病原菌培养结果及临床体征诊断存在产褥期感染25例，感染率为9.92%,分离病原菌25株，其中革兰阴性菌15株(60.00%),革兰阳性菌8株(32.00%),真菌2株(8.00%)。多因素分析结果显示，产前白蛋白<35 g/L、胎膜早破、第二产程剖宫产、瘢痕子宫、产后出血是产褥期感染的独立危险因素(P<0.05)。依据危险因素构建高危产妇剖宫产术后产褥期感染的风险预测模型，利用受试者工作特征(ROC)曲线对模型进行内部验证，结果显示，模型预测感染的曲线下面积为0.738(95%CI:0.682～0.789),提示模型诊断能力良好。结论 多种因素与高危产妇剖宫产产褥期感染相关，构建预测模型可定量评估产褥期感染风险，为临床个体化预防措施的制定提供参考。     

剖宫产术后产褥感染病原菌及其影响因素研究

目的 探讨剖宫产术后产褥感染的病原菌情况及其影响因素,为剖宫产术后产褥感染临床实践提供参考借鉴。方法 对2018年1月1目至2020年12月31日期间在上海市某医院行剖宫产的单胎分娩产妇进行跟踪随访,包括体温测量、阴道分泌物和宫腔分泌物采集进行培养及鉴定,并进行白细胞检测,对产褥期是否发生感染进行描述性分析,并对感染组和非感染组相关指标进行比较,采用多因素Logistic回归分析方法对产褥期感染影响因素进行分析。结果 共纳入分析1 679名剖宫产手术产妇,产褥感染发生率为4.87%。检出的116株病原菌中,大肠埃希菌和铜绿假单胞菌分别为31株（26.72 %）和20株（17.24%）。多因素Logistic回归分析结果显示,产前生殖道感染（OR=2.775）、妊娠期合并疾病（OR=3.224）、第二产程剖宫产（OR=2.212）、产后出血（OR=2.443）、胎膜早破（OR=4.201）和瘢痕子宫（OR=1.958）是导致剖宫产术后产褥感染发生的危险因素。结论 剖宫产术后产褥感染情况应引起临床重视,大肠埃希菌和铜绿假单胞菌是导致剖宫产产妇术后出现产褥感染的主要病原菌。产前生殖道感染、妊娠期合并疾病、第二产程剖宫产、产后出血、胎膜早破和瘢痕子宫是导致剖宫产术后产褥感染的危险因素,临床上应针对病原菌和危险因素给予针对性治疗和干预。     

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.     

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.     

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.     

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.