人工流产与输卵管性不孕的危险

目的:探索人工流产与输卵管性不孕的关系.方法:1:2病例对照研究.病例组为双侧输卵管阻塞的不孕妇女;两对照组:不孕对照为双侧输卵管通畅不孕妇女,妊娠对照为同期妊娠妇女.使用统一问卷进行面对面调查,收集资料包括人口学特征、妇产科史、手术史和避孕史等.采用多因素逐步Logistic回归技术进行数据分析.结果:与两对照组相比,均未发现人工流产与输卵管性不孕的联系(与不孕对照比较:OR=1.01,95%CI=0.56-1.80;与妊娠对照比较:OR=1.06,95%CI=0.62-1.81).急性盆腔炎史、下腹外科手术史、痛经史和妊娠史增加了输卵管性不孕的危险性.结论:针对目前输卵管性不孕病例增加的疑虑,不应忽视长期生殖道感染的影响,尤其是无症状性感染,而不是仅考虑人工流产.     

输卵管性不孕的高危因素分析

目的:探讨输卵管性不孕(TFI)的病因,并为其预防和临床治疗提供参考依据。方法:采用病例-对照研究方法,病例组为在弋矶山医院确诊为输卵管性不孕妇女,对照组为在妇产科人流妇女。两者均填写统一调查表,并检测衣原体(CT)、支原体(UU)。资料采用非条件Logistic回归分析。结果;病例组衣原体、支原体感染(25.7%、18.8%)明显高于对照组(6.7%、2.5%)。危险因素为:初次性生活年龄20岁(OR:3.373)、性伴侣数1人(OR:3.056)、人流史(OR:1.057)、输卵管妊娠史(OR:6.579)、宫颈炎(OR:2.890)、盆腔炎史(OR:6.488)、结核史(OR:4.986)、阑尾炎史(OR:4.915)。结论:UU、CT感染,初次性生活年龄过小、性伴侣多、输卵管妊娠史、宫颈炎、盆腔炎史、结核史、阑尾炎史是输卵管性不孕的危险因素。人流史与TFI无显著相关。     

输卵管梗阻性不孕症患者行输卵管介入再通术后妊娠情况及影响因素

目的：探究输卵管梗阻性不孕症患者行输卵管介入再通术后妊娠情况的影响因素。方法：收集2020年6月-2022年2月本院164例行输卵管介入再通术的输卵管梗阻性不孕症患者临床资料,统计术后1年自然妊娠率。采用多因素logistic回归分析确定行输卵管介入再通术后自然妊娠的影响因素。结果：术后排除失访病例,纳入研究的155例患者术后1年自然妊娠74例,占比47.7%。多因素logistic回归分析显示,年龄≥35岁(OR=2.41,95%CI 1.20～4.85)、不孕类型为原发性不孕(OR=2.79,95%CI 1.38～5.62)、不孕年限>5年(OR=2.19,95%CI 1.17～4.08)、输卵管梗阻部位为远端(OR=3.10,95%CI 1.36～7.06)、有盆腔手术史(OR=3.87,95%CI 1.83～8.19)、术中盆腔造影剂弥散不均匀(OR=2.75,95%CI 1.30～5.79)均为术后未自然妊娠独立危险因素(P<0.05)。结论：输卵管梗阻性不孕症患者行输卵管介入再通术后自然妊娠影响因素多样,继发性不孕、不孕年限短、输卵管近端梗阻、无盆腔手术史的年轻...     

不同流产方式及次数对继发性不孕影响的探究

目的探究不同流产方式及次数对继发性不孕的影响,为继发性不孕的临床治疗和预防策略提供一定的依据。方法采用以医院为基础的病例对照研究方法,利用医院数据库收集信息,采用t检验、χ2检验、Logistic回归分析处理数据。结果人工流产(OR=2.95,95%CI[2.41,3.60])和药物流产(OR=9.25,95%CI[5.27,16.23])是继发性不孕的可能危险因素;人工流产不同组别(1~2次组:OR=2.85,95%CI[2.30,3.53];3~5次组:OR=3.07,95%CI[1.88,5.02];5以及5以上组:OR=10.72,95%CI[1.24,92.57])、1~2次药物流产病例组与照组有统计学差异(OR=9.15,95%CI[5.13,16.34]),且人工流产随着次数的增加继发性不孕的危险度加大(χ2=111.80,P0.05)。结论应加强卫生宣教,减少非自然流产的发生,降低流产术前和术后的感染风险。     

体外受精—胚胎移植术后宫内外同时妊娠的影响因素分析

目的探讨体外受精—胚胎移植(IVF-ET)后宫内外同时妊娠(HP)的发病危险因素,为尽早确诊及治疗HP,为提高宫内持续妊娠率提供理论依据。方法收集2010年1月—2020年12月于医院行体外受精—胚胎移植(IVF-ET)助孕患者的临床资料,追踪其妊娠结局。依据妊娠结局,选取助孕后发生HP患者45例为病例组,选取同期行IVF-ET治疗后正常宫内妊娠者98例为对照组。采用单因素分析比较两组患者的一般情况(年龄、体质量指数、不孕年限、宫腔操作史、异位妊娠(EP)史、输卵管手术史、盆腔炎性疾病史、不孕类型、子宫输卵管造影结果、不孕原因)、治疗周期中相关参数指标,如肌注HCG日子宫内膜厚度、肌注HCG日E2水平、肌注HCG日Gn水平、卵巢过度刺激综合征(OHSS)、移植第12天HCG水平,探讨其中有统计学意义的相关影响因素,并进行多因素分析。结果单因素分析显示,病例组异位妊娠史、宫腔操作史、输卵管手术史、不孕原因及OHSS的比例高于对照组,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,异位妊娠史(OR=10.793,95%CI:3.105-37.513)、宫腔操作史(OR=1.355,95%CI:1.205-3.973)及OHSS(OR=4.42),95%CI:1.930-10.167),是HP发生的独立影响因素。结论行IVE-ET助孕患者,术前合并异位妊娠史、宫腔操作史或助孕过程中发生OHSS,增加IVF-ET术后HP发生风险,建议术后加强监测,尽早确诊及时治疗,避免腹腔大出血等严重并发症,提高宫内持续妊娠率。     

3种方式治疗输卵管性不孕的临床效果及影响因素分析

目的:探讨不同治疗方法对输卵管性不孕的疗效影响。方法:2006年1月～2008年12月,在3家医疗机构选择输卵管性不孕患者310例,分别接受输卵管通液、宫腔镜输卵管插管疏通、宫腹腔镜联合输卵管疏通手术3种治疗方式,随访1年,记录其妊娠情况。统计分析采用χ2检验和多项logistic模型。结果:共283例得到1年后随访。输卵管通液治疗方式对任何部位阻塞的输卵管疏通效果差,妊娠率较低;近端阻塞患者采用宫腔镜输卵管插管疏通[OR=3.370,95%CI(1.456,7.798)]与宫腹腔镜联合输卵管疏通[OR=3.095,95%CI(1.112,8.614)]疗法宫内妊娠率相当;而远端阻塞患者采用宫腹腔镜联合输卵管疏通[OR=5.962,95%CI(1.497,23.749)]易宫内妊娠。沙眼衣原体阳性、解脲支原体阳性、阻塞程度是影响输卵管性不孕治疗效果的因素。结论:输卵管通液治疗输卵管性不孕效果较差,宫腔镜输卵管插管疏通操作相对简单安全且妊娠率高,宫腹腔镜联合输卵管疏通方式治疗合并有盆腔粘连不孕症的效果更好,且不增加发生异位妊娠的风险。     

女性生殖道沙眼衣原体感染与输卵管性不孕的临床分析

目的:探讨女性生殖道沙眼衣原体感染与输卵管性不孕的关系。方法:从86例输卵管性不孕妇女(观察组)的宫颈及输卵管内取样,用聚合酶链反应(PCR)检测沙眼衣原体,并从50例正常妊娠妇女(对照组)的宫颈及输卵管提取样本作为对照。结果:宫颈沙眼衣原体感染率在两组间无明显差异,但观察组输卵管沙跟衣原体感染率为20.93％,明显高于对照组(4.00％),两组比较有显著性差异(P<0.05),输卵管不同病变间的沙眼衣原体阳性率无明显差异。结论:输卵管性不孕妇女的输卵管沙眼衣原体感染率高,生殖道沙眼衣原体感染是输卵管性不孕的重要因素。     

未足月胎膜早破的危险因素及其对妊娠结局的影响

目的探讨未足月胎膜早破(PPROM)的相关危险因素及其对母婴妊娠并发症和结局的影响。方法选取118例PPROM产妇作为病例组,随机选取118例未发生胎膜早破的产妇为对照组,应用病例对照的研究方法,采用单因素χ²检验、Logistic回归法分别筛选PPROM的相关危险因素,并采用χ²检验比较妊娠并发症和妊娠结局发生率。结果影响PPROM的危险因素包括人工流产史(OR=2.883)、双胎妊娠(OR=3.939)、生殖道感染(OR=5.073)、胎位异常(OR=2.555)及腹压增加(OR=4.293)等。病例组的剖宫产率、产后出血率、产褥感染率、胎儿窘迫率、新生儿窒息率及新生儿感染率均高于对照组,差异有统计学意义(P<0.05)。结论影响PPROM发生的独立危险因素包括人工流产史、双胎妊娠、生殖道感染及胎位异常及腹压增加等,PPROM会增加母婴妊娠并发症发生率,影响母婴妊娠结局。     

孕期危险因素与儿童孤独症关系的Meta分析

目的:探讨孕期危险因素与儿童孤独症的关系,为孤独症的早期预防提供科学依据。方法:利用Meta分析RevMan5.1软件,对国内2000～2011年关于儿童孤独症危险因素的病例对照研究资料进行定量综合分析。通过异质性检验后计算合并的优势比(OR)及其95%置信区间,再评估发表偏倚和敏感性。结果:纳入文献12篇,累计病例1 292例,对照组1 301例。孕期各危险因素的合并比值比及其95%CI分别为:先兆流产,OR=3.75,95%CI:2.40～5.88;孕期病毒性感冒,OR=3.77,95CI:2.64～5.38;孕期服药史,OR=3.70,95%CI:2.73～5.00;孕期精神压抑,OR=2.76,95%CI:1.59～4.79;妊娠剧吐,OR=3.08,95%CI:1.08～8.80;遗传史,OR=4.73,95%CI:2.31～9.66。结论:孤独症的发生可能与先兆流产、孕期病毒性感冒、孕期服药史、孕期精神压抑、妊娠剧吐、遗传史有关。     

26万女性队列人群中乳腺癌与人工流产关系的研究(上海)

目的:评估人工流产(指手术流产)对乳腺癌危险性的可能影响.方法:研究在上海267 040例妇女的一项乳房自我检查随机试验的队列人群中进行,由队列研究和巢式病例对照研究两部分组成.结果:依据基线调查表采集的资料分析,人工流产不增加乳腺癌危险性.调整潜在的混淆因素后,OR=1.06(95%CI:0.91～1.25).人工流产次数增加无危险性趋势增加.从更详细的652例乳腺癌病例和694例对照资料分析,得出相似的结果.人工流产发生在首次生育后不增加危险性;少数妇女在首次生育前人工流产以及妊娠13周后人工流产,虽然被观察到危险性有增加,但无显著性统计学意义.结论:在中国,人工流产不是乳腺癌发生的重要原因.     

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.     

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.     

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.     

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.