老年耐多药肺结核患者肺部感染的病原菌分布及感染危险因素分析

目的 分析老年耐多药肺结核病患者肺部感染病原菌分布及感染危险因素,指导控制预防老年耐多药肺结核病发生肺部感染的临床治疗,降低感染率。方法 选取2009-2013年老年耐多药肺结核患者合并肺部感染230例,分离培养病原菌并进行药敏试验,研究老年耐多药肺结核病患者合并肺部感染的危险因素,采用SPSS13.0进行统计处理。结果 共发生肺部感染的患者72例,感染率为31.30%,共分离得77株病原菌,其中革兰阳性菌29株占37.66%,革兰阴性菌40株占51.95%,真菌8株占10.39%;合并肺部感染的危险因素主要包括:患者年龄大、住院时间长、肺结核病程长、合并有其他疾病、进行侵入性操作以及为预防性应用抗菌药物。结论 老年耐多药肺结核患者肺部感染的发生率高,临床应采取措施控制老年耐多药肺结核患者肺部感染的发生。     

急性脑卒中患者肺部感染的病原菌特点及危险因素分析

目的调查急性脑卒中患者并发肺部感染的临床特点,分析其危险因素。方法回顾性分析2012年3月-2016年3月189例急性脑卒中患者肺部感染率及病原菌分布,并对感染相关危险因素进行分析。结果 189例急性脑卒中患者发生肺部感染53例,感染率为28.0%;肺部感染患者中共分离出病原菌61株,其中有两种细菌同时感染者4例占7.5%,三种细菌同时感染者3例占5.7%,病原菌分布以革兰阴性菌为主占57.4%,革兰阳性菌占31.1%,真菌占11.5%;住院时间长、卧床时间长、NIHSS评分高、有侵入性操作和吞咽困难等与患者发生肺部感染相关,差异有统计学意义(P<0.05);logistic回归模型分析显示,住院时间、卧床时间、侵入性操作、合并低蛋白血症和合并COPD是急性脑卒中患者并发肺部感染的独立危险因素(P<0.05)。结论住院时间、卧床时间、侵入性操作、合并低蛋白血症和合并COPD是急性脑卒中患者并发肺部感染的独立危险因素,临床应采取针对有效的措施,控制感染的发生发展。     

急性脑卒中患者医院感染的临床特点分析

目的探讨急性脑卒中患者医院感染的临床特点及相关危险因素,为临床控制医院感染提供依据。方法选取医院2014年6月-2015年6月收治的急性脑卒中患者340例进行研究,筛选出发生医院感染的患者,统计医院感染发生率,分析感染部位,病原菌分布及相关影响因素。结果 340例急性脑卒中患者发生医院感染58例,感染率为17.06%;其中肺部感染31例占9.12%,尿路感染13例占3.82%,消化道感染9例占2.65%,其他部位感染5例占1.47%;共分离出69株病原菌,其中革兰阴性菌47株占68.12%,革兰阳性菌7株占10.14%,真菌15株占21.74%,年龄、意识障碍、球麻痹、侵入性操作、机械通气、糖尿病、肌力3级以下、预防性应用抗菌药物及住院时间长是急性脑卒中患者发生医院感染的影响因素;多因素Logistic回归分析显示,意识障碍、机械通气、肌力3级以下、预防性应用抗菌药物及住院时间长是其发生医院感染的独立危险因素。结论急性脑卒中患者的医院感染发生率高,应加强脑血管病的一级和二级预防,减少卒中风险,积极治疗原发病,控制相关危险因素,从而减少医院感染的发生。     

老年脑卒中患者肺部感染的临床分析

目的探讨老年脑卒中患者肺部感染的临床特征及危险因素,为临床治疗提供依据。方法调查2013年1月-2014年2月344例老年脑卒中住院患者临床资料,感染病原菌采用法国生物梅里埃公司自动细菌鉴定仪进行检测,并分析影响感染的相关因素,数据采用SPSS 13.0统计软件进行处理。结果 344例老年脑卒中住院患者中发生肺部感染79例,感染率为22.97%;共分离出104株病原菌,革兰阴性菌64株占61.54%,革兰阳性菌40株占38.46%,其中以肺炎克雷伯菌、金黄色葡萄球菌居多,分别占37.50%、25.96%;患有呼吸系统疾病及糖尿病、年龄≥60岁、住院时间>4周、多种抗菌药物联合使用、侵入性诊疗、低蛋白血症等均是脑卒中患者发生肺部感染的危险因素。结论肺部感染在老年脑卒中住院患者中发生率较高,病原菌分布复杂且影响危险因素多,临床控制危险因素的同时选择针对性抗菌药物控制感染。     

脑梗死患者肺部感染危险因素与病原菌分析

目的探讨脑梗死长期卧床患者肺部感染危险因素及病原菌分布特点,为降低患者肺部感染提供参考。方法回顾性分析2011年9月-2014年9月医院收治的300例脑梗死患者临床资料,统计肺部感染发生率、病原菌分布;采用logistic回归方程计算导致肺部感染的独立危险因素。结果 300例脑梗死卧床患者中73例发生肺部感染,感染率24.3%;分离出病原菌59株,其中革兰阴性菌43株占72.8%、革兰阳性菌11株占18.7%、真菌5株占8.5%;年龄≥65岁、存在意识障碍、行气管插管、合并糖尿病、使用呼吸机、卧床时间长、有留置鼻饲管的患者肺部感染发生率显著上升(P<0.05);多因素分析显示,年龄、气管插管、意识障碍、使用呼吸机、卧床时间、留置鼻饲管是导致脑梗死长期卧床患者肺部感染的独立危险因素。结论年龄、气管插管、意识障碍、使用呼吸机、卧床时间、留置鼻饲管是脑梗死长期卧床患者肺部感染的独立危险因素,临床上需要针对感染的危险因素制定针对性的预防措施,并根据病原菌的特点选择敏感性高的抗菌药物,以改善患者预后。     

中耳炎患者医院感染危险因素与病原菌分析

目的探讨中耳炎患者医院感染危险因素及病原菌分布,为减少中耳炎患者医院感染提供理论依据。方法选取医院2010年1月-2014年12月收治的600例中耳炎患者,其中30例出现医院感染,对中耳炎感染患者医院感染的危险因素及病原菌分布进行统计;采用SPSS17.0软件进行统计分析。结果 600例中耳炎患者,其中30例发生医院感染,感染率为5.00%;共分离出病原菌30株,其中革兰阴性菌17株占56.67%,以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌11株占36.67%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主,真菌2株占6.66%,以白色假丝酵母菌为主;单因素分析结果显示,住院时间、病程、损伤性操作、咽喉疾病、不规范使用抗菌药物与中耳炎患者发生医院感染具有相关性(P<0.05);进一步行多因素logistic分析,结果显示,住院时间、病程、损伤性操作、咽喉疾病、不规范使用抗菌药物是中耳炎患者医院感染的危险因素。结论中耳炎患者医院感染的危险因素较多,根据危险因素进行有针对性的干预,根据病原菌分析选择合适的抗菌药物的进行治疗,可有效减少中耳炎患者医院感染的发生。     

2型糖尿病患者尿路感染的临床分析

目的探讨2型糖尿病患者尿路感染的临床特点、病原菌分布及其影响因素,为采取针对性的预防举措提供依据。方法回顾性分析2010年2月-2013年9月医院收治的2型糖尿病患者419例,调查患者住院期间发生尿路感染率,对发生尿路感染的患者尿标本进行病原菌培养和鉴定,观察感染患者的相关因素。结果 419例2型糖尿病患者发生尿路感染83例,感染率为19.81%,女性以及≥60岁患者较多,分别有55例和67例,占66.27%和80.72%;女性、高龄、糖尿病病程长、住院时间长、有留置导尿管、高糖化血红蛋白是2型糖尿发生尿路感染的危险因素;83例2型糖尿病合并尿路感染患者尿培养共检出病原菌89株,其中革兰阴性菌53株,占59.55%,革兰阳性菌24株,占26.97%,共检出12株真菌,占13.48%。结论 2型糖尿病合并尿路感染以女性和老年患者居多,以革兰阴性菌感染为主,影响2型糖尿病合并尿路感染的危险因素众多,临床应采取针对性措施积极预防感染。     

重型颅脑损伤并发颅内感染患者肺部感染的影响因素及病原学特点

目的分析重型颅脑损伤并发颅内感染患者肺部感染的影响因素,并制定相关护理对策,为临床提供指导。方法选择2015年5月-2017年10月医院收治的144例重型颅脑损伤并发颅内感染患者为研究对象,其中发生肺部感染患者21例作为研究组,未发生肺部感染患者123例作为对照组。回顾性分析两组患者性别、年龄、损伤类型、合并症等临床资料,单因素及多因素Logistic回归分析患者发生肺部感染的影响因素,采集感染患者临床标本,应用全自动微生物分析仪进行病原菌鉴定和药敏试验。结果年龄>50岁、有吸烟史、开放性损伤、多发损伤、合并症>2个、昏迷>2d、气管切开、住院治疗时间>20d是重型颅脑损伤并发颅内感染患者发生肺部感染的影响因素;21例感染患者共检出23株病原菌,其中,革兰阳性菌6株占26.09%,以金黄色葡萄球菌为主,革兰阴性菌15株占65.22%,以铜绿假单胞菌、鲍氏不动杆菌为主,真菌2株占8.7%;主要革兰阳性菌未检出对万古霉素耐药菌株;主要革兰阴性菌对哌拉西林/舒巴坦、美罗培南、阿米卡星、左氧氟沙星的耐药株数较少。结论重型颅脑损伤并发颅内感染患者肺部感染风险较高,革兰阴性菌是肺部感染主要病原菌,需根据病原菌具体分布及药敏情况采用合理抗菌药物以及相关护理干预措施,以增强治疗效果,避免感染加重,促进康复进程。     

颅脑损伤患者肺部感染的病原菌分布与耐药性分析

目的分析颅脑损伤患者肺部感染的病原菌分布及耐药性,为临床合理选用抗菌药物提供参考。方法选择医院2010年4月-2013年12月收治的1 084例颅脑损伤患者,调查分析其中132例发生肺部感染患者的临床资料,统计其感染病原菌分布及耐药性,数据采用SPSS13.0软件进行统计分析。结果 1 084例颅脑损伤患者,发生肺部感染132例,感染率为12.2%;共分离出病原菌164株,革兰阴性菌95株占57.9%、革兰阳性菌53株占32.3%、真菌16株占9.8%;革兰阴性菌对亚胺培南和美罗培南耐药率最低为0~3.0%,革兰阳性菌对替考拉宁、万古霉素和克林霉素耐药率最低,分别为0~15.4%,真菌对氟康唑和伏立康唑的耐药率均为0。结论颅脑损伤患者肺部感染的病原菌多为革兰阴性菌,其对大多数抗菌药物耐药,应加强临床病原菌的监测,为临床合理用药、及时控制感染具有重要意义。     

肿瘤化疗患者感染病原菌分布及危险因素分析

目的研究肿瘤化疗患者感染病原菌分布及其对抗菌药物的耐药率,探讨发生医院感染的危险因素,分析肿瘤化疗后预防感染对策,控制肿瘤化疗后患者的感染。方法选择2011-2013年肿瘤化疗患者768例,利用BACTECTM9000全自动培养系统分离培养病原菌,采用K-B琼脂法进行药敏试验,研究肿瘤化疗患者医院感染的危险因素,数据采用SPSS 13.0统计软件进行分析,计数资料采用χ2检验。结果 768例肿瘤化疗患者中发生医院感染86例,感染率为11.20%;感染患者病原菌检出革兰阳性菌36株占39.13%,革兰阴性菌56株占60.87%;年龄大、住院时间长、进行手术、合并有其他疾病、进行侵入性操作以及未预防性应用抗菌药物等是肿瘤化疗患者医院感染的危险因素。结论肿瘤化疗患者医院感染率高,医护人员应采取措施控制化疗患者医院感染的发生。     

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.     

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.