沈阳市4 028例幼儿园儿童声导抗听力检测结果分析

目的 通过对学龄前儿童进行声导抗听力筛查,了解儿童中耳炎及中耳功能异常的发生率,探讨有效开展听力保健的方法。方法 运用声阻抗技术,对沈阳市幼儿园4 028名儿童进行听力检查。结果 声阻抗鼓室异常图形检出率(B型为4.11%、C型为15.46%)共为19.57%。不同性别之间差异有统计学意义(P<0.05)。2~4岁年龄组较5~6岁组中耳异常发病率高。男童比女童更易患中耳疾病。 结论 利用声导抗对学龄前儿童进行听力及中耳功能筛查是早期发现中耳炎及中耳功能异常的有效方法,是开展听力保健的重要措施。     

腺样体切除联合置管术在小儿难治性分泌性中耳炎治疗中的应用研究

目的 探讨腺样体切除联合置管术应用于小儿难治性分泌性中耳炎的治疗效果.方法 选取上海交通大学医学院附属上海儿童医学中心2012年4月至2014年2月间入院治疗的小儿难治性分泌性中耳炎患者90例,应用随机数表法随机分为观察组45人和对照组45人.对照组使用低温等离子腺样体切除术;观察组则应用腺样体切除联合置管术治疗.统计两组患者治疗效果、炎性积液及并发症情况,按显效、有效和无效来评价患儿临床疗效,记录并统计参与试验患儿中耳炎性积液时间和听力损失、鼓膜穿孔等并发症情况.结果 临床疗效方面,观察组和对照组的治疗总有效率分别为91.11%和73.33%,两组差异具有统计学意义(χ2=8.631,P<0.05).观察组患儿中耳积液时间为7.63±1.27天短于对照组的11.78±1.75天,差异具有统计学意义(t=3.481,P<0.05).观察组治疗后中耳炎复发的比例(2.22%)比对照组(42.22%)低,差异具有统计学意义(χ2=9.165,P<0.05).两组并发症发生率分别为8.88%和40.00%,患儿鼓膜穿孔、化脓性中耳炎和听力损失等方面较对照组发生数明显更少,差异具有统计学意义(χ2=8.186,P<0.05).结论 腺样体切除联合置管术能够有效治疗小儿难治性分泌性中耳炎,改善临床症状,提高治疗有效率,应用效果良好,值得临床推广.     

声导抗测试在噪声性听力损失诊断中的应用

目的探讨噪声性听力损失的声导抗特征,为噪声性听力损失的诊断提供客观依据。方法选取70例(140耳)不同程度听力损失的噪声作业工人为观察对象(噪声组),20例(40耳)非接触噪声的听力正常人为对照组,分别对双耳进行声导抗测试,将所得数据用SPSS 13.0软件进行统计处理。结果噪声组与对照组的镫骨肌声反射引出率各频率间比较,差异均有显著性(P<0.05),尤以4 000 Hz最为明显(P<0.001);不同程度听力损失的镫骨肌声反射引出率比较,听力损失V级者500~2 000 Hz引出率与其他各组比较差异均有显著性(P<0.05),而4 000 Hz引出率组间比较差异无显著性(P>0.05)。结论噪声性听力损失的镫骨肌声反射引出率明显下降;听力损失越严重,镫骨肌声反射的引出率越低,临床可以将镫骨肌声反射作为噪声性听力损失诊断的一项重要指标。     

鼻腔冲洗治疗婴幼儿分泌性中耳炎疗效分析

目的探讨鼻腔冲洗对婴幼儿分泌性中耳炎的临床疗效。方法选择2013年2月至2014年2月期间我院门诊确诊分泌性中耳炎患儿128例180耳为研究对象,将其随机分为对照组和观察组两组各64例患儿(各90耳),对照组采取常规治疗,观察组给予高渗盐水200 m L(清诺,内含3%高渗盐水)喷鼻腔,3次/日,连续4周,同时辅以桉柠蒎及鼻炎合剂口服;治疗4周后,分别检查鼓膜情况并行声导抗、纯音听力检测及纤维鼻咽镜检查,分析比较两组患儿的临床疗效。结果 4周后,每组各有9例患儿未能坚持治疗失去随访。观察组患儿中总有效率为93.59%,对照组总有效率为73.08%,观察组总有效率高于对照组,差异具有统计学意义(P<0.05)。结论鼻腔冲洗能改善鼻咽部局部环境,促进咽鼓管功能恢复,可有效治疗婴幼儿分泌性中耳炎。     

鼻内镜下中耳置管术治疗儿童分泌性中耳炎的护理

目的探讨鼻内镜下中耳置管术治疗儿童分泌性中耳炎的临床护理及其对患儿术后恢复的影响。方法选取2013年10月至2014年10月期间我院收治的分泌性中耳炎患儿共46例,随机分为实验组和对照组,每组23例。实验组在常规护理基础上进行特殊护理,对照组仅采取常规护理。比较两组的治疗效果及护理满意度。结果实验组患儿经治疗与护理后总有效率为95.7%,对照组为65.2%,实验组护理效果明显优于对照组,两组比较差异具有统计学意义(P<0.05);实验组护理满意度为87.0%,对照组为56.5%,两组比较差异具有统计学意义(P<0.05)。结论对鼻内镜下中耳置管术患儿实行有针对性、合理有效的术后护理,有助于提高治疗效果,对于患儿的术后恢复具有重要意义。     

330例儿童复发性分泌性中耳炎的临床特征及影响因素分析

目的探讨330例儿童复发性分泌性中耳炎的临床特征及影响因素。方法回顾性收集2014年10月-2017年4月在该院行鼓膜切开置管手术的分泌性中耳炎患儿1 020例(1487耳)的临床资料,患儿术后取出通气管后随访1年,根据治疗效果分为治愈组和复发组,统计整理所有患儿临床资料,包括性别、年龄、有无吸烟环境、通气管保留时间、有无慢性鼻-鼻窦炎、有无乳突气化不良、有无腺样体肥大/鼻咽部淋巴组织增生、有无鼻腔结构异常、既往有无置管病史、有无反复呼吸道感染及病程等。分析导致分泌性中耳炎复发的影响因素,并分析儿童复发性分泌性中耳炎临床特征。结果共收集1 020例(1 487耳)在该院行鼓膜切开置管手术的分泌性中耳炎患儿临床资料,术后复发330例(473耳),复发率为32. 35%;治愈690例(1 014耳),治愈率为67. 65%。单因素分析结果显示,治愈组患儿在性别、有无吸烟环境、有无鼻腔结构异常、既往有无置管病史及病程等方面与复发组患儿比较,差异无统计学意义(P>0. 05);治愈组患儿在年龄、通气管保留时间、有无慢性鼻-鼻窦炎、有无乳突气化不良、有无腺样体肥大/鼻咽部淋巴组织增生及有无反复呼吸道感染方面与复发组患儿比较,差异有统计学意义(P<0. 05)。多因素Logistic回归分析结果显示,年龄≤6岁、通气管置留时间≤6个月、有慢性鼻-鼻窦炎、有乳突气化不良、有腺样体肥大/鼻咽部淋巴组织增生及反复呼吸道感染为分泌性中耳炎患儿术后复发的危险因素。复发性分泌性中耳炎以听力减退、中耳积液为主要表现;声导抗测试显示声导抗图以B型为主,鼓膜检查可见鼓膜内陷,鼓室内可有积液和气泡;复发性分泌性中耳炎多发于年龄≤6岁儿童,其发生率随着年龄的增加呈下降趋势。结论复发性分泌性中耳炎多发于年龄≤6岁儿童,临床表现为听力减退、中耳积液等。分泌性中耳炎经手术治疗后受多种因素影响可出现复发,其中年龄≤6岁、通气管置留时间≤6个月、有慢性鼻-鼻窦炎、有乳突气化不良、有腺样体肥大/鼻咽部淋巴组织增生、反复呼吸道感染是导致分泌性中耳炎术后复发的危险因素,因此临床对合并上述因素患儿需行对症干预,以期降低分泌性中耳炎复发率。     

听力损失幼儿听性脑干反应、听觉稳态诱发反应检测及听力特点分析

目的探讨听性脑干反应(ABR)和听觉稳态诱发反应(ASSR)检测在听力损失幼儿中的诊断价值及其听力学特点。方法选取2015年6月-2018年6月嘉兴市第二医院接收的300例听力筛查未通过幼儿为研究对象,回顾性分析其临床资料,按照随机数表法将受检幼儿分为研究组和对照组,每组各150例。对照组幼儿进行听力诊断时进行ABR检测并将检测结果作为参考依据;研究组幼儿进行听力诊断时则采用ABR联合ASSR和鼓室声导抗测试,按照ABR与ASSR的共同反应阈作为诊断标准;判断两组幼儿的听力异常率,同时观察研究组幼儿鼓室声导抗在不同听力损伤程度下的发生率,并调查幼儿家属对检测及诊断的综合满意度。结果研究组幼儿听力异常检出率显著高于对照组,差异有统计学意义(P0. 05)。在组内比较中,研究组组内只有当载波频率定为0. 5kHz时,中度听力损伤幼儿和重度损伤幼儿的ASSR阈值高于ABR阈值,差异有统计学意义(P0. 05);轻度听力损伤与中度听力损伤幼儿的鼓室声导抗异常率显著高于其他分组,差异有统计学意义(P0. 05)。在满意度调查上,研究组幼儿家属对检测的总体满意度显著高于对照组,差异有统计学意义(P0. 05)。结论采用ABR联合ASSR的测试方法可对幼儿的听力损伤程度作出更加准确的判断,减少漏诊与误诊的出现,提高家属对检测结果的满意度,为后期临床治疗提供可靠依据。     

学龄前儿童分泌性中耳炎的早期诊断

目的探讨提高学龄前儿童分泌性中耳炎早期诊断的有效方法。方法回顾分析我科门诊169例338耳,以鼻-鼻窦炎和鼾症症状为主述(家长代述)但未发现听力障碍就诊的学龄前儿童,经询问病史、专科体查及声导抗测试,确诊为分泌性中耳炎的临床资料。依病因分为鼻-鼻窦炎、鼾症和鼻-鼻窦炎并鼾症三组,分析各组分泌性中耳炎患耳率并与对照组比较。结果鼻-鼻窦炎、鼾症、鼻-鼻窦炎并鼾症及对照组分泌性中耳炎患耳率分别为:55.96%、48.08%、63.24%、11.19%,经卡方检验前三组与对照组间比较患耳率差异有统计学意义(P<0.001),而前三组间患耳率差异无统计学意义(P>0.05)。结论学龄前儿童是分泌性中耳炎的高危人群,发病有隐袭性特点,鼻-鼻窦炎、鼾症是主要病因。经详细询问病史、仔细的专科体查及简便易行的声导抗测试即可明确诊断,应引起家长、老师和医务人员的高度重视,以免延误早期诊治。     

耳内镜下鼓膜置管联合腺样体切除术治疗儿童分泌性中耳炎

目的：分析儿童分泌性中耳炎采用耳内镜下鼓膜置管联合腺样体切除术治疗的临床效果。方法：将我院接诊的儿童分泌性中耳炎患儿50例（94耳）作为研究对象,随机均分为研究组与对照组。其中对照组患儿采用鼓膜置管处理,而研究组在对照组基础上加用腺样体切除术治疗,对比分析两组患儿临床治疗效果。结果：两组患儿纯音听力皆有提高,但组间听阈提高幅度对比差异无统计学意义（P〉0．05）;研究组患儿在中耳积液时间、复发耳数与感染耳数等方面皆明显低于对照组,组间对比差异有统计学意义（P〈0．05）。结论：儿童分泌性中耳炎患儿采取耳内镜下鼓膜置管联合腺样体切除术治疗可以取得比较良好的效果,中耳积液时间明显缩短,同时复发与感染较低,值得借鉴。     

儿童分泌性中耳炎家长关心的几个问题

正分泌性中耳炎,又名中耳积液,是以中耳内黏液或液体积聚为主要特征的一种中耳非化脓性炎性疾病,该病在孩子发育过程中好发,发病率高,为儿童耳鼻喉最常见疾病。分泌性中耳炎可造成儿童的听力损失,影响语言发育,应高度警惕和及时观察治疗。引起儿童分泌性中耳炎的病因有哪些儿童分泌性中耳炎,主要在患儿感冒、鼻炎等上呼吸道感染后继发。该病好发于儿童,主要与小儿特殊的鼻咽部解剖结构有关。人耳的鼻腔与中耳腔通过鼻     

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.