胎儿中心监护系统在产时的应用研究

目的:探讨胎儿中心监护系统在产时的临床应用。方法:对实验组的1960例孕妇临产进行连续胎心监护,并与对照组的1820例孕妇未进行产时连续胎心监护的比较,两组产妇基本情况无明显差异,评估指标两组相同。结果:实验组新生儿窒息发生率显著下降,与对照组比较有极显著差异(P<0.01);两组剖宫产率差异无显著意义(P<0.01)。结论:应用胎儿中心监护系统进行产时连续胎心监护,能及时发现胎儿宫内窘迫,有效降低新生儿窒息发生率,不增加剖宫产率。     

802例异常胎心监护临床分析

目的探讨胎心监护对剖宫产率的影响。方法回顾性分析我院2011年1月~2013年7月我院所有因胎心监护异常诊断为胎儿窘迫而行剖宫产产妇共802例,观察胎心监护图形的异常与术中羊水污染、脐带因素、羊水过少和新生儿窒息的关系并对资料进行分析统计。结果胎心加速组102例中羊水污染33.33%,羊水清亮66.66%,新生儿窒息0%。随着孕周的延长羊水污染χ2=0.363,P0.05,羊水污染与新生儿窒息χ2=0, P0.05均无显著性差异。胎心减速组共700例中羊水污染37.71%,羊水清亮62.29%,新生儿窒息5.28%。随着孕周的延长羊水污染χ2=5.242,P0.05,羊水污染与新生儿窒息χ2=14.020,P0.05有显著性差异。高危妊娠与非高危妊娠羊水污染χ2=28.927,新生儿窒息χ2=12.540,P0.05有显著性差异。结论胎心监护可以早期发现胎儿窘迫,为临床处理提供依据,但仅凭胎心监护图形的异常而诊断胎儿窘迫会出现假阳性的判断,增加剖宫产率,诊断胎儿窘迫,临床医生需要综合判断。     

农村地区实行分娩期连续胎儿监护的比较研究

目的探讨农村基层医疗机构应用连续胎儿监护在减少胎儿宫内窘迫和新生儿窒息中的作用。方法选取2001年1月至2006年7月在我院分娩的孕周≥37周的孕妇为研究对象,根据监护方式分为连续胎心监护组(实验组)和非连续胎心监护组(对照组),分析两组胎儿窘迫检出率及新生儿窒息发生率。结果实验组胎儿窘迫检出率明显升高,两组比较,差异有显著意义(P<0.05);新生儿窒息发生率明显下降,两组比较,差异有显著意义(P<0.05)。结论连续性胎心监护可及时地反映胎儿在宫内缺氧程度及动态变化,筛查胎儿窘迫,预测围出儿结局,减少新生儿窒息的发生,有利于农村地区产科质量的提高。     

脐带绕颈对分娩方式及围生儿结局的影响

目的：观察脐带绕颈阴道试产对孕产妇分娩方式及围生儿结局的影响。方法选取在常州市新北区三井街道社区卫生服务中心就诊的108例存在胎儿脐带绕颈的孕产妇做为观察组,同期86例健康无胎儿脐带绕颈的孕产妇为对照组,两组均行阴道试产,观察并分析两组孕产妇分娩方式以及胎儿宫内窘迫、新生儿窒息、胎儿病死等发生情况。结果①观察组剖宫产率显著高于对照组(χ2=4.999,P<0.05),脐带绕颈≥2周的剖宫产率明显高于绕颈1周者(χ2=16.883,P<0.01),脐带绕颈≥2周的剖宫产率与对照组比较有显著性差异(χ2=22.554,P<0.01),脐带绕颈1周的剖宫产率与对照组比较无显著性差异(χ2=0.756,P=0.385);②观察组中胎儿宫内窘迫发生率和新生儿窒息发生率与对照组比较均有显著性差异(χ2=3.874,P=0.049<0.05;χ2=4.692,P=0.030<0.05),两组病死率比较无显著性差异(P=1.000);脐带绕颈≥2周的宫内窘迫发生率和新生儿窒息发生率均高于脐带绕颈1周者(χ2=24.233,P=0.000;χ2=28.524,P<0.01),两组病死率比较无显著性差异(P=0.185);脐带绕颈1周者与对照组比较,胎儿宫内窘迫率、新生儿窒息率均无显著性差异,P值分别为0.749和0.786,两组病死率均为0;脐带绕颈2周者与对照组比较,胎儿宫内窘迫、新生儿窒息均有显著性差异,χ2值分别为24.492和30.631,均P<0.01),两组病死率比较无显著性差异(P=0.189)。结论脐带绕颈≥2周对围生儿有不良影响,临床需谨慎选择正确的分娩方式,而绕颈1周者完全可阴道分娩。     

中央胎心监护在产程中的应用分析

目的探讨中央胎心监护在产程中应用的意义。方法对我院2009年11月至2010年5月1200例孕妇（研究组）进行中央胎心监护系统进行全产程监护,对2006年1月至2006年6月的1456例孕妇（对照组）进行常规多普勒听胎心,比较两组孕妇胎儿窒息的检出率、新生儿窒息的发生率和剖宫产率。结果研究组与对照组胎儿宫内窘迫检出率分别为10.5%、5.2%;新生儿窒息发生率分别为6.25%、10.37%;新生儿重度窒息率分别为0%、0.92%;研究组剖宫产率相对增高,为8.5%,对照组的剖宫产率为6.7%。结论产时应用中央胎心监护网络系统对产妇进行全程监护能提高胎儿宫内窘迫的检出率,降低围产儿死亡率及胎儿窒息率,相对增加剖宫产率。     

胎儿脉搏氧在产时不可靠胎心监护图形应用的临床价值

目的:研究胎儿脉搏氧在产时不可靠胎心监护图形应用的临床价值。方法:选择161例无妊娠合并症和并发症的足月、单胎、头位的初产妇,随机分为研究组81例,在胎心电子监护(CTG)的同时使用胎儿脉搏氧监护胎儿的氧合状况,对照组80例行胎心电子监护。比较两组的剖宫产率、新生儿窒息率及脐动脉pH值与出生前胎儿脉搏氧测定值的相关性。结果:研究组剖宫产率为29.63%,明显低于对照组的41.25%,两者比较差异有显著性(P<0.05);两组新生儿窒息率无显著差异,分别为4.94%和6.25%(P>0.05);研究组脐动脉pH值与出生前胎儿脉搏氧具有明显的相关性(相关系数r=0.8123,P<0.05)。结论:在产时胎心电子监护出现不可靠图形时,联合应用胎儿脉搏氧监测,可有效降低剖宫产率,不增加新生儿窒息率。     

枣庄峄城区脐带绕颈临床资料调查研究

目的 探讨脐绕颈分娩方式的选择及对围产儿预后的影响.方法 对枣庄峄城区2009至2010年住院分娩的14 906例中脐带绕颈的2 586例孕妇,随机抽取815例为观察组,抽取同期无脐带绕颈的孕妇815例为对照组,分析脐带绕颈与胎儿窘迫、新生儿窒息的发生率以及孕妇分娩方式的关系.结果 脐绕颈1周组与对照组比较剖宫产率、胎儿窘迫、新生儿窒息发生率无显著差异,χ2值分别为1.02、2.52、1.86,均P＞0.05.脐带绕颈2周和以上者观察组与对照组比较其剖宫产率、胎儿窘迫发生率及新生儿窒息率(增加)有显著性差异,χ2值分别为4.70、4.14、80.97,均P＜0.05.结论 孕妇若不伴有其他剖宫产指征在严密观察产程持续胎心电子监护下,脐带绕颈1周者可鼓励孕妇首选阴道试产.脐带绕颈2周及以上者可适当放宽剖宫产指征,严密观察并积极合理的处理产程中的问题,是提高产科质量的重要手段.     

脐带绕颈对妊娠结局及分娩方式的影响

目的 探讨产前诊断脐带绕颈对分娩方式和妊娠结局的影响.方法 回顾性分析125例头位有脐带绕颈(实验组)及153例头位无脐带绕颈(对照组)的病例,全部病例产时均进行连续胎心监护及超声多普勒检查;并对两组间S/D、脐带长度、剖宫产率、胎儿窘迫率及新生儿窒息率进行比较.结果 脐带绕颈组与无脐带绕颈组间的剖宫产率、胎儿窘迫率及新生儿窒息率比较无显著性差异(p＞0.05);脐带绕颈2周组分别与脐带绕颈1周组、对照组进行S/D比较,有统计学差异(p＜0.05);脐带长度各组间比较有统计学差异(p＜0.05). 结论产前脐血S/D检查对产时急性缺氧无预测作用;脐带绕颈不应作为剖宫产指征,加强产程监护及早发现并正确处理胎儿窘迫,可使围产儿预后良好.     

产前无应激胎心监护联合产时电子胎心监护的临床效果分析

目的探究产前无应激胎心监护联合产时电子胎心监护的临床效果。方法将滁州市第一人民医院2016年9月至2017年3月符合纳入要求的120例足月妊娠产妇作为研究对象,予以产前无应激胎心监护、产时电子胎心监护单独检查以及联合检查,分别计算各项检查的灵敏度和特异度,并比较两种监护方法所示结果胎儿及新生儿的预后转归。结果产时电子胎心监护在诊断胎儿宫内窘迫的灵敏度和特异度较产前无应激胎心监护高,两者联合诊断的灵敏度和特异度较单一检查高,宫内窘迫组羊水Ⅱ～Ⅲ度粪染、宫内窘迫和新生儿窒息发生率均高于胎儿正常组,差异有统计学意义(P <0. 05)。结论产前无应激胎心监护联合产时电子胎心监护,能提高对胎儿宫内窘迫的诊断率,诊断灵敏度和特异度均较高。     

硬膜外阻滞麻醉分娩镇痛配合Doula式分娩及连续胎心监护的临床分析

目的观察硬膜外腔阻滞麻醉分娩镇痛配合Doula式分娩及连续胎心监护的临床效果及对产科质量的影响.方法将低浓度罗哌卡因和小剂量含芬太尼的混合液注入硬膜外腔,配合Doula式分娩及连续胎心监护,用于76例没有产科并发症及麻醉禁忌症进入活跃期的初产妇作为观察组,将单纯采用Doula式分娩的89例相同条件的初产妇作为对照组,比较两组的镇痛效果及其对产科质量的影响.结果两组镇痛效果有极显著性差异(P＜0.01),催产素使用有显著性差异(P＜0.05),产程时间、分娩方式、产后出血量、胎儿窘迫、胎心监护异常发生率及新生儿窒息发生率无显著性差异(P＞0.05).结论硬膜外腔阻滞麻醉用于分娩镇痛,效果可靠,对母婴无不良影响,配合Doula式分娩及连续胎心监护,安全有效.     

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.