心血管内科住院患者医院获得性肺炎的临床分析

目的 观察心血管内科患者合并医院获得性肺炎的特点,为临床治疗提供参考依据.方法 回顾性分析960例心血管内科住院患者的临床资料.结果 合并医院获得性肺炎50例,占5.21％；具有典型症状58.00％、表现为非特异性症状20.00％、无症状者22.00％;下呼吸道分泌物培养出致病菌98株,其中革兰阳性菌占22.41％、革兰阴性菌占61.22％ 、真菌占18.37％;医院获得性肺炎组年龄(65.45±14.12)岁、心功能NYHA分级(2.43±0.34)级、有创检查治疗54.00％、制酸剂38.00％、预防应用抗菌药物36.00％,均高于无医院获得性肺炎组的(57.12±13.13)岁、(2.02±0.29)级、12.31％、17.36％、10.77％ (P＜0.05),是医院获得性肺炎的危险因素；医院获得性肺炎住院时间(24.89±8.12)d、死亡率12.00％,高于无医院获得性肺炎组(14.89±6.23)d、1.11％(P＜0.05).结论 心血管内科患者医院获得性肺炎发生率高,延长住院时间增加死亡率,应实施针对性措施减少医院获得性肺炎的发生.     

神经内科老年患者医院感染的危险因素及防护措施

目的 探讨神经内科老年患者发生医院感染的高危因素及其防护干预措施.方法 回顾性分析医院神经内科843例老年患者临床资料.结果 发生医院感染率为11.98％,其中呼吸道感染占62.38％,泌尿道感染占23.76％,血液感染占5.94％;年龄≥70岁、合并基础疾病、有吸烟史、侵入性操作、糖皮质激素使用、广谱抗菌药物使用及意识不清、住院时间≥15 d的患者医院感染发生率明显高,是引起医院感染的主要危险因素;共检出病原菌109株,其中革兰阴性菌68株占62.39％,前3位依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌,分别占22.94%、15.60％、11.93％;革兰阳性菌37株占33.94％,前两位为金黄色葡萄球菌、表皮葡萄球菌,分别占22.94％、5.50％;真菌4株,占3.67％.结论 神经内科老年患者医院感染发生率高,导致医院感染的危险因素较多,针对危险因素进行有效地防护,有助于降低医院感染发生率.     

医院获得性肺炎危险因素及病原菌特点分析

目的 探讨引起医院获得性肺炎的相关因素及病原菌的分布及耐药特点，并对经验性使用抗菌药物的合理性作出评价。方法 对2001年我院l70例医院获得性肺炎进行研究：包括其基础疾病、使用抗菌药物、使用侵入性器械、致病菌菌株的分布及耐药性特点进行分析。结果 平均医院感染时间为20d；发生医院感染思者的基础疾病中非呼吸系统疾病占74．7％，呼吸道侵入性操作占30．6％，呼吸系统疾病占25．3％；病原菌分离：以金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、白色念珠菌、肺炎克雷伯菌为主；药敏结果表明，所有革兰阴性菌对抗菌药物耐药率均呈上升趋势，尚未发现耐万古霉素的MRSA菌株。结论 住院时间长、呼吸道侵入性操作、长时间使用抗生意是医院获得性肺炎的易感因素。     

老年冠心病患者医院感染的危险因素分析及护理干预措施

目的 探讨老年冠心病患者医院感染的危险因素及护理干预措施.方法 对635例老年冠心病患者医院感染情况进行回顾性调查.结果 635例老年冠心病患者中有84例发生医院感染,医院感染率为13.2％,以下呼吸道感染为主;老年冠心病患者的医院感染发生与患者住院天数、侵入性操作、合并心力衰竭、使用抗菌药物密切相关,差异有统计学意义(P＜0.01).结论 住院天数、侵入性操作、合并心力衰竭、使用抗菌药物是老年冠心病患者医院感染发生的危险因素,医护人员应给予患者针对性的预防保护措施,控制相关危险因素,以有效地降低医院感染的发生.     

慢性心力衰竭患者合并医院感染相关因素及预防对策

目的 探讨引起慢性心力衰竭患者医院感染的危险因素及预防对策.方法 选择420例慢性心力衰竭患者作为研究对象,总结医院感染发生率、感染部位分布,对医院感染可能因素进行logistic回归分析.结果 420例患者医院感染60例,感染率为14.23％,感染部位构成下呼吸道28例、上呼吸道12例、泌尿道10例、胃肠道8例、口腔2例;logistic回归分析影响医院感染因素包括:年龄≥60岁、心功能分级差、实施侵入性操作、预防应用抗菌药物、住院时间长,OR值分别为3.56、3.23、3.04、2.78、2.69.结论 慢性心力衰竭患者医院感染发生率较高,影响因素复杂,加强老年患者管理、积极纠正心力衰竭、严格侵入性操作的指征、合理应用抗菌药物、缩短住院时间以减少医院感染的发生.     

慢性心力衰竭患者医院感染相关因素的病例对照研究

目的 探讨慢性心力衰竭患者合并医院感染的影响因素及预防对策.方法 调查950例慢性心力衰竭患者,比较合并医院感染组与无医院感染组在年龄、性别、侵入性诊疗操作、心功能分级等指标差异进行统计学分析.结果 950例患者中发生医院感染90例占9.47％,医院感染组年龄平均为(61.45±13.78)岁、侵入性诊疗操作占35.6％、心功能Ⅲ～Ⅳ级占47.8％、应用抑酸制剂占34.4％、预防应用抗菌药物占40.0％、住院时间(21.84±8.25)d,高于无医院感染组的(54.24±11.45)岁、11.3％、10.7％、9.8％、29.5％、(16.45±3.56)d,差异均有统计学意义(P＜0.05),是医院感染的相关因素.结论 慢性心力衰竭患者医院感染率较高,影响因素较多,应针对上述因素实施相应的对策,将高危人群纳入重点监测范围,避免不必要侵入性操作,合理使用抗菌药物,及时有效地纠正基础疾病.     

糖尿病患者合并医院获得性肺炎的临床特点观察

目的探讨糖尿病患者医院获得性肺炎的临床特征。方法回顾性分析2008年2月-2010年2月,1620例糖尿病住院患者的临床资料。结果发生医院获得性肺炎90例,发生率为5.56%,具有感染表现60例,30例症状不典型;痰培养阳性80例,其中革兰阴性杆菌43株、革兰阳性菌26株、白色假丝酵母菌11株;年龄?病程、血糖控制、侵入性操作、并发症、住院时间、预防应用抗菌药物是医院获得性肺炎相关因素;医院获得性肺炎死亡率为21.11%。结论糖尿病医院获得性肺炎发生率高,感染症状部分不典型,应将胸部X线检查应作为检查常规;规范应用抗菌药物。     

老年患者医院获得性肺炎36例

目的探讨老年患者医院获得性肺炎的发病情况、治疗效果及危险因素。方法对我院2005年1月至2006年12月36例老年患者医院获得性肺炎的发病率、发病时间、基础疾病、临床特点、病原菌分布、药物敏感性及治疗转归进行回顾性分析。结果老年患者医院获得性肺炎占医院感染的35．3％，住院时间超过30天者最多，占47．2％（17／36），基础疾病以心脑血管病、糖尿病、慢性阻塞性肺疾病为主，死亡率30．6％（11／36）。结论老年患者医院内获得性肺炎发病率及死亡率均高，治疗效果差，住院时间长、免疫功能差、原有基础疾病是老年患者医院获得性肺炎的主要危险因素。     

老年患者医院获得性肺炎的病原菌及耐药性探讨

目的 调查鄂西山区医院老年患者医院获得性肺炎的病原菌分布及耐药性,为内科病区预防、控制医院获得性肺炎及合理使用抗菌药物提供参考依据.方法 根据卫生部制定的《医院感染诊断标准》筛选年龄≥60岁的医院获得性肺炎患者,感染病原菌培养鉴定按照《全国临床检验操作规程》进行;药敏试验采用CLSI推荐的K-B法和最新规则进行操作与评价;采用WHONET 5.4-5.5版本分析数据.结果 共分离247株病原菌,分离率居前6位的病原菌依次为铜绿假单胞菌占25.9％、肺炎克雷伯菌占16.6％、金黄色葡萄球菌占15.0％、鲍氏不动杆菌占14.6％、白色假丝酵母菌占8.1％、大肠埃希菌占7.3％;主要病原菌对常用抗菌药物均产生了较为严重的耐药性,耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌分别达10.9％、13.9％;产ESBLs大肠埃希菌和肺炎克雷伯菌检出率为40.7％;耐甲氧西林金黄色葡萄球菌检出率为48.6％;但肠杆菌科细菌对碳青霉烯类抗菌药物100.0％敏感;革兰阳性球菌对糖肽类抗菌药物100.0％敏感.结论 鄂西山区老年医院获得性肺炎的病原菌耐药性呈上升趋势,应采取干预措施,延缓和控制细菌耐药率快速增长的不利局面.     

中晚期痴呆患者院内获得性肺炎的高发因素及应对策略

目的 探讨中晚期痴呆患者院内获得性肺炎的高发因素,为痴呆患者临床康复提供应对策略.方法 回顾性分析436例中晚期痴呆患者的临床资料,分析院内获得性肺炎的发生率和病原菌特征,采用x2检验分析相关影响因素.结果 436例痴呆患者发生肺部感染75例,感染率为17.20％;共分离出88株病原菌,革兰阴性菌59株占67.05％,革兰阳性菌22株占25.00％,真菌7株占7.95％;排名前5位的病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌和表皮葡萄球菌,分别占29.55％、17.05％、13.64％、10.23％和9.09％;肺部感染与年龄、病程、住院时间、合并疾病情况、吞咽困难、侵入性操作、预防性使用抗菌药物和抗精神药物使用时间有关(P＜0.05).结论 中晚期痴呆患者院内获得性肺炎的感染率较高,应针对其高发因素,采用相应的应对策略,降低肺部感染的发生率.     

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.