Characteristics of menstrual problems associated with Norplant discontinuation: results of a multinational study

This paper presents a secondary analysis of 3419 Norplant users from 11 countries throughout Asia, Africa and Latin America. The main objective was to identify the menstrual problems associated with a high risk of early discontinuation of Norplant use. Eligible participants were divided into two groups: those who continued use (n = 2667) for the first 3 years and those who discontinued use because of bleeding or pain (n = 752) during the first 3 years of use. Menstrual characteristics of the women were compared between groups using a logistic regression model with generalized estimating equations. Flow duration of more than 7 days, excessive amount of flow, dysmenorrhea and intermenstrual bleeding for more than 7 days were associated with a significant risk of discontinuation. The highest risk was observed in association with flow duration of more than 7 days (adjusted odds ratios of 1.85, 2.01 and 2.20 at 1, 2 and 3 years, respectively). The appropriate management of prolonged or excessive bleeding, namely by continuous counseling, is essential for successful Norplant use.     

植入物医院感染的危险因素调查分析

目的调查分析综合医院植入物医院感染的危险因素,为控制植入物后医院感染管理工作提供更有效的措施。方法采用回顾性调查方法,对医院2007-2009年1287例植入物的医院感染进行调查分析。结果植入物医院感染73例,感染率为5.67%;其中金属器械植入后医院感染58例,占79.45%;其危险因素主要与急诊手术、开放性创口、手术时间、年龄及住院时间长短有密切相关。结论分析植入物医院感染的危险因素,加强植入物及危险因素的管理,是防止植入物医院感染的重要措施。     

耐碳青霉烯类肠杆菌医院感染风险分析

目的识别耐碳青霉烯类肠杆菌(CRE)医院感染的风险关键控制点,以提升CRE感染预防控制水平。方法基于医院信息系统,回顾性调查医院2013年1月-2015年2月CRE医院感染患者的临床资料,通过构建非条件logistic回归模型分析,预测CRE医院感染的风险,数据分析采用SAS9.2软件。结果 121例CRE医院感染患者主要分布在外科、ICU和内科,分别占35.5%、28.9%和24.8%;感染部位主要为下呼吸道、血液、泌尿道和手术部位,分别占46.0%、16.0%、14.0%和10.0%;主要耐药菌是肺炎克雷伯菌占73.4%、大肠埃希菌占18.8%;多因素分析显示,入住ICU、联用抗菌药物、感染前使用碳青霉烯类抗菌药物是CRE医院感染的独立危险因素。结论对重点科室住院患者开展早期CRE筛查,合理使用碳青霉烯类抗菌药物并减少联用,可降低CRE医院感染的风险。     

Effect of Norplant contraceptive use on hemoglobin, packed cell volume and menstrual bleeding patterns

A study was conducted to evaluate the effect of NORPLANT use on hemoglobin levels (HB), packed cell volume (PCV) and menstrual bleeding patterns. NORPLANT insertions were performed on 50 healthy volunteers in Ilorin, Nigeria, between January-March 1986. Whole blood samples were collected at admission, 6-month and 12-month follow-up visits, and each acceptor was asked to keep a daily bleeding calendar. Mean age of the acceptors was 32.8 years with a mean parity of 5.3 live births. Almost 50% of the acceptors indicated that they did not want any more children. After 12 month's follow-up, there were a total of three discontinuations, two for excessive menstrual bleeding and one due to husband's objection. Mean HB and PCV values remained relatively unchanged from admission to 12 months. Nearly 50% of the women experienced at least one episode of 8 or more days of continuous bleeding during the first six months of use, and about 20% reported amenorrhea of 90 or more days. Despite the incidence of menstrual bleeding irregularities, acceptability of the NORPLANT method was high as indicated by a 1-year continuation rate of 93.7 per 100 users. Clinically more important was the finding that despite a high proportion of women reporting menstrual pattern changes, HB and PCV levels remained unchanged.     

国产皮下埋植剂因月经异常停用的影响因素分析

长效单纯孕激素皮下埋植剂上市20多年来,因其高效、安全、方便、长效、可逆等优点,受到广大育龄妇女的欢迎,但单纯孕激素引起的月经紊乱问题成为限制其可接受性的主要因素[1]。本文通过5年的随访研究,采用COX多元逐步回归方法分析中国经产妇使用国产皮下埋植剂后因月经异常停用     

耐碳青霉烯类鲍氏不动杆菌医院感染风险分析

目的识别耐碳青霉烯类鲍氏不动杆菌(CRAB)医院感染的风险关键控制点,为有效预防控制及治疗提供参考依据。方法采用病例对照研究,收集2014年5月-2015年5月CRAB医院感染患者37例以及碳青霉烯类敏感鲍氏不动杆菌(CSAB)医院感染患者30例的临床资料,构建非条件logistic回归模型分析,预测CRAB医院感染风险。结果 68株医院感染鲍氏不动杆菌中CRAB 38株占55.88%;CRAB感染的科室及感染部位分布均比较集中,ICU及神经外科在48.64%和43.24%,下呼吸道感染占71.05%;入住ICU(OR=26.244)和感染前使用碳青霉烯类抗菌药物(OR=9.488)与CRAB医院感染之间存在关联(P<0.05)。结论入住ICU和感染前使用碳青霉烯类抗菌药物是CRAB医院感染的独立危险因素,强化ICU医院感染预防控制措施,合理应用碳青霉烯类抗菌药物是预防CRAB的重要方式。     

结直肠癌手术切口感染因素分析

目的 分析结直肠癌患者手术切口感染病原菌分布特点及感染因素.方法 回顾性分析医院2009年2月-2011年5月收治的结直肠癌患者病历资料,对术后切口感染患者切口分泌物进行细菌培养鉴定,并对相关因素进行分析.结果 296例患者发生切口感染50例,感染率为16.9％;共检出64株病原菌,革兰阴性杆菌37株,占57.8％,革兰阳性球菌21株,占32.8％,真菌6菌株,占9.4％;肥胖患者术后切口感染率高,为24.1％,合并糖尿病患者术后感染率较无糖尿病患者高,差异有统计学意义(P＜0.05),不同Dukes分期的感染率差异有统计学意义(P＜0.05).结论 结直肠癌术后伤口感染与患者体质肥胖、糖尿病及Dukes分期有重要关系,应采取相应预防措施预防手术切口感染.     

肿瘤介入治疗发生医院感染的危险因素

目的 分析探讨肿瘤介入治疗发生医院感染的危险因素,为预防医院感染提供科学依据.方法 回顾性调查分析2010年5月-2011年10月入院的64例肿瘤介入治疗医院感染患者的临床资料,对可能影响感染的危险因素进行单因素和多因素logistic同归分析.结果 单因素分析显示,患者的年龄(x2=12.4)、癌症部位(x2=23.9)、住院时间(x2=16.3)、放化疗治疗(x2=13.8)、使用多种抗菌药物(x2=21.8)是发生医院感染的危险因素,差异有统计学意义(P＜0.05);多因素logistic分析显示,癌症部位(OR=9.29,x2=16.37)、住院时问(OR=6.82,x2=11.32)、放化疗治疗(OR=5.27,x2=10.31)、使用多种抗菌药物(OR=4.89,x2=8.84)是发生医院感染的高危因素.结论 合理使用抗菌药物,缩短住院时间,减少侵入性操作可以预防肿瘤介入治疗发生医院感染.     

肿瘤介入治疗患者医院感染的危险因素分析

目的 分析肿瘤在介入治疗过程中发生医院感染的危险因素,以加强医院肿瘤介入治疗感染的防治.方法 参照卫生部颁发的《医院感染诊断标准》采集病例,共收集2009年10月-2012年10月的肿瘤介入治疗患者502例,采用前瞻性监测方法,进行资料统计与分析,纳入因素包括患者性别、年龄、肿瘤部位、住院时间、放化疗治疗、基础疾病数量、使用抗菌药物时间和白细胞数.结果 患者年龄、肿瘤部位、住院时间、放化疗治疗、基础疾病数,使用抗菌药物时间、白细胞数是肿瘤介入治疗发生医院感染的危险因素,其中肿瘤部位(OR＞8.65),住院周数(OR＞7.23)、放化疗治疗(OR＞6.96)、基础疾病数(OR＞5.26)、使用抗菌药物时间(OR＞5.12)是介入治疗发生感染的高危因素.结论 提高患者机体免疫能力、缩短住院时间、合理控制抗菌药物的使用能有效降低肿瘤介入治疗发生感染的概率.     

鲍氏不动杆菌医院获得性肺炎预后危险因素分析

目的探讨影响鲍氏不动杆菌医院获得性肺炎(ABA-HAP)预后的危险因素,为临床早期干预高危患者提供参考依据。方法回顾性分析2011年1月-2013年12月199例ABA-HAP住院患者的临床资料,根据患者发病后30d预后情况分为存活组119例和死亡组80例,两组间采取单因素及多因素logistic回归分析,确定ABA-HAP预后的危险因素。结果单因素分析发现,入住ICU、昏迷、气管插管/切开、机械通气、发生ABAHAP后糖皮质激素使用≥1周、低白蛋白血症、APACHEⅡ≥20分、耐碳青霉烯类鲍氏不动杆菌(CRAB)、多药耐药鲍氏不动杆菌(MDRAB)与ABA-HAP死亡有关(P<0.05);多因素logistic回归分析发现,ABA-HAP发病时APACHEⅡ≥20分、昏迷、ABA-HAP发病后糖皮质激素使用≥1周、CRAB是ABA-HAP患者死亡的独立危险因素(P<0.05)。结论患者发生ABA-HAP时APACHEⅡ高分值、昏迷,提示其预后差,糖皮质激素长期使用以及CRAB感染明显增加ABA-HAP患者死亡风险。     

Norplant皮下埋植避孕150例临床研究

目的:探讨Norplant皮下埋植避孕的效果。方法:选择Norplant皮下埋植避孕妇女150例作为治疗组,以宫内节育环避孕妇女150例作为对照组,比较两组使用情况、避孕效果和月经紊乱情况。结果:5年后随访,治疗组因不适取出32例,取出率为21.33%,其余118例全部达到避孕效果,有效率100.00%;期间出现月经紊乱58例,发生率为49.15%;对照组因不适取出或自行脱出10例,取出率为6.67%,其余140例中达到避孕效果115例,有效率82.14%,出现月经紊乱33例,发生率为23.57%。两组避孕效果、月经紊乱和不适失败率比较均具有统计学差异(P<0.01)。结论:对生育期要求避孕妇女行皮下Norplant埋植避孕手术可达到有效的避孕效果,但月经紊乱发生率相对较高,宫内节育环避孕有效率较皮下Norplant埋植避孕手术低,但月经紊乱发生率亦较治疗组低。使用Norplant埋植避孕如何减少月经紊乱,仍是今后值得探讨的一个问题。     

Risk factors for the discontinuation of home medical care among low-functioning older patients

Objectives

Older patients receiving home medical care often have declining functional status and multiple disease conditions. It is important to identify the risk factors for care transition events in this population in order to avoid preventable transitions. In the present study, therefore, we investigated the factors associated with discontinuation of home medical care as a potentially preventable care transition event in older patients.

Methods

Baseline data for participants in the Observational study of Nagoya Elderly with HOme MEdical (ONEHOME) study and data on the mortality, institutionalization, or hospitalisation of the study participants during a 2-year follow-up period were used. Discontinuation of home care was defined as admission to a hospital for any reason, institutionalization, or death. Univariate and multivariate Cox hazard models were used to assess the association of each of the factors with the discontinuation of home care during the observational period. The covariates included in the multivariate analysis were those significantly associated with the discontinuation of home care at the level of P<0.05 in the univariate analysis.

Results

The univariate Cox hazard model revealed that a low hemoglobin level (< 11g/dL), low serum albumin level (< 3g/dL), higher Charlson Comorbidity Index score, and low Mini Nutritional Assessment Short Form score (< 7) were significantly associated with the discontinuation of home care. A multivariate Cox hazard model including these four factors demonstrated that all four were independently associated with home-care discontinuation.

Conclusions

The present results demonstrated that anemia, hypoalbuminemia, malnourishment, and the presence of serious comorbidities were associated with the discontinuation of home medical care among low-functioning older patients.

     

Risk factors for deaths due to respiratory infections among Brazilian infants

In a population based case-control study, 127 Brazilian infants who died due to a respiratory infection were compared with 254 neighbourhood controls. The main risk factors associated with mortality were low socioeconomic status (including low levels of parental education) and--after adjustment for socioeconomic status--lack of breastfeeding, lack of supplementation with non-milk foods, crowding, the number of under-fives in the family, lack of a flush toilet, low birthweight, low weight-for-age and having a young mother. In a multivariate analysis, the variables found to be most closely associated with mortality were breastfeeding, education of the father, the number of under-fives, family income and birthweight. Having a low weight-for-age was also strongly associated with mortality but the retrospective nature of the study makes this finding difficult to interpret.     

A simple technique for localization of deeply inserted, nonpalpable Norplant implant

Norplant removal may be complicated if deep insertion causes difficulty in localization with palpation. Various methods have been used to locate these deeply seated implants. Soft tissue X-ray films (standard anteroposterior and lateral views) with a paper clip placed as a marker by the clinician provide a simple method of locating deep implants.     

皮下埋植避孕剂用于临床避孕的疗效研究

目的:对皮下埋植剂避孕剂避孕的临床疗效及安全性进行研究,对其临床应用的前景进行展望。方法:对2007年4月～2008年4月在东台市计划生育指导站实行避孕术的妇女进行回顾性分析,选取98例符合标准者,观察组使用皮下埋植避孕剂进行避孕,对照组使用宫内节育器进行避孕。对两组研究对象避孕效果、术后阴道出血、月经情况、放置率、患者满意率等临床数据进行比较。结果:术后对患者随访5年,观察组有效率为97.9%,较对照组91.3%有优势。观察组出现不良反应4例,不良反应率为8.5%;对照组出现不良反应11例,不良发应率为23.9%,观察组不良反应率低于对照组(P<0.05)。观察组在放置率及患者满意率明显优于对照组。结论:皮下埋植避孕剂在临床避孕的使用中,具有避孕率高,不良发应少,放置率高等优势,受到临床医患的认可,适于推广使用。     

Risk factors for severe disease due to Toxoplasma gondii in HIV-positive patients

The objective of this study was to assess the risk of toxoplasmosis in HIV-positive subjects as a basis for primary prophylaxis. A retrospective chart review of 400 consecutive patients was carried out and clinical and laboratory markers at first presentation and follow-up data on the occurrence of toxoplasmosis were recorded. Independent variables were identified, laboratory parameters were stratified, and estimates for the risk of toxoplasmosis and the impact of different variables on its occurrence were made using conventional statistical methods.An increased risk of toxoplasmosis was strongly associated with a positive Toxoplasma gondii IgG EIA in conjunction with a CD4+ cell cont below 0.15/nl (the estimated risk of toxoplasmosis was 20% and 35% after 12 and 24 months, respectively) or a history of one or more opportunistic infections (the estimated risk was 12% and 30% after 12 and 24 months, respectively). Toxoplasma gondii-seropositive patients with CD4+ cell counts below 0.15/nl and those with antecedent opportunistic infections are most likely to develop toxoplasmosis and thus might benefit from primary prophylaxis. The risk of disease probably outweighs the risk of medication in these subjects. Prospective clinical trials are needed to define the optimal choice of drugs.Corresponding author.     

种植牙早期感染危险因素及其炎症因子水平

目的 探究早期感染对种植牙周围骨丧失、磷脂酰肌醇(PI3K)/蛋白激酶B(AKT)信号通路及相关炎症因子水平影响。方法 选择2018年3月-2021年3月于海口市第三人民医院进行植牙手术患者为研究对象,植牙术后1周牙周感染患者54例为感染组,未出现牙周感染患者76例为非感染组,比较两组患者植牙术后1周种植牙周围骨丧失情况和PI3K/AKT信号通路及相关炎症因子水平变化。单因素及多因素回归分析种植牙术后早期感染的影响因素。结果 两组患者种植牙周围骨丧失发生率(7.41%vs 3.95%),比较差异无统计学意义(Z=0.218,P=0.640)。感染组患者PI3K mRNA、AKT mRNA、NF-kB mRNA、IL-6、TGF-β1水平均高于非感染组(P<0.05); NF-kB mRNA、IL-6及吸烟史是种植牙术后早期感染的危险因素(P<0.05)。结论 早期感染不会导致种植牙周围骨丧失发生率升高,但是会诱使PI3K/AKT信号通路激活,上调炎症因子水平,NF-kB mRNA、IL-6及吸烟史是种植牙术后早期感染的危险因素。     

A cohort study of Norplant implant: Side-effects and acceptance

Objectives Menstrual irregularity is the main cause of termination of Norplant use; a study of its safety and level of acceptance is needed.Study methods A cohort study using medical records of Dr Kariadi Hospital, Semarang, Indonesia and interviews between Norplant and IUD users who had in 1993 been followed-up for 5 years. Expulsion rate, removal rate, level of acceptance and satisfaction were examined.Results From 170 Norplant and 168 IUD acceptors, the net cumulative pregnancy rates by month 36 of the Norplant and the IUD groups were 0.0% and 1.19%, respectively (p<0.05). The net cumulative expulsion rates were 0.61% and 1.32% (p>0.05). The net cumulative rates of removal for medical reasons were 2.37% and 1.97% (p<0.05). The net cumulative removal rates for nonmedical reasons were 1.80% and 10.38% (p<0.001); the net cumulative continuation rates were 95.29% and 85.60% (p<0.002). The net cumulative acceptance rates were 97.04% and 93.83% (p<0.05). The Norplant users experienced less menstrual and inter-menstrual bleeding and more amenorrhea than the IUD group. The psychological satisfaction scores among the Norplant and IUD users were high (p<0.05). The Norplant contraceptive is well accepted.Conclusions The findings could be very useful for further steps in promoting Norplant as a contraceptive that is long-acting, with good efficacy, acceptance, and safety.

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ResumenObjetivos La irregularidad menstrual es la principal causa de terminación de Norplant; se necesita un estudio de su seguridad y nivel de aceptación.Métodos del estudio Un estudio cohorte utilizando los historiales médicos del Dr. Kariadi Hospital Semarang, Indonesia y entrevistas con comparaciones entre usuarias de Norplant y de DIU que en 1993 habían sido seguidas durante 5 años. Se estudiaron las tasas de expulsión y retiro y el nivel de aceptación y satisfacción.Resultados De 170 aceptadoras de Norplant y 168 aceptadoras de DIU, las tasas netas acumulativas de embarazo al mes 36 de Norplant y de los grupos de DIU son 0,0% y 1,19%, respectivamente (p>0,05). Las tasas acumulativas netas de expulsión son 0,61% y 1,32% (p>0,05). Las tasas acumulativas netas de retiro por razones médicas son 2,37% y 1,97% (p>0,05). Las tasas acumulativas netas de retiro por razones no médicas son 1,80% y 10,38% (p<0,001); las tasas acumulativas netas de continuación son 95,29% y 85,60% (p<0,002). Las tasas acumulativas netas de aceptación son 97,04% y 93,83% (p>0,05). Las usuarias de Norplant experimentaron menos sangrado menstrual e intermenstrual y más amenorrea que el grupo de DIU. Los puntajes de satisfacción psicológica entre las usuarias de Norplant y DIU son altas (p>0,05). El anticonceptivo Norplant es bien aceptado.Conclusiones Los resultados podrían ser muy útiles para las etapas siguientes en la promoción de Norplant como anticonceptivo de acción prolongada con buena eficacia, aceptación y seguridad.

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ResuméObjectifs Les irrégularités du cycle menstruel sont la cause principale de l'abandon du Norplant. Il est nécessaire de procéder à une étude de la sécurité de cette méthode et de la mesure dans laquelle elle est acceptée.Protocole d'étude Etude cohorte utilisant les dossiers médicaux du Dr Kiriadi Hospital Semarang (Indonésie) et les résultats d'entrevues, afin de comparer les utilisatrices de Norplant et de DIU qui, en 1993, avaient été suivies pendant 5 ans. Les pourcentages d'expulsion, de retrait, ainsi que le degré d'acceptation et de satisfaction ont été examinés.Résultats Sur 170 utilisatrices de Norplant et 168 de dispositifs intra-utérins, les taux nets cumulés de grossesses jusqu'au 36ème mois étaient de 0,0% et de 1,19% respectivement dans le groupe DIU et le groupe Norplant (p>0,05). Les taux nets cumulés d'expulsions s'élevaient à 0,61% et 1,32% (p>0,05). Les taux nets cumulés de retrait pour des raisons médicales étaient de 2,37% et 1,97% (p>0,05). Les taux nets cumulés de retrait pour d'autres raisons que médicales étaient de 1,80% et 10,38% (p<0,001). Les taux nets cumulés de poursuite sont de 95,29% et 85,60% (p<0,002). Les taux nets cumulés d'acceptation sont de 97,04% et 93,83% (p<0,05). Les femmes utilisant Norplant ont été moins sujettes à des écoulements sanguins menstruels et inter-menstruels et davantage à l'aménorrhée que celles du groupe DIU. Le facteur de satisfaction chez les utilisatrices de Norplant et des DIU est élevé (p>0,05). Le contraceptif Norplant est bien accepté.Conclusion Ces résultats pourraient être très utiles lors de futures démarches pour la promotion de Norplant en tant que contraceptif agissant pendant longtemps avec efficacité, bien accepté et sûr.

     

The contraceptive sponge: factors in initiation and discontinuation of use

This study examined characteristic of the contraceptive sponge that were important in women's decisions to use the contraceptive sponge and reasons why women discontinued sponge use. A sample of 385 current sponge users and 407 former sponge users participated in a national telephone survey on sponge use. Important reasons for trying the sponge were effectiveness, comfort, convenience and ease of use and it "would not interfere with sexual pleasure." The media and physicians were of considerable influence in women's decisions to initiate sponge use, but sexual partners, friends, parents and relatives exerted little influence. The most important reasons for discontinuing use of the sponge were pregnancy, both planned and accidental, and irritation, discomfort or vaginal infection. Women may decide to use the sponge because they have unrealistically positive perceptions of sponge characteristics.