Total versus tube-related additional work of breathing in ventilator-dependent patients

BACKGROUND: In tracheally intubated or tracheostomized spontaneously breathing patients, tube resistance can highly increase the patient's work of breathing. In this study we focused upon the relationship between total (WOBtot) and tube-related additional inspiratory work of breathing (WOBadd) and compared different ventilatory modalities for proper tube compensation. METHODS: In ten tracheostomized spontaneously breathing patients we measured WOBtot and WOBadd in the continuous positive airway pressure (CPAP) mode, under inspiratory pressure support of 5, 10, and 15 cmH2O in the pressure support ventilation (PSV) mode, and under flow-adjusted pressure support in the automatic tube compensation (ATC) mode. WOBadd and WOBtot were calculated on the basis of measured tracheal pressure and esophageal pressure, respectively. Inspiratory peak tracheal pressure above PEEP was taken as an estimate of pressure support beyond mere tube compensation (i.e., overcompensation). RESULTS: The percentage of the tube-related WOBadd on WOBtot in the CPAP mode was 52%. It decreased with increasing pressure support in the PSV mode from 32% (PSV 5 cmH2O) to 17% (PSV 15 cmH2O). WOBadd was only 15% of WOBtot in the ATC mode. In contrast to the other ventilatory modes, reduction of WOBadd in the ATC mode was achieved with the smallest amount of overcompensation, i.e. with minimal pressure assist beyond mere tube compensation. CONCLUSION: In tracheally intubated or tracheostomized spontaneously breathing patients, adequate compensation of tube resistance (i.e. with minimal overcompensation and minimal undercompensation) is best done by the ATC mode.     

高校医院改革应与学校卫生工作相适应

高校医院是保障教学科研、稳定教学秩序、全面推进素质教育、推动学校发展不可缺少的一环,重心是在医疗保健 服务、健康咨询及就医指导上,这与单纯承担医疗任务看病收费的社会医院有很大的不同.高校医院改革应与学校卫生保健需求相适应,以学校卫生工作的根本任务为中心,不能简单地与学校其他后勤部门一样纳入后勤社会化管 理.校医工作是搞好学校卫生工作的关键,只有不断提高校医的业务水平,才能更好地促进学校卫生工作的开展, 使学校卫生工作真正起到服务于培养合格人才的作用.     

职业紧张对化工工人工作能力的影响

目的　为了解化工工人的职业紧张水平及工作能力状况 ,探讨影响工作能力的相关性因素。方法　应用工作能力指数问卷 (WAI)和职业紧张问卷 (OSQ) ,对某市化工行业10 30名工人 (研究组 4 81名 ,对照组 5 49名 )进行调查和工作能力降低的危险度评价。结果　研究组的WAI和OSQ评分与对照组均有显著性差异 (P <0 0 1)。两组的工作能力与职业紧张均存在显著的负相关关系 (P <0 0 1) ,研究组的相关程度明显高于对照组 ,且工作能力随着紧张程度的增高而降低。研究组工人随年龄的增长工作能力逐渐降低。以工作能力降低为结局变量 ,经多元logistic回归分析显示 ,在研究组中引起工作能力降低的主要紧张危险因素是肌肉骨骼疼痛 (OR =2 884 )、健康状况估计 (OR =2 6 5 1)、疾病的影响 (OR =2 4 98)、情绪情况 (OR =2 4 0 7)、缺乏体育锻炼 (OR =1 95 6 )、体力负荷 (OR =1 2 5 4)等 ,这些紧张因子都与工作能力降低有密切关系。结论　化工工人的职业紧张水平及不同紧张因素对工作能力降低有一定的影响 ,为工人的健康监测和提高工作能力水平提供了有益的帮助。     

Don’t Have No Time: Daily Rhythms and the Organization of Time for Low‐Income Families*

Using ethnographic data from Welfare, Children, and Families: A Three‐City Study, we examined time obligations and resource coordination of low‐income mothers. Longitudinal data from 75 African American, Hispanic, and non‐Hispanic White families residing in Chicago, including information on daily routines, perceptions of time, and access to resources, were gathered via participant observation and intensive semistructured interviews over 4 years. Results indicated that families constantly improvised daily rhythms to obtain and sustain resources, including child care, transportation, and social services. Participants were proactive in identifying and coordinating resources to transition from welfare to work or to maintain paid employment. Strategies used to coordinate resources and the cost associated with the inability to do so are discussed. Policy and social service recommendations are offered.     

New‐Concept Part‐Time Employment as a Work‐Family Adaptive Strategy for Women Professionals with Small Children*

This study investigates how the option for new‐concept part‐time (NPT) employment influences the ability of mothers of preschool children working in professional occupations to successfully integrate work and family responsibilities. Female NPT professionals (n = 279) and female full‐time (FT) professionals (n = 250) were compared. The NPT group reported 20 fewer weekly work hours and about $18,000 less estimated annual household income than the FT group. They allocated this additional time primarily to caring for and nurturing their dependent children. They also reported less job‐related travel, unnecessary work, and work‐to‐family conflict, as well as greater work‐family success, childcare satisfaction, and family success. However, NPT mothers reported a more traditional division of labor in household responsibilities and less career opportunity and work success. Implications are presented and discussed.     

Spectacle use and reduced unaided vision in third grade students: a comparative study in different educational settings

Background: The development of myopia is influenced by hereditary factors, environmental factors and geneenvironment interaction. Reading and near‐work activity are associated with myopia and myopic progression. This study sought to determine and compare the prevalence of reduced unaided vision and spectacle use among third grade Israeli students from three different educational settings. Method: A sample of 917 students (mean age 8.5 years, range seven to 10 years) was drawn from the three Israeli educational streams: secular, Orthodox and ultra‐Orthodox. Children in the ultra‐Orthodox education pathway begin studying at the age of three years and their daily reading involves sustained near work with increased accommodative effort accompanied by head‐rocking movements. Reduced distance vision was used to indicate the likely development of or an increase in the amount of myopia. Spectacle lenses were measured to determine the prevalence of myopia. Results: Of the 917 students studied, 103 (11.2 per cent) wore spectacles (14.2 per cent of the males and eight per cent of the females); 82.5 per cent of those who wore spectacles were myopic. Males from ultra‐Orthodox schools had the highest rate of reduced unaided vision (72.5 per cent) compared with males from secular schools (27.3 per cent), males from Orthodox schools (59.3 per cent) or with females from all three groups (average of 34.8 per cent, p < 0.0001, chi squared). Males had a higher rate of reduced unaided vision, especially in the Orthodox and ultra‐Orthodox schools. Conclusions: Our study suggests that Jewish ultra‐Orthodox males have a higher prevalence and degree of myopia. The study habits of young children, including exposure to prolonged near tasks, high accommodative demands and possibly optical defocus induced by body sway, may contribute to the development of myopia.     

焦炉作业与代谢综合征的相关性研究

[目的]探讨焦化厂焦炉作业与代谢综合征之间的相关性。[方法]以焦炉作业工人为研究对象,选取男性焦炉作业工人432名,其中炉顶工208名、炉侧工161名和炉底工63名。112名对照选自机电车间工人。检测所有研究对象的身高、体重、血压、血糖、高密度脂蛋白以及三酰甘油水平,按照中华医学会糖尿病分会(CDS)建议的标准诊断代谢综合征。[结果]采用多元Logistic回归分析对各组间年龄、工龄、吸烟和饮酒状况等因素进行校正后,发现炉顶组及炉侧组与对照组相比患代谢综合征的危险度升高,调整OR值分别为3．33(95％可信区间为1．07-10．34)和3．43 (95％可信区间为1．13-10.37);且炉顶组及炉侧组高血压患病率也显著高于对照组(P<0．05),而炉底组危险度未见升高。[结论]炉顶和炉侧作业可增加该作业人群患代谢综合征的危险度。     

社会工作对医疗纠纷的介入初探

当前医疗纠纷事件频繁发生，其解决主要还是通过法律调解、行政仲裁以及医患双方直接协商解决等传统方式。作为一种以利他主义为指导的专业助人服务活动，社会工作则提供了一种介入医疗纠纷问题的新的视角，而且独具的性质、专业的理念和科学的方法充分保证了其所拥有的优势和可行性，但是这种新的介入方式在我国的发展还面临着诸多困难。     

医院工作质量的灰色综合评判

目的介绍改进的灰色综合评判法，并用该法评判医院工作质量，为提高医院的管理、服务水平提供科学依据。方法选用9项指标和不同的权重，利用灰色综合评判法对医院工作质量进行综合评价。结果综合评判出了医院不同年度的医疗质量水平，找出了差异及原因。结论应用灰色综合评判法评判医院工作质量，原理简单，计算简捷，结果客观可靠。     

外出打工者肺结核病危险因素分析

目的 分析外出打工者肺结核病危险因素。方法 采用病例对照研究，选取51名近3年具有外出打工史的25～60岁的涂阳肺结核病人为病例组，同时从病例住所左右邻居中选取57名年龄在25～60岁之间、近3年有外出打工史的健康人作对照；制定统一的调查表进行入户调查；采用非条件Logistic回归进行分析。结果单因素分析显示，有统计学意义（P〈0．05）的因素有工作场所条件不舒适、每天工作时间较长（〉8h）、每周无休息日、不能按时吃饭，以及婚姻史中的单身、不良嗜好中的吸烟2个因素。其OR值分别为4．80，4．56。3．96。3．94，4．53，2．72；多因索分析进入模型的因素（P〈0．05）有工作场所条件不舒适、每天工作时间较长（〉8h）、每周无休息日以及婚姻史中的单身，其OR值分别为3．82．4．45，3．30，5．61。结论工作场所条件不舒适、每天工作时间超过8h、每周没有休息日是外出打工者肺结核病的危险因素；改善打工者的工作环境、维护打工者的合法休息时间，有助于保障外出打工者的身体健康及结核病疫情的控制。