Vaccines and the risk of acute disseminated encephalomyelitis

BackgroundIt is important to examine the risk of Acute disseminated encephalomyelitis (ADEM) after vaccination.MethodsWe conducted a nested case–control study between January 2011 and December 2015. Four controls per case were matched for age, gender, address. An independent expert committee validated the diagnoses of cases and controls. Data on vaccinations were obtained from computerized vaccination records. The analyses were conducted with the use of conditional logistic regression.ResultsThe analyses include 272 cases of ADEM and 1096 controls. No increase in the risk of ADEM was observed for vaccination against hepatitis B, influenza, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, meningitis, hepatitis A, varicella and rabies vaccines. Vaccine was associated with a statistically significant increase in risk in the 31–60-day exposure interval (OR, 4.04 [95% CI, 1.07–12.69]), but not the 0–30 and 61–180-day interval. There was no association between vaccine received and the recurrence of ADEM.ConclusionsFindings from the present study do not demonstrate an association of vaccines with an increased risk of ADEM and its recurrence among either paediatric (≤18 years) or adult (>18 years) individuals within the 180 days after vaccinations. The finding in children in the 31–60 day risk interval is likely coincidental and was not confirmed in separate self-control analyses.     

Infrared thermography to assess dermatomal levels of labor epidural analgesia with 1 mg/mL ropivacaine plus 0.5 µg/mL sufentanil: a prospective cohort study

BackgroundAssessment of the effectiveness of obstetric epidural analgesia may be difficult and techniques for objective assessment of epidural spread of local anesthetic would be useful. In this prospective cohort study we assessed whether obstetric epidural analgesia from a low concentration of ropivacaine led to significant change in cutaneous temperature, related to sympathetic block detected by infrared thermography, at dermatomes C4, T4, T10, L2 and L5.MethodsWomen in spontaneous labor who requested epidural analgesia were consecutively recruited. Epidural analgesia was induced with a bolus of 10–15 mL of ropivacaine 1 mg/mL and sufentanil 0.5 µg/mL, followed by continuous epidural infusion. Skin temperature was measured using thermography before and 20 min after the epidural bolus. The verbal pain score using a numeric rating scale was recorded before and 60 min after the epidural bolus. The upper sensory block to cold sensation was tested 30 and 60 min after the bolus by a physician blinded to the skin temperature. Failed epidural analgesia was defined as verbal pain score >3 at 60 min.ResultsFifty-three parturients were included and analyzed. We found a significant increase in skin temperatures measured at T4, T10, L2 and L5 dermatomes, but not at C4, and a significant difference in the change in skin temperature at T10 between failed (n=3) and successful (n=50) epidural analgesia.ConclusionsThese results suggest that infrared thermography might be useful for the early diagnosis of successful obstetric epidural analgesia.     

产科母婴同室产妇和陪护手卫生的重要性及健康教育有效途径

分析手卫生对于产科母婴同室的重要性,同时结合产科母婴同室临床护理及手卫生健康教育中存在的问题,探讨母婴同室产妇和陪护手卫生健康教育的有效方法途径,如加强护理人员能力培养,提高手卫生综合宣教水平。手卫生健康教育对于保证母婴同室的医疗护理安全具有极其重要的意义,因此要继续采取科学丰富的健康教育形式,向产妇、家属乃至社会更多层面的公众传播手卫生健康知识,以促进广大社会公众建立和养成全新的健康理念和行为习惯。     

Haemostatic changes in diabetic coma

Summary Diabetic coma is frequently associated with thromboembolic complications. A prospective study was undertaken of the haemostatic changes occurring in 15 patients (12 with ketoacidosis, three with the hyperosmolar syndrome) during diabetic coma. When compared with the results after stabilization of the diabetes, ketoacidosis was associated with significantly higher levels of factor VIII coagulant activity, factor VIII-related antigen and fibrin degradation products, a shorter partial thromboplastin time and reduced concentrations of antithrombin III. These results suggest that in uncomplicated ketoacidosis, haematological changes occur which may reflect vascular endothelial damage and intravascular fibrin deposition. Out of three deaths, two patients (both with the hyperosmolar syndrome) had evidence of disseminated intravascular coagulation. To reduce further the mortality and morbidity from diabetic coma, controlled clinical trials of anticoagulant and antiplatelet drugs may be indicated.     

Anal sphincter repair in patients with obstetric trauma

PURPOSE: This study was designed to determine whether advancing age affects the outcome of anal sphincter repair in patients with obstetric trauma and fecal incontinence. METHODS: Anal sphincter repair was performed on 24 patients younger than 40 (median age, 30) years and on 14 patients older than 40 (median age, 57) years. All patients had previous obstetric trauma. RESULTS: Twenty patients younger than 40 years (83 percent; 95 percent confidence interval, 63–95 percent) became continent, or incontinent to flatus only, after anal sphincter repair, whereas four patients had unchanged incontinence. Among patients older than 40 years, six patients (43 percent; 95 percent confidence interval, 18–71 percent) became continent, whereas eight patients remained incontinent (40 percent difference in functional outcome between younger and older patients; 95 percent confidence interval, 10–70 percent). CONCLUSION: Older females have a poorer outcome of anal sphincter repair for obstetric trauma compared with younger females.     

产前健康教育对产妇及新生儿的影响

目的：探讨孕妇在产前给予合理有效的健康教育对孕产妇以及新生儿健康影响分析。方法：选取本院2012年1月-2013年1月收治的220例围产期孕产妇作为研究对象,按照随机数字表法将其分为观察组和对照组各110例,所有孕妇均行基础产前准备与护理,观察组在此基础上在产前给予健康教育。观察比较两组孕产妇生活质量、产后出血量、抑郁程度、满意度之间的差异。结果：观察组产妇待产期生活质量明显高于对照组,产后出血量明显少于对照组,且抑郁程度明显低于对照组,母婴保健知识和对产科服务的满意度均明显高于对照组,差异均有统计学意义（P〈0.05）。结论：在孕妇产前给予合理有效的健康教育服务模式对于提高产科质量具有积极意义,综合护理干预可以有效提高产科护理水平,改善产妇待产期生活质量、降低产后出血量及抑郁水平,提高产妇对于母婴保健知识的掌握程度,增强其对产科服务的评价。     

2012年昆山市产科现状分析与对策

目的：了解全市产科服务现状,以便对各接产机构的产科服务能力与潜力做出客观评价,为卫生行政部门制定缓解产科医疗服务供需矛盾的决策提供依据。方法对全市所有助产服务机构产科资源利用和服务数量进行调查。结果2012年全市共有产科医院11家其中一级医院7家,二级医院2家,三级医院2家。分娩产妇17728人,其中在一级医院、二级医院、三级医院分娩占比分别是15.90%、20.16%、63.94%。产妇分娩与床位比44.32：1,其中一级医院、二级医院、三级医院的产妇分娩与床位比为17.29：1、53.36：1、66.68：1。产科人均助产服务率84,其中一级医院、二级医院、三级医院分别为43、80、113。全市产科人员与床位比为0.91：1。结论产科服务的供需矛盾集中凸显＂结构性＂问题,服务对象集中于三级医院,呈现＂重心上移＂,而使服务资源出现＂超负荷＂与闲置并存现象,急需以＂缓解短期矛盾和解决深层次问题＂双管齐下为原则,从供需两方考虑解决对策。