泰国医院护士长领导作用与护士工作满意度相关性研究

目的 了解泰国医院护士对护士长领导作用的评价及其与护士工作满意度的相关性,为我国护理管理者领导作用的变革性观念提供参考.方法 对泰国沙缴省立医院145名护士采用自设的护士对护士长领导作用的评价量表及护理工作满意度调查表进行调查.结果 泰国沙缴省立医院护士对护士长领导作用的评价及护士工作满意度均为中等偏上水平,两者呈显著正相关(P<0.01).结论 泰国医院护士对护士长的领导作用评价较高,其领导作用在某种程度上影响看护士工作满意度.我国护理管理者可借鉴泰国医院护士长管理经验,通过改进管理方法 ,更好地发挥领导职能,以提升护士工作的满意度.     

Depot-medroxyprogesterone acetate (dmpa) and risk of edometrial cancer

This is a report of results from a case-control study of the relationship of the long-acting progestational contraceptive, depot-medroxyprogesterone acetate (DMPA) to risk of endometrial carcinoma. Prior use of DMPA and information on known and suspected risk factors for endometrial cancer were ascertained in personal interviews with 122 women with histologically confirmed disease and 939 controls selected from 2 hospitals in Bangkok and 1 in Chiang Mai, Thailand. Based on 3 exposed cases and 84 exposed controls, the relative risk of endometrial cancer was estimated to be 0.21 (95% confidence interval = 0.06,0.79) in women who had ever used DMPA (but who had not first used DMPA in the year prior to diagnosis). All 3 exposed cases had also received estrogens pre-menopausally. Exposure to such estrogens enhanced risk of endometrial cancer and reduced the apparent protective effect of DMPA. Although based on small numbers of exposed women, the protective effect of DMPA appeared to last for at least 8 years after cessation of use. The reduction in risk of endometrial cancer is at least as great for DMPA as for combined oral contraceptives.     

A population-based study of prevalence of Down syndrome in Southern Thailand

Background

Down syndrome (DS) is the most common chromosomal disorder that causes mental retardation. In 2009, a population-based birth defects study was implemented in three provinces in southern Thailand. This study aimed to determine the prevalence of DS in the studied regions, and the proportion of DS fetuses detected by prenatal screening.

Methods

Data were obtained from a population-based surveillance study undertaken during 2009-2013. Entries in the birth defects registry included live births, stillbirths after 24 weeks gestational age, and terminations of pregnancy following prenatal diagnosis. Infants with clinical characteristics of DS had a chromosomal study to make a definite diagnosis.

Results

Of the total 186 393 births recorded during the study period, 226 DS cases were listed, giving a prevalence of 1.21 per 1000 births [95% confidence interval (CI) 1.05-1.37]. The median maternal age was 36.5 years with a percentage of maternal age ≥35 years of 60.6%. Seventy-seven cases (34.1% of all cases) were diagnosed prenatally and these pregnancies were terminated. The prevalence of DS per 1000 births was significantly higher in older women, from 0.47 (95% CI 0.28-0.67) in mothers aged <30 years to 0.88 (95% CI 0.59-1.17) in mothers 30-<35 years (P<0.01), and to 4.74 (95% CI 3.95-5.53) in mothers ≥35 years (P<0.001).

Conclusions

The prevalence of DS significantly increased with maternal age. About 35% of DS cases were detected prenatally and later terminated. Hence, examining only registry live births will result in an inaccurate prevalence rate of DS.

     

Topical psoralen photochemotherapy (PUVA therapy) for severe atopic dermatitis (I): An analysis of correlation between effectiveness of PUVA therapy and clinical parameters

Twenty-five patients with severe atopic dermatitis (AD) were subjected to PUVA therapy (topical 8-MOP application plus UVA irradiation). Excellent resolution was achieved in 18 cases (72%). Complete remission lasting 6.3 months in average was gained. In addition, the correlation between effectiveness of PUVA therapy and clinical parameters was statistically analyzed. As a result, an effectiveness of PUVA on AD was well correlated with sex (female), lower minimal phototoxic dose, higher severity and higher blood eosinophil counts. On the other hand, such correlation with the effectiveness was little in serum IgE levels, IgE.RAST scores to the house dust antigens and total irradiation doses.     

Ultrastructure of cholangiocarcinoma associated with opisthorchiasis.

An electron microscopic study was carried out on eleven surgical liver biopsy specimens obtained from patients with cholangiocarcinoma associated with opisthorchiasis. The tumor cells of histologically well differentiated cholangiocarcinoma had few cytoplasmic organelles. They contained relatively large nuclei, abundant free ribosomes and numerous groups of fine fibrils. Each cell was surrounded by a basement membrane. Numerous long microvilli were seen projecting into the glandular lumen. The moderately differentiated cholangiocarcinomatous cells exhibited increased organelle content, marked variation in the shape of the nuclei with deep cytoplasmic invagination into the nuclear membrane; there were small intranuclear pseudoinclusions, and shorter microvilli. The tumor cells showed intracellular microvillus-lined spaces, abundant free ribosomes, many fine fibrils and their surrounding basement membranes were incomplete. The ultrastructure of the poorly differentiated cholangiocarcinoma was similar to that of the moderately differentiated tumor, except for fewer microvilli, abundant cytoplasmic organelles, and ill-defined or absent basement membrane.     

Emergency splenectomy in adult idiopathic thrombocytopenic purpura. A report of seven cases

Seven adult patients with idiopathic thrombocytopenic purpura underwent emergency splenectomy. Six were female and one was a male, aged 16 to 61 years. All of them had a life-threatening episode. Six patients had progressive intracranial bleeding and one had postsurgical intra-abdominal bleeding. All patients were saved by surgery, except one for whom operation was delayed. There was no postoperative bleeding or surgical complication. Immediate splenectomy should be the treatment of choice in any patient with idiopathic thrombocytopenic purpura complicated by life-threatening hemorrhage.     

Measuring herpes zoster, zoster-associated pain, post-herpetic neuralgia-associated loss of quality of life, and healthcare utilization and costs in Thailand

Objectives This study aimed to measure the herpes zoster‐associated burden of illness, healthcare utilization, and costs among Thai patients. Methods This prospective cohort study of 180 patients aged ≥ 50 years and healthy, or ≥ 20 years and immunosuppressed, with zoster rash, was conducted in Bangkok and its environs, Thailand, during 2007–2008. Each patient was followed for six months for zoster‐associated rash, pain, quality of life (QoL), and healthcare utilization and costs. Results A total of 180 subjects were enrolled in the study. Their mean ± standard deviation (SD) age was 58.9 ± 13.8 years. Of the 180 patients enrolled, 138 (76.7%), 34 (18.9%) and eight (4.4%) patients were elderly, HIV‐infected, and receiving immunosuppressive agents, respectively; 35 (19.4%) had post‐herpetic neuralgia (PHN), and 13 (7.2%) had zoster ophthalmicus. The severity of zoster pain was moderately highly correlated with activities of daily living (ADL), at 0.68 ≤ ρ ≤ 0.76. Most patients required only one or two outpatient visits. The mean ± SD total of direct healthcare costs was 3083.4 ± 5047.0 Thai baht or ～ 1.1% of annual income per capita. Conclusions Herpes zoster contributes a significant burden of illness to both patients and the wider community.