Zum Einfluß von Operationszeitpunkt und Kliniksorganisation auf die postoperativen Komplikationen

Zusammenfassung Über ein Jahr wurden 1082 allgemeinchirurgische Planeingriffe prospektiv konsekutiv erfaßt und ihre Komplikationen mit einem Score bewertet. EinflußgröBen und die Komplikationsraten, die unter Umständen von der Kliniks-organisation abhängig sind, sollten analysiert werden. Es fand sich eine Beziehung zwischen Komplikationen und Wochentag, Operationsdauer sowie der Abweichung der tatsächlich benötigten von der geplanten Operationszeit. Mit höherer Auslastung der Operationssäle pro Arbeitstag stiegen die Komplikationsraten ebenfalls an.Keinen Einfluß auf die Komplikationsraten hatten Operationsbeginn und-monat sowie die monatliche Auslastung der Säle. Ob das Wetter einen Einfluß auf die Komplikationsraten nahm, konnte nicht entschieden werden: so fanden sich im Sommer- höhere Komplikationsraten als im Winterhalbjahr, jedoch war der Score von der Höhe der Außentemperatur und der Luftfeuchtigkeit unabhängig.

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The influence of time of operation and hospital organization on postoperative complication rates

Summary During a 1-year period 1082 general surgical interventions were prospectively documented and their complication rates evaluated by a score system. Factors responsible for the complication rates and possibly depending on hospital organization should be analysed. The complication rates were influenced by the selection of the weekday, the length of operation time and the extent of discrepancy between planned and required operation time. Furthermore, the complication rates paralleled the extent of utilization of the operation theatre during a workday. The complication rates werenot affected by the beginning of operation and the operation month as well as the monthly utilization of the operation theatres. Whether the weather did influence the complication rates could not be decided: higher complication rates were found in the summer as compared to the winter period, but the complication score was independent of the level of the outside temperature and humidity.

     

医疗卫生机构气候韧性和环境可持续评价工具研究进展

目的 气候变化给医疗卫生机构带来诸多不确定性威胁,医疗卫生机构亟需提高自身的气候韧性并采取积极的应对措施,如何系统评价医疗卫生机构应对气候变化的能力成为应对气候变化挑战的工作重点。方法 使用范围综述筛选医疗卫生机构气候韧性和环境可持续评价工具相关文献和最新进展,并对密切相关的文献采用引文检索拓展研究范围。结果 借鉴国际经验已开发出适用于我国的《绿色医院建筑评价标准》,但对于医疗卫生机构气候韧性的指南和要求仍在探索中。国际上已经发展了三套较完整的工具包和指南,并已探索性开展了实地应用,包括加拿大的医疗卫生机构气候变化韧性工具包、美国的可持续和气候韧性医疗卫生机构工具包,以及世界卫生组织的气候韧性和环境可持续性的医疗卫生机构指南。结论 医疗卫生机构气候韧性和环境可持续能力评价工具构建是开展脆弱性评估和干预的基础,应积极借鉴国外相关经验开发适宜我国的评价工具,以增强机构和人员应对气候变化的能力。     

Un sistema de vigilancia de salud pública para el cambio climático en las ciudades

This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field.     

环境因子对我国卵形硬蜱适生区分布的影响研究

目的 探索影响卵形硬蜱适生区分布的环境因子及未来环境变化对卵形硬蜱适生区分布的影响.方法 通过文献检索获取我国已知卵形硬蜱分布点数据,结合环境因子数据,运用最大熵模型对卵形硬蜱适生区分布进行模拟,并根据2050、2070年环境数据对卵形硬蜱适生区分布变化进行预测.结果 目前我国卵形硬蜱适生区面积为311.0万km2,占...     

气候变化对鼠传疾病的影响研究

气候多样性和气候变化对于啮齿类动物传播疾病的潜在影响,相比于蚊类等其他媒介传播的疾病更具不确定性,所受关注也较少。但是鼠类作为一种重要的媒介生物,其传播的疾病比如因携带鼠疫耶尔森菌而引起的鼠疫,对人类健康构成的严重威胁却不容忽视。气候变化影响了鼠类传播传染病宿主、媒介的生长发育,改变了鼠疫等传染病的流行、传播和分布。本文拟对近年来气候变化之下鼠类传染病流行特点的变化做一综述,为公共卫生决策部门制定科学防控措施提供可借鉴经验。     

基于Bayesian-INLA的宏观因素对手足口病疫情的时空响应分析

目的分析中国大陆31个省市手足口病的发病情况,从宏观角度探讨气象和社会经济因素与手足口病的时空变化关系。方法收集并整理2016年12个月份手足口病数据和宏观因素指标,利用负二项广义可加时空模型进行建模,并在贝叶斯分层结构框架下运用嵌套拉普拉斯逼近(Bayesian-Integrated Nested Laplace Approximation)方法估计模型。结果分析结果显示,在气象和社会经济因素中,平均气温的影响最为显著(RR=2.8775,95%CI:2.3305~3.5516),手足口病的发病相对危险呈双高峰模式,其中5、6月以及11、12月发病相对危险较高,且手足口病的发病相对危险呈空间异质性。结论手足口病的发病相对危险的时空特性需引起重视,建议相关部门加强对重点地区的预防,并将季节变换时期做为重点防控时期,谨防气象因素变化尤其是气温变化导致手足口病疫情的恶化。     

Wastewater irrigation and environmental health: implications for water governance and public policy

Climate change is a large-scale and emerging environmental risk. It challenges environmental health and the sustainability of global development. Wastewater irrigation can make a sterling contribution to reducing water demand, recycling nutrients, improving soil health and cutting the amount of pollutants discharged into the waterways. However, the resource must be carefully managed to protect the environment and public health. Actions promoting wastewater reuse are every where, yet the frameworks for the protection of human health and the environment are lacking in most developing countries. Global change drivers including climate change, population growth, urbanization, income growth, improvements in living standard, industrialization, and energy intensive lifestyle will all heighten water management challenges. Slowing productivity growth, falling investment in irrigation, loss of biodiversity, risks to public health, environmental health issues such as soil salinity, land degradation, land cover change and water quality issues add an additional layer of complexity. Against this backdrop, the potential for wastewater irrigation and its benefits and risks are examined. These include crop productivity, aquaculture, soil health, groundwater quality, environmental health, public health, infrastructure constraints, social concerns and risks, property values, social equity, and poverty reduction. It is argued that, wastewater reuse and nutrient capture can contribute towards climate change adaptation and mitigation. Benefits such as avoided freshwater pumping and energy savings, fertilizer savings, phosphorous capture and prevention of mineral fertilizer extraction from mines can reduce carbon footprint and earn carbon credits. Wastewater reuse in agriculture reduces the water footprint of food production on the environment; it also entails activities such as higher crop yields and changes in cropping patterns, which also reduce carbon footprint. However, there is a need to better integrate water reuse into core water governance frameworks in order to effectively address the challenges and harness the potential of this vital resource for environmental health protection. The paper also presents a blueprint for future water governance and public policies for the protection of environmental health.     

麻黄加术汤对寒湿环境下小鼠脾淋巴细胞增殖能力作用的实验研究

目的探讨寒湿环境因素对正常及呼吸道合胞病毒感染小鼠脾淋巴细胞增殖能力的影响以及麻黄加术汤的治疗作用。方法借助人工气候箱模拟寒湿外邪环境,通过体外细胞培养、MTT法检测脾淋巴细胞增殖能力的变化,分析寒湿外邪及麻黄加术汤对病毒感染小鼠免疫状态产生的影响。结果与正常组比较,病毒组和寒湿组均使小鼠脾淋巴细胞增殖能力显著下降（P〈0．001）。与病毒模型组和寒湿病毒模型组分别比较,麻黄加术汤和利巴韦林均使小鼠脾淋巴细胞的增殖能力显著升高（P〈0．001）;与病毒＋麻黄加术汤组比较,寒湿病毒＋麻黄加术汤组显著降低（P〈0．05）。结论寒湿环境对上呼吸道感染小鼠脾淋巴细胞增殖能力的影响较呼吸道合胞病毒滴鼻更加显著。麻黄加术汤可提高小鼠的免疫功能,而其对寒湿病毒所致小鼠脾淋巴细胞的增殖能力降低的改善不及病毒所致,可能是由于寒湿病毒较病毒使小鼠脾淋巴细胞的增殖能力降低更显著所致。     

The potential health impacts of climate change: An overview

Climate change would have a range of impacts on human health. Health impacts would be caused by the direct effect of climatic factors on human health, such as heat stress, and possible changes in the frequency and intensity of extreme weather events such as storms, floods and droughts. Impacts on health would also be mediated by the indirect effects of climate change, such as changes in availability of food and water and the distribution of vector‐borne diseases. The majority of health impacts would be adverse and would depend greatly on the vulnerability of populations.     

Climate and socioeconomic influences on interannual variability of cholera in Nigeria

Cholera is one of the most important climate sensitive diseases in Nigeria that pose a threat to public health because of its fatality and endemic nature. This study aims to investigate the influences of meteorological and socioeconomic factors on the spatiotemporal variability of cholera morbidity and mortality in Nigeria. Stepwise multiple regression and generalised additive models were fitted for individual states as well as for three groups of the states based on annual precipitation. Different meteorological variables were analysed, taking into account socioeconomic factors that are potentially enhancing vulnerability (e.g. absolute poverty, adult literacy, access to pipe borne water). Results quantify the influence of both climate and socioeconomic variables in explaining the spatial and temporal variability of the disease incidence and mortality. Regional importance of different factors is revealed, which will allow further insight into the disease dynamics. Additionally, cross validated models suggest a strong possibility of disease prediction, which will help authorities to put effective control measures in place which depend on prevention, and or efficient response.