193所医院医院感染现患率调查分析

目的：为了解我国医院感染现患率。方法：卫生部全国医院感染监控管理培训基地，组织全国医院感染监控网单位对各单位住院患者2001年6月，27日零时对24时医院感染现患率进行调查，参加调查医院按每50张床位配备1名调查人员，每3－4人1组，采用卫生部《医院感染诊断标准》，对所有住院患者医院感染进行床旁逐个调查和病案调查相结合，结果：共收到197所（70．4％）医院的调查资料，医院感染现患率部分可用资料193份；本次共调查患者107496人，占应查住院患者数（110021）的97．70％，发同医院感染5614人，6001例次，医院感染现患率在4％－8％的医院109所（56．5％）；排在前5位的医院感染衣次为呼吸道感染（48．7％）、泌尿道感染（12．8％）、手术部位（11．9％），胃肠道感染（10．9％）和皮肤软组织（6．7％）。结论：我国人次现患率和例次现患率分别为5．22％和5．58％，大多数医院的医院感染现患率在4％－8％之间，常见的医院感染为呼吸道、泌尿道、手术部位，胃肠部和皮肤软组织感染。     

医院感染横断面研究报告

目的 探讨横断面调查的优势，评价日常监测资料的准确性。方法 采用横断面调查方法，床旁调查和病历调查相结合，调查我院1d的医院感染现患率。结果 调查住院患者1137人，现患率为7．04％，例次现患率为7．83％；重症监护病房的现患率最高为33．33％；下呼吸道感染占28．09％，泌尿道感染占14．60％，手术部位感染占13．49％；年龄＜2岁和＞60岁、泌尿道插管、动静脉插管、免疫抑制剂、激素、化疗、手术切口污染程度是医院感染的高危因素；日抗菌药物使用率为59．3％。结论 横断面调查简单、方便，节省人力，资料更准确。     

重庆市万盛区某医院院内感染现状调查

目的 为了解重庆市万盛区某医院感染的基本情况，制定有效减少医院感染的措施。方法 于2005年2～4月对该院15个科室住院病人全体进行普查。结果 共调查754例病人，发现医院感染病例26人，现患率3．45％。各科室感染现患率神经外科最高（13．80％），其次为高干病房（12．50％）与泌尿外科（11．70％），感染部位主要为下呼吸道、手术切口及泌尿道。结论 与医院感染有关的危险因素主要有侵入性操作、免疫抑制治疗、手术、入ICU、抗生素滥用及年龄等，需制定综合性预防措施，控制医院感染。     

某院医院感染现患率调查分析

对某院2005年7月28日0：00-24：00所有住院患者进行医院感染现患率调查。共调查383例患者，发生医院感染24例，医院感染现患率为6．27％；医院感染部位依次为下呼吸道（33．33％）、泌尿道（25．00％）、皮肤软组织（20．83％）等；检出病原菌14株，以革兰阴性菌为主，其中大肠埃希菌4株，沙雷菌属、肠杆菌属各3株，克雷伯菌属、铜绿假单胞菌、变形杆菌属、腐生葡萄球菌各1株；抗菌药物使用率为55．61％。     

中医病种医院感染监测资料分析

目的 了解中医病种医院感染状况及影响因素。方法 对2004年1～12月医院住院患者进行现患调查与回顾性调查相结合。结果 医院感染率6．18％，例次感染率为6．95％，高发时间段平均入院约23d；医院感染部位分布以下呼吸道多见，占41．79％，其次为泌尿道24．78％、上呼吸道12．54％；中医病种中的虚劳、积证、岩证、中风病是全院感染发病率（按感染例次率排序）较高病种；医院感染的高危因素以老年患者为主。结论 医院感染率高，与多种因素有关，应分别采取针对性措施预防，以减少医院感染的发生。     

某三甲医院2014—2018年医院感染现患率调查

目的 了解医院感染的实际情况及变化趋势，分析医院感染的危险因素。方法 选取某三级甲等医院，采用横断面调查方法，2014-2018年每年调查一次，调查期为1日，调查对象为当日全部在院和出院患者，统计分析5年医院感染资料。结果 共调查患者9 718例，医院感染现患率为4.55%，例次现患率为5.01%，五年医院感染现患率及例次现患率均呈逐年下降趋势，差异均有统计学意义（均P<0.001）。医院感染部位以下呼吸道为主，193例次，占39.63%，其次分别为手术部位（75例次，15.40%）、泌尿道（65例次，13.35%）和上呼吸道（29例次，5.95%）。医院感染现患率最高的科室为血液科（15.73%），例次现患率最高的为重症监护病房（16.72%）。共检出医院感染病原体414株，其中革兰阴性菌258株，革兰阳性菌112株，真菌38株，其他病原体6株。最常见的病原体为铜绿假单胞菌（51株），其次为大肠埃希菌（49株）、鲍曼不动杆菌（43株）、金黄色葡萄球菌（43株）和肺炎克雷伯菌（42株）。结论 医院感染现患率调查有助于了解医院感染发生情况，器械相关感染和手术部位感染是医院感染防控的重点。     

医院感染现患率调查资料分析

目的 探讨医院感染现患率调查资料的意义及开展医院感染现患率调查的经验、教训，为今后医院感染现患率调查积累经验。方法 对3次医院感染现患率调查资料之间，并与相应月份医院感染前瞻性全面综合性监测资料进行对比分析。结果 3次医院感染现患率分别为5．43％、5．01％、5．48％，差异无统计学意义（P〉0．05）；其相应3个月份前瞻性全面综合性监测医院感染发病率分别为5．47％、7．04％、6．95％，差异无统计学意义（P〉0．05）；3次医院感染平均现患率为5．23％，相应3个月份前瞻性全面综合性监测的平均医院感染发病率为6．60％，差异有统计学意义（P〈0．05）。结论 医院感染现患率调查尚不能完全取代医院感染前瞻性全面综合性监测，采取医院感染现患率调查与目标性监测相结合的方式，进行医院感染病例调查的时机尚不成熟。     

178所医院医院感染危险因素调查分析

目的 了解我国医院感染现息情况和危险因素。方法 采取床旁调查和同期住院病历调查相结合的方法，调查1天的所有住院病人医院感染患病情况。结果 共收到可用资料178份，病人现患率和感染例次现患率分别为5．36％(5466／101991)和5．73％(5843/101991)；ICU的现患率最高(26．17％)；不同性别、年龄，是否有泌尿道插管、动静脉插管、使用呼吸机、气管切开、血液透析、免疫抑制剂、激素、放疗、化疗，切口污染程度，基础疾病数等都与医院感染有关；气管切开(RR＝7．55)、使用呼吸机(RR＝3．24)、泌尿道插管(RR＝2．55)、动静脉插管(RR＝2．37)等相对危险度较高；引起医院感染的病原体中铜绿假单胞菌最多(12．38％)，其次为白色念珠菌10．83％)。结论 ICU的现患率较高；铜绿假单胞菌、白色念珠菌是常见病原体；侵入性操作是重要危险因素。     

医院感染现患率调查与分析

目的了解医院感染情况,为进一步做好医院感染工作提供科学依据。方法2010年10月25日0：00－24：00的所有住院患者进行现患率调奇;采取床边调查和翻阅病历相结合的方法。结果医院感染现患率为1．15％。感染率高的科室是神经内科和神经外科;感染部位为下呼吸道（54．55％）、上呼吸道（9．09％）、泌尿道（18．18％）、表浅切口和其它（9．09％）。抗菌药物使用率为54．33％0。结论现患率调查中神经内科、神经外科、肿瘤内科等感染率高的科室将作为医院感染管理的重点科室进行监控,调整监测方案,加强目标性监测管理,控制院内感染的发生。     

重症监护病房医院感染流行病学调查及预防

目的：探讨重症监护病房（ICU）医院感染流行病学的特征和相关因素，为预防控制医院感染提供依据，方法：对2002年1月～2004年12月收治的319例ICU患者进行医院感染回顾性调查。结果：ICU医院感染发生率17，24％，常见感染部位前5位的是下呼吸道感染50．9l％、上呼吸道感染20．00％、泌尿道感染9．09r‰、胃肠遭感染7．27％、血液感染5，45％；分离出病原菌29株，革兰阴性菌占62．07％；居前3位的是假单胞菌31．03％、金黄色葡萄球菌20．69％、不动杆菌17，24％；医院感染的危险因素是使用呼吸机、泌尿道插管、动静脉插管、留ICU时间长。结论：ICU医院感染发生率高；病原菌以革兰阴性菌为主；应针对相关危险因索和常见医院感染进行预防。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.