AF-A低噪音阻菌式输氧器和传统氧气湿化瓶使用分析

目的 探讨传统的氧气湿化瓶导致医院感染的途径,选择安全、有效控制医源性感染的吸氧设施. 方法 分别对51例呼吸道感染患者痰液、37例使用传统氧气湿化瓶吸氧的湿化瓶、98例使用一次性AF-A低噪音阻菌式输氧器,使用1～6 d后进行细菌培养. 结果 51例医院感染患者中使用传统氧气湿化瓶的细菌培养与患者痰液培养的病原菌结果有明显的一致性,痰培养检测到铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌,分别占21.43%、21.43%、10.71%、3.57%;湿化瓶检测到铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌,分别占34.78%、21.74%、8.69%、13.05%,而AF-A低噪音阻菌式输氧器使用4 d内无细菌生长,安全使用期为5 d. 结论 传统氧气湿化瓶易被细菌污染,是导致医源性呼吸系统感染的危险因素,而使用一次性AF-A低噪音阻菌式输氧器可防止因氧气湿化瓶污染引起的医院感染.     

重症监护病房下呼吸道获得性感染的细菌及耐药性分析

目的了解重症监护室(ICU)下呼吸道感染的细菌及耐药情况,为临床治疗及ICU感染的控制提供依据。方法将1250份痰标本进行培养,分离出139株细菌并采用法国生物梅里埃公司细菌鉴定仪鉴定。结果139株细菌中,G-杆菌127株(占91.37%),G 球菌12株(占8.63%);G-杆菌中铜绿假单胞菌的检出率为36.69%、肺炎克雷伯菌为17.27%、阴沟肠杆菌占10.0%、产气肠杆菌为8.63%、鲍曼不动杆菌为5.76%、大肠埃希菌为5.76%。G 球菌(金黄色葡萄球菌)检出率为8.63%。结论下呼吸道感染的致病菌以G-杆菌为主,感染菌的耐药性高,临床上及时掌握病原菌变化规律及耐药情况,可以更有效地预防和治疗ICU获得性感染。     

综合ICU氧气湿化瓶污染细菌与医院感染关系分析

目的调查综合ICU氧气湿化瓶污染细菌,分析氧气湿化瓶与医院感染的关系,为防范医院感染提供依据。方法采集感染、非感染患者使用后和安装未使用共3组氧气湿化瓶标本和呼吸道感染患者痰液标本,对其细菌进行分离鉴定,分析常见细菌的耐药率。结果感染组和非感染组氧气湿化瓶的污染率分别为86.79%和79.25%,两者比较,差异无统计学意义,与安装未使用组(30.18%)比较,差异有统计学意义;氧气湿化瓶和患者下呼吸道痰液分离的细菌以革兰阴性菌为主,分别占64.81%和75.38%,两者的细菌分布差异有统计学意义(P<0.05);而湿化瓶之间的细菌谱差异无统计学意义;感染患者下呼吸道痰液培养的细菌耐药率远高于氧气湿化瓶培养的细菌耐药率,差异有统计学意义(P<0.01)。结论氧气湿化瓶污染是重症监护病房患者医院感染的一个不可忽视的因素,定期更换氧气湿化瓶对于防治因其导致的医院感染至关重要。     

长春市老年人下呼吸道感染常见革兰阴性杆菌耐药监测

目的:了解长春市老年人下呼吸道感染常见革兰阴性杆菌(G-杆菌)的耐药情况.方法:采用VITEK-2全自动细菌鉴定仪进行细菌鉴定;药物敏感试验使用K-B法;采用WHONET软件对耐药数据进行分析.结果:共分离G-杆菌910株,以铜绿假单胞菌210株(23%)占首位,大肠埃希菌190株(21%)次之,克雷伯菌170株(19%),鲍曼不动杆菌100株(11%),其他阴性杆菌240株(26%).所有阴性杆菌对抗菌药物的耐药率由低至高依次为亚胺培南5.6%;美罗培南6.6%;头孢派酮/舒巴坦12.9%;派拉西林/三唑巴坦17.2%;头孢比肟19.8%,其中铜绿假单胞菌对氨苄西林/舒巴坦耐药高达100%;所有阴性杆菌对三代头孢的耐药率高达50%以上.结论:长春市老年患者下呼吸道感染常见G-杆菌多重耐药非常严重,因此应定期监测该市革兰阴性杆菌的耐药趋势,对指导临床合理使用抗生素是非常必要的.     

老年肺结核继发下呼吸道革兰氏阴性菌感染的病原学及耐药性分析

目的探讨老年肺结核继发下呼吸道革兰氏阴性杆菌(G-杆菌)感染的病原学和药敏情况,为临床合理选用抗生素提供参考。方法对2004～2007年间老年肺结核继发下呼吸道感染患者的痰标本细菌培养分离及药敏结果作回顾性分析。结果分离的G-杆菌中排在前3位的细菌分别为铜绿假单胞菌、鲍曼/溶血不动杆菌、肺炎克雷伯氏菌,检出率分别为30.84%、27.31%、22.47%;检出的G-杆菌大部份呈多重耐药,而总体耐药率最低为亚胺硫霉素(4.7%),其次为氧哌嗪青霉素/Tazo(9.4%),其中亚胺硫霉素对我站老年肺结核患者继发下呼吸道感染患者分离的鲍曼/溶血不动杆菌、大肠埃希菌、肺炎克雷伯氏菌、阴沟肠杆菌和铜绿假单胞菌的耐药率最低,分别为0.9%、3.4%、3.7%、5.9%、9.8%。结论老年肺结核继发下呼吸道感染的病原菌以G-杆菌为主,其对常用抗菌药物的敏感性低。     

重症监护病房革兰阴性杆菌分布及其耐药特征

目的了解某院重症监护病房(ICU)革兰阴性(G-)杆菌分布及其耐药特征,为临床合理应用抗菌药物提供依据。方法对2005年11月—2006年10月ICU送检的血、尿及痰等各类标本进行细菌培养、分离与鉴定并进行抗菌药物敏感试验,同时测定超广谱β-内酰胺酶(ESBLs)、AmpC酶和金属酶。结果共获得G-杆菌117株,常见分离菌依次为鲍曼不动杆菌(31.63%)、大肠埃希菌(22.22%)、铜绿假单胞菌(18.81%)和肺炎克雷伯菌(8.55%)。在观察的15种抗菌药物中,ICU分离的G-杆菌对亚胺培南最为敏感(耐药率15.38%),其次为哌拉西林/他唑巴坦(36.75%)、阿米卡星(42.74%)和头孢他啶(45.30%),对其余抗菌药物耐药率均>50%,且ICU分离菌的耐药率均高于同期非ICU分离菌。产ESBLs率,大肠埃希菌为23.08%、肺炎克雷伯菌为20.00%;肠杆菌属产AmpC酶株占20.00%(2/10);铜绿假单胞菌产金属酶株占9.09%(2/22)。结论该院ICU分离的G-杆菌以鲍曼不动杆菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌为主,其耐药性相当严重,应根据药敏结果合理用药,并采取措施防止耐药菌扩散。     

ICU主要感染病原菌与非ICU菌株耐药性比较分析

[目的]分析ICU病原茵与非ICU菌株耐药性,为临床合理治疗感染提供科学依据.[方法]对本院2004年1月～2005年12月ICU前5种主要感染病原菌和同期非ICU相同菌株,采用美国Dade Behring Microscan Walkawav40全自动细菌鉴定及药敏测试仪及其配套药敏鉴定板测定MIC值.χ2统计分析.[结果]ICU前5种感染病原菌依次为鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌,其中G-杆菌4种占87.5%,G 球菌4种占12.5%.ICU菌株主要来源于痰标本,而非ICU菌株多数从痰、尿、脓中分离而得.5种ICU菌株对大多数抗菌药物09耐药率明显高于非ICU菌株,耐苯唑西林金黄色葡萄球菌几乎是非ICU的2倍,G-杆菌对第3代头孢菌素的耐药率均明显高于非ICU;但金黄色葡萄球菌ICU株与非ICU株对万古霉素的耐药率均为0,肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌ICU株与非ICU株对亚胺培南的耐药率无差别(P＞0.05),均低于15%,尚处于低水平.[结论]多数ICU主要感染病原菌的耐药率明显高于非ICU菌株,临床治疗感染应区别对待,加强各区域细菌耐药性监测,为合理使用抗菌药物提供依据,减少耐药菌的产生.     

重症监护病房下呼吸道医院获得性感染革兰阴性杆菌耐药性调查

目的 调查重症监护病房(ICU)下呼吸道医院获得性感染革兰阴性杆菌分布与耐药现状,为临床医师正确诊断与合理用药提供科学依据.方法病原菌分离按<全国临床检验操作规程>进行;菌株鉴定采用美国Microscan auto-4细菌鉴定仪进行;药物敏感试验采用琼脂扩散法(K-B法),结果依据CLSI 2007年折点判读.结果 319株革兰阴性杆菌分离率居前4位的依次为铜绿假单胞菌(23.5%)、肺炎克雷伯菌(17.5%)、鲍氏不动杆菌(14.4%)、大肠埃希菌(14.1%);体外药敏检测结果表明,4种重要病原菌均产生了严重的耐药性,除碳青酶烯类抗菌药物对肠杆菌科细菌尚保持了100.0%的抗菌活性外,铜绿假单胞菌及鲍氏不动杆菌对碳青酶烯类已产生了19.6%～22.7%的耐药率;鲍氏不动杆菌和铜绿假单胞菌已出现泛耐药菌株;产超广谱β-内酰胺酶肺炎克雷伯菌与大肠埃希菌检出率分别为39.3%和42.2%.结论 ICU下呼吸道医院获得性感染的革兰阴性杆菌多为多药耐药菌,应加强监测与控制.     

医院感染革兰阴性杆菌的构成比及耐药性分析

目的 分析医院感染革兰阴性(G-)杆菌的构成比及耐药现状,为临床医师治疗感染性疾病提供科学依据.方法 按照<全国临床检验操作规程>对临床分离的376株G-杆菌进行细菌培养和鉴定,采用K-B法进行药敏试验,并进行G-杆菌构成比统计.结果 医院G-杆菌中分离率居前列的菌株依次为:铜绿假单胞菌(21.5%)、肺炎克宙伯菌(17.6%)、鲍氏不动杆菌(14.4%)、大肠埃希菌(10.9%)、嗜麦芽寡养单胞菌(5.9%);药敏结果表明,以上均为多药耐药细菌,除嗜麦芽寡养单胞菌对亚胺培南天然耐药外,铜绿假单胞菌和鲍氏不动杆菌对亚胺培南分别产生了16.0%、24.1%耐药率;产ESBLs菌平均检出率为40.2%.结论 革兰阴性杆菌的耐药件已非常严重,务必加强细菌耐药性的监测与控制.     

呼吸重症监护病房肺部感染的病原菌分布及其耐药性

目的了解呼吸重症监护病房(RICU)最常见的肺部感染痰菌的分布及耐药性. 方法对207例RICU肺部感染患者280次阳性痰培养结果及药物敏感试验进行分析. 结果 G 菌77株,占27.5%;其中金黄色葡萄球菌62株占22.1%,耐甲氧西林金黄色葡萄球菌(MRSA)53株占18.9%;G-菌162株,占57.9%,占前4位者分别为铜绿假单胞菌56株(20%),嗜麦芽寡养单胞菌25株(8.9%),肺炎克雷伯菌17株(6.1%),鲍氏不动杆菌14株(5%);真菌41株,占14.6%;其中以白色念珠菌为主,占10.7%;药物敏感试验显示铜绿假单胞菌对抗生素多重耐药率较高,嗜麦芽寡养单胞菌对环丙沙星耐药率较低,肺炎克雷伯菌和鲍氏不动杆菌仍然对碳青酶烯类敏感. 结论该组RICU肺部感染以G-杆菌为主;其中铜绿假单胞菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌和鲍氏不动杆菌构成主要G-感染菌株;MRSA和真菌感染的比例较高.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.