三甲综合性医院住院医师抑郁现状调查及影响因素

目的:调查三甲综合性医院住院医师抑郁现状并分析其影响因素,为提高临床住院医师生活质量及工作效率提供依据。方法:选择三甲综合性医院临床各科室住院医97例为研究对象,调查其性别、年龄、文化程度、婚姻状况等基线资料,采用抑郁自评量表(SDS)对其基线资料进行分析,并采用logistics回归分析住院医师抑郁状态发生的影响因素。结果:97例住院医师SDS评分为(48.99±9.78)分显著高于人群常模(41.85±10.57)分(t=3.212,P0.05),其中抑郁的发生率(35.05%)显著高于正常人群(16.07%)与护士人群(22.55%)(x2=9.437,4.124;P0.05);多因素分析显示,未取得执业医师证书(OR=2.241,P0.05)、不喜欢医生职业(OR=3.722,P0.05)及对工作不满意(OR=7.713,P0.05)是住院医师发生抑郁的危险因素。结论:三甲住院医师的抑郁发生率处于较高水平,未取得执业医师证书、不喜欢医生职业、对工作不满意是住院医师发生抑郁的危险因素。     

急性脑梗塞后肺部感染的相关因素及预后

目的:分析探讨急性脑梗塞后肺部感染的相关因素及其预后,以有利于进一步预防及治疗。方法:对2009年5月至2011年5月收治的258例脑梗塞急性期患者的临床资料进行回顾性调查分析,根据是否合并肺部感染分为肺部感染组和对照组,分析肺部感染的危险因素和其预后的相关性。结果:258例脑梗塞患者中发生肺部感染45例,感染率为17.4%,其中心源性脑栓塞占67%。与对照组相比,急性脑梗塞后肺部感染患者年龄偏高(分别为74.2±13.2和69.8±12.7,P<0.021),住院过程中的误吸(OR5.513)及住院时的NIHSS评分(OR1.090)是独立性危险因素,而肺部感染是加重病情的独立性危险因素(OR5.838)。结论:对于高龄、入院时NIHSS评分高、误吸和心源性急性脑梗塞患者应及早预防,已发生肺部感染者应当给予积极有效的治疗。     

城市社区与乡镇卫生院医务人员工作倦怠情况分析

目的 分析基层医疗卫生机构中的城市社区卫生服务中心与乡镇卫生院医务人员的工作倦怠情况及影响因素,探讨两类机构中医务人员倦怠的水平差异。方法 采用Maslach职业倦怠普适量表（MBI-GS）对东北某地区城市社区卫生服务中心及乡镇卫生院进行问卷调查。结果 城市社区卫生服务中心医务人员工作倦怠检出率为27.8%,工作倦怠程度影响因素是学历、职称、工资收入和绩效方案合理性。乡镇卫生院工作倦怠检出率为34.1%,倦怠程度主要受性别、工作时间、工作量和工资收入影响。结论 乡镇卫生院较城市社区卫生服务中心医务人员的工作倦怠感严重,应引起有关管理部门的重视并采取相应的干预措施。     

影响妇科腹腔镜术后下肢深静脉血栓形成的相关因素分析

目的:探讨妇科腹腔镜手术后下肢深静脉血栓形成(DVT)的危险因素。方法:回顾性分析339例行妇科腹腔镜手术患者的临床资料,对患者的一般临床资料、术前实验室检查指标、手术类型、术中治疗及术后干预措施等进行单因素及多因素Logistic回归分析。结果:339例行妇科腹腔镜手术患者中30例术后发生DVT(发生率约8.8%),年龄(OR=1.438)、手术类型(腹腔镜妇科恶性肿瘤手术)(OR=3.153、血浆D-二聚体水平≥0.5 mg/L(OR=2.531)、术前合并症(OR=2.885)、术中气腹压(OR=2.835)、手术时间≥1h(OR=1.397)、术后卧床天数(OR=1.498)与妇科腹腔镜手术后发生DVT呈正相关(P0.05)。结论:年龄、手术类型、血浆D-二聚体水平、术前合并症、术中气腹压、手术时间及术后卧床天数是妇科腹腔镜术后发生VDT的独立危险因素。     

婴幼儿抗生素相关性腹泻的危险因素分析及其护理

目的探讨引起婴幼儿抗生素相关性腹泻(AAD)的危险因素及预防护理措施。方法选择798例住院应用抗生素的患者作为研究对象,以发生AAD者作为观察组,与没有发生腹泻者进行对比分析。结果 798例中发生AAD 187例(23.4%)。单因素分析结果显示:结果显示婴幼儿AAD的发生与发病年龄、合并有感染性疾病、病情严重程度、抗生素种类、抗生素使用天数、抗生素联合应用、微生态制剂使用、激素应用、住院天数、血红蛋白量、侵入性操作等因素相关,差异有统计学意义。经Logistic回归分析,筛选出5个AAD独立相关因素:合并有感染性疾病(OR=1.431)、病情重(OR=1.985)、抗生素时间长(OR=2.117)、抗生素联合应用≥2种(OR=3.783)、侵入性操作(OR=4.092)、使用微生态制剂(OR=0.706)。微生态制剂OR1,表示使用微生态制剂为AAD的保护因素。。结论接受抗生素治疗的婴幼儿特别是婴儿发生AAD的可能性大,侵袭性操作、重症患儿、抗生素应用时间长、联合用药是AAD的高危因素,应合理应用抗生素,预防性应用微生态制剂,防止AAD的发生。     

慢性心力衰竭院内感染病原菌监测及危险因素分析

目的:探究慢性心力衰竭(CHF)患者医院感染的现状、病原菌分布及耐药情况,分析CHF患者发生医院内感染的危险因素。方法:选择2012年9月~2015年9月中心医院及开发区分院收治的390例CHF患者为研究对象,根据CHF患者是否发生医院内感染将其分为观察组(感染患者41例)和对照组(未感染患者349例);收集患者基线资料,对观察组患者进行病原菌培养及药敏实验,分析CHF患者发生医院内感染的危险因素。结果:CHF患者中医院感染的发生率为10.51%(41/390),感染部位以呼吸道19例(46.34%)和泌尿道12(29.27%)为主;前三位的病原菌为铜绿假单胞菌14株(29.79%)、大肠埃希菌11株(23.40%)和肺炎克雷伯菌8株(17.02%);铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌对头孢哌酮、美罗培南及亚胺培南均具有药物敏感性;年龄≥60岁(OR=2.26,P0.05)、住院时间≥2两个月(OR=5.12,P0.05)、有侵袭性操作(OR=7.45,P0.05)、病程长(OR=4.36,P0.05)是CHF患者发生医院内感染的危险因素。结论:CHF患者医院感染的发生率较高,年龄≥60岁、住院时间≥2个月、侵袭性操作及病程5年是CHF患者发生医院内感染的危险因素;应当针对患者医院感染特点及药敏实验结果,采取针对性的预防措施和对策,有效控制及降低医院感染的发生。     

老年脑梗死患者急性期全脑血管造影及脑动脉狭窄的危险因素分析

目的:探究老年脑梗死患者急性期全脑血管造影(DSA)及脑动脉狭窄的危险因素。方法:选择2010年1月~2016年9月期间我院收治的562例老年脑卒中患者为研究对象。经DSA造影观察脑血管动脉造影脉狭窄情况,并收集患者一般资料,采用单因素分析及多因素logistics回归分析脑动脉狭窄的危险因素。结果:562例脑卒中患者经DSA检查共发现469例患者出现脑动脉狭窄,中度狭窄301例,血管重度狭窄168例;颅内段发生率显著高于颅外段(P0.05);高龄(OR=1.434,P0.05)、高血压(OR=2.084,P0.05)、糖尿病(OR=2.235,P0.05)及吸烟(OR=2.734,P0.05)是老年脑卒中患者脑血管狭窄的危险因素。结论:DSA显示老年人脑卒中患者多存在脑血管动脉狭窄的发生,年龄、高血压、糖尿病及吸烟是老年脑卒中患者脑血管狭窄的危险因素。     

癫痫持续状态的发病危险因素分析

目的:探讨癫痫持续状态的发病危险因素。方法:对西京医院神经内科2000年1月至2009年11月连续登记住院的癫痫持续状态患者的临床资料进行回顾性分析,采用条件logistic回归方法筛选癫痫持续状态的危险因素。结果:共收集98例癫痫持续状态患者,一般情况显示:男性发病率明显高于女性,成人发病率明显高于儿童,CSE发生率明显高于NCSE;logistic回归结果显示:中枢神经系统感染(OR值为4.74)为SE的主要危险因素,其次为脑血管病(OR值为3.93)和颅脑外伤(OR值为1.84)。SE发作的有明显诱因的占19例,其中上呼吸道感染伴发热者比例较高。结论:中枢神经系统感染、脑血管病、脑外伤是癫痫持续状态最主要的危险因素,急性上呼吸道感染伴发热者最常见的诱因。预防感染、防治脑血管病、避免外伤,减少各种诱因是预防本病的关键。     

《西北植物学报》2014年刊载论文第一作者信息统计

《西北植物学报》2014年第1~12期共发表论文365篇(含英文论文7篇)。从刊载论文第一作者信息统计看,具有博士和硕士学位(含在读博士)的共164人,占44.9%,具有中级以上职称120人,占32.9%,其中具有副高以上职称的57人,占15.6%;从论文研究单位看,主要来源于大学(280篇,占76.7%)和研究所(80篇,占21.9%,其中中国科学院系统19篇,占5.2%);从年龄方面看,第一作者中30岁以上的占40.8%。由此可以看出,《西北植物学报》2014年度刊发的论文作者具有厚实的学术研究底蕴,研究单位也     

胸外科手术术后神经病理性疼痛的发生情况及相关因素分析

目的:探讨胸外科手术术后神经病理性疼痛的发生情况及相关危险因素。方法:回顾性分析2015年至2016年就诊于我院行胸外科手术的患者的临床资料,包括患者的年龄、性别、吸烟史、BMI、术前是否使用催眠药物、术前诊断、手术侧别、手术方式、是否为微创、硬膜外自控镇痛泵使用情况、术中失血量、手术持续时间、引流管引流时间及是否发生神经病理性疼痛,对比分析是否发生神经病理性疼痛患者的临床资料,对有差异的临床资料进行多因素Logistic回归分析探讨发生神经病理性疼痛的危险因素。结果:共有123例患者纳入研究,33例(26.8%)患者的患者术后出现神经病理性疼痛,6例(4.9%)患者在术后一年仍有持续性神经性病理疼痛,术后出现神经病理性疼痛的平均时间为术后第7天,平均持续时间为75天,发生神经病理性疼痛的患者吸烟比例(81.8%)、术前使用催眠药比例(57.6%)、开胸手术比例(81.8%)、术中失血量(185 mL)、手术时间(196分钟)、术后引流时间(2.5天)均高于没有发生神经病理性疼痛的患者。多因素分析显示术前使用催眠药(OR=2.322,P<0.001)、手术时间延长(OR=3.703,P<0.001)和术后引流时间延长(OR=2.675,P=0.002)均是神经病理性疼痛发生的危险因素,电视辅助胸腔镜手术方式是保护性因素(OR=0.453,P=0.002)。结论:术前使用催眠药物、延长的手术时间及术后引流时间增加了神经病理性疼痛发生的风险,电视辅助胸腔镜技术可减少其发生率。     

Burnout phenomenon and its occupational risk factors among Japanese hospital nurses.

To identify and evaluate recent working conditions and job content of hospital nurses in Japan, as well as the prevalence of the burnout phenomenon and the occupational risk factors responsible for it, a questionnaire survey was carried out. The subjects consisted of 898 nurses and 255 municipal service workers as the control group. Working conditions and workload burdens were more severe among nurses than among the municipal workers. The burnout phenomenon among the nurses was characterized by emotional exhaustion as well as depersonalization. Moreover, the rate ratio and multivariate analyses indicated that a great variety of occupational factors, not only interpersonal relationships, but the general working conditions and specific physical or mental workloads influenced the burnout phenomenon as well. Therefore, in examining measures dealing with the burnout phenomenon among nurses, it is considered important to evaluate the occupational factors systematically and comprehensively.     

Rates of medication errors among depressed and burnt out residents: prospective cohort study

Objective To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors.Design Prospective cohort study.Setting Three urban freestanding children’s hospitals in the United States.Participants 123 residents in three paediatric residency programmes.Main outcome measures Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month.Results 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2).Conclusions Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their non-depressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.     

护士职业压力与职业倦怠的相关性研究

目的:了解护士职业压力、职业倦怠现状;探讨两者之间的关系。方法:方便抽样,抽取哈尔滨市5所三级医院的468名护士进行问卷调查。采用护士一般情况调查表、护士工作压力源量表、职业倦怠量表进行调查。结果:护士职业倦怠程度为中等,去人格化属于中度倦怠,情感衰竭、低成就感程度达到了高度倦怠;职业压力得分为87.56±20.43,以工作量及时间分配维度压力最高,病人护理维度压力最低。情感耗竭与除工作环境及资源之外的职业压力维度呈显著正相关;去人格化与职业压力各维度均呈显著正相关;低成就感与职业压力中护理专业及工作、病人护理呈显著负相关(P0.05)。护士职业压力各维度对其职业倦怠的3个维度均有较好的预测作用,尤其对护士情感耗竭的解释程度达25.5%。结论:护士职业倦怠现象不容忽视,护理管理者有针对性的对护士进行管理,鼓励护士加强自身修养、学会自我疏导,适当授权等是降低护士职业倦怠的正性激励措施。     

Chlamydia in canine or feline coronary arteriosclerotic lesions

Background

This study examined the associations of job control, organizational justice and bullying at the workplace with emotional exhaustion. This was done by adjusting firstly for age and occupational class, secondly physical work factors, thirdly mutually adjusting for the three psychosocial factors and fourthly adjusting for all studied variables simultaneously. Data were derived from the Helsinki Health Study baseline surveys conducted in 2001 and 2002, including 40-60-year-old employees of the City of Helsinki (n = 5819, response rate 66%). Exhaustion was measured with a six-item subscale from Maslach Burnout Inventory (MBI). Psychosocial factors included Karasek's job control, organizational justice and bullying at the workplace. Logistic regression analysis was used.

Results

Among women 23% and among men 20% reported symptoms of emotional exhaustion. Among women all psychosocial factors were associated with exhaustion when adjusted for age and occupational class as confounders. When physical work factors were additionally adjusted for, the associations slightly attenuated but remained. When psychosocial work factors were simultaneously adjusted for each other, their associations with exhaustion attenuated but remained. Among men all psychosocial factors were associated with exhaustion when adjusted for confounders only. When adjusted for physical work factors the associations slightly attenuated. When psychosocial factors were simultaneously adjusted for each other, associations of organizational justice and bullying with exhaustion attenuated but remained whereas job control lost its association.

Conclusions

Identifying risk factors for emotional exhaustion is vital for preventing subsequent processes leading to burnout. Psychosocial factors are likely to contribute to exhaustion among female as well as male employees. Thus management and occupational health care should devote more attention to the psychosocial work environment in order to be able to prevent exhaustion and burnout at the workplaces.     

Daily and yearly burnout symptoms in Israeli shift work residents

Burnout is a syndrome of physical and emotional exhaustion that develops among individuals who are open to public demands. In view of their heavy work load and sleep deprivation, we decided to evaluate the impact of long working hours on burnout and psychological status among a sample of residents during the first 2 years of their residency. Seventy-eight residents participated in the study, all residents completed self-administered questionnaires, and their sleep-wake cycle was monitored by a wrist-worn actigraph for a period of 5-7 days. The questionnaires included a short form suitable for Experience Sampling Method (ESM), and a longer background Questionnaire. The results revealed that sleep duration, Work Load and the interaction between them, explain the Negative Mood the day after the night shift. However, positive mood, and fatigue were not affected by sleep duration or workload. In general, after one year of residency, residents become more stressed, less involved in the job, and had a high level of burnout and psychosomatic symptoms. However, after the second year, the burnout symptoms were almost the same as at the beginning except for the level of stress that remained high. Sleep duration was unrelated to the burnout symptoms.     

江苏北部某村农民高血压的危险因素及控制情况分析

目的:研究江苏北部某村农民高血压的危险因素及控制情况,为农村高血压疾病的防控提供更多的参考依据。方法:选择2018年1月~2018年12月江苏北部某村124名农民高血压患者作为观察组,124名非高血压人群作为对照组,通过应用单因素和多因素分析方法分析其高血压发病的主要危险因素,并统计其血压控制情况。结果:单因素分析结果显示超重或肥胖(OR=6.038,P<0.001)、高盐饮食(OR=6.167,P<0.001)、高油饮食(OR=9.626,P=0.002)、家族史(OR=8.008,P<0.001)、缺乏体育锻炼(OR=4.202,P<0.001)、吸烟(OR=3.067,P<0.001)等因素与该村农民高血压发生显著相关。多因素分析结果显示超重或肥胖(Exp(B)=3.931,P<0.001)、家族史(Exp(B)=6.212,P<0.001)、高盐饮食(Exp(B)=2.257,P<0.001)、缺乏体育锻炼(Exp(B)=3.393,P=0.007)、吸烟(Exp(B)=2.513,P=0.018)是该村农民高血压发生的危险因素。124例高血压患者的血压控制率为47.58%(59/124),不同性别和年龄段农民高血压患者的血压控制率比较无统计学差异(P>0.05)。结论:高血压发病是遗传因素和生活习惯共同作用的结果,超重或肥胖、高盐饮食、缺乏体育锻炼、吸烟是农村地区高血压发病的危险因素。农村高血压的控制情况一般,需引起重视。     

Occupational Injuries in Germany: Population-Wide National Survey Data Emphasize the Importance of Work-Related Factors

Unintentional injuries cause much of the global mortality burden, with the workplace being a common accident setting. Even in high-income economies, occupational injury figures remain remarkably high. Because risk factors for occupational injuries are prone to confounding, the present research takes a comprehensive approach. To better understand the occurrence of occupational injuries, sociodemographic factors and work- and health-related factors are tested simultaneously. Thus, the present analysis aims to develop a comprehensive epidemiological model that facilitates the explanation of varying injury rates in the workplace. The representative phone survey German Health Update 2010 provides information on medically treated occupational injuries sustained in the year prior to the interview. Data were collected on sociodemographics, occupation, working conditions, health-related behaviors, and chronic diseases. For the economically active population (18–70 years, n = 14,041), the 12-month prevalence of occupational injuries was calculated with a 95% confidence interval (CI). Blockwise multiple logistic regression was applied to successively include different groups of variables. Overall, 2.8% (95% CI 2.4–3.2) of the gainfully employed population report at least one occupational injury (women: 0.9%; 95% CI 0.7–1.2; men: 4.3%; 95% CI 3.7–5.0). In the fully adjusted model, male gender (OR 3.16) and age 18–29 (OR 1.54), as well as agricultural (OR 5.40), technical (OR 3.41), skilled service (OR 4.24) or manual (OR 5.12), and unskilled service (OR 3.13) or manual (OR 4.97) occupations are associated with higher chances of occupational injuries. The same holds for frequent stressors such as heavy carrying (OR 1.78), working in awkward postures (OR 1.46), environmental stress (OR 1.48), and working under pressure (OR 1.41). Among health-related variables, physical inactivity (OR 1.47) and obesity (OR 1.73) present a significantly higher chance of occupational injuries. While the odds for most work-related factors were as expected, the associations for health-related factors such as smoking, drinking, and chronic diseases were rather weak. In part, this may be due to context-specific factors such as safety and workplace regulations in high-income countries like Germany. This assumption could guide further research, taking a multi-level approach to international comparisons.     

Individual and occupational risk factors for knee osteoarthritis: results of a case-control study in Germany

Introduction

A number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health.

Methods

In a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data.

Results

In total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (≥1,440 hours/life); men, 2.58 (≥3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (≥1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR.

Conclusions

The results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.