某院医务人员职业暴露的现状调查

职业暴露是医务人员最常见的职业伤害,为探求有效的防护方法,对我院2005年至2008年报告的职业暴露进行了分析,结果发现医务人员职业暴露漏报严重,护士发生职业暴露最多(占57.4%),主要为针刺伤(占85.2%),暴露源以乙型肝炎为主(占53.2%).应加强医务人员标准预防和职业安全知识的教育与培训,建立和健全职业暴露的监测体系.     

急性脑梗死早期OCSP分型的临床应用评价

为了研究急性脑梗死早期OCSP（Oxfordshire Community Stroke Projet）分型的应用价值,连续收集首次发病的脑梗死患者326例,按OCSP分型分为完全前循环梗死（TACI）、部分前循环梗死（PACI）、腔隙性脑梗死（LACI）、后循环梗死（PCI）,入组后各亚型比较急性期神经功能缺损评分和结构影像学特征,3个月的病死率和日常生活活动（ADL）能力评分。显示,TACI大面积脑梗死占74．4％,PACI中等面积脑梗死占64．5%。LACI腔隙灶脑梗死占90％,POCI大面积脑梗死占22．7％,中等面积脑梗死占40.9％,小梗死占36.4％。急性期神经功能缺损以TACI最严重,PACI和POCI次之,LACI最轻,TACI与其他各型之间,PACI和POCI与LACI之间的差异均有极显著性意义（P〈0．0005）,PACI和POCI之间差异无显著性意义（P〉0．05）。TACI的病死率为44．2％,PACI为10．2%,POCI为18．2%赫,LACI为2．6％,TACI病死率与各型比较有极显著性意义（P〈0．01）.TAC13个月的ADL为重度依赖,POCI为中度依赖,另2个亚型均为轻度依赖,有极显著性意义（P〈0．005）。由此得出结论,OCSP分型与影像学有良好对应关系。不同的OCSP分型可以反映脑梗死急性期神经功能缺损的严重程度,OCSP分型有利于脑梗死急性期个体化治疗选择。     

广西各种意外性急性中毒2330例的特点分析

为了探讨广西意外急性中毒特点,调查分析了63家市、县、乡镇医疗单位的2330便意外性急性中毒病历资料。结果显示农村以男性、36岁～60岁、务农与农药类毒物的病例分布率（依序为：55．19％、42．21％、72．81％、40．21％）明显高于城镇（依序为：45．35％、30．95％、3．50％、3．83％）,城镇以女性、20岁～35岁、务工、无职业、化学类毒物的病例分布率（54．65％、38．11％、35．15％、29．69％、56．56％）显著高于农村（44．81％、25．26％、4．59％、11．26％、21.32％）（均为P〈0．005）。另农村农药类毒物以有机磷（占48．28％）最高,城镇化学类毒物以CO（占89．16％）最高;意外中毒病例数平均每年以13．82％的速度在递增。说明广西意外中毒人群结构与毒物种类在城乡间具有明显差别。     

大学生宗教信仰现状调查与分析

为了解大学生宗教信仰基本现状,加强大学生信仰教育提供参考。使用自编调查问卷,随机对1016名学生进行问卷调查。回收有效问卷837份,调查发现大学生有宗教信仰者64人,占被试的7．65％;其中大学生的信仰宗教排名依次为佛教、道教、基督教：信教学生最初接触宗教的原因主要是：承袭家庭传统占37．5％,寻求心灵寄托占35．94％,受信仰群体的感染26．56％;大学生去宗教场所的主要原因从高到低依次为（1）祈福占51．73％;（2）参观浏览,占49．34％;（3）陪同他人参观,占44．68％;（4）好奇,占32．38％;在对待宗教的态度上,92％的信教学生对不同宗教信仰者持好感和理解态度．另有89％的无宗教信仰学生对宗教信徒持好感和理解态度;无宗教信仰的学生中有8．12％A-有皈依某种宗教的想法．有10．51％人没有参加宗教的原因是由于时间的限制,他们有可能成为潜在的宗教信仰人群。因此,需要加强对大学生共产主义信仰的教育及马克思主义关于宗教理论的教育。     

认真贯彻落实党和同家的民族政策——省直部门贯彻执行民族政策基本情况

贵州是一个多民族省份,少数民族人口占全省总人口的39％。全省建有3个自治州、11个自治县,民族自治地方面积占全省总面积的55．5％（民族自治地方和民族乡面积占全省总面积的68．2％）,民族自治地方人口占全省总人口的42％（民族自治地方少数民族人口占全省少数民族人口的63％）。认真贯彻执行党和国家的民族政策,     

我国药物性肝损伤病因演变的Meta分析

评价我国1999年～2012年药物性肝损伤（DILI）病因变化特点。在Medline、EMBASE、Wanfang、VIP和CNKI中国期刊全文数据库中检索已发表的关于DILI的病例序列研究。利用R软件对各药物所占比率进行单个率的Meta分析。Meta分析表明：抗结核药是1999年～2005年DILI的首要病因,其构成比为26．54％。2006年～2012年DILI的病因则以中药为主,其构成比为30．38％,而抗结核药所占比例下降（构成比为20．57％）,抗肿瘤化疗药所占比例（构成比为10．26％）较1999年～2005年（构成比为8．73％）增加。我国DILI病因存在时间演变,中药及抗肿瘤化疗药所占比例上升,抗结核药所占比例有所下降,但仍是DILI主要病因之一．     

不良性认知心理是导致心身疾病的关键环节

为了了解大学生不良性认知心理和心身疾病的关系,统计了2002年-2006年5年中因不良性认知心理导致心身疾病休学人数占休学总数的比例。结果显示,5年中因各类疾病休学的人数为330人,其中因心身疾病休学的人数为260人,占休学总数的78．79％。心身疾病发病率与其他疾病构成比有显著性差异（x^2=60．12,P〈0．01）;且呈逐年上升趋势（x^2=105．72 P〈0．01）。因此,大学生不良性认知心理是导致心身疾病的关键环节。     

孤立性心肌桥-壁冠状动脉患者的多层螺旋CT及临床分析

试图分析孤立性心肌桥-壁冠状动脉（MB—MCA）病变患者的多层螺旋CT（MSCT）的影像学特点与临床表现之间的内在联系。回顾性收集自2003年1月至2007年3月,在我院住院并行MSCT,保存有清楚影像学资料,临床排除有其他心脏病合并症的MB—MCA患者,共53例,发现MB—MCA病变65处。平均年龄（57．3±12．6）岁,其中男性27例,LAD病变59例。MCA长度（20．8±11．2）mm,MB厚度（2．0±1．6）mm。58．5％的患者有心电图改变,大部分为女性,有胸部不适症状者占90．6％。单纯应用非二氢吡啶类钙离子拮抗剂者15例,治疗有效率达到73．3％（11例）,单纯应用β受体阻滞剂者12例,症状缓解率达到66．7％（9例）。单纯应用硝酸酯类药物者16例,仅有2倒（12．5％）缓解。MB—MCA可能导致心肌缺血和临床症状,可进行干预性治疗;对硝酸酯类药物不能缓解的胸痛患者要想到MB—MCA可能,有条件者应该进行MSCT等影像学检查,诊断明确的可以试用β受体阻滞剂及非二氧吡啶娄拮抗剂．     

认真贯彻落实党和国家的民族政策——省直部门贯彻执行民族政策基本情况

贵州是一个多民族省份,少数民族人口占全省总人口的39％。全省建有3个自治州、11个自治县,民族自治地方面积占全省总面积的55．5％（民族自治地方和民族乡面积占全省总面积的68．2％）,民族自治地方人口占全省总人口的42％（民族自治地方少数民族人口占全省少数民族人口的63％）。认真贯彻执行党和国家的民族政策,关系到贵州的民族团结、社会稳定,关系到贵州经济社会发展历史性跨越目标的实现。多年来,特别是近五年来,省委、省政府高度重视民族工作,不断开拓创新,积极推动省直部门认真贯彻执行党和国家的民族政策,认真贯彻执行“一法两规定”,履行上级国家机关职责,有力地促进了全省民族地区经济社会的发展,取得了较好成绩。     

中年人睡眠相关行为与高血压关系的病例对照研究

为探讨中年人睡眠相关行为与高血压发病风险之间的关系。本研究采用1：1匹配的病例对照研究法;资料收集方法采用问卷调查法;资料处理分析采用t检验及多元条件Logistic回归模型分析法。结果显示中年人病例组与对照组睡眠质量存在显著性差异（t=6．19,P〈0．05）。（1）睡眠相关行为（每日睡眠不足、夜间睡眠不足、睡眠时点延迟、睡眠质量差、入睡困难、每周入睡困难次数增加及打鼾等因素）多元条件Logistic回归模型的OR值和95％CI分别为[（OR=5．07,95％CI：3．12～8．21）;（OR=5．57,95％CI：3．43～9．04）;（OR=2．27,95％CI：1．49～3．47）;（OR=2．17,95％CI：1．60～2．94）;（OR=3．36,95％CI：1．47～7．69）;（OR=1．55,95％CI：1．08～2．24）;（OR=2．69,95％CI：1．86～3．88）]。（2）适当午睡为（OR=0．85,95％CI：0．74～0．98）。（3）早起与否（OR=1．40,95％CI：0．87～2．20）。因此（1）中年人睡眠相关行为与高血压发病密切相关,每日睡眠不足、夜间睡眠不足、睡眠时点延迟、睡眠质量差、入睡困难、每周入睡困难次数增加及打鼾等因素可能为高血压发病的危险因素;（2）中年人适当午睡可能是高血压发病的保护性因素;（3）是否早起与高血压发病关系尚不清晰。     

BEHAVIORAL TECHNOLOGY FOR REDUCING OCCUPATIONAL EXPOSURES TO STYRENE

We conducted a test of the usefulness of behavioral methods to control occupational health problems by reducing workers' exposures to toxic chemicals. Four plastics workers were trained in nine behaviors selected for potential to reduce their exposures to styrene, a common chemical with multiple toxic effects. Behavioral measures indicated that the workers quickly came to emit most of the behaviors. Measures of air samples indicated that large decreases in exposures to styrene accompanied the changes in behaviors for the three workers who had been selected because they most needed relief from their exposures and because they had opportunities to control their exposures by the ways they behaved.     

Systematic review of stress-related injury vulnerability in athletic and occupational contexts

Injury is a pervasive, expensive and, to some extent, preventable problem. Stress is a psychological risk factor for injury but little is known about how stress processes compare in athletic and occupational contexts. This paper reviews research on stress-related injury vulnerability in athletic and occupational contexts to characterize and compare samples, methods, and conclusions from the perspective of an integrated model of stress-related injury vulnerability. A comprehensive search of four major databases identified research in both athletic (n = 34) and occupational contexts (n = 22). Studies were coded to extract characteristics of the samples, research designs, measures, and conclusions about stress-injury relations. Studies used more prospective than cross-sectional or case control research designs. Injury was most frequently defined as missing one subsequent day of training or work (35.7%). Approximately 75% of the identified studies in each context indicated a positive association between stress and injury occurrence. The consistency of findings suggested a robust stress-related injury vulnerability for both exposures and responses, however, caution is warranted due to the diversity of measures and surveillance periods and the lack of experimental designs. New hypotheses are identified to refine models of stress-related injury vulnerability in athletic and occupational contexts.     

Consequences of Violence Exposures by Emergency Nurses

Emergency nurses are among the most likely groups of health care professionals to be exposed to violence. Violence exposure is the witnessing or receiving of a violent act with or without the intention to cause physical or psychological harm. The purpose of this paper is to evaluate the literature in relation to emergency nurses' exposure to violence and discuss the implications for emergency nursing practice. A review of the literature was conducted using the keywords violence, emergency nursing, health care workers, and productivity. Emergency nurses exhibited anxiety, vulnerability, guilt, anger, sadness, and peer blaming following violence exposures. Violence exposures affect emergency nurses both physically and psychologically. Interventions should be developed to reduce the negative consequences of violence exposures.     

甲状腺结节的评估

甲状腺结节(TN)是很常见的疾患,在成人中触诊可查出5%,但超声检查则可高达50%,TN的评估重要性在于对恶性结节需及时外科手术治疗,对大多数的良性结节则采取更为保守的治疗方法。近年对TN的诊断方法有许多进展,其中超声检查是第一线方法,超声检查TN如有以下特征时要考虑恶性的可能:(1)边缘不整;(2)形状不规则;(3)实体回声结构;(4)低回声;(5)晕轮消失;(6)微钙化;(7)结节内血流。而细针穿刺抽吸细胞学活检在诊断TN时是最准确和直接的方法。其他有实验室检查(TSH、Tg测定),CT、MRI和PET-CT等。在TN的原发疾病中,良性多结节腺肿最为多见,占60%左右;甲状腺癌的发生率为5%～15%,这需看其年龄、性别、放射线病史、家族史等因素而定。慢性淋巴细胞性甲状腺炎、甲状腺囊肿、Graves病和高功能结节等则比较少见。     

Burnout among healthcare workers at L’Aquila: its prevalence and associated factors

Burnout, which is now recognized as a real problem in terms of its negative outcome on healthcare efficiency, is a stress condition that can be increased by exposure to natural disasters, such as the 2009 L’Aquila earthquake. This study aims to evaluate burnout syndrome, its associated risk factors and stress levels, and the individual coping strategies among healthcare professionals at L’Aquila General Hospital. A cross-sectional study of 190 healthcare workers was conducted. There was a questionnaire for the collection of the socio-demographic, occupational and anamnestic data, and the Maslach Burnout Inventory, the General Health Questionnaire-12 items (GHQ-12) and the Brief COPE were used. The burnout dimensions showed high scores in Emotional Exhaustion (38.95%), in Depersonalization (23.68%) and in lack of Personal Accomplishment (23.16%), along with the presence of moderate to high levels of distress (54.21%). In addition to factors already known to be associated with burnout (job perception and high levels of distress) exposure to an earthquake emerged as a factor independently associated with the syndrome. Adaptive coping strategies such as religiosity showed a significant and negative relationship with burnout. Our research highlights the need for interventions directed at a reduction in workload and work-stressors and an improvement of adaptive coping strategies, especially in a post-disaster workplace.     

A comparison of coping factors in Western and non-Western cultures

This study presents convergent support for the use of three empirically constructed factors, across four samples, from the Ways of Coping Questionnaire. Planning, Positive Reappraisal, and Distancing factors were congruent for comparisons made between U.S. healthcare workers, Chinese healthcare workers, Chinese teachers, and Taiwanese teachers. Additional evidence of congruency was provided on specific factors between specific pairs of groups. The results support the usage of common factors across languages, cultures, and occupational groups but also highlight the importance of not administering a test in a different cultural setting without assessing its dimensionality.     

2009年全球甲型H1N1流感流行病学特征分析

截至8月30日,全球5大洲177个国家或地区共报告甲型H1N1流感确诊病例254206例,死亡2837人,病死率1．12％。病例以青壮年为主,无性别差别,年龄中位数12岁～17岁（范围0岁～85岁）,约10％需住院治疗,37％的住院病例和80％的死亡病例有基础性疾病史或妊娠。全球甲型H1N1流感总体较温和,适时将其纳入季节性流感常规监测,掌握其流行病学和病原学变化,研制安全有效的疫苗;提高医务人员重症病例救治能力均能有效地预防控制甲型H1N1流感。     

2000年～2009年国内胃食管反流病误诊文献回顾分析

为探讨胃食管反流病(GERD)误诊现状、原因和对策,对2000年～2009年10年间国内公开发表的GERD误诊报道文献97篇进行回顾性分析。既往10年间共报道GERD误诊病例2629例,共涉及38个病种,其中最常见的误诊病种是冠心病/心绞痛(48.04%)、慢性咽炎(24.23%)、支气管炎(10.27%)、支气管哮喘(8.56%)。主要误诊原因是GERD非典型表现繁杂,非消化科医生缺乏相关知识,忽视相关鉴别诊断。心血管、耳鼻喉、呼吸科医生是强化GERD认识的重点人群。     

肥胖和/或NAFLD患者的药物性肝损伤

与药物有关的肝毒性是一个严重的健康问题,广泛影响着患者、医疗机构和政府监管机构.另外,由于久坐的生活方式和热量过度摄取,我们还面临着肥胖和非酒精性脂肪性肝病（NAFLD）的流行和困扰,因为肥胖和/或NAFLD提高各种疾病的风险,成为影响公众健康的又一个主要问题,这些患者平均使用药物的量远高于非肥胖患者.越来越多的证据表明,某些药物能够增加肥胖和NAFLD患者药物诱发肝损伤（DILI）的风险.因此,我们应该重视和防治肥胖和NAFLD患者DILI的发生.     

Psychological effects of occupational exposure to various chemical agents

Research on the psychological effects of occupational exposure to various chemical agents began at the Institute of Occupational Health in Helsinki in the last half of the 1950′s. At first workers occupationally exposed to carbon disulfide in a rayon fiber factory were clinically examined. These workers were submitted to psychological testing because they complained of numerous subjective psychological symptoms. Since then the behavioral effects of occupational exposure to various common solvents and lead have been studied with psychological methods. The earlier projects were either clinical or epidemiologic studies, but now experimental studies with animals have also begun. In all these investigations one of the main objectives has been to develop and find methods sensitive and specific enough to detect adverse behavioral effects.