保留后方韧带复合体在胸腰椎骨折治疗中的意义

[目的]探讨保留后方韧带复合体在胸腰椎骨折治疗中的意义。[方法]1998～2002年单一节段胸腰椎爆裂骨折治疗中保留后方韧带复合体44例，同期行胸腰椎爆裂骨折治疗切除后方韧带复合体者35例。两种方法分别有15例（定义为A组）和12例（定义为B组）行2次手术取出内固定物，比较AB两组间2次手术前后腰椎功能JOA评分。[结果]2次手术前腰椎功能JOA评分：A组平均24．5分（19～29分）；B组平均22．8分（19～29分），二者无显著性差异（P〉0．05）。2次手术后JOA评分：A组平均24．8分（20～29分），B组平均17．5分（13～26分）。二组有显著性差异（P〈0．05）。[结论]胸腰椎骨折治疗中保留后方韧带复合体，利于术后腰椎功能恢复。     

Screening for major depression in persons with HIV infection: the concurrent predictive validity of the Profile of Mood States Depression‐Dejection Scale

Major Depressive Disorder (MDD) is among the most prevalent but underdiagnosed psychiatric disorders in persons with HIV infection. Given the known adverse impact of comorbid MDD on HIV disease progression and health‐related quality of life, it is important both for research and for efficient, effective clinical care, to validate existing screening measures that may discriminate between MDD and the somatic symptoms of HIV (such as fatigue). In the current study, we evaluated the concurrent predictive validity of the Profile of Mood States (POMS) Depression‐Dejection scale in detecting current MDD in 310 persons with HIV infection. The Structured Clinical Interview for DSM‐IV (SCID) diagnosis of MDD and the Cognitive‐Affective scale from the Beck Depression Inventory (BDI‐CA) served as comparative diagnostic and severity measures of depression, respectively. Results demonstrated that the POMS Depression‐Dejection scale accurately classified persons with and without MDD SCID diagnoses, with an overall hit rate of 80%, sensitivity of 55%, specificity of 84%, and negative predictive power of 91% using a recommended cutpoint of 1.5 standard deviations above the normative mean. Moreover, the POMS performed comparably to the BDI‐CA in classifying MDD. Findings support the predictive validity of the POMS Depression‐Dejection scale as a screening instrument for MDD in persons with HIV disease. Copyright © 2006 John Wiley & Sons, Ltd.     

江门市区实施乙型肝炎免疫策略16年的效果评价

目的：对江门市区1986年1月1日起全面实施的乙型肝炎(乙肝)免疫策略进行效果评价。方法：运用血清流行病学调查和疫情资料对比分析，比较实施“免疫策略”前后江门市区0～15岁人群乙肝发病率和感染率变化情况和乙肝表面抗体(抗-HBs)增长情况。结果：实施“免疫策略”后16年，0～15人群的乙肝发病率由1985年的367．39／10万，降至2001年的21．10／10万，下降94．26％；HBsAg阳性率由1985年的9．17％降至2002年的0．6％，下降93．46％；乙肝病毒总感染率由1985年的35．82％降至2002年的1．20％，下降96．65％；抗-HBs阳性率由1985年的24．64％上升到2002年的93．00％，上升2．77倍。结论：江门市区现行乙肝免疫策略效果显，能有效预防和控制地区性大面积的乙肝流行与传播。经过一代人的努力，能彻底改变人口乙肝高发病率和HBV高感染率及高携带率的状况。     

Nursing Assessment of Altered Sexuality: A Review of Salient Factors and Objective Measures

TOPIC. Nursing assessment of altered sexuality.
PURPOSE. To review salient factors affecting assessment and objective measures available for use in assessment.
SOURCE. Literature specific to nursing assessment of sexuality and to instruments measuring altered sexuality.
CONCLUSIONS. Many standards of care include the assessment of sexuality, and nurses believe it to be an important aspect of care. However, the assessment of altered sexuality does not often occur in actual practice. The use of an objective measure of sexuality is recommended for both initial and on-going assessments in acute-care and community-based settings.     

Localized pleural plaques and lung cancer.

In a mass chest radiography survey conducted in 1971 for 7,986 residents of three Finnish communities, 604 subjects (7.6%) with pleural plaques but not other asbestos-related radiographic signs were identified. The same number of referents, each individually matched to each plaque carrier on sex, birth year, and community, was selected from among persons in the same source population with no pleural plaques. The two groups were followed for investigation of incidence of lung cancer during 1972-1989. Twenty-eight of those with plaques and 25 referents contracted lung cancer (crude conditional RR = 1.1; CL95 = 0.7, 1.9). The application of the proportional hazards model, with adjustment for sex, age, and residence, resulted in a hazard ratio of 1.1 (CL = 0.6, 1.8). The risk ratio estimate may be biased; hence, the result is inconclusive in regard to the predictive assessment of lung cancer risk among carriers of pleural plaques.     

孔边裂纹J积分失效评定曲线

计算了单边椭圆缺口试件（ＳＥＮＣＰ）高应变区裂纹的Ｊ积分失效评定曲线（ＦＡＣ），考察了影响ＦＡＣ的几种因素。结果表明：在外加载荷与塑性屈服载荷之比（Ｌｒ）１．０时，用Ｒ６通用失效评定曲线进行结构高应变区裂纹断裂评定与疲劳剩余寿命估算是安全的。     

lnter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward

The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.