脑外伤后人格改变评定量表的编制与信效度分析

目的 编制脑外伤后人格改变评定量表,并制定条目的 评分细则,确定不同程度人格改变的等级划界分,为脑外伤后人格改变的客观评估提供标准化评定工具.方法 根据器质性人格改变的基本概念、诊断标准及临床特征.结合临床实践经验,编制脑外伤后人格改变评定量表及评分细则,对相关被试进行初试、修改及条日筛选后,再用于排除了伪装等(有影响评定结果)的脑外伤后精神伤残鉴定案例.结果 (1)量表总分对无人格改变、轻度人格改变、中度人格改变及重度人格改变划界分分别为≤6分、7～14分、15～21分、≥22分.(2)全量表的Cronnbach's α仅系数为0.876,Guttman分半信度为0.847,重测相关在0.972,评分者相关在0.965以上.(3)与专家诊断比较,对有无人格改变的评定特异性96.9%,灵敏度99.4%,总准确率97.9%.结论 编制的脑外伤后人格改变评定量表符合心理测量学的基本要求,能为脑外伤后有人格改变的伤残鉴定案例提供量化的客观依据.     

Infectious Disease in a Warming World: How Weather Influenced West Nile Virus in the United States (2001–2005)

Background

The effects of weather on West Nile virus (WNV) mosquito populations in the United States have been widely reported, but few studies assess their overall impact on transmission to humans.

Objectives

We investigated meteorologic conditions associated with reported human WNV cases in the United States.

Methods

We conducted a case–crossover study to assess 16,298 human WNV cases reported to the Centers for Disease Control and Prevention from 2001 to 2005. The primary outcome measures were the incidence rate ratio of disease occurrence associated with mean weekly maximum temperature, cumulative weekly temperature, mean weekly dew point temperature, cumulative weekly precipitation, and the presence of ≥ 1 day of heavy rainfall (≥ 50 mm) during the month prior to symptom onset.

Results

Increasing weekly maximum temperature and weekly cumulative temperature were similarly and significantly associated with a 35–83% higher incidence of reported WNV infection over the next month. An increase in mean weekly dew point temperature was significantly associated with a 9–38% higher incidence over the subsequent 3 weeks. The presence of at least 1 day of heavy rainfall within a week was associated with a 29–66% higher incidence during the same week and over the subsequent 2 weeks. A 20-mm increase in cumulative weekly precipitation was significantly associated with a 4–8% increase in incidence of reported WNV infection over the subsequent 2 weeks.

Conclusions

Warmer temperatures, elevated humidity, and heavy precipitation increased the rate of human WNV infection in the United States independent of season and each others’ effects.     

Smoking cessation in England: Intentionality,anticipated ease of quitting and advice provision

Smoking prevalence in England continues to reduce but further reduction is increasingly difficult. Cessation policy has successfully targeted those who want to quit but further reduction will need to shift attention to more difficult ‘core smoker’ populations. Following the established ‘stages of change’ perspective, this paper considers the characteristics of people who do not intend to quit smoking, anticipate difficulties in quitting and have not received advice about quitting. We deploy multilevel models of data drawn from the Health Survey for England years 2002–2004, and the NHS Primary Care Trust Patient Surveys for 2004 and 2005. It was found that variations in intentionality and anticipated ease of quitting are associated with individual factors such as smoking intensity, parental smoking, age/length of time as a smoker and the nature of the advice-giving consultation. Household composition and household income are also implicated in the intention to quit and anticipated difficulties in quitting. Once individual and household factors are taken into account the only identifiable area-level variation is reduced intentionality towards quitting in rural areas. We conclude by arguing that further gains in smoking cessation must focus on understanding the characteristics of ‘hard-to-engage’ populations.     

Communication skills for behaviour change in dietetic consultations

Background: Both the UK’s National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health‐related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. Methods: In October 2007, a cross‐sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free‐text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre‐ and post‐registration level. Results: There were 1158 respondents; a response rate of 19.3%. Ninety‐eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post‐registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post‐registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. Conclusions: This study has explored an important and under‐researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post‐registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice.     

儿童计划免疫行为改变通径模型分析

目的 构建儿童计划免疫行为改变通径模型,探讨少数民族地区儿童计划免疫的影响因素及行为改变模式.方法 在贵州省黔东南州实施儿童计划免疫信息、教育与传播(IEC)策略的3个试点县进行终末评估,采用分层整群随机抽样方法,采用自行设计的调查问卷;调查2岁～儿童母亲291人;根据调查数据,应用通径分析方法,建立儿童计划免疫行为改变通径分析模型.结果 被调查母亲在有关计划免疫知识、态度、行为意向、突变管理能力、社会支持、计划免疫行为上的得分依次为39.70,11.80,11.82,11.10,10.60,28.30.各变量对于儿童计划免疫行为的决定系数(R2)分别为0.4477,0.2813,0.2125,0.3990,0.2435,0.1161.绪论计划免疫行为受IEC策略、知识、态度、行为意向、突变管理能力、社会支持以及一般人口社会学特征的影响,并且这些影响因素之间也存在相互作用.     

Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study

OBJECTIVES: To examine trajectories of change in everyday function for individuals with cognitive deficits suggestive of mild cognitive impairment (MCI). DESIGN: Using data from the longitudinal, multisite Advanced Cognitive Training for Independent and Vital Elderly Study allowed for post hoc classification of MCI status at baseline using psychometric definitions for amnestic MCI, nonamnestic MCI, multidomain MCI, and no MCI. SETTING: Six U.S. cities. PARTICIPANTS: Two thousand eight hundred thirty-two volunteers (mean age 74; 26% African American) living independently, recruited from senior housing, community centers, hospitals, and clinics. MEASUREMENTS: Mixed-effect models examined changes in self-reported activities of daily living and instrumental activities of daily living (IADLs) from the Minimum Data Set Home Care Interview in 2,358 participants over a 3-year period. RESULTS: In models for IADL performance, IADL difficulty, and a daily functioning composite, there was a significant time by MCI classification interaction for each MCI subtype, indicating that all MCI groups showed faster rates of decline in everyday function than cognitively normal participants with no MCI. CONCLUSION: Results demonstrate the importance of MCI as a clinical entity that not only predicts progression to dementia, but also predicts functional declines in activities that are key to autonomy and quality of life. MCI classification guidelines should allow for functional changes in MCI, and clinicians should monitor for such changes. Preservation of function may serve as a meaningful outcome for intervention efforts.     

Cyclosporin A is superior to cyclophosphamide in children with steroid-resistant nephrotic syndrome—a randomized controlled multicentre trial by the Arbeitsgemeinschaft für Pädiatrische Nephrologie

First line immunosuppressive treatment in steroid-resistant nephrotic syndrome in children is still open to discussion. We conducted a controlled multicentre randomized open label trial to test the efficacy and safety of cyclosporin A (CSA) versus cyclophosphamide pulses (CPH) in the initial therapy of children with newly diagnosed primary steroid-resistant nephrotic syndrome and histologically proven minimal change disease, focal segmental glomerulosclerosis or mesangial hypercellularity. Patients in the CSA group (n = 15) were initially treated with 150 mg/m(2) CSA orally to achieve trough levels of 120-180 ng/ml, while patients in the CPH group (n = 17) received CPH pulses (500 mg/m(2) per month intravenous). All patients were on alternate prednisone therapy. Patients with proteinuria >40 mg/m(2) per hour at 12 weeks of therapy were allocated to a non-responder protocol with high-dose CSA therapy or methylprednisolone pulses. At week 12, nine of the 15 (60%) CSA patients showed at least partial remission, evidences by a reduction of proteinuria <40 mg/h per m(2). In contrast, three of the 17 (17%) CPH patients responded (p < 0.05, intention-to-treat). Given these results, the study was stopped, in accordance with the protocol. After 24 weeks, complete remission was reached by two of the 15 (13%) CSA and one of the 17 (5%) CPH patients (p = n.s.). Partial remission was achieved by seven of the 15 (46%) CSA and two of the 15 (11%) CPH patients (p <0.05). Five patients in the CSA group and 14 patients in the CPH group were withdrawn from the study, most of them during the non-responder protocol. The number of adverse events was comparable between both groups. We conclude that CSA is more effective than CPH in inducing at least partial remission in steroid-resistant nephrotic syndrome in children.     

Footprint of greenhouse forcing in daily temperature variability

Changes in mean climatic conditions will affect natural and societal systems profoundly under continued anthropogenic global warming. Changes in the high-frequency variability of temperature exert additional pressures, yet the effect of greenhouse forcing thereon has not been fully assessed or identified in observational data. Here, we show that the intramonthly variability of daily surface temperature changes with distinct global patterns as greenhouse gas concentrations rise. In both reanalyses of historical observations and state-of-the-art projections, variability increases at low to mid latitudes and decreases at northern mid to high latitudes with enhanced greenhouse forcing. These latitudinally polarized daily variability changes are identified from internal climate variability using a recently developed signal-to-noise-maximizing pattern-filtering technique. Analysis of a multimodel ensemble from the Coupled Model Intercomparison Project Phase 6 shows that these changes are attributable to enhanced greenhouse forcing. By the end of the century under a business-as-usual emissions scenario, daily temperature variability would continue to increase by up to a further 100% at low latitudes and decrease by 40% at northern high latitudes. Alternative scenarios demonstrate that these changes would be limited by mitigation of greenhouse gases. Moreover, global changes in daily variability exhibit strong covariation with warming across climate models, suggesting that the equilibrium climate sensitivity will also play a role in determining the extent of future variability changes. This global response of the high-frequency climate system to enhanced greenhouse forcing is likely to have strong and unequal effects on societies, economies, and ecosystems if mitigation and protection measures are not taken.

The effect of anthropogenic greenhouse gas emissions on mean climatic conditions is well understood. Theory, observational, and modeling work all demonstrate that average temperatures increase as a result of elevated greenhouse gas concentrations (1). However, it is also of considerable importance to natural and human systems whether changes in the temporal variability of climatic conditions have accompanied historical global warming and whether they will do so in the future (2–5). A more variable climate implies greater uncertainty and greater frequency of extremes, both of which constitute more damaging conditions.The variability of climate from one year to the next has received considerable attention. Large-scale climatic oscillations, such as the El Niño Southern Oscillation and the Indian Ocean Dipole, are dominant determinants of interannual variability (6–8) and have been shown to exhibit more frequent extremes under enhanced greenhouse forcing within comprehensive climate models (9–11), results that are supported by paleoclimatic evidence (12). Identifying a response in interannual temperature variability has been less conclusive. Some studies have attributed recent summer temperature extremes to greater interannual variability, both regionally (13) and globally (14), but there is still debate as to the extent of the role of interannual variability (15–17). Some regional trends in interannual temperature variability have been identified (17–21), but there is no consensus between observations and climate models (22).Here, we focus on variability of temperature at a higher frequency (daily), which a growing body of econometric literature has identified as an important determinant of societal outcomes, including human health (23–27), agriculture (28–30), and economic growth (31). The effect of enhanced greenhouse gas concentrations on the daily variability of temperature is therefore of wide societal importance and a critical component of the impact of anthropogenic climate change.Decreases in daily temperature variability at northern mid to high latitudes have been detected in observations (32–34) and agree well with predictions from comprehensive climate models (34–36) and physical reasoning (34, 35). Previous generations of climate models have also suggested that daily variability may increase during European summer (37) and across the tropics (36, 38), but these predictions have not yet been detected in observations or confirmed in state-of-the art climate models. This paper unifies these works by presenting a global analysis of changes in subseasonal, daily temperature variability under enhanced greenhouse forcing in both reanalyses of historical observations (National Oceanographic and Atmospheric Administration [NOAA] 20th Century Reanalysis Version 3 and the European Centre for Medium-Range Weather Forecasts Reanalysis 5 [ERA-5]) and the latest generation of comprehensive climate models (Coupled Model Intercomparison Project phase 6 [CMIP-6]). Daily temperature variability refers to the intramonthly SD of daily surface temperature from hereon. We consider changes in daily variability in boreal winter (“DJF”), boreal summer (“JJA”), and across the year (“annual”) to both assess the season specific mechanisms identified in previous work and to provide an aggregated overview of variability changes.     

Tumor Necrosis Rate Adjusted by Tumor Volume Change Is a Better Predictor of Survival of Localized Osteosarcoma Patients

Background We assessed whether new parameter that considers both tumor volume change and necrosis rate predicts metastasis-free survival of localized osteosarcoma patients. We also evaluated relationship between tumor volume change and necrosis rate or metastasis-free survival. Methods We retrospectively reviewed 151 patients with stage II osteosarcoma who were treated with surgery and neoadjuvant chemotherapy. The tumor volume change was measured and calculated based on pre- and postchemotherapy magnetic resonance images. The mean metastasis-free interval was 83.1 months. We calculated adjusted tumor necrosis rate as following formula: 100–(100–necrosis rate) × postchemotherapy/prechemotherapy tumor volume. Survival and logistic regression analyses were used to evaluate the correlation among size parameters, tumor necrosis rate and survival. Results The 5-year metastasis-free survival rate of 151 patients was 71.4% (95% CI, 67.7–75.1%). American Joint Committee on Cancer (AJCC) stage IIB (RR 2.27; 95% CI, 1.11–4.62; P = 0.025) and poor adjusted tumor necrosis rate (RR 2.02; 95% CI, 1.05–3.89; P = 0.035) independently correlated with metastasis-free survival period. Further, tumor volume change independently correlated with necrosis rate. Decreased tumor volume could predict good response, with sensitivity of 80.2%, specificity of 68.6%, and positive predictive value (PPV) of 74.7%. Increased or stable tumor volume could predict poor response, with sensitivity of 68.6%, specificity of 80.2%, and PPV of 75.0 %. Conclusion The necrosis rate adjusted by the tumor volume change is an independent prognostic factor in osteosarcoma. This adjusted tumor necrosis rate may serve as a basis for risk-adapted therapy in combination with other prognostic factors.     

Assessment of physical activity in middle-aged and older adults with schizophrenia

BACKGROUND: Regular physical activity (PA) decreases morbidity in the general population; yet, information about the amount and effects of PA in persons with schizophrenia is scant. To develop interventions to increase PA and to assess its potential benefits in this group, accurate measurement of PA is needed. The purpose of this study was to characterize PA and determine the test-retest reliability and concurrent validity of the Yale Physical Activity Scale (YPAS), a self-report measure, in persons with schizophrenia. METHODS: PA was assessed with the YPAS, a scale of motivational readiness for PA, and accelerometry in middle-aged and older persons with a diagnosis of schizophrenia (n=54) and in a comparison group with no known psychiatric diagnosis (n=27). RESULTS: On the YPAS measures, persons with schizophrenia reported on average 11 h per week of PA, whereas the non-psychiatric comparison group reported about 32 h per week. Only about 30% of schizophrenia subjects were classified as being regularly active relative to 62% of the comparison group on PA motivational stages of readiness. On the accelerometry measures, the schizophrenia group had lower levels of light activity than the comparison group, but there were no differences in moderate and vigorous activity or sedentary behavior. Only in the comparison group were there significant associations between YPAS and accelerometer variables. Several YPAS scores demonstrated high test-retest reliability in both groups, and concurrent validity was supported between the YPAS and PA motivational stages of readiness. CONCLUSIONS: We found that the YPAS is a reliable measure of PA in schizophrenia for some indices. Although the YPAS demonstrated concurrent validity with other self-report measures, it did not demonstrate concurrent validity when compared to PA measured by accelerometry in persons with schizophrenia. Use of multiple measures, both subjective and objective, is recommended when assessing PA in schizophrenia.