SF-36量表应用于城市化居民生命质量评价的信度和效度分析

目的 评价SF-36量表用于城市化居民生命质量评价的信度和效度,为选择合适的健康测量工具提供参考。方法 采用多阶段整群系统抽样方法,使用SF-36量表进行入户调查,利用Spearman-Brown系数和Cronbach''s α 系数评价量表分半信度和内部一致性信度,集合效度实验和区分效度实验成功率评价量表集合效度和区分效度,采用相关分析和非参数检验以自评健康状况为标准进行标准关联效度分析,结构效度评价采用基于结构方程模型的验证性因子分析。结果 SF-36量表应用于城市化居民生命质量评价具有良好的分半信度(R=0.94)和内部一致性信度(除"躯体疼痛"和"精力"维度外,Cronbach''s α 系数为0.70~0.91),量表集合效度(定标成功率为88.57%)、区分效度(定标成功率为90.61%)和准则效度(γ_s=0.56,评分与自评健康状况相一致)良好,二阶验证性因子分析模型对数据拟合度较差(拟合优度指数为0.721,调整拟合优度指数为0.682,比较拟合指数为0.731,残差均方和平方根为0.084,近似误差均方为0.098),提示结构效度欠佳。结论 SF-36量表用于城市化居民生存质量评价具有良好的信度、集合效度、区分效度和标准关联效度,但结构效度欠佳,建议在实际应用中对相应条目进行调整。     

Urbanization influences dietary habits of Cypriot children: the CYKIDS study

Objectives:  Nutrition transition and urbanization have been linked to the adoption of a Western diet. An increasing number of Cypriot have abandoned their traditional eating habits and replaced them with a more westernized diet. Therefore, we aimed to examine the relationship between dietary habits of preadolescent children in Cyprus and their place of residence, with reference to nutrition transition. Methods:  CYKIDS is a national, cross-sectional study, among 1140 children (10.7 ± 0.98 years). Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire Adherence to the Mediterranean diet was evaluated by the KIDMED index. Logistic regression and bivariate analyses were used for data analysis. Results:  Differences between children from urban and rural areas were not major, but it was found that children from rural areas consumed more traditional foods, were less likely to eat fast food [OR = 0.66, 95% CI (0.49–0.88)] and more likely to have meals with the family [OR = 2.49, 95% CI (1.62–3.81)]. Conclusions:  The minor differences relating the dietary patterns to the place of residence reflect the changes in eating habits and the abandonment of the traditional Mediterranean diet, which may be attributed to the nutrition transition and urbanization phenomena. Submitted: 02 April 2008; revised: 29 September 2008; 22 November 2008; accepted: 29 November 2008     

Intraurban Variations in Adult Mortality in a Large Latin American City

Urbanization is high and growing in low- and middle-income countries, but intraurban variations in adult health have been infrequently examined. We used spatial analysis methods to investigate spatial variation in total, cardiovascular disease, respiratory disease, and neoplasm adult mortality in Buenos Aires, Argentina, a large city within a middle-income country in Latin America. Conditional autoregressive models were used to examine the contribution of socioeconomic inequalities to the spatial patterning observed. Spatial autocorrelation was present in both men and women for total deaths, cardiovascular deaths, and other causes of death (Moran’s Is ranging from 0.15 to 0.37). There was some spatial autocorrelation for respiratory deaths, which was stronger in men than in women. Neoplasm deaths were not spatially patterned. Socioeconomic disadvantage explained some of this spatial patterning and was strongly associated with death from all causes except respiratory deaths in women and neoplasms in men and women [relative rates (RR) for 90th vs 10th percentile of percent of adults with incomplete high school and 95% confidence intervals: 1.23 and 1.09–1.39 vs 1.24 and 1.08–1.42 for total deaths in men and women, respectively; 1.36 and 1.15–1.60 vs 1.22 and 1.01–1.47 for cardiovascular deaths; 1.21 and 0.97–1.52 vs 1.07 and 0.85–1.34 for respiratory deaths; 0.94 and 0.85–1.04 vs 1.03 and 0.87–1.22 for neoplasms; and 1.49 and 1.20–1.85 vs 1.63 and 1.31–2.03 for other deaths].There is substantial intraurban variation in risk of death within cities. This spatial variability was present for multiple causes of death and is partly explained by the spatial patterning of socioeconomic disadvantage. Our results highlight the pervasive role of space and social inequalities in shaping life and death within large cities. Diez Roux and Green Franklin are with the Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA; Alazraqui and Spinelli are with the National University of Lanus, Buenos Aires, Argentina.     

城镇化水平与慢性病及健康相关行为的关联分析

目的：探究中国不同城镇化水平与慢性病的关系,为城镇化过程中相关卫生政策的设计提供依据。方法： 通过2011年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）获得健康相关数据,利用多阶段抽样方法,调查覆盖150个区县,样本有全国代表性;利用地理信息系统（geo information system, GIS）方法计算出各个地区面积,结合第六次人口普查数据计算出各个地区的人口密度作为城镇化水平的代理变量。采用Logistic模型分析不同城镇化水平对高血压、糖尿病、吸烟、饮酒、超重、肥胖的影响。结果： 上海市、深圳市城镇化水平最高,人口密度超过3 000人/平方公里。整体而言,中国西北地区的城镇化水平明显低于东南地区,沿海地区的城镇化水平普遍高于内陆地区。高血压患病率随着城镇化水平的提高而增加,但是差异无统计学意义。糖尿病患病率呈现先上升后下降的趋势。饮酒率、超重率和肥胖率在城镇化水平较低时呈上升趋势,之后经历下降过程,拐点数值分别依次是737、1 186、1 353人/平方公里;而人群吸烟率经历先下降后上升的变化,拐点为1 029人/平方公里。结论： 不同城镇化水平对慢性病患病率、健康相关行为及超重、肥胖的影响不同。城镇化水平较低时可能对健康产生负向影响,而较高水平时可能由于卫生服务可及性、环境改善等原因又会提高居民的健康状况。决策者在城镇化水平的不同时期要侧重关注居民的不同健康问题,包括环境污染的影响、卫生资源配置、卫生服务可及性等,尽量减少或者避免城镇化对慢性病的负面影响,以应对慢性病带来的威胁。