基于多维项目反应理论的学龄前儿童饮食行为量表的再评价

目的 采用多维项目反应理论(MIRT)理论对“学龄前儿童饮食行为量表”进行进一步的条目评估,探索MIRT理论在医学量表编制中的可行性和有效性,编制出更加完善精简的“学龄前儿童饮食行为量表”,为我国儿童饮食行为评价和相关研究提供基本工具。方法 广泛查阅国内外相关文献,2017年6月以西安市城、郊3～6岁儿童“学龄前儿童饮食行为量表”测试结果为基础,采用MIRT下的条目区分度、难度和猜测系数对各条目进行评价和筛选,采用Cronbach’s α系数、分半信度系数、重测信度系数以及因子分析等对修订后的量表的信度、效度、反应度进行再检验,并与原量表进行对比。结果 依据MIRT下的条目区分度、难度和维度载荷共删除3个条目,并调整了1个条目的维度归属。修订的量表同质信度Cronbach’s α系数为0.94,Guttman分半信度系数为0.81,重测信度系数为0.73,探索性因子分析显示累积方差贡献率为59.04%,验证性因子分析显示范拟合指数(NFI)=0.86,非范拟合指数(NNFI)=0.92,比较拟合指数(CFI)＝0.93,均方根残差(RMSR)=0.04。不同体重分集在过饱响应、食物响应、挑食、不良进食习惯维度得分上差异均有统计学意义(P<0.05)。修订后量表的信度、效度和区分度各类指标中大部分都优于原量表。结论 MIRT理论下的条目筛选方法可进一步调高量表的信度和效度,使量表更加精简,新修订的学龄前儿童饮食行为量表更适合于儿童饮食行为问题的评估和研究。     

老年人社会支持评价量表的汉化及信效度检验

  目的  汉化老年人社会支持评价(the social support appraisals scale, SS-A)量表,并进行文化调适和信效度检验。  方法  遵循Brislin翻译模式进行量表的翻译、回译及文化调适。采用便利抽样对548名老年人进行一对一访谈调查,分析中文版量表的信度和效度。  结果  中文版量表共包含20个条目,3个维度。结构效度:探索性因子提取3个因子,可解释的总变异为59.706%;模型拟合指标为:χ2/υ=2.648、比较拟合指数(comparative fit idex, CFI)=0.907、增值适配指数(iciemental fit index, IFI)=0.908、拟合优度指数(goodness of fit index, GFI)=0.862、非标准适配指数(Tucker-Lewis index, TLI)=0.889、渐进残差均方和平方根(root mean square error of approximation, RMSEA)=0.078、残差均方和平方根(root mean square residual, RMR)=0.019。收敛效度:平均方差抽取量(average vriance extracted, AVE)=0.579。区分效度:低分组和高分组差异均有统计学意义(均有P＜0.05)。一致性信度:总量表克朗巴赫(Cronbach’s α)系数为0.927;3个维度的Cronbach’s α系数分别为0.884、0.858和0.697。重测信度:组内相关系数(intraclass correlation coefficient, ICC)为0.780,3个维度ICC值分别为0.869、0.655和0.505,且均有统计学意义(均有P < 0.001)。  结论  中文版老年人社会支持评价量表信效度良好,可用于中国老年人社会支持的评价。     

中文版婴儿运动发育家庭支持环境量表的信效度分析

目的 对婴儿发育家庭环境支持量表(AHEMD-IS)的信效度进行评价,为早期运动环境的筛查和干预提供有效工具。方法 本研究采用横断面调查的方法,选择上海市分娩量最大的二、三级妇幼保健院以及江苏省盐城市妇幼保健院。招募2014年12月—2015年9月儿保门诊定期体检的婴儿作为研究对象,年龄范围3~11月龄,共纳入研究对象1 250例。信效度评价使用Cronbach′s α系数来测量内在一致性信度,使用Guttman折半系数测量外在一致性信度,使用条目水平内容效度指数(Item-level Content Validity Index,I-CVI)测量内容效度,使用探索性因素分析测量婴儿家庭环境支持量表的结构效度。结果 3~11月龄婴儿发育家庭环境支持量表中文版总体Cronbach′s α系数为0.836,量表26个条目的折半系数为0.515,条目水平的内容效度指数除了第17条目I-CVI得分为0.625,其他条目得分均在0.75~1之间。采用主成分分析法提取4个公因子,累计贡献率为49.27%,分别命名为“活动空间”、“活动多样性”、“大运动玩具”、“精细运动玩具”,与原量表结构符合。结论 婴儿发育家庭环境支持量表达到了基本心理测量学标准。可在研究地区婴儿中使用,作为针对婴儿运动发育环境筛查的有效工具。     

抑郁症病耻感量表的汉化及在社区人群中的信效度评价北大核心

目的 汉化抑郁症病耻感量表(DSS),并检验其在社区人群中的信效度。方法 通过翻译、回译、专家委员会评议、预调查,形成中文版抑郁症病耻感量表。对2000名社区居民进行抑郁症病耻感调查,采用临界比值法和Pearson相关分析对量表进行条目分析;Cronbach′s α系数和重测信度评价量表的信度;经专家测评评定量表的内容效度,因子分析评价量表的结构效度。结果 DSS量表各条目的内容效度指数(I-CVI)为0.778~1.000,量表水平的内容效度指数(S-CVI)为0.914。探索性因子分析提取两个公因子,各条目的因子归属情况与原量表保持一致。进一步验证性因子分析结果显示模型的契合度良好。个人病耻感维度、感知病耻感维度、量表总分的Cronbach′s α系数分别为0.710、0.810、0.812,P<0.001;重测信度分别为0.902、0.734、0.901,P<0.001。结论 中文版抑郁症病耻感量表经文化调适后在中国社区人群中具有良好的信效度,可用于社区居民对抑郁症患者的态度、抑郁症患者自身的病耻感水平的测评。     

中文版老年人抑郁量表(DIA-S)的信效度研究

目的 翻译老年人抑郁量表(the Depression In old Age scale,DIA-S),并评价其信效度。方法 采用Brislin法对量表进行汉化,应用便利抽样法,对辽宁省锦州市社区老年人进行调查,运用SPSS22.0和Amos17.0软件对数据进行分析。结果 中文版DIA-S量表的总Cronbach′s α系数为0.829,分半信度为0.831,重测信度为0.907;量表水平的内容效度指数(S-CVI/UA)为0.900,条目水平的内容效度指数(I-CVI)为0.833～1.000,平均量表水平的内容效度指数(S-CVI/Ave)为0.983;各条目与总分的Pearson相关系数为0.475～0.789,差异有统计学意义(P＜0.05)。探索性因子分析(EFA)得到1个公因子,累积方差贡献率为62.16%,各条目共同度为0.378～0.731。验证性因子分析(CFA)得到拟合良好的结构方程模型,模型适配度(拟合度)指标中,x2/df=2.679,GFI=0.948,AGFI=0.911,PGFI=0.552,IFI=0.944,TLI=0.919,CFI=0.943,RMSEA=0.073,RMR=0.010,标准化回归系数取值范围为0.35～0.77。结论 中文版老年人抑郁量表(DIA-S)信效度良好,可用于评估社区老年人抑郁情况。     

医学生用药认知水平量表的信效度评价

目的 评价自制的医学生用药认知水平量表(QMCLMS)的信效度,以期对量表进行改进和完善。方法 分层抽取甘肃平凉地区1 375名医学生与非医学生的有效问卷数据,采用信度分析和因子分析等方法系统评价量表的信度、内容效度和结构效度。结果 量表Cronbach’s α系数为0.851;除了F5因素分量表Cronbach’s α系数为0.476之外,其余因素分量表Cronbach’s α系数均大于0.7。经因子分析,因子结构与量表设计吻合,结构效度较好。经独立样本T检验,F2、F3、F4、F5分量表积分和量表总分在医学生与非医学生之间明显存在统计学差异,提示量表的实证效度较好。结论 QMCLMS量表的信度和效度评价令人满意,可在医药院校中进行推广和使用。     

中国城区0～6岁儿童家庭内意外伤害环境量表的研制与性能测试

目的 研制我国城区0～6岁儿童的家庭内意外伤害环境量表,并对其进行性能测试。方法 经查阅文献、咨询专家和预调查等确定量表相关内容后,采用多阶段分层整群随机抽样方法在长沙市城区抽取1 104名0～6岁儿童,问卷收集儿童基本信息、发生意外伤害和家庭环境情况等内容。采用Cronbach′s α和分半系数评价量表信度;分别采用Pearson相关分析、因子分析法评价量表的内容效度、结构效度;根据是否发生家庭内意外伤害将儿童分为两组,采用t检验分析量表的区分效度。结果 量表共包含6维度54条目;共回收有效问卷1 074份,男童554名(51.6%);<3岁儿童519名(48.3%);意外伤害的发生率为18.34%(197名),家庭内意外伤害发生率为10.71%(115名)。总量表的Cronbach′s α系数为0.87,分半系数为0.82,达到信度0.70以上的标准。量表各维度和总量表之间的Pearson相关系数为0.53～0.84之间,P均<0.001。总量表的公因子累积方差贡献率为58.34%,54个条目的因子载荷均>0.30;量表的近似误差均方根、比较拟合指数和拟合优度指数...     

儿童肥胖健康素养量表家长版的编制及评价

目的 编制“儿童肥胖健康素养量表(家长版)”,并评价其信度和效度。方法 依据健康素养内涵,基于世界卫生组织(WHO)提出的终止儿童肥胖相关内容,构建儿童肥胖健康素养量表(家长版)条目池,然后在合肥市小学生家长中进行调查,应用探索性因子分析和验证性因子分析对量表的效度进行检验,应用内部一致性对量表信度进行检验。结果 本次研究共有2 170名小学生家长参与调查,通过敏感性分析、代表性分析、独立性分析及Cronbach′s α系数进行条目筛选,再通过探索性因子分析和验证性因子分析,最终形成29个条目的儿童肥胖健康素养量表(家长版),量表构建成为健康意识、健康知识、健康行为、健康认知及操作技能5个维度。验证性因子分析得到近似误差均方根(root mean square error of approximation,RMSEA)为0.047,残差均方根(root of the mean square residual,RMR)为0.026,拟合优度指数(goodness-of-fit index,GFI)、标准拟合指数(normed fit index,NFI)、相对拟合指数(relative fit index,RFI)和比较拟合指数(comparative fit index,CFI)均接近1,显示模型拟合较好。量表的Cronbach′s α系数为0.833,问卷各维度的Cronbach′s α系数在0.618~0.866之间。结论 所编制的儿童肥胖健康素养量表(家长版)具有较好的信度和效度。     

脑力劳动者职业倦怠测量工具的信度和效度分析

目的 评价修订的职业倦怠问卷在脑力劳动者中运用的信度与效度.方法 采用分层整群随机抽样的方法 抽取管理者、高校教师等1250名脑力劳动者进行职业倦怠问卷调查.结果 探索性因素分析提取得到3个公因子与原理论模型基本一致,分别代表情感耗竭、人格解体与成就感降低.问卷与3个子项(情感耗竭、人格解体、成就感降低)的Cronbach α值介于0.721～0.832.除人格解体的分半信度和情感耗竭的重测信度外,其余修订后的信度指标均高于原量表的研究结果 .利用验证性因素分析进行结构效度的分析,发现整个模型拟合良好,条目在3个潜因子负荷>0.4(P<0.01),说明相应的条目度最对应的潜在因子的结构比较合理.无论是单样本还是总体样本,三因素模型拟合指数均优于单因素和二因素模型拟合指数.修订后量表的三因素模型拟合指数整体上优于原量表.同时量表具有较好的内容效度.结论 修订后的职业倦怠问卷是较可靠、有效的测量工具,可用于脑力劳动者的职业倦怠研究.     

流动人口SF-12生命质量量表信度、效度评价

目的 评估SF-12生命质量量表用于评价流动人口生命质量时的信度和效度.方法 采用内部一致性信度评估SF-12生命质量量表的信度,采用集合效度、区分效度和结构效度评估SF-12量表的效度.结果 SF-12生命质量量表用于评价流动人口生命质量时的内部一致性信度cronbach's α=0.84,各维度与总分的相关系数除了躯体活动功能(PF)=0.43,其余均>0.50;各维度的cranach's α系数均>0.70,且在删除相应维度后的cronbach's α系数均>0.70;8个维度的集合效度定标实验成功率均为100%,区分效度定标实验成功率均为100%;对量表的理论结构模型进行验证性因子分析,所得模型结构与原始假定一致,拟合指标结果为不规范拟合指数(NNFI)=0.95、比较拟合指数(CFI)=0.96、调整后的拟合优度指数(AGFI)=0.96、近似误差均方根(RMSEA)=0.06.结论 SF-12生命质量量表用于评价流动人口生命质量时具有较好的信度和效度.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.