国际功能、残疾和健康分类康复组合-17在临床多学科住院患者中应用的信效度研究

目的 验证国际功能、残疾和健康分类（ICF）康复组合-17在临床多学科患者功能评估中的信度和效度。 方法 选取来自江苏省三家三级医院的康复医学科、骨科、神经内科和神经外科的住院患者359例。在入院和出院时均采用ICF康复组合-17对所有患者进行评估,计算评估工具的内部一致性。用组内相关系数(ICC)检验评估者间和评估者内信度,用主轴法的直接斜交转轴法进行因子分析,检验ICF康复组合-17的结构效度。 结果 ICF康复组合-17的内部一致性Cronbach′s α系数为0.945。评估者间信度分析显示,ICF康复组合-17总分的ICC为0.946;除b280痛感外,该量表的剩余条目ICC为0.630～0.948（P<0.001）。评估者内信度分析显示,ICF康复组合-17总分和条目的ICC为0.471～0.947（P<0.001）。经过因子分析,得到3个特征值大于1的因子,累计解释变异量为74.123%,无双重负荷的条目。将3个公因子分别命名为“运动能力”,“睡眠感知交往能力”和“生活自理能力”。 结论 ICF康复组合-17在多学科住院患者功能评定中具有良好的内部一致性、评估者间信度、评估者内信度和结构效度。     

糖尿病简明ICF核心要素量表在糖尿病肾病血液透析患者中应用的信效度分析

目的:检验糖尿病简明ICF核心要素量表在糖尿病肾病血液透析患者中应用的信度和效度。方法:将该量表应用于165例糖尿病肾病血液透析患者中,采用项目分析、结构效度、效标关联效度、内部一致性信度、重测信度以及评定者间信度对量表的信效度进行分析。结果:除"身体结构"维度中的条目"s550胰的结构"相关系数较低(r0.2),其余各条目得分与量表总分均相关(r=0.367~0.745,P0.01);探索性因子分析提取4个公因子,共解释了62.45%的总方差;效标关联效度为0.615(P0.01)。量表总的Cronbach’sα系数为0.838;重测信度为0.885;评定者间信度为0.905。结论:糖尿病简明ICF核心要素量表具有良好的信效度,适合在国内糖尿病肾病血液透析患者中进行临床应用。     

威斯康星州肾结石生活质量量表的汉化及信效度检验

目的汉化威斯康星州肾结石生活质量量表,并对其进行信效度检验,以期为临床评估肾结石患者生活质量提供特异性量表。方法对源量表进行翻译、回译、跨文化调试和预调查,形成中文版威斯康星州肾结石生活质量量表。对162例肾结石患者进行调查研究,其中量表内容效度检验采用内容效度指数作为检测指标;结构效度采用探索性因子分析方法;效标关联效度采用Spearman相关系数作为检测指标;信度检验采用内部一致性信度Cronbach’sα系数作为检测指标。结果条目水平内容效度指数在0.8～1.0,量表水平内容效度指数为0.907;探索性因子分析提取出7个公因子,累计贡献量77.081%,同时各条目在相应公因子上载荷均大于0.3;Spearman相关系数为0.846;中文版威斯康星州肾结石生活质量量表总的Cronbach’sα系数为0.948。结论中文版威斯康星州肾结石生活质量量表具有良好的信效度,可作为评估肾结石患者生活质量的特异性工具。     

孕期体质量管理保护动机问卷的编制及信度效度检验

目的 :编制孕期体质量管理保护动机问卷,进行信度、效度检验。方法 :以保护动机理论为理论基础,通过文献分析法、半结构式访谈和德尔菲专家函询形成初始问卷,采用目的抽样法对381名孕妇进行调查,通过项目分析法、内容效度、结构效度、内部一致性信度、组合信度、重测信度对问卷进行评价。结果 :最终形成的孕期体质量管理保护动机问卷包含6个维度,32个条目;探索性因子分析提取出7个公因子,保留6个公因子,解释方差贡献度的63.236%;验证性因子分析显示χ~2/df=1.331,RMSEA=0.047,CFI=0.942,IFI=0.927,TLI=0.917;问卷的内容效度指数S-CVI/UA=1.00,S-CVI/AVE=0.92,各条目的内容效度指数为0.83～1.00;问卷整体Cronbach’sα系数为0.894,各维度的Cronbach’sα系数为0.652～0.920。问卷整体的重测信度为0.947,各维度的重测信度为0.846～0.956;各维度的组合信度系数在0.563～0.915,平方方差抽取量均在0.305～0.624。结论 :孕期体质量管理保护动机问卷信度、效度较好,可作为评价我国孕期妇女体质量管理保护动机水平的工具,能在一定程度上预测孕妇在孕期采取体质量管理健康行为可能性的大小,为临床孕期体质量管理方案的制定与评价提供依据和参考。     

脑卒中患者康复锻炼行为执行意向问卷的编制及信度效度检验

目的 :编制脑卒中患者康复锻炼行为执行意向问卷并检验其信度、效度。方法 :基于执行意向的定义及具体形式,通过文献分析、德尔菲专家函询及小样本预试验形成问卷初稿,采用便利抽样法对234名脑卒中患者进行调查,采用临界比值法、相关性分析、探索性因子分析、内容效度、结构效度、内部一致性信度、重测信度对问卷进行评价。结果 :脑卒中患者康复锻炼行为执行意向问卷包括19个条目,探索性因子分析提取2个公因子,累计方差贡献率为85.973%。总问卷Cronbach’sα系数为0.980,重测信度为0.884,各维度Cronbach’sα系数为0.982、0.979,重测信度为0.885、0.856。结论 :该问卷具有良好的信度、效度,可作为评价脑卒中患者康复锻炼行为执行意向的工具。     

中文版Jeffries模拟教学设计量表的信度效度评价

目的 :评估中文版Jeffries模拟教学设计量表(Simulation Design Scale,SDS)在模拟教学中的信度和效度。方法 :遵循Brislin双人翻译与回译原则,利用专家咨询法进行文化调适,形成中文版SDS量表,并对306名护生进行调查,用内部一致性信度、内容效度和结构效度等指标进行评价。结果 :中文版Jeffries模拟教学设计量表总Cronbach’sα系数为0.948,各维度Cronbach’sα系数为0.798~0.832;总量表重测信度为0.870,各维度重测信度为0.730~0.920;各维度内容效度均大于0.830,全部条目的平均CVI为0.860;验证性因子分析提取的5个因子共解释总变异的63.26%,除个别条目外,绝大多数条目在相应公因子上的因子负荷在0.4以上。结论 :中文版SDS量表具有较高的信度和效度,可用于指导和评估模拟教学设计,优化教学方案,提高教学质量。     

糖尿病联络护士专科护理管理行为量表信度、效度分析

目的评价德尔菲法形成的“糖尿病联络护士专科护理管理行为量表”的信度和效度。方法在426名基本样本、21名重测样本中检验量表的结构效度、克朗巴哈系数和重测信度,专家评价法检验量表的内容效度。结果量表总的Spearman相关系数为0．822,总的Cronbach’a系数为0．851;量表总的内容效度指数为0．96,特征根大于1的4个因子被旋转,其累积贡献率为69．928％,大部分条目的因子载荷在0．6以上。结论量表的内容效度、结构效度和重测信度、Cronbach’a系数均比较理想,量表具有较好的稳定性和内在一致性。     

HIV感染者/AIDS患者自我管理量表的汉化及信效度评价

目的对HIV自我管理量表(the HIV Self-management Scale, HIVSMS)进行汉化并评价其信效度。方法征得原作者同意后,采用翻译、综合、回译、专家咨询、预测试等步骤对HIVSMS进行汉化。对成都和上海的296例HIV感染者及AIDS患者进行调查,并通过内部一致性、重测信度、内容效度、结构效度及效标效度等指标对中文版HIVSMS进行信效度评价。结果中文版HIVSMS量表水平的内容效度指数为0.957,各条目的内容效度指数为0.769～1.000;总量表的Cronbach’sα系数为0.918,各维度的Cronbach’sα系数范围为0.820～0.959,量表总的重测信度为0.965;探索性因子分析得到3个公因子累计方差贡献率为72.26%;以慢性病自我管理量表为效标的相关系数为0.196～0.296 (P0.01)。结论中文版HIVSMS具有较好的信度和效度,可以作为我国HIV感染者及AIDS患者自我管理能力的评估工具。     

慢性阻塞性肺疾病ICF核心功能组合信度与效度的初步研究

目的探讨中国慢性阻塞性肺疾病（COPD）患者国际功能、残疾和健康分类（ICF）核心功能组合的信度与效度。 方法选择52例COPD患者,采用COPD ICF核心功能组合、SF-36健康调查量表进行评定。信度分析采用内部一致性分析方法;内部一致性信度采用Cronbach α系数和折半信度分析。效度分析采用内容效度和校标效度方法;内容效度采用Spearman相关分析,判断分量表每个类目与该分量表的相关性;校标效度采用Spearman相关分析,判断COPD ICF核心功能各个分量表及总量表与医学结局研究简明调查表（SF-36）平均分、FEV1/FVC、COPD分级、自评健康分数的相关性。 结果COPD ICF核心功能组合的4个分量表中,身体功能、身体结构、活动和参与具有很好的内容一致性,Cronbach α系数在0.698~0.957之间,总量表Cronbach α系数为0.921,折半信度相对较低（0.384~0.916）;环境因素的Cronbach α系数和折半信度不存在。COPD ICF核心功能组合的内容效度分析结果显示：身体功能、活动和参与、身体结构分量表有较好的内容效度;环境因素内容效度差。校标效度分析结果显示：身体功能、身体结构、活动和参与及总量表与作为检测标准的4个指标相关性良好;环境因素的校标效度差。 结论采用COPD ICF核心功能组合对COPD患者的评定功能可靠、有效,但其普适性尚需进一步检验;环境因素分量表尚需调整。     

基于ICF的失能评估工具在临床应用中的信度研究

目的验证基于国际功能、残疾和健康分类(ICF)的功能评定工具在失能评估中的信度。方法选取江苏钟山老年康复医院存在功能障碍的住院患者371例参与本研究,以基于ICF的功能评定工具对患者进行失能评估,以数字化评定量表(0～10分)评估条目失能程度。分析失能评定工具的内在一致性、评估者间信度、评估者内信度。结果基于ICF的失能评定量表的Cronbach′s α系数为0.89,评估者间信度分析显示量表总分的组内相关系数(ICC)为0.85,量表包含的20个条目的ICC在0.78～0.94(P<0.01);评估者内信度分析显示量表的总分ICC为0.95,除b230听力外,量表包含的其它条目ICC在0.72～0.97(P<0.01)。结论基于ICF的失能评定工具与数字评定量表联合在临床失能评估应用中具有良好的内在一致性及评估者间信度和评估者内信度。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。