基于《无障碍设计规范》的超大城市道路交通人行道无障碍建设状况评价——以上海市为例

目的评价上海市道路交通人行道无障碍建设状况。方法 2019年7月至9月,方便抽样选取上海市46条道路交通人行道,基于《无障碍设计规范(GB 50763-2012)》和《无障碍设施设计标准(DGJ08-103-2003)》研制评价工具,对人行道进行客观查检与主观体验,采用描述性分析方法分析人行道各评价维度及评价内容达标率,采用主成分分析法计算各评价维度客观权重,构建人行道综合障碍得分模型,比较上海市不同区域人行道综合障碍得分。2019年9月至11月,对11例功能障碍者进行深度访谈,了解功能障碍者对人行道障碍的主观评价。结果人行道无障碍建设总体达标率为4.35%。人行道无障碍评价内容中,93.5%人行道具有缘石坡道,91.3%坡道与车行道之间存在高差,26.1%人行道未铺设盲道,71.7%盲道被电线杆等阻隔,84.8%盲道被障碍物占道。人行道无障碍评价维度中,提示盲道客观权重最大。中心城区人行道障碍程度(高障碍36.7%、中障碍20.0%)高于主城片区(高、中障碍均为6.3%)(P 0.05)。主观评价显示,人行道使用体验中障碍较多,人行道无障碍设施使用意愿较低。结论上海市大多数人行道未达到人行道《无障碍设计规范》的标准。人行道无障碍设施建设、维护等需求较为迫切。     

深圳市公共体育场馆无障碍设施建设与辅助技术应用

目的 调查深圳市现有体育场馆无障碍设施建设与辅助技术应用现状,分析存在的问题。方法 2022年10月19日至2023年2月17日,运用无障碍体育场馆建设的标准,对深圳8个区级公共体育场馆无障碍建设和服务以及辅助技术应用情况进行现场调查和评估。结果 所有体育场馆均建设缘石坡道、无障碍公共厕所,87.5%(7/8)建设盲道,62.5%(5/8)建设轮椅坡道、无障碍电梯、无障碍轮椅席位,37.5%(3/8)建设无障碍通道,12.5%(1/8)建设扶手,75%(6/8)建设无障碍机动车停车位,25%(2/8)应用辅助技术。结论 本研究对深圳市体育场馆无障碍设施和辅助技术的可及性进行评估,即进入体育场馆、进入体育场馆内部、身体活动期间对各类无障碍环境及其辅助技术的使用和体验情况。在无障碍设施建设方面,缘石坡道和无障碍公共厕所建设场馆数量最多,扶手建设场馆数量最少,辅助技术应用情况最差。     

广州市各级医院无障碍环境现状调查

目的 调查医院建筑中无障碍设施建设存在的问题。方法 2018年3月至2018年10月,根据《国际功能、残疾和健康分类》(ICF)提出的环境因素限定值和分级,对广州市区30所医院的10项无障碍设施(出入口、通道及门、扶手、楼梯及台阶、电梯、盲道、停车位、厕所、低位服务设施和标识系统)进行评定,限定值用“障碍”来判断,每项环境因素0~4分,0分无障碍,4分完全障碍。结果 三级医院1.48分,介于轻度障碍和中度障碍之间;二级医院2.32分,介于中度障碍和重度障碍之间,偏向于中度障碍;一级医院2.66分,介于中度障碍和重度障碍之间,偏向于重度障碍。结论 各级医院的无障碍环境状况介于轻度障碍和重度障碍之间,存在改进的空间。     

发达地区残疾儿童营养状况研究——以上海市为例

目的 了解发达地区残疾儿童的营养状况并分析其影响因素。方法 2019年12月至2020年1月以及2020年8月至9月,方便抽样选取上海市2~18岁残疾儿童主要照护者480例。调查残疾儿童的身高和体质量,计算体质量指数(BMI)。基于儿童超重、肥胖预测的生态模型,从儿童个人、家庭及社会特征3个维度分析残疾儿童营养状况的影响因素。采用χ²检验和二分类Logistic回归模型进行分析。结果 480例残疾儿童的消瘦、超重和肥胖检出率分别为23.75%、13.54%、13.33%。多因素Logistic回归分析显示,薯类摄入(OR = 0.420, 95%CI 0.197~0.893, P < 0.05)、照护者对孩子体质量的感知(OR_过轻 = 4.188, 95%CI 1.488~11.787, P < 0.01)对儿童消瘦有影响;残疾类型(OR_孤独症 = 0.142, 95%CI 0.034~0.591, P < 0.01)、家庭角色(OR_父亲 = 5.519, 95%CI 1.110~27.440, P < 0.05)、照护者对孩子体质量的感知(OR_过重 = 5.669, 95%CI 1.112~28.903, P < 0.05)对儿童超重肥胖有影响。结论 上海市残疾儿童营养不良问题发生率较高,消瘦和肥胖比例远高于正常儿童。残疾类型、自身膳食摄入及家庭特征对残疾儿童营养状况的影响较大。     

社区老年视觉障碍人群生活质量的研究

目的 了解社区老年视觉障碍人群的生活质量,为社区建立建全老年眼保健服务体系提供实际依据.方法 采用生活质量综合评定问卷(GQOLI-74),对社区104例检出有不同程度视力障碍的老年患者,进行调查,并对结果进行分析.结果 生活质量总体评价为(55.05±13.21)分,处于中等水平.在物质生活、社会功能2个维度,主观生活满意度得分高于客观生活质量;而在躯体功能和心理功能2个维度上,均是客观生活质量得分高于主观生活满意度得分.16.35%的老年人得不到社会支持;27.89%自评经济状况差;在业余娱乐生活和运动与感觉功能方面,评价差者,分别为28.85%和17.31%.结论 在社区积极开展初级眼保健知识的教育,对减缓视力衰退、提高老年生活质量有着重要的意义.     

社区空巢老人述情障碍现状及其影响因素分析

目的了解社区空巢老人述情障碍现状并分析其影响因素。方法2018年10月至2019年5月,便利抽样法选取重庆市主城区6个社区的425名空巢老人为研究对象,采用一般资料调查表、多伦多述情障碍量表、阿森斯失眠量表、日常生活活动能力量表(activities of daily living scale,ADLs)及社会支持评定量表对其进行调查。结果社区空巢老人述情障碍的发生率为19.8%,总分为(50.52土8.63)分,各维度得分从高到低依次为外向性思维、情感表达障碍和情感识别障碍。述情障碍得分与ADLs及其各维度得分呈正相关(均P<0.05),与社会支持及其各维度得分呈负相关(均P<0.05)。多元线性回归分析发现,文化程度、婚姻状况、体育锻炼、睡眠质量、日常生活活动能力及主观社会支持是社区空巢老人述情障碍的重要影响因素(均P<0.05)。结论社区空巢老人述情障碍发生率较高,医护人员可从多种影响因素着手,制定切实可行的干预措施,以改善空巢老人的述情障碍。     

精神科护士创伤后应激障碍现状及影响因素分析

[目的]调查精神科护士创伤后应激障碍水平并分析其影响因素。[方法]采取问卷调查法,选取西安市某医院35名精神科护士为调查对象。调查问卷包括基本情况调查表、社会支持评定量表、简易应对方式问卷、创伤应激障碍自评量表。[结果]精神科护士创伤应激障碍阳性率28.67%,创伤后应激障碍自评量表得分44.83分±12.55分;各维度得分从高到低依次为主观评定、反复重现体验、社会功能受损、警觉性增高、回避症状;创伤后应激障碍总分及反复重现体验、回避症状、警觉性增高和社会功能受损维度与消极应对呈正相关(r=0.630~0.852,P0.05),与社会支持呈负相关(r=-0.635~-0.365,P0.05)。[结论]精神科护士创伤应激障碍发生水平较高,消极应对得分越高创伤应激障碍发生率越高,社会支持水平越高创伤应激障碍发生率越低。     

发达地区残疾儿童生活质量现状及其影响因素分析——以上海市为例

目的 分析残疾儿童生活质量现状及其影响因素。方法 2019年12月至2020年1月以及2020年8月至9月,方便抽样方法选取上海市残疾儿童照护者285例,采用欧洲五维健康量表儿童和青少年版(EQ-5D-Y)对残疾儿童进行生活质量测量。采用多元线性逐步回归分析探讨儿童个体因素、照护者因素、环境因素(家庭因素和社会因素)对儿童生活质量的影响。结果 残疾儿童视觉模拟量表(VAS)评分较低(71.66±22.33)。肢体残疾(B = -13.623, 95%CI -25.282~-1.965, P = 0.022)、多重残疾(B = -14.911, 95%CI -27.445~-2.377, P = 0.020),并发疾病(B = -8.995, 95%CI -14.780~-3.210, P = 0.002),情绪不稳定(B = -4.414, 95%CI -7.433~-1.395, P = 0.004),伙伴关系不好(B = 4.965, 95%CI 1.748~8.181, P = 0.003),无学前教育(B = -7.757, 95%CI -12.954~-2.561, P = 0.004),祖辈作为主要照护者(B = -7.999, 95%CI -14.288~-1.710, P = 0.013)的儿童生活质量较差。结论 残疾儿童的生活质量不高,受儿童个体、照护者及环境多维因素的共同影响,其中主要影响因素为个体因素和照护者因素。     

5&#183;12地震后PTSD症状严重性和社会支持之间的相关性研究

目的：探讨社会支持与创伤后应激障碍（PTSD）之间的相关性。方法：地震后1年半,应用德国埃森创伤问卷（ETI）及社会支持评定问卷（SSRS）,以震区454名普通群众为被试,对ETI得分和SSRS得分进行相关性分析。结果：①被试社会支持水平与PTSD整体症状水平存在显著负相关。②被试社会支持各维度的水平与PTSD各症状群均为显著负相关,但相关程度不同。负相关程度排序依次为对支持的利用度、主观支持和客观支持。结论：社会支持水平是PTSD的保护性因子,社会支持中的主观支持和支持利用度与PTSD负相关程度更明显。     

“社区护理学”课程形成性评价体系构建

目的 构建“社区护理学”课程形成性评价体系,以更加客观、全面地评价学生的综合能力。方法 在文献回顾的基础上由研究小组初步拟定函询问卷,运用德尔菲法进行2轮专家函询,形成“社区护理学”课程形成性评价体系,包括评价指标和评价形式、标准、主体,并用层次分析法确定各指标权重。结果 2轮专家函询问卷回收率为100%,判断系数、熟悉系数和权威系数分别为0.872、0.846和0.820。变异系数为0~0.183,协调系数W为0.257和0.436。最终确立评价体系：评价指标包括3个一级指标,14个二级指标,19个三级指标;11个评价形式,35个评价标准和3个评价主体。结论 “社区护理学”课程形成性评价体系构建科学可靠,能够为客观、全面地评价学生学习效果提供量化参考依据。     

Meeting the intent of ADA in sidewalk cross-slope design

Recent work has indicated that prior research is insufficient to support the ADA Accessibility Guidelines' (ADAAG) 2% maximum cross-slope requirement for sidewalks. In addition, the present ADAAG are inflexible in that they do not consider deviations from this maximum for short sections of sidewalk, such as at driveway crossings, which can be of significant concern for state and local departments of transportation. Based upon these findings, a study was undertaken to evaluate the usable range of sidewalk cross-slopes by explicitly considering user perception and effort. Twenty subjects ranging widely in age and type of mobility aid participated in field surveys where they traversed different sidewalk sections varying in cross-slope, primary grade, length, width, and other characteristics. This paper illustrates the use of weighted-least-squares and ordered-probit regression models for analysis of disabled-user response to sidewalk characteristics. The results of these models permit estimation of maximum sidewalk cross-slope consistent with the intent and spirit of ADA. These are estimated to be 4%--where feasible-and 10%--where unfavorable construction conditions exist. Such results should prove useful for consideration of the final requirements of ADA on this topic. However, larger sample sizes and a stronger recognition of the population of interest are necessary before definitive, legislated maxima can be ascertained.     

Public transit bus ramp slopes measured in situ

Purpose: The slopes of fixed-route bus ramps deployed for wheeled mobility device (WhMD) users during boarding and alighting were assessed. Measured slopes were compared to the proposed Americans with Disabilities Act (ADA) maximum allowable ramp slope. Methods: A ramp-embedded inclinometer measured ramp slope during WhMD user boarding and alighting on a fixed-route transit bus. The extent of bus kneeling was determined for each ramp deployment. In-vehicle video surveillance cameras captured ramp deployment level (street versus sidewalk) and WhMD type. Results: Ramp slopes ranged from ?4° to 15.5° with means of 4.3° during boarding (n?=?406) and 4.2° during alighting (n?=?405). Ramp slope was significantly greater when deployed to street level. During boarding, the proposed ADA maximum allowable ramp slope (9.5°) was exceeded in 66.7% of instances when the ramp was deployed to street level, and in 1.9% of instances when the ramp was deployed to sidewalk level. During alighting, the proposed ADA maximum allowable slope was exceeded in 56.8% of instances when the ramp was deployed to street level and in 1.4% of instances when the ramp was deployed to sidewalk level. Conclusions: Deployment level, built environment and extent of bus kneeling can affect slope of ramps ascended/descended by WhMD users when accessing transit buses.

• Implications for Rehabilitation

• Since public transportation services are critical for integration of wheeled mobility device (WhMD) users into the community and society, it is important that they, as well as their therapists, are aware of conditions that may be encountered when accessing transit buses.

• Knowledge of real world ramp slope conditions that may be encountered when accessing transit buses will allow therapists to better access capabilities of WhMD users in a controlled clinical setting.

• Real world ramp slope conditions can be recreated in a clinical setting to allow WhMD users to develop and practice necessary skills to safely navigate this environment.

• Knowing that extent of bus kneeling and ramp deployment level can influence ramp slope, therapists can educate WhMD users to request bus operators further kneel the bus floor and/or redeploy the ramp to a sidewalk level when appropriate, so that the least practicable slope will be presented for ingress/egress.

     

Connected cane: Tactile button input for controlling gestures of iOS voiceover embedded in a white cane

Accessibility of assistive consumer devices is an emerging research area with potential to benefit both users with and without visual impairments. In this article, we discuss the research and evaluation of using a tactile button interface to control an iOS device’s native VoiceOver Gesture navigations (Apple Accessibility, 2014). This research effort identified potential safety and accessibility issues for users trying to interact and control their touchscreen mobile iOS devices while traveling independently. Furthermore, this article discusses the participatory design process in creating a solution that aims to solve issues in utilizing a tactile button interface in a novel device. The overall goal of this study is to enable visually impaired white cane users to access their mobile iOS device’s capabilities navigation aids more safely and efficiently on the go.     

Universal Design in Housing

Universal design in housing is a growing and beneficial concept. It is subtle in its differences from barrier-free, accessible, and industry standard housing. Accessibility standards and codes have not mandated universal design and do not apply to most housing. Universal design exceeds their minimum specifications for accessible design and results in homes that are usable by and marketable to almost everyone. Universal homes avoid use of special assistive technology devices and, instead, incorporate consumer products and design features that are easily usable and commonly available.     

A kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces

The objective of this study was to conduct a kinetic analysis of manual wheelchair propulsion during start-up on select indoor and outdoor surfaces. Eleven manual wheelchairs were fitted with a SMART(Wheel) and their users were asked to push on a course consisting of high- and low-pile carpet, indoor tile, interlocking concrete pavers, smooth level concrete, grass, hardwood flooring, and a sidewalk with a 5-degree grade. Peak resultant force, wheel torque, mechanical effective force, and maximum resultant force rate of rise were analyzed during start-up for each surface and normalized relative to their steady-state values on the smooth level concrete. Additional variables included peak velocity, distance traveled, and number of strokes in the first 5 s of the trial. We compared biomechanical data between surfaces using repeated-measures mixed models and paired comparisons with a Bonferroni adjustment. Applied resultant force (p = 0.0154), wheel torque (p < 0.0001), and mechanical effective force (p = 0.0047) were significantly different between surfaces. The kinetic values for grass, interlocking pavers, and ramp ascent were typically higher compared with tile, wood, smooth level concrete, and high- and low-pile carpet. Users were found to travel shorter distances up the ramp and across grass (p < 0.0025) and had a higher stroke count on the ramp (p = 0.0124). While peak velocity was not statistically different, average velocity was slower for the ramp and grass, which indicates greater wheelchair/user deceleration between strokes. The differences noted between surfaces highlight the importance of evaluating wheelchair propulsion ability over a range of surfaces.     

上海市养老机构护理人员手卫生现况与分析

目的通过调查了解掌握养老机构护理人员手卫生理论知识和行为现况并分析影响因素,为探索提高手卫生依从性和降低院内感染的有效举措提供参考。方法于2018年4-9月,采用WHO推荐的"手卫生认知问卷"和"手卫生依从性观察表"以及自行编制的一般资料调查表和手卫生影响因素问卷,对上海市民政局市属3家养老机构的333名护理人员进行调查。结果 333名被调查的养老机构护理人员对手卫生知识的知晓率仅为39.96%;手卫生依从性为57.76%。在可能的影响因素中,47.45%的护理人员认为是缺乏干手用具;42.04%的人认为洗手液、消毒液对手部皮肤具有刺激性;38.44%认为洗手设施不符合要求;34.23%认为养老机构未提供足够的速干手消毒液;33.03%认为自身手卫生意识不强,常忘记洗手。结论养老机构护理人员对手卫生的正确认知尚不够,整体手卫生依从性较低,管理层应通过各种途径提高护理人员的手卫生知识,改善手卫生执行情况。     

Tracing best PEEP by applying PEEP as a RAMP

Objective: The aim of this study was to show the feasibility of a slow, continuously increasing level of positive end-expiratory pressure (PEEP) (ramp manoeuvre) in selecting best PEEP and to evaluate whether best PEEP, as definded by maximal oxygen transport, coincides with best systemic arterial oxygenation or best compliance. Design: In 11 anaesthetized piglets, PEEP was increased between 0 cmH₂O (zero end-expiratory pressure; ZEEP) and 15 cmH₂O (PEEP₁₅) with a constant rate of 0.67 cmH₂O · min⁻¹. This ramp manoeuvre was performed both under normal conditions and after induction of an experimental lung oedema. During the ramp manoeuvre, haemodynamic and pulmonary variables were monitored almost continuously. Results: During the rise in PEEP, cardiac output declined in a non-linear way. In the series with normal conditions, best PEEP was always found at ZEEP. In the series with experimental lung oedema, best PEEP, as defined by maximum oxygen transport, was found at PEEP_1–6, as defined by maximal compliance, at PEEP_7.5 and by maximal arterial oxygen tension (PaO₂) at PEEP_10–14. Conclusions: Best PEEP according to oxygen transport is lower than best PEEP according to compliance and PaO₂; the use of PEEP as a ramp might prevent unnecessarily high levels of PEEP. Received: 16 June 1997 Accepted: 24 April 1998