新疆医科大学第五附属医院新生儿出生时间高峰期的研究

目的：分析新疆地域某三甲医院新生儿出生时间的高峰期,以探索和掌握其季节性分布特征,为强化产科医疗管理和合理调配人力资源提供科学依据。方法应用圆形分布法分析产科2009至2013年新生儿出生时间的季节性变动。结果2009至2013年某院产科新生儿出生时间高峰期为6月1日至11月31日,平均高峰时点为8月18日。结论应用圆形分布法分析新生儿出生时间的高峰期明确可靠,为制定管理对策和合理调配产科工作提供了较为准确的依据。     

海门市原发性肝细胞癌死亡率时间趋势分析

目的：20世纪80年代以来，海门市实施以改水、管粮、预防乙肝为主要内容的环境因素干预措施进行肝癌防治、肝癌发病率有所下降。为分析1969年－2001年海门市肝癌死亡率的变动趋势是随机因素造成抑或干预措施所致，开展了本次研究。方法：本文应用游程检验法（建立ARIMA模型拟合）和线性趋势检验法（ASTSA For Windows软件和SPSS10．0软件），对肝癌死亡率的时间序列进行平稳性检验和死亡率趋势的显著性检验。结果：海门市1969年以来肝癌死亡率波动于33．18／10万－76．66／10万之间，1969年－1979年平均递增速度为4．04％；1979年－1989年递增速度为3．66％；1989年－2001年递增速度为－2．30％。海门市1969年－2001年肝癌死亡率的时间序列是非平稳的，1990年以后死亡率下降趋势有统计学意义。结论：海门采取的环境因素干预综合防治措施对预防肝癌有一定的实际价值。     

怀孕等待时间离散时间风险模型分析

目的 探讨离散时间风险模型分析怀孕等待时间（TTP）的合理性。方法 于2013年10月-2014年1月采用随机整群抽样方法在四川省南充市1家三级甲等医院和3家二级甲等医院抽取346名孕妇进行问卷调查,并建立离散时间风险模型对其TTP进行分析。结果 在离散时间风险模型中不纳入危险因素变量的模型A结果显示,孕妇在<3、4~6和7~12个月的累积怀孕概率分别为60.69%、84.97%和94.51%。在离散时间风险模型中纳入有无人工流产史、计划怀孕时丈夫是否吸烟2个危险因素变量的模型B结果显示,此2个危险因素均不存在时孕妇在<3、4~6和7~12个月的累积怀孕概率分别为65.63%、88.30%、96.06%;人工流产史危险因素存在时孕妇在<3、4~6和7~12个月的累积怀孕概率分别为60.41%、84.46%、93.96%;计划怀孕时丈夫吸烟危险因素存在时孕妇在<3、4~6和7~12个月的累积怀孕概率值分别为61.86%、85.58%、94.61%;此2个危险因素均存在时孕妇在<3、4~6和7~12个月的累积怀孕概率分别为56.46%、81.20%、91.95%。结论 离散时间风险模型能够识别影响TTP的危险因素,并能估计协变量不同取值下各时间段上的累计怀孕概率,是分析TTP资料的合理方法。     

Non-linear random effects models with continuous time autoregressive errors: a Bayesian approach

Measurements on subjects in longitudinal medical studies are often collected at several different times or under different experimental conditions. Such multiple observations on the same subject generally produce serially correlated outcomes. Traditional regression methods assume that observations within subjects are independent which is not true in longitudinal data. In this paper we develop a Bayesian analysis for the traditional non-linear random effects models with errors that follow a continuous time autoregressive process. In this way, unequally spaced observations do not present a problem in the analysis. Parameter estimation of this model is done via the Gibbs sampling algorithm. The method is illustrated with data coming from a study in pregnant women in Santiago, Chile, that involves the non-linear regression of plasma volume on gestational age.     

病人入院时间分布规律的研究

目的 掌握病人入院时间分布规律，为医院管理提供决策依据。方法 利用圆形分布理论，对2002～2005年医院病人入院时间分布规律进行研究。结果 通过对病人入院时间分布的分析，表明我院病人入院时间高峰时点大约处于8、9月份，高峰时期大约为6月至11月。结论 病人入院时间具规律性分布，即病人入院时间存在高峰时点和高峰时期。     

Informal caregiving,time use and experienced wellbeing

Informal carers report lower evaluative wellbeing than non-carers. In contrast to this literature and our own analysis of evaluative wellbeing, we find carers have a small but higher level of experienced wellbeing than non-carers do. To investigate why, we use decomposition analysis which separates explanatory factors into how time is used and how those uses of time are experienced. We analyze activities and associated experienced wellbeing measured in ten-minute intervals over two days by 4817 adults from the 2014/15 UK Time Use Survey. We use entropy balancing to compare carers with a re-weighted counterfactual non-carer group and then apply Oaxaca-Blinder decomposition. The experienced wellbeing gap of 0.066 is the net result of several substantial competing effects of time use. Carers experienced wellbeing would be higher by 0.188 if they had the same patterns and returns to time use as non-carers which is driven by sleep, time stress and alternative characteristics of time use. However, leisure and non-market activities serve to dampen this increase in experienced wellbeing. Initiatives to improve and assess carer wellbeing should pay close attention to how carers spend their time.     

Validity in assessing time processing ability, test equating of KaTid-Child and KaTid-Youth

Background There is a need for instruments with acceptable psychometric properties for measuring time management/time processing ability. KaTid‐Child (Swedish: Kit for assessing Time processing ability) was developed for children aged 5–10 years. To meet needs of assessing older children, KaTid‐Youth was created. The aim of this study was to investigate the validity of KaTid‐Youth. Methods This study investigates the validity of KaTid‐Youth using Rasch models: partial credit and common item equating. Results Results indicate that KaTid‐Youth has acceptable psychometric properties and seems to measure the same construct as KaTid‐Child. Conclusions Indications of gender differences in the sample call for further research. The results indicate that time processing ability can be seen as one construct in which time perception, orientation and management can be operationalized as different levels of complexity in time processing ability. Expressions of time processing ability differ at different ages. Thus, early intervention in time perception and time orientation may be needed to promote time management in later childhood. Professionals need to take time processing ability into consideration when meeting children who risk delayed development of daily time management.     

A note on the catch‐up time method for estimating lead or sojourn time in prostate cancer screening

Models of cancer screening assume that cancers are detectable by screening before being diagnosed clinically through symptoms. The duration of this preclinical phase is called sojourn time, and it determines how much diagnosis might be advanced in time by the screening test (lead time). In the catch‐up time method, mean sojourn time or lead time are estimated as the time needed for cumulative incidence in an unscreened population to catch up with the detection rate (prevalence) at a first screening test. The method has been proposed as a substitute of the prevalence/incidence ratio in the case of prostate cancer where incidence cannot be treated as a constant. A model is proposed to justify this estimator. It is shown that this model is different from classic Markov‐type models developed for breast cancer screening. In both models, the catch‐up time method results in biased estimates of mean sojourn time. Copyright © 2013 John Wiley & Sons, Ltd.     

不同型号血凝仪检测凝血酶原时间及部分凝血活酶时间的可比性评价

目的探讨同一实验室内不同型号血凝仪检测凝血酶原时间(prothrombin time,PT)及部分凝血活酶时间(activated partial thromboplastin time,APTT)结果的可比性。 方法用卫生行业标准《WS/T407-2012医疗机构内定量检验结果的可比性验证指南》及《WS/T406-2012临床血液学检验常规项目分析质量要求》提出的两种仪器间比对方案,对3台血凝仪(2台Sysmex CA7000和1台CA1500)所检测的PT及APTT进行比对,分析两种比对方案的可行性。 结果用WS/T407-2012比对方案,样本1在3台仪器上检测PT和APTT的相对偏差分别为7.10%和5.20%,样本2的相对偏差分别为5.74%和2.46%,均<7.50%的比对要求。用WS/T406-2012比对方案,3台仪器分别检测20份标本,以相对偏差<7.50%、符合率≥80%为标准,CA1500与基准仪器CA7000比较,PT及APTT的符合率分别为85%(17/20份)、80%(16/20份),CA7000-2与基准仪器CA7000比较,PT及APTT的符合率分别为85%(17/20份)、90%(18/20份)。 结论按照两种方案提出的比对方法,3个检测系统测定PT和APTT的结果具有可比性,实验室可根据实际情况选择合适的方案进行仪器间比对,以保证不同检测系统间检验结果的可比性。     

Health status and the allocation of time

We consider the relationship between health and time allocation in the American Time Use Survey. Better health is associated with large positive effects on home production and larger positive effects on market production, but less consumption of leisure. Theoretically, if market- and home-produced goods are perfect substitutes, the positive correlation between health and home production implies that health exerts larger effects on home than on market efficiency. Notably, these correlations are higher for single people than for married people, perhaps reflecting a lack of market substitutes for the time of married people.     

Health,education and time preference

Education has been shown to be the most important correlate of health. However, the mechanism through which education influences health has been largely unexplained. Grossman argued that education improves health production efficiency. In contrast, Fuchs argued that the association between health and education is not primarily causal but reflects unobserved causes of both outcomes. Instead of education causing better health, some ‘third’ variables may be related to both education and health. The ‘third’ variable most frequently mentioned is time preference. The aim of this paper is to investigate the role of time preference in the relationship between education and health. The role of risk attitude is also investigated. The paper exploits a unique data set of households that incorporated stated preference questions eliciting individuals' time preferences. The results show that the effect of education reduces but does not disappear when controlling for individuals' time preferences. Copyright © 2010 John Wiley & Sons, Ltd.     

Modelling time to event with observations made at arbitrary times

In many time‐to‐event studies, particularly in epidemiology, the time of the first observation or study entry is arbitrary in the sense that this is not a time of risk modification. We present a formal argument that, in these situations, it is not advisable to take the first observation as the time origin, either in accelerated failure time or proportional hazards models. Instead, we advocate using birth as the time origin. We use a two‐stage process to account for the fact that baseline observations may be made at different ages in different subjects. First, we marginally regress any potentially age‐varying covariates against age, retaining the residuals. These residuals are then used as covariates in fitting an accelerated failure time or proportional hazards model — we call the procedures residual accelerated failure time regression and residual proportional hazards regression, respectively. We compare residual accelerated failure time regression with the standard approach, demonstrating superior predictive ability of the residual method in realistic examples and potentially higher power of the residual method. This highlights flaws in current approaches to communicating risks from epidemiological evidence to support clinical and health policy decisions. Copyright © 2012 John Wiley & Sons, Ltd.     

Development of a new assessment of time processing ability in children, using Rasch analysis

Background Children with disabilities like ADHD, Autism or Intellectual Disabilities may have problems with everyday functioning related to time management and hence there is a need to develop systematic methods for evaluation of the ability to understand and use time information. The purpose of this study was to examine aspects of construct validity of a new instrument, KaTid, for assessing time processing ability (TPA) in children. Methods Data from 144 typically developing, 5–10‐years‐old typically developing children, were analysed with Rasch analysis. Instruments used were the KaTid, a self‐rating scale measuring autonomy in daily routines and a parent scale measuring daily time management. Results Fifty‐one items in KaTid, initially defined in three subcategories: time perception, time orientation and time management, all demonstrated acceptable goodness‐of‐fit to a Rasch model, indicating evidence of internal scale validity. Performance of the children on the KaTid also provided evidence for validity in response processes and that it may discriminate among children with different levels of TPA. Relationships between the KaTid measures and the parents' ratings of the child's daily time management indicated further evidence of construct validity. Conclusions The results of this study supports evidence of construct validity in the KaTid when used with typically developing 5–10 years‐old children. Further research is needed to evaluate the validity of KaTid in children with known time processing difficulties.     

血培养报阳时间及病原菌分布

目的了解血培养阳性标本的菌群分布及报阳时间,为实验室病原菌诊断及临床制定治疗方案提供依据。方法收集2015年5—11月某院临床各科室送检的血标本,记录血培养报阳时间并将所获得病原菌鉴定至菌种。结果从血培养标本中共分离157株病原菌,其中革兰阳性球菌占31.85%,革兰阴性杆菌占57.32%,真菌占10.83%。培养阳性病原菌及其报阳的中位时间分别为:肠杆菌科细菌0.50 d,非发酵菌0.63 d,肠球菌属0.60 d,链球菌属0.80 d,葡萄球菌属1.01 d,真菌1.44 d。结论血培养阳性标本报阳时间从早到晚依次是:肠杆菌科细菌、肠球菌属、非发酵菌属、链球菌属、葡萄球菌属、真菌。引起血流感染的病原菌均在4 d内仪器阳性报警,大多数病原菌在1 d内报阳性。     

Birthmother Perceptions of the Psychologically Present Adopted Child: Adoption Openness and Boundary Ambiguity*

Secondary analysis of interviews with 163 birthmothers revealed that the adopted child remains psychologically present. Ten indicators of psychological presence were identified. Indicators related to roles were more salient the more open the adoption, and supernatural referents were more salient when a birthmother once had mediated communication but now has none. Degree of psychological presence was highest in fully‐disclosed adoptions and lower in ongoing‐mediated, confidential, and time‐limited‐mediated adoptions, respectively. Valence was generally positive, but more so in fully‐disclosed adoptions.     

室间隔缺损封堵术后卧床时间的观察

目的：探讨室间隔缺损（VSD）封堵术后卧床时间与并发症发生的关系。方法：将162例病人随机分为两组,各81例,实验组术后36小时下床活动;对照组按常规24小时下床活动。观察两组病人术后3天内并发症发生情况。结果：实验组术后并发症中血肿发生率小于对照组（p〈0.01）,而其他并发症两组比较无明显差异（P〉0.05）。结论：VSD病人封堵术后延长卧床时间,有效降低血肿发生率,而其他并发症以及长时间卧床而引起的不适感并未明显增加。     

血培养阳性菌的分布与报警时间分析

目的了解1 056株血培养阳性菌的分布与报警时间的关系,第一时间指导临床医师准确合理选择抗菌药物。方法采用回顾性调查方法,运用χ2检验和直线相关分析对医院全自动血培养仪检出的1 056株阳性菌的分布及报警时间进行统计分析。结果 1 056株血培养检出的阳性标本中革兰阴性菌427株占40.4%,革兰阳性菌347株占32.8%,真菌78株占7.4%,厌氧菌35株占3.3%,复数菌107株占10.1%,污染菌62株占5.9%;阳性菌主要分布在急诊科、ICU、基本外科、血液肿瘤内科和普通内科;血流感染994株污染62株,报警时间<12h污染菌占该时间段阳性菌的比率明显低于其他时间段(P<0.01);报警时间<12h、12~24h进行需氧和厌氧培养呈正相关关系(P<0.01),其他时间段无法确定是否有直线相关关系。结论血培养阳性菌以葡萄球菌属和埃希菌属为主;血流感染多发生于危急重症患者、外科术后及烧伤病、血液肿瘤病、长期暴露在病原菌周围及免疫力低下等;血培养阳性报警时间结合微生物生长特点可以初步判断是致病菌或污染菌;多数菌在需氧和厌氧培养病原菌报警时间无明显区别,但是同时进行需氧和厌氧培养能提高血培养阳性率。     

新生儿肛温测量时间的探讨

目的：为探讨新生儿肛温测量准确时间。方法：对150例新生儿在30s、60s、90s、120s、180s测得肛温数值进行比较。结果：肛温测量30s、60。、90s、120s、180s,所测得数值比较均无显著差异。结论：肛温测试30s能可靠反应机体的真实体温情况,建议新生儿肛温测试时间可以以30s为限,但对于发热等特殊情况,可适当延长测量时间。     

紧急时刻的信息传播

医疗卫生行业是一个频繁出现紧急时刻的行业,紧急时刻意味着处理媒介关系的关键时刻。紧急时刻出现时,能否妥善处理组织与媒介的关系影响着信息的有效传播。在危机事件中,由于组织对信息控制严格,而媒介则渴求最大化获取信息,所以这一时间段的媒介沟通比往常更复杂、更艰巨。因此,医疗卫生领域在危机中的信息传播应该注意了解新闻界工作特征及其在特殊时刻的需要,认识到媒体的信息诉求取向。在信息传播中,主动进行态度管理以传递良好形象信息,积极协助媒介,尽可能提供新闻报道需要的事例和素材,促进媒体客观、真实报道新闻事件。任何时候,制定突发事件预案,注重早期监测和媒介管理依然是紧急时刻应对危机的最佳媒介策略。