不同职业入伍的新兵社会状况及心理素质的研究

目的 研究不同职业入伍新兵的社会状况和心理素质特点.方法 整群抽取某部2630名集训新兵进行社会状况分析,并应用症状自评量表(SCL-90)、艾森克成人个性问卷(EPQ)、自我和谐量表(SCCS)、简易应对方式问卷(CSQ)、社会支持量表(SSRS)进行心理调查.结果 收回有效问卷2599份,城镇入伍、双亲家庭、高中以上文化、主动入伍、要求进步的新兵中入伍前职业是学生者较多;农村入伍、单亲家庭、初中以下文化、被动入伍的新兵中其他职业入伍者较多(P<0.05).SCL-90:学生新兵强迫、人际关系敏感、抑郁、焦虑、敌对、精神病性因子得分低于其他职业新兵(P<0.05,P<0.01);EPQ:学生新兵内外向因子得分高于其他职业新兵,而神经质和精神质得分低于其他职业新兵(P<0.01);SCCS:学生新兵自我不和谐、自我刻板性因子得分低于其他职业新兵,而自我灵活性得分高于其他职业新兵(P<0.01);CSQ:学生新兵积极应对得分高于其他职业新兵(P<0.01);学生新兵SSRS各因子得分均高于其他职业新兵(P<0.01).结论 学生新兵心理素质较好,可塑性强,入伍前职业是影响新兵心理素质的重要因素之一;新兵入伍后应结合入伍动机、目的、家庭状况,从自我和谐、积极应对、主动寻求支持等方面加强新兵的个性塑造.     

Cost-effectiveness analysis of a multinational RCT with a binary measure of effectiveness and an interacting covariate

In a recent multinational randomized clinical trial, 1356 patients from 14 countries were randomized between two arms. The primary measure of effectiveness was 30-day survival. Health care utilization was collected on all patients and was combined with a single country's price weights to provide patient-level cost data. The purpose of this paper is to report the results of the cost-effectiveness analysis for the country that provided the cost weights, so as to provide a case study for illustrating recently proposed methodologies that account for skewed cost data, the between-country variation in treatment effects, possible interactions between treatment and baseline covariates, and the difficulty of estimated adjusted risk differences. A hierarchal model is used to account for the two sources of variation (between country and between patients, within a country). The model, which uses gamma distributions for cost data and recent methods for estimating adjusted risk differences, provides overall and country-specific estimates of treatment effects. Model estimation is facilitated by Markov chain Monte Carlo methods using the WinBUGS software. In addition, the theory of expected value of information is used to determine if the data provided by the trial are sufficient for decision making.     

医疗服务价格动态调整机制模型研究

目的:就医疗服务价格调整的基本原则进行探讨,并提出动态调整机制的模型,以期为国家医疗保障局制定医疗服务价格动态调整机制提供借鉴。方法:本研究基于文献回顾法及访谈调研法,结合我国医疗服务价格调整的历史背景及目前医疗价格进行分析。结果:提出了操作性较强的医疗服务价格动态调整机制的模型,及动态调整工作应遵循"公益、平衡、系统、动态"的原则。结论:建立医疗服务价格动态调整机制,坚持公立医院公益性,保障公立医院良性发展。     

Postdivorce Coparenting Typologies and Children's Adjustment

The authors performed a cluster analysis on data from 270 divorced or separated parents to classify their perceived coparental relationship with their ex‐spouse and test if parents' perceptions of their children's postdivorce adjustment differed based on their perceptions of their postdivorce coparental relationship. The cluster analysis resulted in three types of coparenting relationships: cooperative and involved, moderately engaged, and infrequent but conflictual. Despite the expectation that children fare better if their divorced parents' develop a cooperative coparenting relationship, the authors found that parents' reports of their children's internalizing and externalizing behaviors and their social skills did not significantly differ by type of postdivorce coparental relationships. Results, therefore, suggest that the direct influence of postdivorce coparenting on children's adjustment may not as robust as predicted in the literature.     

胫骨前嵴作为全膝关节置换术胫骨假体旋转对位解剖参考的可靠性研究

目的:通过CT测量正常膝关节探讨胫骨前嵴作为全膝关节置换术(total knee arthroplasty,TKA)胫骨旋转对线参考的可靠性。方法:自2017年7月至2018年6月选择122例因下肢创伤行CT血管造影(computed tomography angiography,CTA) 检查的患者,其中男 89 例,女 33 例;年龄 18 ～ 81 (51.4±16.4) 岁。使用影像归档和通信系统(picture archiving and communication system,PACS)标记健侧正常膝关节的外科通髁线(surgical epicondylar axis,SEA),外侧平台远端8 mm平面的髌韧带内侧缘与后叉韧带胫骨止点中点的连线(髌韧带内侧缘轴),胫骨横轴,髌韧带止点与后叉韧带胫骨止点中点投影的连线(Akagi线),髌韧带止点中内1/3与后叉韧带胫骨止点中点投影的连线(髌韧带止点中内1/3轴),胫骨结节中内1/3与后叉韧带胫骨止点中点投影的连线(Insall线),胫骨结节内侧缘与后叉韧带胫骨止点中点投影的连线(胫骨结节内侧缘轴)。把前缘锐利的胫骨前嵴等分为3部分,取上下顶点和中间2个点,标记4个点在该平面与与后叉韧带胫骨止点中点投影的连线(胫骨前嵴近端轴、胫骨前嵴中段轴1、胫骨前嵴中段轴2以及胫骨前嵴远端轴)。测量胫骨横轴和SEA之间以及其他各轴与SEA垂线的角度。对比10个胫骨轴之间的两两关系。结果:髌韧带内侧缘轴、胫骨前嵴近端轴、胫骨前嵴中段轴1、胫骨前嵴中段轴2、胫骨前嵴远端轴、Akagi线、髌韧带止点中内1/3轴、Insall线、胫骨结节内侧缘轴与SEA垂线的角度分别为(-1.6±4.5)°、(12.0±6.9)°、(7.2±8.6)°、(7.1±10.4)°、(6.6±13.5)°、(1.4±5.0)°、(10.2±5.1)°、(11.9±5.4)°和(3.6±4.8)°。胫骨横轴与 SEA 的夹角为(4.1±5.3)°。髌韧带内侧缘轴相对于SEA外旋,Insall线、髌韧带止点中内1/3轴和胫骨前嵴近端轴明显大于Akagi线、胫骨横轴、胫骨结节内侧缘轴(P0.001)。胫骨前嵴中段轴1和2以及胫骨前嵴远端轴明显大于Akagi线、胫骨横轴、胫骨结节内侧缘轴(P0.001)。但是胫骨前嵴中段轴1和2以及胫骨前嵴远端轴小于Insall线、髌韧带止点中内1/3轴和胫骨前嵴近端轴(P0.01)。胫骨前嵴中远段3个轴间比较差异无统计学意义(P0.05)。结论:胫骨前嵴中段可以作为TKA胫骨假体旋转对线参考一个选择,其可靠性优于Insall线,但要差于Akagi线、胫骨横轴和胫骨结节内侧缘轴。     

某野战部队官兵心理适应不良者人格特征分析

目的：探讨某野战部队官兵心理适应不良者的人格特征,为部队征兵和官兵心理辅导提供理论指导．方法：采用华东师范大学1988年修订的卡特尔16种人格因素量表(16PF),对某野战部队官兵945名进行团体测试,以心理健康指数Y1得分区分出心理适应不良者和适应良好者,并对其人格特征进行分析．结果：①某野战部队心理适应不良者(心理健康指数≤18分者)比例为27．5％;②1,2a兵及5a以上兵心理适应不良者比例较多,分别占27．3％,25．4％和24．2％;③心理适应不良者的人格特征表现为2低5高的特点,即低情绪稳定性、低兴奋性、高怀疑性、高忧虑性、高紧张性、高焦虑性和内向型．结论：该部队官兵心理适应不良者有一定人格偏离,必须对他们进行人格教育。     

Ajustement psychologique des couples confrontés à un cancer du sein : perceptions des comportements de soutien du conjoint

This cross-sectional study for couples explores the relationship between the perceptions within the couple of the spouse's supportive behaviors and the psychological adjustment of both partners during treatment for breast cancer. Forty-eight women operated on for a non-metastatic breast cancer and their spouses completed questionnaires assessing psychological adjustment (STAI, BDI-SF), and the spouse's support behaviors during discussions about the disease (PSE). Support behaviors are positively valued by both partners, especially non-verbal comfort and concrete actions. Support by minimization is associated with fewer depressive symptoms in patients and spouses. For spouses, the positive perception of support by concrete action is associated with a lower depression score. Moreover, high adjustment difficulties for spouses are linked to greater perception differences between partners on emotional support and minimization. These results highlight the importance of non-verbal comfort and minimization for the perception of social support within the couple, and the usefulness of support by concrete actions proposed by spouses. Advices for professionals are available.     

Female Sexuality in Thai Discourses about Maechii (‘lay nuns’)

By examining competing discourses about women who are maechii (or ‘lay nuns’) in Buddhist Thai society, this paper demonstrates that, although maechii vow to be celibate, social constructions of their role are grounded in sexuality. The discourses examined are those of the Buddhist canon and Sangha (Order of Monkhood), the Thai Maechii Institute, the mass media, and the government. The analysis is supplemented with field observations and interviews with monks, maechii, and lay persons. Findings suggest that maechii comprise an ambiguous category linguistically, Buddhistically, and in terms of their sexuality. Case studies of the founders of nunneries conducted in ChiangMai indicate that maechii leaders have been resisting the prevalent views that most maechii are social misfits, yet also are capable of undermining monks' celibacy and, by extension, the larger social order. The analysis contributes to the understanding of the interconnectedness of gender and sexuality in contemporary Thai society.     

孕妇围产期的营养注意和身体调节

目的探讨孕妇围产期的营养注意和身体调节对围产期结局的影响。方法选择孕妇1200例,其中共有587例患者进行了科学营养注意和身体调节,将其设置为观察组,其余孕妇设置为对照组。对两组患者的并发症情况进行统计分析。结果观察组孕妇并发症发生率、新生儿窒息等概率明显低于对照组,P<0.05,差异具有统计学意义。结论对孕妇进行围产期的营养指导和身体调节,能够有效降低孕妇发生并发症的几率,明显改善围产期结局。     

A note on calculating asymptotic confidence intervals for the adjusted risk difference and number needed to treat in the Cox regression model

Recently, Laubender and Bender (Stat. Med. 2010; 29: 851–859) applied the average risk difference (RD) approach to estimate adjusted RD and corresponding number needed to treat measures in the Cox proportional hazards model. We calculated standard errors and confidence intervals by using bootstrap techniques. In this paper, we develop asymptotic variance estimates of the adjusted RD measures and corresponding asymptotic confidence intervals within the counting process theory and evaluated them in a simulation study. We illustrate the use of the asymptotic confidence intervals by means of data of the Düsseldorf Obesity Mortality Study. Copyright © 2013 John Wiley & Sons, Ltd.