夜间最低血氧饱和度联合睡眠相关量表筛查儿童阻塞性睡眠呼吸暂停的应用

目的 评价夜间最低血氧饱和度(LSaO₂)联合OSA-18量表和针对儿童的改良版Epworth嗜睡量表(ESS-CHAD)初筛儿童阻塞性睡眠呼吸暂停(OSA)的准确性,以探讨更简便、快捷、可行的基层医院初筛疑似儿童OSA的方法。方法 纳入2020年8月13日—2021年2月8日就诊于本院耳鼻咽喉头颈外科睡眠监测中心完成整夜多导睡眠监测的儿童139例作回顾性分析研究,其家长在医生协助下完成OSA-18量表和ESS-CHAD。分析LSaO₂和两种量表及三者联合早期初筛疑似儿童OSA的诊断价值。结果 LSaO₂预测儿童是否患OSA的最佳界值为90.5%(P<0.00, AUC=0.82)。OSA-18和ESS-CHAD依据不同界值分别诊断儿童OSA的灵敏度最高,分别为74.8%、22.7%。LSaO₂/OSA-18,LSaO₂/ESS-CHAD、OSA-18/ESS-CHAD诊断儿童OSA的灵敏度最高,分别为88.2%、68.1%、77.3%。 结论 LSaO₂有诊断儿童OSA的临床价值,OSA-18量表较ESS-CHAD初筛疑似儿童OSA有更高的灵敏度,但特异度低,LSaO₂联合OSA-18量表诊断儿童OSA的灵敏度、特异度均较其他联合诊断方式高。在无法进行睡眠监测的基层医院可考虑应用LSaO₂ 与OSA-18量表结合的方式初步筛查儿童OSA。     

Frailty in Nursing Homes—A Prospective Study Comparing the FRAIL-NH and the Clinical Frailty Scale

ObjectivesFrailty is common in nursing home (NH) residents, but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (1) obtain the prevalence of frailty, (2) investigate the agreement between both instruments, and (3) evaluate their predictive validity for adverse health events in German NH residents.DesignProspective cohort study.Setting and participantsGerman NH residents (n = 246, age 84 ± 8 years, 67% female).MethodsFrailty status was categorized according to FRAIL-NH (nonfrail, frail, most frail) and CFS (not frail, mild to moderately frail, severely frail). Agreement between instruments was examined by Spearman correlation, an area under the receiver operating characteristic curve (AUC) with 95% CI, and sensitivity and specificity using the “most frail” category of FRAIL-NH as reference standard. Adverse health events (death, hospital admissions, falls) were recorded for 12 months, and multivariate cox and logistic regression models calculated.ResultsAccording to FRAIL-NH, 71.1% were most frail, 26.4% frail, and 2.5% nonfrail. According to CFS, 66.3% were severely frail, 26.8% mild to moderately frail, and 6.9% not frail. Both scales correlated significantly (r = 0.78; R² = 60%). The AUC was 0.92 (95% CI 0.88-0.96). Using a CFS cutoff of 7 points, sensitivity was 0.90 and specificity 0.92. The frailest groups according to both instruments had an increased risk of death [FRAIL-NH hazard ratio (HR) 2.19, 95% CI 1.21-3.99; CFS HR 2.56, 95% CI 1.43-4.58] and hospital admission [FRAIL-NH odds ratio (OR) 1.95, 95% CI 1.06-3.58; CFS OR 1.79, 95% CI 1.01-3.20] compared to less frail residents. The FRAIL-NH predicted recurrent faller status (OR 2.57, 95% CI 1.23-5.39).Conclusions and implicationsFrailty is highly prevalent in German NH residents. Both instruments show good agreement despite different approaches and are able to predict adverse health outcomes. Based on our findings and because of its simple administration, CFS may be an alternative to FRAIL-NH for assessing frailty in NHs.     

富阳农村居民的健康状况研究

目的：探讨SF－36量表用于农村居民健康状况测定的可能性。方法：用中文版SF－36量表测定富阳2－7名14岁以上的农村居民,分析其信度,效度。结果：除了SF,RE维度,其余6维度内部一致性信度系数大于0．50,7维度内部一致性信度大于与其他维度的相关,因子分析产生3个主成分,累计方差贡献为64．6％,65岁以上者无应答,青年组与中年组各维度平均分数差异不显著,不同性别只在RP维度上判别显著,吸烟者与不吸烟者,饮酒者与不饮酒者的得分差异不显著,不同文化程度人群的得分差异不显著。结论：尚需更多证据支持SF－36量表适用于农村居民健康状况测定。     

天然水处理剂单宁的改性及性能研究

对单宁进行了胺甲基化、季铵盐化和磺化3种改性,通过红外光谱分析了改性产物的结构,并采用失重法,极化曲线、静态阻垢和杀菌实验等手术对其进行了性能评价与研究。实验结果表明,不同的改性方法可以在很大程度上改善单宁的缓蚀、阻垢和杀菌等性能,具有良好的开发前景。     

氯化钛白氧化反应器壁结疤机理

利用预燃烧直管反应器,研究氯化钛白氧化反应器内的结疤机理。氧化反应器内结疤支要起因子氧化过程生成的超细TiO2颗粒在反应器壁的沉积和烧结,反应器壁面温度越高结疤速率越快。当反应器壁面温度较低时,靠近壁面为ＴiO2颗粒堆结层,而告气体相主体的疤层发生了部分烧结。反应温度升高、反应物浓度增大时,结疤速度增大;壁面状态对结疤速率影响不大。     

Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis

PurposeThis study aimed to investigate the association between clinical factors and temporary changes in functional performance in patients undergoing hemodialysis.MethodsThis was a retrospective, longitudinal observational study conducted from 2015 to 2017. Eight-two patients undergoing hemodialysis in the outpatient clinic were enrolled. Functional performance was measured using the Karnofsky Performance Status (KPS) scale. Collected data for analysis included demographics, laboratory parameters, and KPS scale scores. All participants were grouped into a high KPS cluster and a low KPS cluster based on dynamic changes in KPS scales from 2015 to 2017.ResultsParticipants in the high KPS cluster demonstrated an approximate trend, and those in the low KPS cluster demonstrated a low pattern. By stepwise selection model analysis, age (OR 1.12, 95% CI 1.03–1.23, p = 0.011), serum BUN (OR 1.08, 95% CI 1.02–1.16, p = 0.015), calcium levels (OR 3.24, 95% CI 1.2–8.73, p = 0.02), and beta-2-microglobulin (OR > 1.0, CI >1.00-<1.01, p = 0.031) showed risk for the low KPS cluster. Male sex (OR 0.20, 95% CI 0.04–0.96, p = 0.045) and albumin level (OR 0.02, 95% CI 0–0.4, p = 0.009) showed a low risk for the low KPS cluster.ConclusionsA different trajectory pattern was observed between the high and low KPS clusters in a 3-year period. Risk factors for the low KPS cluster were age, serum BUN, calcium, and beta-2-microglobulin levels. Male sex and serum albumin levels reduced the risk for the low KPS cluster.     

Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents’ attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, test–retest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall ‘Cronbach's alpha’ (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model. The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales (‘value of adult vaccination’, ‘safety concerns’ and ‘perceived barriers’) demonstrated strong concurrent associations with participants’ attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.     

护士职业应对自我效能量表的汉化及信效度研究

目的 对英文版护士职业应对自我效能量表（occupational coping self-efficacy scale for nurses,OCSE-N）进行汉化,并检验中文版护士职业应对自我效能量表在中国护士群体中的信效度。方法 运用便利抽样方法抽取深圳市5所公立医院共1172名护理人员进行调查,运用SPSS 23.0软件和AMOS 23.0软件对数据进行信效度检测。结果 中文版护士职业应对自我效能量表的Cronbacha α为0.882,重测信度为0.991（95%CI:0.985～0.993,P＜0.01）。各条目-总分相关系数为0.482～0.683（P＜0.01）。内容效度指数（scale-level content validity index, S-CVI）:全体一致S-CVI为0.889,平均S-CVI为0.981,经探索性因子分析后,量表提取2个公因子,其累计方差贡献率为67.508%,各条目共同度为0.524～0.860;经验证性因子分析各拟合指标:卡方/自由度（〖XC小五号.EPS;P〗/df）为1.452,GFI为0.987,AGFI为0.977,RMR为0.035,NFI为0.977,IFI为0.969,均达到推荐标准。结论 中文版护士职业应对自我效能量表信效度良好,可以用来评价我国护理人员职业应对自我效能的测评工具。     

戒毒人员健康状况评定量表的初步编制和考评

目的:初步编制评价戒毒人员整体健康水平的综合多维评定量表,并检验其信度和效度。方法:根据WHO的健康定义提出理论构想,查阅相关文献,听取各专家意见,形成初始量表。对949例戒毒人员进行实测后,检验其信效度。结果:(1)通过条目分析,确定量表由120个条目组成(包括效度量表的14条),分属四个维度11个因子,生理维度(D1)35条,心理A维度(D2)26条,心理B维度(D3) 31条,社会维度(D4)14条。(2)重测相关和Cronbaehα系数各因子为0.615～0.879和0.650～0.949,各维度为0.791～0.893和0.844～0.966,总量表为0.899和0.965,所有P<0.01。(3)探索性因子分析显示,各因子的因素负荷均在0.7以上。(4)验证性因素分析结果显示,(?)~2/df=2.415,CFI=0.842,TLI= 0.838,RMSEA=0.039。(5)总量表及生理维度、心理A维度、心理B维度、社会维度得分与QOL—DA的总分及相应维度分的相关系数分别为0.682、0.539、0.698、0.153、0.687(P<0.01)。结论:初步编制的戒毒人员健康状况评定量表,信度和效度均达到了心理测量学的要求。     

EPDS在产后抑郁筛查中应用

本研究共纳入１６７例在北医大一院产科病房住院分娩的产妇，所有产妇均评定了Ｅｄｉｎｂｕｒｇｈ产后抑郁量表（ＥＰＤＳ）。对部分产妇同时评定了Ｚｕｎｇ氏抑郁量表和Ｈａｍｉｔｌｏｎ抑郁量表。结果表明ＥＰＤＳ之灵敏度、特异性及总效率均令人满意。与Ｚｕｎｇ氏量表相比，ＥＰＤＳ的效度更高，是比较理想的产后抑郁筛查工具。