特殊疾病医疗保险对糖尿病患者治疗费用的影响及相关因素分析

目的比较重庆市已纳入慢病管理系统2型糖尿病患者中，有、无特殊疾病医疗保险（简称特病医保）者之间的治疗费用情况及可能影响申请该特病医保的因素。方法采用结构化问卷，调查患者的基本信息及与糖尿病有关的药房、门诊、住院治疗费用情况。使用SAS 9.1软件进行数据统计分析，计数资料分析采用 χ ²检验，有统计学差异的变量再纳入多因素逐步logistic回归模型。连续性变量用中位数（四分位数间距）[ M（ Q）]来表示，采用Wilcoxon秩和检验。 结果门诊组有特病医保的患者年人均总费用[2160（3081）元]较无特病医保的患者高[1000（2100）元， P < 0.01]，年次均自费比例（54.04%）低于无特病医保患者的自费比例（93.78%， P < 0.01）。就申请特病医保而言，中等收入水平（ OR=1.94）、高收入水平（ OR=2.11）、参加城镇职工医疗保险（ OR=4.19）、病程超过5年（ OR=2.04）都是其可能的影响因素，具有这些特征的患者相对更容易申请到特病医保。 结论为缓解2型糖尿病患者经济负担，政府应大力宣传特病医保的相关政策，鼓励患者主动了解，积极申报。同时，医保部门与医疗机构应加强监管，简化办理流程，建议增加特殊疾病定点零售药店的数量和覆盖面，提高特病医保利用的可及性。同时，应更加关注低收入人群和病程相对较短的患者，增强他们抵御疾病经济风险的能力，提高特病医保的利用及公平性。     

临床护理教师教学能力观与教学能力的相关性研究

目的 调查临床护理教师教学能力观及教学能力现状,并探讨两者的相关性.方法 采用自设问卷对302名临床护理教师教学能力观和教学能力进行调查,其中教学能力观为自评,教学能力采用自评与他评(302名实习学生、302名护士长)相结合.结果 临床护理教师教学能力观均分为(4.59±0.38)分,教学能力均分为(3.99±0.28)分,两者各维度及总均分都呈正相关.结论 可以尝试通过改善临床护理教师的教学能力观提高其教学能力.     

Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

BackgroundThe clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.ObjectivesThe aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.DesignA systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).Data sourcesThe Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.Review methodsThe included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.ResultsThe search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.ConclusionsClinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.     

The minimal clinically important difference determined using item response theory models: an attempt to solve the issue of the association with baseline score

ObjectivesDetermining the minimal clinically important difference (MCID) of questionnaires on an interval scale, the trait level (TL) scale, using item response theory (IRT) models could overcome its association with baseline severity. The aim of this study was to compare the sensitivity (Se), specificity (Sp), and predictive values (PVs) of the MCID determined on the score scale (MCID-Sc) or the TL scale (MCID-TL).Study Design and SettingThe MCID-Sc and MCID-TL of the MOS-SF36 general health subscale were determined for deterioration and improvement on a cohort of 1,170 patients using an anchor-based method and a partial credit model. The Se, Sp, and PV were calculated using the global rating of change (the anchor) as the gold standard test.ResultsThe MCID-Sc magnitude was smaller for improvement (1.58 points) than for deterioration (−7.91 points). The Se, Sp, and PV were similar for MCID-Sc and MCID-TL in both cases. However, if the MCID was defined on the score scale as a function of a range of baseline scores, its Se, Sp, and PV were consistently higher.ConclusionThis study reinforces the recommendations concerning the use of an MCID-Sc defined as a function of a range of baseline scores.     

Baduanjin exercise improved premenstrual syndrome symptoms in Macau women

ObjectiveTo investigate the effect of Baduanjin, a traditional Chinese medical exercise, on improving premenstrual syndrome (PMS) symptoms in women.MethodsForty reproductive age women with PMS in Macau practiced standardized Baduanjin exercise for three menstrual cycles. A questionnaire, the daily record of severity of problems (DRSP), was used to measure symptom severity. DRSP was filled out every day starting from the last cycle before exercise (i.e., the first menstrual cycle) to the third cycle after exercise initiation (i.e., the fourth menstrual cycle). The total scores and the scores of each item during the 5 premenstrual days and follicular phase (5-9 postmenstrual days) were calculated.ResultsAfter exercise, the total DRSP scores during the 5 premenstrual days and differences in the total DRSP scores between the 5 premenstrual days and the follicular phase were both significantly reduced. Of note, the physical symptom total scores in the 5 premenstrual days and the differences between its total score in the 5 premenstrual days and in the follicular phase were both significantly reduced. The differences between the total scores of depressed mood, anxious mood, loss of interest, and reduction in social activity during the 5 premenstrual days and the follicular phase were also reduced.ConclusionsBaduanjin exercise was able to improve the mental and especially the physical symptoms of PMS.     

Utilization of dental health services among middle-aged people in Sweden and Denmark

In 1999, questionnaires were sent to random samples of 1001 Swedish citizens aged 55-79 years and 1175 Danish citizens aged 45-69 years. Various questions were asked concerning dental conditions, dental visit frequency per year, and money spent annually on dental care, etc. The objectives were to assess differences in the utilization of dental services and to compare out-of-pocket costs for dental care in Sweden and Denmark with control for age, gender, dental conditions and income. More than 80% of the subjects reported that a dentist had examined them less than 1 year previously. However, 77% of the Danes reported dental visits twice a year or more compared to 28% of the Swedes. Although the Danes reported a more frequent use of dental services, they had poorer dental conditions compared to the Swedes. Even though the Swedes used dental services less often than the Danes did, more subjects reported high 12-month out-of-pocket costs. In the present study, separate models were constructed for the two countries because there could be different mechanisms at play, as indicated by the results. The different insurance systems along with different degrees of commercialization in the two countries might be the most decisive factors in this context.     

中国中西部8县母亲孕期贫血与儿童发育迟缓的关联性研究

目的 了解中国中西部8县的母亲孕期贫血状况,并探讨其与儿童发育迟缓的关联性,为相关干预措施提供依据。方法 2016年10月-2017年1月采用横断面研究和按容量比例概率抽样法,调查了中国中西部地区8个县的1 100名1~59月龄儿童母亲孕期贫血状况,使用年龄与发育进程问卷(ASQ)评价儿童发育状况。运用多因素Logistic回归分析,计算调整混杂因素后的比值比(OR)和95%置信区间(95%CI)。结果 被调查地区儿童母亲孕期贫血患病比例为38.1%。控制了儿童性别、月龄、孩次、分娩方式、出生胎龄、出生体重、营养不良、儿童贫血、家庭年人均纯收入及母亲文化程度等因素后,孕期贫血是儿童沟通能区(OR=2.02,95%CI:1.09~3.75,P=0.025)和ASQ总评分(OR=1.63,95%CI:1.12~2.38,P=0.011)的可疑发育迟缓的危险因素。结论 被调查地区儿童母亲孕期贫血与儿童可疑发育迟缓的发生存在关联。     

Adaptación y validacion al español de un cuestionario específico de calidad de vida en pacientes con traqueostomía (TQOL)

Background and objectiveA long-term tracheostomy can have significant negative effects on quality of life because it causes physical, functional, sensory, psychological, social, economic, and work impairments to the life of the individual. The objective of this study was to validate in Spanish a quality-of-life questionnaire for these patients.Materials and methodsA psychometric validation study of a questionnaire in 45 patients over 18 years of age, with tracheostomy for six months, who understand Spanish and have a good understanding of the questions of the SF-36 questionnaire and a specific quality of life questionnaire for the patient with tracheostomy (TQOL-versión española). This questionnaire is a modification and cultural adaptation into Spanish of the original English instrument named Tracheostomy Specific Quality of Life Questionnaire (TQOL). The 2 questionnaires (TQOL-versión española) and the SF-36 were completed 6 months after the tracheostomy and between 30 and 50 days after the first administration. The reliability, repeatability, and construct validity of the TQOL-versión española were evaluated. The construct validity was assessed by the correlation between the results of the TQOL-versión española and the dimensions of the SF-36 questionnaire.ResultsThe reliability of the TQOL-versión española measured by Cronbach's alpha coefficient was .814, with variation between items from .783 to .817 in the sample at 6 months and from .794 in the validation sample, with variation between items from .758 to .813. There was intraclass correlation for the total score of the scale using the concordance analysis of Bland-Altman and agreement for the individual questions with the McNemar symmetry test. There was also a good correlation between the scales of the TQOL-versión española and the dimensions of the S-F36.ConclusionsThe TQOL-versión española showed good reliability, repeatability, and construct validity, therefore it is a useful tool to assess the impact on individual patients with a tracheostomy in place for more than 6 months, and to establish strategies at the healthcare and social levels to improve the quality of daily life.     

Translation and cross-cultural adaptation of the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ)

ObjectiveTo translate and cross-culturally adapt the Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) for use in Brazilian Portuguese. The CBBDQ is an 18-item tool covering 10 bladder and 8 bowel symptoms that was developed for use with children of 5 to 12 years of age with bowel and bladder dysfunction (BBD). The instrument has already been validated for use in Dutch and English.MethodIn the process of translation and cultural adaptation from English to Portuguese, the CBBDQ was submitted to undergo the required steps as established by the international methodological criteria: forward translation, synthesis, back-translation, expert panel review and pre-testing.ResultsNinety-three parents of children with lower urinary tract dysfunction answered the questionnaire. The mean age of the children was 7.6 ± 2.1 years and 54 were female. Internal consistency was excellent, with a Cronbach’s alpha of 0.91 to 0.96. Additionally, reliability was high, with an intraclass correlation coefficient of 0.94 (95%CI: 0.85-0.93; p < 0.0001).ConclusionThe translation and cultural adaptation of the CBBDQ enabled a quantitative evaluation of bladder and bowel symptoms to be performed in Brazilian children. The scores achieved allow the severity of BBD to be evaluated, as well as the patient’s progress during treatment. The use of this questionnaire in clinical practice and research will allow more consistent data on BBD to be obtained.     

脑瘫儿童父母睡眠质量的调查分析

目的 了解脑瘫儿童父母的睡眠情况.方法 采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表作为调查工具,对36例脑瘫儿童的父母和36例正常儿童的父母的睡眠情况进行调查.结果 脑瘫儿童父母睡眠质量问题报告率为34.72％,正常儿童父母睡眠质量问题报告率为19.44％,差异有统计学意义(x2=4.255,P＜0.05).脑瘫儿童父母PSQI总分(5.72±3.54 vs 3.19±2.76,t=3.380,P＜0.01)、主观睡眠质量(1.33±0.83 vs 0.78±0.34,t=3.371,P＜0.01)、入睡时间(1.28±0.88 vs 0.72±0.36,t=3.027,P＜0.01)、睡眠时间(1.16±0.72 vs l.01±0.62,t=2.278,P＜0.05)、睡眠障碍(1.23±0.56 vs 0.75±0.28,t=2.949,P＜0.01)得分与正常儿童父母相比,差异有统计学意义；脑瘫儿童母亲PSQI总分(6.21±0.85 vs 4.32±0.73,t=3.380,P＜0.01)、主观睡眠质量(1.14±0.73 vs 0.89±0.66,t=2.986,P＜0.01)、入睡时间(1.22±0.81 vs 0.96±0.83,t=2.853,P＜0.01)、睡眠时间(1.09±0.66 vs 0.85±0.71,t=2.136,P＜0.05)、睡眠障碍(1.15±0.63 vs 0.83±0.62,t=2.513,P＜0.01)、日间功能影响(1.19±0.43 vs0.88±0.62,t=2.586,P＜0.01)得分与父亲相比,差异有统计学意义.结论 脑瘫儿童父母存在一定的睡眠质量问题,值得关注.