OGTT、IRT和CPRT联检在DM2诊治中的价值

目的：评价口服葡萄糖耐量试验（OGTT）、胰岛素释放试验（IRT）和C-肽释放试验（CPRT）联合应用在糖尿病（DM）诊断和治疗中的价值。方法：选用已进行上述三种试验的217例受检者资料进行回顾性分析。结果：①在可疑DM人群中，未诊断、未治疗的DM2病人占69％（49／71），其中空腹血糖（FPG）正常者占53％（26／49）。②以2hPG筛查DM，只有8％（4／49）的病人可能会漏诊。③糖尿病治疗达到控制标准者占24％（35／146）。结论：OGTT、IRT和CPRT联合应用可提高诊断准确性，降低漏诊率，并能够指导临床治疗。     

Developing Item Response Theory–Based Short Forms to Measure the Social Impact of Burn Injuries

Objective

To develop self-reported short forms for the Life Impact Burn Recovery Evaluation (LIBRE) Profile.

Is Going Beyond Rasch Analysis Necessary to Assess the Construct Validity of a Motor Function Scale?

Objective

To examine whether a Rasch analysis is sufficient to establish the construct validity of the Motor Function Measure (MFM) and discuss whether weighting the MFM item scores would improve the MFM construct validity.

餐后血糖对2型糖尿病诊断的意义

目的通过口服葡萄糖耐量（OGTT）和胰岛素释放（IRT）试验,解析空腹和餐后血糖对糖尿病诊断的意义。方法收集2005年1月—2007年6月,内分泌和代谢科门诊及住院患者共3 588例进行OGTT和IRT检测。以血浆葡萄糖5.6、6.1、7.0mmol/L为空腹血糖切点,7.8、11.1mmol/L为餐后血糖切点,分析患者分布情况以及空腹血糖（FPG）、餐后1h血糖（1 h PG）和餐后2 h血糖（2 h PG）等不同切点对糖尿病诊断的价值。结果依据1999年WHO糖尿病诊断标准,诊断糖尿病患者3097例。其中FPG≥7.0mmol/L者2654例,单独检测2hPG漏诊62例,占2.33%;单独检测1hPG仅漏诊18例,占0.68%,差别有统计学意义（P〈0.001）。2 h PG≥11.1 mmol/L者中FPG〈7.0 mmol/L的占14.60%（443/3 035）;1 h PG≥11.1mmol/L者中FPG〈7.0mmol/L的占14.00%（429/3065）,差别无有统计学意义（P=0.503）。FPG和餐后2hPG均正常202例〔但其中113例存在高胰岛素血症和（或）胰岛素分泌延迟,占55.94%〕,其余289例为糖耐量受损和（或）空腹血糖受损。在1 hPG≥11.1 mmol/L且2 h PG〈11.1 mmol/L的291例中,54例FPG≥7.0mmol/L经复查诊断为糖尿病,另有125例餐后30 min血糖≥11.1 mmol/L者的HOMA指数及胰岛素曲线下面积与FPG5.6～6.1mmol/L而2 h PG≥11.1mmol/L的糖尿病患者接近。结论1 h PG与FPG的一致性不比2 h PG差,且更敏感,提示1 h PG同2 h PG一样,可以作为糖尿病的餐后血糖诊断切点。     

早期糖尿病的实验室检测指标

糖尿病早期诊断能够提高治疗效果、降低并发症发生概率、延缓糖尿病进程，是提高患者生活质量的关键之一。应用实验室检测指标诊断糖尿病，对于早期发现糖尿病、科学治疗和制定临床预防方案有重要意义。     

An application of item response mixture modelling to psychosis indicators in two large community samples

OBJECTIVE: Previous research has suggested that psychosis is better described as a continuum rather than a dichotomous entity. This study aimed to describe the distribution of positive psychosis-like symptoms in two large community samples using an item response mixture model. METHOD: An item response mixture model was used to explain the pattern of psychosis-like symptom endorsement. This model incorporated two elements. First, a continuous non-normal latent variable to explain the observed pattern of data. Second, a categorical latent variable to explain the variation in the continuous non-normal latent variable. RESULTS: For both samples, representing broadly and narrowly defined psychosis, the best fitting model was a four-class solution. In both cases, the classes differed quantitatively rather than qualitatively. CONCLUSIONS: The analysis showed that psychosis-like symptoms at the population level could be best explained by four classes that appeared to represent an underlying continuum.     

Functioning and validity of a Computerized Adaptive Test to measure anxiety (A-CAT)

Background: The aim of this study was to evaluate the Computerized Adaptive Test to measure anxiety (A‐CAT), a patient‐reported outcome questionnaire that uses computerized adaptive testing to measure anxiety. Methods: The A‐CAT builds on an item bank of 50 items that has been built using conventional item analyses and item response theory analyses. The A‐CAT was administered on Personal Digital Assistants to n=357 patients diagnosed and treated at the department of Psychosomatic Medicine and Psychotherapy, Charité Berlin, Germany. For validation purposes, two subgroups of patients (n=110 and 125) answered the A‐CAT along with established anxiety and depression questionnaires. Results: The A‐CAT was fast to complete (on average in 2 min, 38 s) and a precise item response theory based CAT score (reliability>.9) could be estimated after 4–41 items. On average, the CAT displayed 6 items (SD=4.2). Convergent validity of the A‐CAT was supported by correlations to existing tools (Hospital Anxiety and Depression Scale‐A, Beck Anxiety Inventory, Berliner Stimmungs‐Fragebogen A/D, and State Trait Anxiety Inventory: r=.56–.66); discriminant validity between diagnostic groups was higher for the A‐CAT than for other anxiety measures. Conclusions: The German A‐CAT is an efficient, reliable, and valid tool for assessing anxiety in patients suffering from anxiety disorders and other conditions with significant potential for initial assessment and long‐term treatment monitoring. Future research directions are to explore content balancing of the item selection algorithm of the CAT, to norm the tool to a healthy sample, and to develop practical cutoff scores. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.     

Validity of the Severity of Dependence Scale (SDS) Construct Applying the Item Response Theory to a Non-Clinical Sample of Heroin Users

Aims: The purpose of this work is to study the validity of the Severity of Dependence Scale (SDS) construct by applying Rasch models to a non-clinical sample of heroin abusers. Subjects: 982 (73% men) young people 30 years old or under (mean age 25.9 years) participated. All of them were captured from the community in the metropolitan areas of Madrid, Barcelona and Seville, between April 2002 and December 2003. Analysis: Dimensionality of the scale and calibration of items were studied using the Rating Scale model, which is a Rasch-type model. A factorial analysis was also performed to check the dimensionality of the scale. Results: The analysis of fit shows that all the items have infit and outfit values between ± 2 logits, indicating that the data fit the model and that it may be assumed to be unidimensional. The principal components analysis also showed the existence of a principal factor that explains 52.5% of the variance observed. Item calibration found that they are between +0.89 and ?1.04 logits on the scale. Conclusion: The results show unidimensional structure of the SDS scale. Item calibration shows they are distributed along the continuum, which must be taken into account when calculating total scores. The study's limitations are noted.