310例心脏瓣膜替换术临床分析

对３１０例心脏瓣膜替换术的手术技术、麻醉、体外循环、心肌保护以及近期和远期死亡原因进行分析。结果近期死亡１４例占４．５％。死亡原因占首位的为心律失常和低心排,其次为感染和肾衰;远期死亡９例占２．９％。原因占首位的为栓塞和感染,其次为严重低心排、心律失常和抗凝过度大出血。结果表明心肌保护是手术成功的关键,严格的术后抗凝是提高术后生存率的重要因素。     

An alternative approach for the analyses and interpretation of attachment sort items

Attachment Q-Sort (AQS) is a tool for quantifying observations about toddler/caregiver relationships. Previous studies have applied factor analysis to the full 90 AQS item set to explore the structure underlying them. Here we explore that structure by applying multidimensional scaling (MDS) to judgements of inter-item similarity. AQS items are arranged in the MDS solution along three easily interpretable axes: a model that is compatible with but more parsimonious than factor analysis solutions. This geometrical approach suggests ways to modify the AQS—primarily a research tool—to make it more practical for clinical applications. Sets of AQS data are represented and interpreted in the three-dimensional model as vectors. Summaries at a finer-grained level are obtained by finding points in the model where variability across datasets is greatest. We report re-analyses of archival (published) data, and also data collected with streamlined procedures more suitable in the field. Although not reported here, collection and analysis can both be performed online via a website. The general methodology is not restricted to the current application of toddler attachment.     

Congruent validity and inter-day reliability of two breath by breath metabolic carts to measure resting metabolic rate in young adults

Background & aims

Achieving high inter-day reliability is a key factor to analyze the magnitude of change in RMR, for instance after an intervention. The aims of this study were: i) to determine the congruent validity of RMR and respiratory quotient (RQ) with two breath by breath commercially available metabolic carts [CCM Express (CCM) and Ultima CardiO2 (MGU)]; and ii) to analyze the inter-day reliability of RMR and RQ measurements.

我院七年制口腔医学专业学生综合素质的调查与分析

通过对我院七年制口腔医学专业学生综合素质的调查，分析了七年制医学生的特点与不足。根据教育部对七年制医学人才培养目标的要求，提出只有转变教育思想和观念，建立新型的医学人才培养模式，加强对医学生综合素质和能力的培养，才能为我国卫生事业培养出“基础厚、素质高、能力强”的复合型人才。     

A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.     

Mood and anxiety symptom questionnaire anxiety items in an adult british clinical sample: One scale or two?

In seeking to establish British clinical normative data for the two anxiety scales (anxious symptoms and anxious arousal) of the Mood and Anxiety Symptom Questionnaire (MASQ), the responses of 237 British National Health Service outpatients were examined. Factor analyses (exploratory and confirmatory) failed to confirm the expected structure. Data were presented and discussed, considering the 28 anxiety item pool in terms of being either two highly correlated scales of somatic anxiety versus psychological anxiety, or as a single general anxiety scale. As neither of these outcomes accorded with the test constructors' assumptions, it was concluded that the MASQ is not a suitable measure for assessing the tripartite model of adverse mood states in British clinical samples. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Exploratory and confirmatory factor analyses failed to confirm the a priori MASQ anxiety items' structure. ? Alternative explanations were of either a) two highly correlated scales of somatic anxiety and psychological anxiety or b) a single general anxiety scale.     

儿童丹佛发育筛查临床使用情况调查与分析

目的 了解丹佛发育筛查(Denver Development Screening Test,DDST)的临床应用情况；探讨智力低下的原因。方法 对727例0岁—6岁儿童做DDST筛查。结果 为≥2岁儿童做DDST比例与＜2岁儿童差异无显性(P＞0.05)；DDST智测的异常和可疑，男女相似；受试中无特殊病史的占26．3％，异常和可疑为28．4％；智测儿童中缺乏应有教养的占33．1％，其智测异常和可疑为68．5％；育与非育父母所生的小儿智测结果差异有显性(P＜0.05)。结论 DDST作为婴幼儿智测的筛查手段具有普及意义；缺乏应有的教养是小儿智力低下的重要原因之一。     

杭州市下城区1998—2007年病毒性肝炎疫情分析

[目的]了解杭州市下城区1998—2007年病毒性肝炎的流行特征及趋势,以及可用疫苗预防的肝炎(甲、乙型肝炎)与无疫苗可预防的肝炎(丙、戊型肝炎)发病构成比变化的情况,为采取综合防治措施提供依据。[方法]病毒性肝炎的流行特征采用描述流行病学分析,总体发病趋势及各型肝炎构成比的变化趋势采用Cox-Stuart检验。[结果]1998年病毒性肝炎发病率为124.75/10万,2007年为26.76/10万。10年中肝炎总发病趋势经Cox-Stuart检验差异有统计学意义(P<0.1);肝炎的发病时间和地区差异无统计学意义,而人群分布中,中青年年龄段(15~39岁,62.16/10万)与低年龄段(0~14岁,4.45/10万)发病率差异有统计学意义;10年中戊肝的发病构成比经Cox-Stuart检验差异有统计学意义(P<0.1)。[结论]1998—2007年下城区病毒性肝炎发病呈下降趋势;肝炎发病在季节和地区上差异无统计学意义,肝炎发病率中青年年龄段高于15岁以下儿童;戊肝发病构成比呈上升趋势,间接证明了甲、乙型肝炎疫苗接种在预防病毒性肝炎中的重要作用。