ObjiectiveTo obtain reliable evidence of diagnosis and treatment through evaluating the validity of pneumonia severity index (PSI), CURB-65 and acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores in predicting risk stratification, severity evaluation and prognosis in elderly community-acquired pneumonia (CAP) patients.MethodsClinical and demographic data were collected and retrospectively analyzed in 125 in-hospital patients with CAP admitted in Shanghai Dahua Hospital from January 2012 to April 2015. The severity of pneumonia was calculated with PSI, CURB-65 and APACHEⅡgroups during 1 to 3 days after admission. Mortality and intensive care unit (ICU) admission rates were evaluated among patients in each scores and was categorized into three classes, namely mild, moderate and severe groups during 1 to 3 days after admission. Mortality and ICU admission rates were evaluated among patients in each severity level. Through evaluating the sensitivity, specificity, the predicting values and the area under receiver operating characteristic (ROC) curve (AUC) among PSI, CURB-65 and APACHEⅡ, the validity and consistency of these three scoring systems were assessed.ResultsUsing PSI, CURB-65 and APACHEⅡ scoring systems, the patients were categorized into mild severity (48.8%, 64.0% and 52.8%, respectively), moderate severity (37.6%, 23.2% and 32.0%, respectively) and severe severity (13.6%, 12.8% and 15.2%, respectively). In PSI, CURB-65 and APACHEⅡ systems, the mortality in high risk groups was 41.3%, 62.5% and 47.4%, respectively; The ICU-admission rate in high risk groups was 88.3%, 100.0% and 94.7%, respectively. The sensitivity of PSI, CURB-65 and APACHEⅡ was 50.0%, 71.4% and 64.3% in predicting mortality, and was 46.8%, 50.0% and 59.3% in predicting ICU-admission, respectively. PSI, CURB-65 and APACHEⅡ showed similar specificity (approximately 90%) in predicting mortality and ICU admission. ROC was conducted to evaluate the sensitivity of PSI, APACHEⅡ and CURB-65 in predicting mortality and ICU admission. The AUC had no significant difference among these three scoring systems. The AUC of PSI, CURB-65 and APACHEⅡwas 0.893, 0.871, 0.880, respectively for predicting mortality, and was 0.949, 0.837, 0.949, respectively for predicting ICU admission. There was no significant difference among these three scoring in predicting mortality and ICU admission (all P>0.05).ConclusionsPSI, CURB-65 and APACHEⅡ performed similarly and achieved high predictive values in elderly patients with CAP. The three scoring systems are consistent in predicting mortality risk in elderly CAP patients. The CURB-65 is more sensitive in predicting the risk of death, and more early in identifing patients with high risk of death. The APACHEⅡ is more sensitive in predicting the risk of ICU admission, and has good value in identifying severe patients and choosing the right treatment sites.
【摘要】 目的 调查成都市未成年犯管教所民警心理健康水平。 方法 2010年5月采用症状自评量表（symptom checklist 90，SCL-90）和健康调查简表（short form 36 health survey questionnaire，SF-36）调查成都市某未成年犯管教所153名民警的心理健康水平，并对比相应人群的常模分数。 结果 未成年犯管教所民警SCL-90阳性率57.5%，SCL-90总分及各因子分均高于1999年修正常模、1986年全国常模（Plt;0.05）。SCL-90的人际关系敏感因子分与北京监狱民警常模差异无统计学意义（Pgt;0.05），偏执因子分低于北京监狱民警常模（Plt;0.05），SCL-90总分及其余因子分均高于北京监狱民警常模（Plt;0.05）；SCL-90总分及各项因子分男性高于女性（Plt;0.05），直接监管犯人者高于内务、管理工作者（Plt;0.05）；年龄lt;35岁者的抑郁、偏执、精神病性因子分高于年龄gt;35岁者（Plt;0.05）。SF-36各因子分均低于1998年四川居民、2005年上海公安局民警（Plt;0.05）；SF-36各因子与SCL-90总分、各因子均呈负相关（Plt;0.05）。 结论 应重视并改善未成年犯管教所民警的心理健康水平。【Abstract】 Objective To investigate and analyze the mental health of policemen in juvenile reformatory and their relationships. Methods The mental health of 153 policemen working in a juvenile reformatory were assessed by using symptom checklist (SCL)-90 and short form 36 health survey questionnaire (SF-36) in May, 2010. The data was compared with norm and other relative data, such as SCL-90 China norm, norm revised in 1999, SCL-90 of judicial police in Beijing, etc. Results The positive rate of SCL-90 of policemen in reformatory was 57.5%. The total score and factor score of SCL-90 were significantly higher than that of the China norm revised in 1999. Furthermore, compared with the judicial policemen in Beijing, except for the interpersonal sensitivity and paranoid ideation, the total score and other factor scores were significantly higher. The SCL-90 total score and various factors of the males were significantly higher than that of the females. The score of the guards was higher than that of charging of quarters and management. In youth (less than 35 years old) depression, paranoid ideation, psychoticism factor scores were significantly higher than that in the middle-aged groups. SF-36 factor score of the reformatory police was significantly lower than that of Sichuan resident in 1998, and also the policemen in Shanghai Public Security Bureau in 2005. And SF-36 factor score of the reformatory policemen had a significant negative correlation with the total score and every factor score of SCL-90. Conclusion We should pay attention to the juvenile reformatory policemen’s mental health and and improve it.
【摘要】 目的 了解新护士的心理健康状况及应付方式。 方法 采用心理卫生自评量表（SCL-90）和应付方式量表对2008年1月-2009年12月新上岗的64名护士进行测查。 结果 新护士强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分、总均分及阳性项目数与全国常模比较偏高，差异有统计学意义（Plt;0.05）；SCL-90阳性者与阴性者应付方式比较，阳性者自责、幻想、退避、合理化因子均分均高于阴性者，差异有统计学意义（Plt;0.01）；新护士应付方式各因子均分、退避、幻想、自责因子均高于吴超等人的研究（Plt;0.05）。 结论 新护士心理健康状况低于一般人群；较其他年龄段护士更多采用不成熟应付方式；成熟应付方式有益心理健康。护理管理者应重视新护士心理健康，引导新护士多采取成熟应付方式，提高心理健康水平。【Abstract】 Objective To evaluate the psychological states of new nurses and their coping styles. Methods Sixty-four nurses starting work between January 2008 and October 2009 in our hospital were investigated by Symptom Checklist 90 (SCL-90) and Coping Style Questionnaire. Results The scores of compulsion and mental disorder, average score, and the number of positive items were statistically higher than the national norm of China (Plt;0.001). The scores of athymia, anxiety, hostility, and phobia factors were higher than the national norm (Plt;0.01). The score of paranoid factor was also statistically higher than the national norm (Plt;0.05). Based on the results of SCL-90, we found that the scores of factors of self-accusation, fantasy, back-off (Plt;0.05) and the factor of rationalization (Plt;0.01) in the positive group were significantly higher than those of the negative group. Compared with the result of the research made by WU Chao and his colleges, the average scores of such factors as back-off (Plt;0.001), fantasy (Plt;0.01) and self-accusation (Plt;0.05) were statistically higher in the study group than those in the control group. Conclusion The psychological states of new nurses are worse than the general population. Compared with older nurses, new nurses are more inclined to use immature coping styles. Mature coping styles are favorable to their psychological states. The nursing regulators should pay more attention to the psychological states of new nurses and guide them to use mature coping styles to improve their psychological states.
Objective To explore the mental health status of college students in the Xining region. Methods A total of 1 875 college students were surveyed by the Symptom Checklist-90 (SCL-90) and the Eysenck Personality Questionnaire (EPQ).Results Out of the 1 875 college students, 21.5% had at least one item scoring more than 3. Compared with the normal samples, college students scored significantly higher on SCL-90 indicating that the students had worse mental health. Significant differences were noted in the dimensions of EPQ between college students and the normal samples. The total score of SCL-90 was found to be significantly related to four factors, namely neuroticism, family economic status, school and nationality. Conclusion The mental health status of college students in Xining region is lower than that of the normal population, and factors of neuroticism, family economic status, school and nationality are related to their mental health.
目的:了解成都市集体儿童的健康状况及变化趋势,进一步做好托幼机构的卫生保健工作。方法:对1998-2007年成都市托幼机构集体儿童定期体检的资料进行分析、研究。结果:成都市集体儿童身高、体重达标率,身高、体重年增长合格率呈上升趋势;中、重度营养不良(体重低下、发育迟缓、消瘦)患病率逐年下降;单纯性肥胖发生率逐年升高;贫血的患病率呈下降趋势;视力不良患病率无明显下降;龋齿患病率呈下降趋势。结论:成都市集体儿童体格发育良好。儿童营养不良减少,肥胖明显增加,视力不良患病率无明显下降,今后托幼园所要将肥胖的预防和干预作为卫生保健工作的重点,并重视眼保健工作。
【Abstract】ObjectiveTo compare the reliability of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and APACHE Ⅲ to estimate mortality of critical patients in abdominal surgery. MethodsTwo hundred and sixtyone critical patients in abdominal surgery were included in this study. The clinical data of the first day in ICU were collected and evaluated with both APACHE Ⅱand APACHE Ⅲ prognostic systems and statistical analysis were performed. Probability of survival (Ps) was compared with actual mortality. ResultsThe scores of APACHE Ⅱ and APACHE Ⅲ of death group were significantly higher than those of survival group respectively (P＜0.01). The actual mortality of patients whose Ps was no more than 0.5 was higher than that whose Ps was over 0.5 (P＜0.01). With two prognostic systems, the scores and mortality were the highest in pancreatitis patients and the lowest in patients with gastrointestinal malignant tumor. ConclusionAPACHE Ⅱ and APACHE Ⅲ prognostic systems can be effectively applied to the estimation of mortality of critical patients in abdominal surgery. For certain diagnostic categories, APACHE Ⅲ is better than APACHE Ⅱprognostic system.
Objective To analyze the predictive value of von Willebrand factor (vWF) and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score on severity and prognosis of acute respiratory distress syndrome (ARDS). Methods The ARDS patients who were admitted between January 2010 and May 2012 were recruited in the study. APACHEⅡ score and plasma vWF were detected on the first day and the third day after diagnose of ARDS. The patients were divided intoasurvival group andadeath group according the prognosis. The predictive value of vWF and APACHEⅡ score on prognosis were analyzed by the receiver operating characteristic (ROC) curve. Lung injury score was calculated and its relationship with vWF and APACHEⅡ score were analyzed. Results One-hundred and twelve cases of ARDS were enrolled. There were no significant differences between the survival group and the death group in sex, age, respiration rate, blood pressure, white blood cells, procalcitonin or C-reactive protein (P > 0.05). On the first day after diagnosis of ARDS, the APACHEⅡ score and vWF level of the survival group were significantly lower than those in the death group (P < 0.05). On the third day, the APACHEⅡ score was increased but vWF level declined compared with those on the first day (P < 0.05). On the first day, lung injury score of the survival group was 1.7±0.4, significantly lower than that in the death group (2.5±0.6). On the third day, lung injury score in the survival group decreased, while lung injury score of the death group was significantly increased (P < 0.05). On the first day, vWF and APACHEⅡ score were positively correlated with lung injury score (r=0.75, P < 0.05; r=0.79, P < 0.05), respectively. On the first day, the area under the ROC curve of APACHEⅡ score and vWF were 0.87 and 0.91, respectively (P < 0.05). Conclusion APACHEⅡ score and vWF have high diagnostic value in evaluating the degree of lung injury and predicting the prognosis of patients with ARDS.
Objective To compare the clinical value of Acute Physiology and Chronic Health Evaluation ( APACHE) Ⅱ / Ⅲ scoring system in predicting the prognosis of patients complicated with acute kidney injury ( AKI) and multiple organ dysfunction syndrome ( MODS) in ICU. Methods 318 patients with AKI and MODS treated with continuous blood purification in ICU fromJanuary 2004 to June 2010, were evaluated with APACHE Ⅱ and APACHEⅢ and analyzed retrospectively. The area under the receiveroperating characteristic curve ( AUC) and the Lemeshow-Hosmer goodness-of-fit of APACHEⅡ and Ⅲ were assessed. Results Mean scores and predicted hospital mortality of APACHEⅡ and Ⅲ were all significantly lower in the survival group than those in the non-survival group ( P lt; 0. 01) . The AUC were 0. 782 for APACHEⅡ, and 0. 755 for APACHEⅢ, with Youden’s indexes of 46. 4% and 36. 7% , respectively. Hosmer-Lemeshow test showed the calibration of the two systems was reasonable. Conclusion APACHEⅡ and Ⅲ are both good for predicting the severity and prognosis of patients complicated with AKI and MODS in ICU but APACHEⅡ is superior in clinical practice.