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.
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.
ObjectivesTo compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.MethodsClinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. ResultsA total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.ConclusionsAPACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.
Objective To investigate the health status of residents in rural areas of China as well as their needs for health service, and to explore the effective way to improve the health status of rural residents so as to provide a basis for the training of community healthcare professionals. Methods Using the method of stratified cluster random sampling, we investigated 4190 rural residents from 1200 families, which were sampled from 13 provinces of China according to the geographical distribution. Results The 2-week prevalence rate was 27.9%. 32.7% of the patients saw a doctor, and 20.5% did not take any measures. Among those who did not take any measures, 78.4% thought their illness was mild and did not need any treatment; and the second reason for no treatment was lack of money (accounting for 36.5%). The prevalence rate of chronic diseases during the past half year was 24.9%, among which lumbar and leg pain was the most prevalent (accounting for 7.8%), followed by hypertension (accounting for 5.5%). The rates of visiting a doctor were 43.9% and 61.5% in township level and village level health institutions, respectively, during the past one year. 70.0% of the patients looked for treatment, 8.4% chose to ignore, and 20.8% took medicine by themselves. Among those who visited a doctor, 61.0% preferred hospitals near their houses, and 34.0% preferred those with lower expenses. More than half of the residents (accounting for 57.3%) did not have any physical examination during the past 3 years, and 28.3% did have a check-up but not regularly. Among the rural residents investigated, 64.2% obtained health care knowledge from television, newspapers, books and radio broadcasting, and 67.3% were desirous of regular physical examination. 56.3% and 33.1% of the rural residents considered the skill of the healthcare professionals in town-level institutions to be acceptable and satisfactory, respectively; and 61.7% and 24.6% evaluated the skill of those in village-level institutions to be acceptable and satisfactory, respectively. Conclusion The health status of rural residents is not optimistic, and their health behaviors need to be correctly guided, and the medical facilities and healthcare service quality of primary healthcare institutions should be improved. It is suggested that the government and medical colleges take the responsibility to train healthcare professionals for the primary health care in rural areas.