目的 探讨团体心理辅导对改善一年级儿科规培住院医师心理状况的作用.方法 选取某三级甲等专科医院的一年级儿科规培住院医师89人,将其分为实验组和对照组,实验组在半年内进行三次团体心理辅导活动,对照组不采取任何心理干预活动,使用简易应对方式问卷、交往焦虑量表和领悟社会支持量表测量两组研究对象的心理健康情况.结果 两组住院医师在积极应对、消极应对和领悟社会支持得分的差异均有统计学意义,交往焦虑得分的差异无统计学意义.结论 团体心理辅导活动能改善一年级儿科规培住院医师的应对方式和领悟社会支持情况.

Background: With the development of economy and urbanization, methods of child-feeding have significantly changed in China over the past three decades. However, little is known about breastfeeding in China since 2009. This study aims to update information on the prevalence of breastfeeding in China. Methods: Data were obtained from the first Health Service Household Interview Survey of Hunan Province, China. Of 24,282 respondents, 1659 were aged five years or younger. We ran multivariable logistic regression to examine the impact of urban/rural setting, gender, age and household income per capita on the use of breastfeeding. Results: A total of 79.4% of children aged 5 years or younger had been breastfed at some point and 44.9% been breastfed exclusively in the first 6 months of life. After controlling for setting urban/rural setting, gender and child age, children from households with average family income were more likely to be breastfed than those from households with the lowest family income (adjusted odds ratio: 2.28). Children from households with higher and the highest family income were less likely to be exclusively breastfed in the first 6 months of life compared to those from households with the lowest family income (adjusted odds ratio: 0.51 and 0.68, respectively). Conclusions: It is encouraging that the prevalence of exclusive breastfeeding for infants in the first 6 months of life in Hunan Province, China is approaching the goal of 50% proposed by the World Health Organization (WHO). Nevertheless, more efforts are needed to further promote exclusive breastfeeding in the first 6 months after birth.

ObjectivePublished research has not considered acute diseases and injuries in assessing the impact of varying disease counts on health-related quality of life (HRQoL). We used Chinese value sets of EQ-5D-3L to examine the relationship between the number of diseases individuals had (including chronic diseases, acute diseases and injuries) and their HRQoL.MethodsA total of 19 387 individuals aged 18 years and older were included in the study. Using data from the First Provincial Health Services Survey of Hunan, China, HRQoL was assessed with the EQ-5D-3L scale, a standardized instrument developed by the EuroQoL group. The EQ-5D-3L utility score was calculated using the Chinese EQ-5D-3L value set. This survey coded disease using the list of 133 conditions that was defined by the First Provincial Health Services Survey of Hunan, China, based on the 10th International Classification of Diseases. 126 conditions were disease-related and were therefore included in data analysis.ResultsOf 15 245 respondents, urban residents and male constituted 53.0% and 48.2%, respectively. 19.3% of respondents had one disease and 5.0% had at least two diseases. Of the five dimensions of the EQ-5D-3L, the pain/discomfort dimension had the highest proportion of moderate or serious problems among the respondents (14.4%, 95% CI 10.5% to 18.2%). The average Visual Analogue Scale (VAS) score and utility score were 78.0 (95% CI 76.9 to 79.1) and 0.958 (95% CI 0.946 to 0.970), respectively. Residents with 1 and ≥2 diseases had higher proportions of moderate or serious problems in five dimensions of the EQ-5D-3L scale during the previous 2 weeks than those without disease after controlling for location (urban/rural), sex, age, education level and household income, respectively (adjusted ORs: 3.1–3.7 and 4.4–6.6, respectively). The mean of the EQ VAS score was 8.4 and 13.6 points lower in respondents with 1 and ≥2 diseases than in respondents without disease; the corresponding mean score difference was 0.048 and 0.086 in EQ-5D-3L utility score. Disease-specific analyses were not conducted due to the inadequacy of sample size.ConclusionsThe HRQoL of residents aged 18 years and older declines distinctly as the number of diseases increases. Actions should be taken to improve the HRQoL of residents with multiple diseases in China (including acute diseases, chronic diseases and injuries).

目的 了解湖南省某儿童医院跌落伤住院患者在时间、人群以及跌落位置的分布特点,为跌落伤的预防策略提供依据.方法 自湖南省某儿童医院的医院信息系统(Hospital Information System,HIS)中收集2010-2014年间确诊为跌落伤的患者有关信息,采用频数、构成比和增长速度对住院患者特征进行描述,组间构成比差异采用卡方检验进行比较.结果 湖南省某儿童医院2010-2014年跌落伤病例2 207人,发生人次呈逐年增加的趋势;男性患者的比例高于女性,住院患者的年龄主要集中在1～6岁,6岁以上患者随着年龄增加住院人次减少,农村患者所占比例大于城镇患者;主要从同一水平面或高处跌落;年龄、住院季节、跌落位置、受伤部位、受伤性质对疾病转归有影响.结论 应该根据跌落伤患者的住院特征,针对高危因素采取具体措施预防跌落伤的发生.

目的 分析2013年湖南省居民两周患病与≥15岁居民半年慢性病患病的疾病构成及顺位.方法 采用多阶段随机抽样得到24 282人为调查对象,用Rao-Scott调整X2检验比较不同人口学特征间患病率差别、估算前10位疾病构成.结果 湖南省城乡居民两周患病率接近(23.03％和22.75％),但农村15～岁、35～岁居民两周患病率(5.52％和14.96％)均分别高于城市(2.18％和9.40％),差异均有统计学意义(均有P＜0.05).＜5岁、5～岁和15～岁年龄段居民两周患病以急性呼吸道疾病和伤害为主,≥35岁居民两周患病中慢病占较大比例.≥15岁城市居民半年内慢病患病率为32.97％,高于农村的27.68％,但差异无统计学意义(X2=1.34,P=0.247).≥35岁城乡居民慢病患病以高血压、糖尿病和椎间盘疾病最常见.结论 湖南省35岁以下居民两周患病以急性呼吸道传染性疾病和伤害为主,≥35岁居民中,随着年龄增加慢病所占比重增长迅速.≥15岁居民半年慢病患病率已达28.92％;高血压、糖尿病和椎间盘疾病成为≥35岁城乡居民最主要的慢性病.

Background: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. Methods: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao–Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. Results: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45–64 years, 46%; 18–44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1–3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7–6.5) for young adults aged 18–44 years. The associations were not statistically significant for age groups 45–64 years and 65 years or older. Conclusion: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey.

Background: To examine urban-rural differences in the severity of non-fatal disease and injury using the latest household interview survey data of Hunan Province, China.Methods: Two-week illness data were from the first provincial health household interview survey of Hunan in 2013. The proportion of patients being bedridden, the average days of being bedridden and the average off-work days were calculated to measure the severity of two-week illness. Rao-Scott-adjusted chi-square test was performed to examine the significance of two-week illness severity differences from demographic variables. Multiple logistic regression and linear regression were used to control for sex, age and household income.Results: The two-week illness prevalence was 22.8 % in Hunan province. Despite similar two-week ill prevalence rates between urban areas and rural areas (23.0 % vs. 22.8 %), rural residents had higher proportions of being bedridden and of being off work than urban residents after controlling for sex, age and household income, with adjusted odds ratios of 3.4 and 6.9, respectively. Similarly, the average days of being bedridden and of being off work in rural residents were 0.45 days and 1.61 days longer than in urban residents after controlling for demographic variables, respectively.Conclusion: The recent data shows that two-week illness in rural residents is more serious than urban residents in Hunan Province, China in spite of very similar two-week prevalence rates. The neglected urban-rural disparities in the severity of two-week illness deserve the attention of health policy-makers and researchers.

目的:为进一步提高病案统计信息服务质量,利用DRGs形式,按照疾病的病种进行国际疾病分类编码,再归纳入DRGs相关的组别并以它计算出收费的指数,并据此进行医疗付费与管理,为医院提供信息数据的同时也为临床科室绩效考核定期发布相关数据,配合各相关部门,提出多项病案质量安全风险防范管理措施,并形成长效机制.方法:根据国际疾病分类编码原则对疾病和手术进行分类,国际疾病分类是为DRGs系统实施的关键,编码的是否正确可直接影响数据的价值与医疗费用的支付其首要课题是做好病案摘录.结果:编码的误差影响到数据的价值和医疗费用的支付.结论:每一个疾病诊断准确分类才能更好发挥疾病分类编码在医疗付款、医院管理中的作用.

目的 分析湖南省某儿童医院儿童异物伤害住院病例特征,为儿童异物伤害的防控提供一定依据.方法 从湖南省某儿童医院的医院信息系统中收集2010-2014年间确诊为异物伤害的患儿有关信息,采用描述性及单因素分析方法分析异物伤害的有关特征.结果 2010-2014年间异物伤害患儿住院3 782人次,患儿人次数呈逐年增加趋势,男女比例为1.77∶1,呼吸道异物伤害性别比高于消化道异物伤害和其他异物伤害,异物伤害的高发年龄段为1～2岁,呼吸道异物伤害在儿童1～3月易发生,不同部位异物伤害治愈率均高于90％,住院天数逐年下降,而住院费用逐年上升,其中呼吸道异物伤害住院天数和住院费用均大于消化道和其他异物伤害.结论 应根据异物伤害住院病例特征,针对高危人群,高发年龄段,高发季节采取强化防控措施.

目的 分析2013年湖南省15岁及以上城乡居民近一年的饮酒状况及其影响因素. 方法 数据来自2013年湖南省第一次卫生服务调查结果,该调查采用多阶段随机抽样得到的24 286人作为调查对象.采用多阶段抽样进行权重估算,用Rao-Scott调整卡方比较不同人口学特征的率的差别,用复杂抽样的非条件logistic回归进行影响因素分析. 结果 有效调查人数24282人,有效率为99.98％,其中≥15岁居民人数为19869.≥15岁居民近一年的加权饮酒率为14.74％,其中男性为27.73％,远高于女性的2.28％(x2=159.34,P＜0.001);55 ～ 65岁年龄组居民最高,达到19.04％.≥15岁居民近一年的加权经常饮酒率为10.40％,其中农村为11.54％,高于城市的6.65％ (x2=9.41,P＜0.001).多因素logistic回归分析显示,男性、较高年龄、较低文化程度和丧偶可能增加居民饮酒行为,男性、较高年龄、较低文化程度、已婚与丧偶可能增加居民经常饮酒行为.其中,相比于女性,男性是饮酒的危险因素,优势比为17.36(x2=125.90,P＜0.001),相比于15～岁,25～岁、35～岁、45～岁、55～岁、65～岁居民饮酒可能性更高,对应的优势比分别为2.93(x2=14.92,P＜0.001)、3.98(x2=62.57,P＜0.001)、4.93(x2=44.11,P＜0.001)、5.74(x2=58.49,P＜0.001)和4.47(x2=92.22,P＜0.001).小学及以下、初中文化居民饮酒可能性高大专及以上人群,对应的优势比分别为1.33(x2=4.38,P=0.04)和1.38(x2 =4.38,P=0.04).丧偶居民饮酒相对于未婚居民的优势比为1.25(x2=4.33,P=0.004).上述因素对经常饮酒率有类似影响,除此之外,已婚者经常饮酒率较高(OR=23.09,P＜0.001),中等收入者经常饮酒率较低(OR=0.78,P＜0.001). 结论 湖南省≥15岁居民饮酒率为14.74％,经常饮酒率为10.40％.男性、高年龄组、低文化程度、丧偶的居民饮酒率相对较高.男性、高年龄组、已婚与丧偶、低文化程度人群经常饮酒可能性较高.

目的：参照零缺陷理论，探讨其在提高病案管理质量中的作用。方法随机抽取笔者医院应用零缺陷理论前后各110例病案资料进行检查，将应用零缺陷理论前的110例病案资料设为对照组，应用零缺陷后的110例病案资料设为研究组，统计并记录两组病案回收工作准确率、出院病案排序正确率、病案信息加工准确率、出院病案装订正确率和病案在架准确率。结果病案回收、信息加工准确率；出院病案排序、装订正确率；病案在架准确率均较未实行以前有提高（P＜0.05）。结论零缺陷理论应用于病案管理有利于提高病案管理的质量，降低出错率，是促进病案管理系统不断发展和完善的有效动力。

OBJECTIVE:To evaluate the satisfaction of service for outpatient within two weeks and for inpatient service within a year in Hunan Province in 2013 and to analyze the influential factors.METHODS:Using the data from the First Health Service Survey of Hunan Province, we evaluated the satisfactions for service in outpatients and inpatients based on the listed satisfaction indicators of the Fifth National Health Service Survey questionnaire. Weighted logistic regression was used to examine the influential factors for patients' satisfactions. SURVEYFREQ and SURVEYLOGISTIC procedures in SAS9.2 were used to conduct statistical analysis.RESULTS:The overall satisfaction proportion was 73.85% (95% CI: 68.67%-79.03%) and 66.31% (95% CI: 61.28%-71.34%) for outpatients and inpatients, respectively. After adjusting the location, gender, age and household income, high degree of satisfaction for outpatients was associated with good patience and trust in medical personnel as well as the low medical costs, with the adjusted odds ratios of 3.64, 5.38 and 3.34, respectively; high degree of satisfaction for inpatients was associated with a good attitude from medical personnel to patients' questions, high patients' trust in medical personnel and low medical costs, with the adjusted odds ratios of 2.56, 4.69 and 4.35, respectively.CONCLUSION:Most of outpatients and inpatients were satisfied with medical services in 2013 in Hunan province. High degree of satisfaction is associated with good attitude from medical personnel to patients' questions, good patience and trust in medical personnel, and low medical costs.

目的 编制适用于我国城市学龄前3～6岁儿童烧烫伤简易风险评估问卷.方法 复习和总结学龄前儿童烧烫伤流行病学调查结果、经典案例、风险评估问卷等文献,采用专题组座谈法、深入访谈法形成问卷初稿.通过对179名儿童预测试筛选问卷条目,通过分层整群抽样调查6所幼儿园468名儿童和医院50名烧烫伤儿童,对问卷进行信度和效度评价.采用百分位数法确定风险等级,采用分布法确定最小显著改变值.结果 城市学龄前3～6岁儿童烧烫伤简易风险评估问卷由15个条目构成,分为“防护不当”、“照顾不当”、“器材使用不当”和“洗澡处置不当”四个维度.问卷的分半信度系数为0.721,Cronbach's α系数为0.773.相关分析显示,每一条目与所属维度之间的相关系数介于0.493～0.879之间,与其他维度之间的相关系数介于0.033～0.475之间;各个维度的Cronbach's α系数均大于与其他维度间的相关系数,各个维度与总分的相关系数均大于各个维度间的相关系数.验证性因子分析的x2/df、比较拟合指数CFI、近似误差均方根RMSEA、规范拟合指数NFI、增值拟合指数IFI分别为3.81、0.070、0.887、0.856、0.889.烧烫伤害组问卷得分显著高于非伤害组(P＜0.05).百分位数法确定风险评估得分≤21分存在低度风险,22～28分存在中度风险,＞28分存在高度风险.分布法确定最小显著变化值为5.10.结论 城市学龄前3～6岁儿童烧烫伤简易风险评估问卷具有较好的信度和效度,可用于该年龄段城市儿童烧烫伤的风险评估.

目的：分析ICD-10分类法在疾病中的编码情况，分析ICD-10分类法在疾病编码中的可行性。方法回顾性分析我院2012～2014年试行ICD-10分类法后的22035份住院病案ICD-10应用前的24065份住院病案，比较疾病名称和疾病编码的准确情况。结果应用ICD-10分类法的疾病分类病案准确率为98.41%，高于应用前地方疾病分类方法（P＜0.05）。结论 ICD-10分类法能提高疾病分类的准确率，分类明确，具有优良的可行性。

OBJECTIVE:To develop the forecasting models for fatal road traffic injuries and to provide evidence for predicting the future trends on road traffic injuries.METHODS:Data on the mortality of road traffic injury including factors as gender and age in different countries, were obtained from the World Health Organization Mortality Database. Other information on GDP per capita, urbanization, motorization and education were collected from online resources of World Bank, WHO, the United Nations Population Division and other agencies. We fitted logarithmic models of road traffic injury mortality by gender and age group, including predictors of GDP per capita, urbanization, motorization and education. Sex- and age-specific forecasting models developed by WHO that including GDP per capita, education and time etc. were also fitted. Coefficient of determination(R(2)) was used to compare the performance between our modes and WHO models.RESULTS:2 626 sets of data were collected from 153 countries/regions for both genders, between 1965 and 2010. The forecasting models of road traffic injury mortality based on GDP per capita, motorization, urbanization and education appeared to be statistically significant(P < 0.001), and the coefficients of determination for males at the age groups of 0-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65+ were 22.7% , 31.1%, 51.8%, 52.3%, 44.9%, 41.8%, 40.1%, 25.5%, respectively while the coefficients for these age groups in women were 22.9%, 32.6%, 51.1%, 49.3%, 41.3%, 35.9%, 30.7%, 20.1%, respectively. The WHO models that were based on the GDP per capita, education and time variables were statistically significant (P < 0.001)and the coefficients of determination were 14.9% , 22.0%, 31.5%, 33.1% , 30.7%, 28.5%, 27.7% and 17.8% for males, but 14.1%, 20.6%, 30.4%, 31.8%, 26.7%, 24.3%, 17.3% and 8.8% for females, respectively.CONCLUSION:The forecasting models that we developed seemed to be better than those developed by WHO.

OBJECTIVE:To predict the burden caused by fatal road traffic injuries from 2015 to 2030.METHODS:We searched the websites of United Nations Population Division,United States Department of Agriculture, World Health Organization, China Energy Research Foundation and other agencies to obtain the predictive values of gross domestic product (GDP) per capita, urbanization, motorization and education from 2015 to 2030 in China. Predicted values were then applied to log-linear models to estimate the numbers and years of life lost due to road traffic injuries from 2015 to 2030.RESULTS:The mortality rate caused by road traffic injury decreased slightly, from 13.7/100 000 in 2015 to 11.8/100 000 in 2030. 191, 189, 183, 169 thousand persons were estimated to die from road traffic crashes in 2015, 2020, 2025 and 2030, respectively, showing a declining trend. Years of Life Lost (YLLs) caused by road traffic deaths were predicted to be 6 918, 6 634, 6 189, 5 513 thousand years in 2015, 2020, 2025 and 2030, respectively, also showing a gradual downward trend. But the YLLs displayed an increase among people at 55 years of age or older, between 2015 and 2030. Results from the sensitivity analysis showed a stable forecasting result.CONCLUSION:Mortality, number of deaths and YLLs from road traffic crashes were predicted to decrease slightly, between 2015 and 2030 but the number of deaths and YLLs due to road traffic injuries will continue to increase from 2015 to 2030.

Objective To report the quantity and quality of published randomised controlled trails (RCT) on injury prevention in China.Design Bibliometric analysis.Setting China, 2001-2010.Data sources The published RCTs that were indexed by four domestic electronic databases and two international databases between 1 January 2001 and 31 December 2010.Main outcome measures Numbers and proportions of published RCTs and those that did not report or specify the quality items recommended by Cochrane Handbook for Systematic Reviews of Intervention V.5.0.0.Results Of 4834 publications of injury prevention, 25 RCTs with 55 431 participants were identified. One study had no full text. Twenty-three RCTs were published in Chinese language. All 25 studies chose education as the intervention, including 19 studies using education as single intervention and 6 studies using education as a part of combined intervention. Eighteen of 19 studies that used injury incidence rate as the primary outcome measure; 10 studies reported 24-59% reductions in injury incidence rate in the intervention group, and 8 studies reported 24-76% rate difference between the intervention group and the control group after the implementation of intervention. Only 1 study reported no significant difference. The other 6 studies only reported improvements in knowledge, attitude and practice/behaviour. None of 24 studies with full text included the information of 'allocation concealment', 'blinding' and 'free of early stopping bias'.Conclusions The value of 25 published RCTs cannot be determined due to the lack of quality information. More high-quality RCTs need to be performed in the future.

目的 编制适用于我国城市3～6岁学龄前儿童的跌倒伤害简易风险评估问卷.方法 通过文献检索、专题小组讨论、访谈法及专家座谈会形成问卷初稿,通过预测试进行条目筛选,利用探索性因子分析构建问卷维度.利用Cronbach's α系数和分半信度系数进行信度考评,采用专家座谈会和专题小组讨论、现场调查反馈、t检验、验证性因子分析和多特征/多条目相关分析分别对内容效度、表面效度、效标效度和结构效度进行评价.采用百分位数法确定风险等级,利用分布法确定最小临床意义变化值.结果 城市3～6岁学龄前儿童跌倒伤害简易风险评估问卷包括6个维度共20个条目.问卷的Cronbach's α系数为0.731;分半信度系数为0.768.过去12个月内出现跌倒伤害的儿童风险评估平均得分高于未出现跌倒伤害者(P＜0.05);验证性因子分析模型拟合x2/df值3.25,拟合指数CFI=0.797、规范拟合指数NFI=0.738、增值拟合指数IFI=0.803、近似误差均方根RMSEA=0.069;多特征/多条目相关分析显示每一条目与所属维度之间的相关系数介于0.402 ～0.852之间,与其他维度之间的相关系数介于0.008 ～ 0.394之间.百分位数法确定风险评估得分＜27分为存在低度风险,27～33分为存在中度风险,＞33分为存在高度风险.分布法确定风险评价的最小临床意义变化值为5.5分.结论 城市3～6岁学龄前儿童跌倒伤害简易风险评估问卷具有较好的信度和效度,可用于该年龄段儿童跌倒伤害风险的评估.

目的 采用动力学模型模拟隔离措施在学校甲型H1N1流感暴发疫情处理中的效果.方法 根据甲型H1N1流感疾病特征和学校人口学特点,建立易感者-潜伏期-显性／隐性感染者-移出者(susceptible-exposed-infectious/a-symptomatic-removed,SEIAR)模型,对长沙市某校甲型H1N1流感暴发疫情进行模拟,采用卡方检验评价模拟结果与实际疫情的拟合优度,并确定模型的关键参数.在SEIAR模型基础上引入隔离措施,构建易感者-潜伏期-显性／隐性感染者-移出者-隔离者(susceptible-exposed-infectious/asymptomatic-removed-quarantine,SEIARQ)模型.为方便基层公共卫生工作者,将对患者(显性感染者)的隔离等分为10个等级(10％、20％、…、90％、100％),以评估不同隔离比例的效果.结果 无干预情况下,疫情基本再生数(λ0)为5.64,疫情持续31天,人群感染率高达99.51％.在对显性感染者采取隔离措施后,随着隔离比例的增加,人群感染率(含显性和隐性感染)和人群罹患率(仅含显性感染)逐渐下降.当隔离全部显性感染患者后,可减少63％的罹患率.在只隔离显性感染措施时,仅当隔离比例超过30％,疫情控制效果才相对显著.结论 单纯隔离患者最多能降低63％的人群甲型H1N1流感罹患率.各地公共卫生机构应根据当地人力和物力情况,采取部分隔离(隔离比例≥30％)与其他措施相结合的方式阻断甲型H1N1疫情的发展.