Addressing social determinants is critical to achieving the End TB Strategy targets. However, the impact of tuberculosis (TB) programmatic indicators amenable to short-term interventions on TB incidence remains underexplored. We aimed to identify modifiable social determinants and evaluate their impact on TB incidence in different risk-specific areas. We compiled individual-level surveillance data on reported pulmonary TB (PTB) cases and county-level data on 12 social determinants between 2011 and 2018 across 108 counties in Shaanxi Province, China. A Bayesian spatiotemporal model quantified associations between PTB incidence rate and social determinants. Model-estimated relative risks (RRs; x-axis) and their annual percentage change (APC; y-axis) were integrated to construct an RR–APC plane diagram for classifying different risk-specific counties. Counterfactual analysis estimated potential reduction in PTB incidence rate if the referral and tracing percentage for PTB patients and suspected cases or the percentage of PTB cases confirmed bacteriologically in these counties were increased to 2018 provincial benchmarks. Five social determinants were significantly associated with PTB incidence rate. A 1

Expanding tuberculosis preventive treatment (TPT) for high-risk populations with latent tuberculosis infection (LTBI) is a key component of the End TB Strategy. However, the high-risk population size is small, which may have limited impact on reducing TB incidence. We aimed to evaluate the health impact and cost-effectiveness of expanding TPT to key community-level population We developed a dynamic transmission model incorporating the effect of TPT and seasonal variations in TB incidence. The model was calibrated by monthly pulmonary tuberculosis (PTB) case data during 2011–2018 from Shaanxi province, China, and validated by data in 2019. We first assessed the TB epidemic trend for seven expanding TPT strategies and sought the optimal TPT strategy that can reach the target of the End TB Strategy by 2035. Then, we calculated the incremental cost-effectiveness ratios (ICER) of this optimal TPT strategy with five TPT regimens (isoniazid monotherapy with two different durations, rifampin monotherapy, and combinations of isoniazid with rifampin or rifapentine) over 2025–2050, compared with no TPT, from a health system perspective. A willingness-to-pay threshold of US 36,378 (three times the per-capita gross domestic product of Shaanxi province in 2023) was used. The optimal TPT strategy is implementing TPT for all WHO-recommended populations and individuals with LTBI aged ≥ 50 at the community level (starting in 2025 with full coverage within 1 year), which could reduce the PTB incidence rate to 1.83/100,000 by 2035, meeting the WHO target of a 90

为探讨基于IMB模型的健康行为管理对初治肺结核患者自我效能、服药依从性和治疗成功率的影响,随机抽取 2021 年 2～10 月间陕西省某市胸科医院新入院肺结核患者146 例,采用随机数字表法将其分为两组,每组 73 例.对照组患者采取肺结核常规护理和健康教育,试验组给予基于IMB模型的健康行为管理,采用结核病自我效能量表、服药依从性量表和治疗成功率进行效果评价.结果表明,试验组在干预后各时间点自我效能得分均高于对照组,服药依从性得分均高于对照组,差异均有统计学意义(P＜0.05).6 月末,试验组的治疗成功率为 87.32%,高于对照组 73.24%(P＜0.05).实施基于IMB模型的健康行为管理可有效提高初治肺结核患者的自我效能、改善并维持患者的服药依从性,提高患者治愈率,为结核病患者治疗期间坚持健康行为提供了一种有效的临床护理参考方法.

Pulmonary tuberculosis (PTB) is a major health issue in Northwest China. Most previous studies on the spatiotemporal patterns of PTB considered all PTB cases as a whole; they did not distinguish notified bacteriologically positive PTB (BP-PTB) and notified bacteriologically negative PTB (BN-PTB). Thus, the spatiotemporal characteristics of notified BP-PTB and BN-PTB are still unclear. A retrospective county-level spatial epidemiological study (2011–2018) was conducted in Shaanxi, Northwest China. In total, 44,894 BP-PTB cases were notified, with an average annual incidence rate of 14.80 per 100,000 persons between 2011 and 2018. Global Moran’s I values for notified BP-PTB ranged from 0.19 to 0.49 ( P < 0.001). Anselin’s local Moran’s I analysis showed that the high–high (HH) cluster for notified BP-PTB incidence was mainly located in the southernmost region. The primary spatiotemporal cluster for notified BP-PTB ( LLR = 612.52, RR = 1.77, P < 0.001) occurred in the central region of the Guanzhong Plain in 2011. In total, 116,447 BN-PTB cases were notified, with an average annual incidence rate of 38.38 per 100,000 persons between 2011 and 2018. Global Moran’s I values for notified BN-PTB ranged from 0.39 to 0.69 (P < 0.001). The HH clusters of notified BN-PTB were mainly located in the north between 2011 and 2014 and in the south after 2015. The primary spatiotemporal cluster for notified BN-PTB ( LLR = 1084.59, RR = 1.85, P < 0.001) occurred in the mountainous areas of the southernmost region from 2014 to 2017. Spatiotemporal clustering of BP-PTB and BN-PTB was detected in the poverty-stricken mountainous areas of Shaanxi, Northwest China. Our study provides evidence for intensifying PTB control activities in these geographical clusters.

BACKGROUND Although gestation and childbirth are progressive physical processes for most pregnant women, there are both physical and great psychosocial challenges throughout the process, which increase the sensitivity and vulnerability of women. Even for women with low-risk pregnancies, it is common to experience degrees of fear, especially for primipara women when faced with childbirth. During their first pregnancy, women may have no relevant health knowledge or experience with delivery and have difficulty identifying prenatal depression and other existing mental health factors; a fear of childbirth (FOC) may engender adverse outcomes for mothers and babies. Social support is a very important influential factor for prenatal depression. METHODS This study adopted a descriptive cross-sectional design. The participant cohort involved 609 primipara women (≥18 years old) who had received routine prenatal care and visited a tertiary care hospital in Xi'an. The participants completed structured questionnaires, including the 10-item Edinburgh Postnatal Depression Scale (EPDS), 12-item Multidimensional Scale of Perceived Social Support (MSPSS), and 33-item Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), alongside contribution of information regarding their demographic characteristics. Descriptive and correlation analyses were adopted to verify the correlations among these variables. Multiple regression models were examined by the SPSS PROCESS procedure with bootstrapping to confirm the significance of the mediation effect. RESULTS The widespread prevalence of FOC in healthy pregnant women was 22.3% (WDEQ score ≥85). The mean scores of depression, social support, as well as FOC scores of participants were 9.50 (5.19), 70.91 (9.25), and 70.43 (20.88), respectively. Remarkable correlations were identified between pregnancy depressive symptoms, social support, and FOC. Results presented an indirect effect, indicating that the impacts of antenatal depression on FOC were mediated by social support. CONCLUSIONS Perceived social support played a mediating role between antenatal depression and FOC among healthy primipara women. Techniques and suggestions for boosting social support may be expected to have a positive impact on the depressive symptoms of pregnant women with FOC.

Aim Fear of childbirth (FOC) is an extreme state of anxiety, distress and worry about childbirth. Despite its common occurrence, the prevalence and risk factors for FOC are inadequately understood in the northwestern region of China. Purpose This study aimed to examine the prevalence and risk factors for fear of childbirth (FOC) in a cohort of pregnant women in northwest of China. Patients and Methods A total of 922 healthy pregnant women were included in this cross-sectional study. Participants filled out a questionnaire on socio-demographic characteristics, as well as the Childbirth Attitudes Questionnaire (CAQ), the Multidimensional Scale of Perceived Social Support (MSPSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Pregnancy Pressure Scale (PPS). Psychosocial factors were analyzed to determine their association with fear of childbirth. Optimal scale regression analysis was used to determine the risk factors associated with FOC. Results The mean score on the CAQ was 33.92 ± 10.17. A total of 72% of participants reported low to mild FOC. Six percent (n=51/922) and 22% (n=199/922) of pregnant women reported severe and moderate FOC, respectively. Based on optimal scaling regression analysis, the factors most strongly associated with FOC were residence, marital status, parity, gestational age, relationship with partner, pregnancy stress, social support and depressive symptoms. Conclusion This study indicates the high prevalence of FOC (70.3%, ranging from mild to severe) in healthy pregnant women in northwest of China. FOC showed a positive correlation with pregnancy-related stress and depressive symptoms and a negative correlation with social support. Screening for FOC and helping pregnant women identify a support system early in pregnancy could reduce a woman’s stress level and severity of depression.

目的 探讨肺结核病患者应对方式、家庭功能与自尊的关系,为开展心理干预及护理提供依据.方法 采用自行设计的一般资料调查问卷、Rosenberg自尊量表(SES)、医学应对问卷(MCMQ)、家庭关怀度指数问卷(APGAR)对325例肺结核患者进行横断面调查.结果 肺结核患者自尊得分均值为29.84±4.50分,不同居住地、文化程度、职业、治疗时间的患者SES得分差异有统计学意义(P<0.05).相关分析结果显示,肺结核患者自尊与面对应对方式呈正相关(r=0.205,P<0.05),与屈服应对方式呈负相关(r=-0.473,P<0.05),与家庭功能呈正相关(r=0.221,P<0.05).回归分析结果显示,屈服、家庭功能、居住地进入自尊回归方程(P<0.05).结论 肺结核患者自尊水平有待提高,医护人员在临床实践中应引导患者采取积极主动的应对方式,并发挥家庭在患者心理健康中的积极作用,缓解患者心理和精神压力,以提高其自尊水平.

针对旅游发展趋势及旅游景点评论观点抽取的难题,提出一种基于机器学习的多级规约条件随机场(conditional random field,CRF)模型的旅游景点评论观点分析方法.分析常见观点分析方法,利用CRF算法从数据集中提取评价观点,基于评论者关系特征构建景点虚假评论者自动识别模型对其评论观点进行过滤,并对评论观点的相关性进行观点合并.实验结果表明:该方法较其他常见方法在准确率、召回率方面有明显提高,且查准率-召回率曲线(precision and recall,PR)及接受者操作特征(receiver operating characteristic,ROC)曲线效果良好,对游客选择旅游目标具有很好的决策作用.

Haini Liu Jingjie Zhao Yi Cao Hualin Jiang Shaoru Zhang Zhongqiu Hua Jing Ren Dan Ren 1Department of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2College of Media, Xijing University, Xian, People’s Republic of China; 3Department of Epidemiology and Health Statistics, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China Purpose: Drug-resistant tuberculosis (DR-TB) remains a major global public health issue. For DR-TB patients, effective adaptation is crucial to prevent disease progression, improve health outcomes and decrease mortality. To date, there is no appropriate tool for evaluating the adaptation status of DR-TB patients. In this work, we aim to develop an adjustment scale for DR-TB patients (AS-DRTBP) and to evaluate its psychometric properties. Patients and Methods: The development of the AS-DRTBP was based on the theory of the Roy adaptation model (RAM). The scale was designed through a literature review, indepth individual interviews, a Delphi survey, and pilot testing. In total, 433 patients with DRTB were recruited to validate the instrument. The split-half reliability coefficient, Cronbach’s alpha coefficient, and test-retest reliability coefficient were calculated to assess the reliability of the instrument. Content validity, construct validity and concurrent validity tests were applied to calculate the validity of the instrument. Results: The final AS-DRTBP consisted of four dimensions and 26 items. The Cronbach’s alpha coefficient, split-half reliability coefficient and test-retest reliability coefficient were 0.893, 0.954, and 0.853, respectively. The content validity index was 0.92. Four factors that explained 64.605% of the total variance were also further determined by confirmatory factor analysis (CFA). The CFA results showed that the fitting effect of the model was appropriate (CMIN/DF = 1.681, GFI = 0.832, AGFI = 0.799, RMSEA = 0.055, SRMR = 0.0684). The AS-DRTBP and adjustment scale had correlation in the total score, and the correlation coefficient was 0.355 (p<0.05). Conclusion: The findings of this study demonstrate that the AS-DRTBP is a reliable and valid instrument formeasuring the adaptation status of patients withDR-TB, allowing health providers to comprehend the adaptive level of DR-TB patients and thus laying the foundation for interventions to help these patients achieve a physiologically, psychologically and socially optimal outcome.

PURPOSE:Drug-resistant tuberculosis (DR-TB) remains a major global public health issue. For DR-TB patients, effective adaptation is crucial to prevent disease progression, improve health outcomes and decrease mortality. To date, there is no appropriate tool for evaluating the adaptation status of DR-TB patients. In this work, we aim to develop an adjustment scale for DR-TB patients (AS-DRTBP) and to evaluate its psychometric properties.PATIENTS AND METHODS:The development of the AS-DRTBP was based on the theory of the Roy adaptation model (RAM). The scale was designed through a literature review, in-depth individual interviews, a Delphi survey, and pilot testing. In total, 433 patients with DR-TB were recruited to validate the instrument. The split-half reliability coefficient, Cronbach's alpha coefficient, and test-retest reliability coefficient were calculated to assess the reliability of the instrument. Content validity, construct validity and concurrent validity tests were applied to calculate the validity of the instrument.RESULTS:The final AS-DRTBP consisted of four dimensions and 26 items. The Cronbach's alpha coefficient, split-half reliability coefficient and test-retest reliability coefficient were 0.893, 0.954, and 0.853, respectively. The content validity index was 0.92. Four factors that explained 64.605% of the total variance were also further determined by confirmatory factor analysis (CFA). The CFA results showed that the fitting effect of the model was appropriate (CMIN/DF = 1.681, GFI = 0.832, AGFI = 0.799, RMSEA = 0.055, SRMR = 0.0684). The AS-DRTBP and adjustment scale had correlation in the total score, and the correlation coefficient was 0.355 (p<0.05).CONCLUSION:The findings of this study demonstrate that the AS-DRTBP is a reliable and valid instrument for measuring the adaptation status of patients with DR-TB, allowing health providers to comprehend the adaptive level of DR-TB patients and thus laying the foundation for interventions to help these patients achieve a physiologically, psychologically and socially optimal outcome.

目的 了解西安市结核病患者心理困扰的发生状况及其影响因素,为临床开展患者心理干预研究提供科学依据.方法 方便抽取陕西省西安市胸科医院420例结核病患者进行横断面调查;采用单因素分析和多元线性回归法筛选可能影响结核患者心理困扰的因素.结果 结核病患者心理困扰得分为(20.33±7.01)分,发生率为72.14％;自尊与心理困扰呈负相关(r=-0.356,P＜0.001),消极应对方式和心理困扰程度呈正相关(r=0.338,P＜0.001);治疗时间、消极应对和自尊是结核病患者心理困扰的影响因素.结论 结核病患者心理困扰发生率较高,应对其加强心理支持和健康指导,对危险因素采取针对性的干预措施.

The role of health literacy on tuberculosis patients has not been evaluated in China, in part because few special health literacy measurements exist. A three-step design process was used: (1) Scale construction: Based on the model of revised Bloom’s taxonomy, the item-pool was drafted from a literature review, focus group discussion, and in-depth interviews. In addition, a Delphi survey was used in order to select items for inclusion in the scales; (2) Pilot study: Acceptability and clarity were tested with 60 tuberculosis patients; and (3) Psychometric testing: Validity analysis includes content validity, construct validity, and discriminative validity. The Cronbach’s alpha coefficient, split-half reliability, and test-retest method were used to assess reliability. Finally, a receiver operating characteristic analysis was conducted to generate a cut-off point. The final scale had 29 items with four domains. The item level Content Validity Index ranged from 0.70 to 1.0, and the scale level Content Validity Index was 0.95. The mean score among the lowest 27% group was significantly lower than that those of the highest 27% group (p < 0.01), which supports adequate discriminant validity. Explanatory factor analysis produced a clear four-factor construct, explaining 47.254% of the total variance. Factor 1 and Factor 2 were consistent with read and memorize TB-related words; Factor 3 was associated with understand the meaning of the health education leaflets and examine if TB patients can apply the correct approach to correct context; Factor 4 was related to the ability of TB patient to calculate and identify what unspecified assumptions are included in known conditions. The confirmatory factory analysis results confirmed that a four-factor model was an acceptable fit to the data, with a goodness-of-fit index = 0.930, adjusted goodness of fit index = 0.970, root mean square error of approximation = 0.069, and χ2/df = 2.153. The scale had good internal consistency and test-retest reliability. Additionally, the receiver operating characteristic analysis indicated that the cut-off point for the instrument was set at 45 and 35. The Chinese Health Literacy scale for Tuberculosis has good reliability and validity, and it could be used for measuring the health literacy of Chinese patients with tuberculosis.

Aiming at the current needs of people's tourism and the difficulty in selecting tourist attractions,this paper propos?es an content-based Recommendations model based on user specific features for scenic spot. According to the specific features of us?er selection,the evaluation view set and user feature set are extracted from the set of self-built tourist attractions review data set, and the user feature set is generated by combining the specific features selected by the user,to avoid the problem of the sparse fea?ture of the new user,and then the Cosine similarity is calculated according to the comments and user features,and the item with high similarity to the user is recommended. The experiment shows that the research method based on the specific features and con?tent of the user is better than the common collaborative filtering recommendations in the accuracy rate and recall rate,and the PR and ROC curves are good. And content-based recommendations is user independence,transparency and new item problem have greater advantages. The limitation of this research is that content-based recommendations can not mine the potential interests of us?ers. The method has a good decision-making function for the tourist to choose the traveling target.

目的:延续性护理联合健康教育对老年高血压患者血压水平及生活质量的应用价值.方法:选取2016年2月—2018年2月于我院进行治疗的120例老年高血压患者为研究对象,随机将其为对照组和观察组各60例,其中对对照组采用常规护理方式;对观察组患者实施延续性护理联合健康教育.比较两组患者干预前后的血压情况及生活质量.结果:入院时,两组血压情况比较无差异(P>0.05),干预后两组血压水平均改善,且观察组的血压水平显著低于对照组(P<0.05);护理干预后,观察组在社交活动、睡眠质量、健康感觉、生活满足感、躯体活动评分明显高于对照组(P<0.05).结论:延续性护理联合健康教育可以有效改善老年高血压患者血压水平,提升其生活质量.

In view of the problems that the online judge is widely used and the existing paper-generating algorithm is low in efficiency,process complexity,and the quality of the paper-generating is not high.Study the artificial papergenerating, random function selection method,backtracking search method and genetic algorithm,and proposes a Hierarchical Solving paper-generating algorithm based on backtracking search.First,establish an algorithm model according to the idea of hierarchical solving pruning,and then the algorithm analysis model is set up with the goal is to improve efficiency and quality of the paper-generating,according to the type of questions,chapters and other indicators,the question bank is hierarchical solved to improve the efficiency of the paper-generating and the quality of the paper-generating.The experimental results show that with the increase of the amount of data,the hierarchical solving paper-generating algorithm based on backtracking search has obviously improved in the efficiency of papergenerating(repetition rate,coverage rate),the quality of paper-generating and the quality of paper(discrimination, reliability)

: The random function method, genetic algorithm, and backtracking search algorithmare widely used to generate paper. However, typical paper-generating algorithms are inefficient to the point that they cannot ensure generate high-quality paper . In this study, we focus on this problem and devise a novel hierarchical backtracking pa-per-generational gorithm (HBPA). The HBPA optimizes the traditional paper-generating algorithm by using a hierarchical structure for pruning to solve the problems of ineffectiveness and inefficiency in the paper generation process. In addition, to measure the efficiency of the algorithm, an algorithm analytical model is established. Evaluation results reveal the effectiveness of the algorithm’s execution, whereby the quality of paper generation improves significantly. In addition, the number of test questions is increased.

目的 针对性护理及健康教育对风湿性心脏病患者的护理价值.方法 选取2016年6月——2018年3月于我院收治的84例风湿性心脏病患者为研究对象,随机将其为对照组和观察组各42例,其中给予对照组患者常规的护理干预;对观察组患者实施针对性护理及健康教育.对患者护理前后的心理状态进行评价;对两组患者护理前后的自护水平进行比较.结果 护理后两组的SDS和SAS评分均低于干预前,且观察组的评分均明显低于对照组(P<0.05);护理后观察组在肢体锻炼、测血压、测体温、测体温方面的自护水平明显高于对照组(P<0.05).结论 针对性护理及健康教育对风湿性心脏病患者改善抑郁焦虑状态起着积极的作用,且可以促进患者自护水平的提高.

针对回溯试探法在题库试题数量较大的情况下,组卷效率低的问题,提出目标终止回溯试探法和缩减深度回溯试探法2种改进的算法.通过建立改进的回溯试探法组卷算法模型,对2种改进算法在组卷效率适用性方面进行分析,并对改进的回溯试探法进行实验验证.实验结果表明:2种改进算法在组卷效率上都有明显地提高,并且各有特点及适应性;如果数据量巨大,适用缩减深度回溯试探法,否则适用目标终止回溯试探法.