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.

肠造口患者有着艰难的心理体验和较重的自我感受负担,医护人员应关注造口患者的内心真实感受,深入了解肠造口患者居家护理状况以及自我感知状态.采用质性研究方法,目的性抽样选择16名肠造口患者进行半结构式访谈,并运用Colaizzi分析法对资料进行分析、归纳主题.结果发现肠造口患者自我感知可归纳为4个主题:复杂的情绪反应;自我护理障碍;渴望支持,维护尊严;寻找自我价值.在住院期间为造口患者提供针对性指导、个性化健康教育外,还要做好患者出院后的延续性护理,并号召家庭及社会支持系统给予造口患者更多的关爱与支持,提高造口患者生活质量,助其回归正常社交和生活.

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.

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.

目的 了解西安市胸科医院结核病专科护士规范留痰的知信行现状并分析知信行总分的影响因素.方法 采用方便抽样法选取2018年12至2019年2月西安市胸科医院275名护理人员为调查对象,采用自行设计的"结核病专科护理人员规范留痰知信行调查问卷量表"对其进行问卷调查,分析结核病专科护士规范留痰知信行影响因素.结果 本研究回收有效问卷270份,有效回收率为98.18％.270名护士知信行总分为(137.45±8.38)分,其中留痰知识评分为(17.63±3.23)分,留痰态度评分为(77.74±5.06)分,留痰行为评分为(42.09±4.80)分.年龄、学历、责任护士为结核专科护士规范留痰的独立影响因素(P<0.05).结论 结核病专科护士规范留痰的知信行水平有待提高,年龄和学历会影响结核病专科护士规范留痰知信行情况,且责任护士的规范留痰知信行情况较好.

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.

该文通过综述国内外伤口造口失禁专科护理的发展,对伤口造口失禁专科护士相关概念进行介绍,分析总结了国外伤口造口失禁专科护士的服务模式、角色职责及培养情况,并对我国目前研究现状进行分析,同时对我国伤口造口失禁专科护士的发展提出了展望.

结核病作为一种慢性传染性疾病,是全球关注的重大公共卫生问题.随着目前治疗观念的改变,以患者为中心的治疗方法得到提倡,人们更多地开始关注患者的自我管理.笔者通过检索国内外结核病患者自我管理的相关研究,对结核病患者自我管理的定义、影响因素、测量工具及干预内容进行综述,以期为后续开展结核病患者自我管理的相关研究提供思路.

Purpose No instrument exists for measuring TB patients’ self-efficacy which is vital for choosing and insisting in benefit TB-management behaviors. Our study aimed to develop and test a new tuberculosis self-efficacy scale (TBSES). Patients and methods The TBSES was designed through literature review, individual interviews, Delphi surveys, and pilot testing. After that, 460 TB patients were recruited to validate TBSES. Exploratory and confirmatory factor analysis and correlation analysis were used to evaluate the scale reliability and validity. The cut-off point for TBSES was identified using receiver operating characteristic (ROC) analysis. Results The final TBSES includes 21 items scored on a 5-point Likert scale, and these items are loaded in four distinct factors that explain 67.322% of the variance, both exploratory and confirmatory factor analysis proved that the scale had good construct validity. The scale had adequate internal consistency, split-half reliability, test-retest reliability, as well as demonstrated content, concurrent validity. The ROC analysis results showed the cut-off point was 86.5. Conclusion This 21-item TBSES demonstrated favorable psychometric properties. It provides an instrument for not only measuring specific self-efficacy in TB, but also identifying patients with low self-efficacy and determining the specific area toward designing interventions for enhance self-efficacy.

Purpose Adherence to treatment is cited as a key challenge in fighting tuberculosis (TB). Treatment of TB requires patients to actively engage in their care. The purpose of this study was to explore the perceptions of patients with TB regarding their engagement in health care. Patients and methods The study was conducted in three medical wards in one hospital. Purposive sampling was used to recruit participants. Semi-structured, audiotaped interviews were conducted and analyzed using thematic analysis. Results Twenty-three patients participated in the study. Four major themes emerged: 1) devaluing engagement; 2) interacting with health care providers (HCPs); 3) facing inability; and 4) seeking external support. Conclusion The patients’ perceptions of their engagement in health care were generally negative. Paying attention to the preferences and needs of patients and making decisions accordingly are effective strategies for promoting patient engagement. Moreover, HCPs should be aware of their crucial role in helping patients make sense of what engagement is and how to engage. In the process of engagement, providers should establish effective interactions with patients and cooperate with family and peers.

目的 了解西安市非医学专业大学生结核病防治“知信行(KAP)”现状,并根据KAP理论构建结构方程模型,分析基本信息、个人史、知识、态度和行为间的相互作用机制,为高校结核病综合防治提供对策和建议.方法 采用分层整群抽样的方法于2016年12月至2017年3月从西安市62所非医学高等院校中抽取4所院校的851名大学生进行问卷调查,问卷包括中国疾病预防控制中心设计的全国公众结核病防治知识信念行为调查问卷(内容为结核病防治相关知识、态度、行为等条目)和自行设计的一般情况调查问卷(内容为学生基本信息及个人史的相关条目).共回收有效问卷808份,有效率为94.9％;对学生KAP现状进行描述性分析,使用Amos 21.0软件分析被调查者的基本信息、个人史、结核病防治知识、结核病防治态度、结核病防治行为之间的关系.结果 大学生结核病防治知识得分较低,正性态度和正性行为持有率分别为70.8％(1715/2424)、37.1％(600/1616).构建的大学生结核病防治KAP结构方程模型拟合良好,部分拟合指标如下:适配度指数(GFI)为0.97,调整后适配度指数(AGFI)为0.95,比较适配度指数(CFI)为0.95.结构方程模型表明:学生个人史、结核病防治知识、结核病防治态度对行为均有正向作用;其中,知识对行为的总效应值最大,为0.74,其中直接效应值为0.69[临界比(CR)=8.38,P=0.003],通过态度产生影响的间接效应值为0.05(P=0.003);个人史对行为产生的间接效应值分别为0.45(P=0.001);态度对行为影响的直接效应值最小,为0.16(CR=2.79,P=0.007).结论 西安市大学生结核病防治知识有待提高.结核病防治知识、个人史、态度均会影响结核病防治行为,结核病防治态度对结核病防治行为的影响较小.应注重提高学生对结核病的认知,注重KAP同步发展.

Lung carcinoma , one of the malignant tumors which severely harm human health , has already become a major public health problem . Among all kinds of carcinomas , the morbidity and mortality of lung carcinoma rank first .The pathogenesis of lung carcinoma is complex ,and is believed to occur due to the interaction between environmental and genetic factors .Many possible factors have been implicated in the pathogenesis of lung cancers .The main risk factor that has been implicated thus far is cigarette smoking .In addition ,the relationship between virus infection and lung carcinoma have received wide attention . The infection of high‐risk human papillomavirus (HPV) is considered one of the risk factors .Unremitting effort is needed to identify the exact relationship between HPV‐16/HPV‐18 and lung carcinoma . It is the new way for early diagnosis and effective treatment .But more work is needed to know the definite mechanism .This article is a summary of the molecular epidemiology studies of high‐risk human papillomavirus infection and lung cancer .