医院焦虑抑郁量表的信度及效度研究

目的探讨医院焦虑抑郁量表(HADS)的信度及效度。方法应用HADS、焦虑自评量表(SAS)、抑郁自评量表(SDS)对615例心血管疾病患者进行测查。采用同质性信度Cronbach'sα系数、重测信度两个指标检测量表的信度。应用HADS量表总分及焦虑、抑郁亚量表分与SAS、SDS的相关分析检验效标效度,应用探索性因子分析检验结构效度。结果 HADS总体、焦虑亚量表及抑郁亚量表的Cronbach'sα系数分别为0.879、0.806、0.806,重测信度组内相关系数(ICC)分别为0.945、0.921、0.932(P<0.001)。效标效度检验显示,HADS总分与SAS、SDS总分相关系数分别为0.596、0.685,HADS焦虑亚量表分与SAS、SDS总分相关系数分别为0.552、0.601,HADS抑郁亚量表分与SAS、SDS总分相关系数分别为0.552、0.663,均呈显著正相关(P<0.001)。探索性因子分析提取3个公因子,方差贡献率为61.415%。结论 HADS具有较好的信效度,可作为综合医院焦虑抑郁情绪的筛查工具。     

两种抑郁自评量表对心血管疾病患者抑郁症状评定的一致性研究

目的探讨医院焦虑抑郁量表抑郁亚量表(HDAS-D)和抑郁自评量表(SDS)对心血管疾病患者抑郁症状评定的一致性。方法抽取615例心血管疾病患者应用HADS-D、SDS进行测评,并对30例患者在首次测评2周后进行重测。计量资料间比较采用F检验,计数资料间的比较采用χ2检验。采用同质性信度Cronbach’sα系数、重测信度检测量表的信度。HADS-D与SDS评分之间的相关性采用Pearson相关分析。量表评定的一致性检验,计算Kappa值。结果 HADS-D、SDS同质性信度Cronbach'sα系数分别为0.806和0.842,HADS-D、SDS重测信度组内相关系数(ICC)分别为0.932和0.938。HADS-D与SDS总分间的Pearson相关系数为0.663(P<0.001)。量表评定的一致性检验显示,以HADS-D≥8分作为抑郁划界分,与SDS≥50分一致性检验,Kappa值为0.59(u=16.94,P<0.001)。结论 HADS-D与SDS均具有较好的信度,HADS-D与SDS间抑郁评定一致性为中等程度。     

中文患者健康问卷天数版抑郁量表在综合医院临床应用的信效度评价

目的评估中文患者健康问卷天数版抑郁量表（Depression Scale of Patient Health Questionnaire Eight-item Days Version,PHQ-8 days）的信效度。方法采用中文PHQ-8 days、抑郁自评量表和贝克抑郁量表,对住院患者及家属共155例施测,分析量表的内部一致性信度、重测信度、条目间的相关系数,并进行验证性因素分析、效标效度及实证效度分析。结果中文PHQ-8 days的 Cronbach’sα系数为0.87,条目间的相关系数为0.26～0.67,各条目与量表总分的相关系数为0.64～0.80;重测信度为0.79;量表的单因素结构与实际数据拟合,χ2=13.74,df=12,P=0.12,RMSEA=0.06,GFI=0.97,CFI=0.99,NFI=0.97,IFI=0.99;PHQ-8 days总分与抑郁自评量表总分、贝克抑郁量表总分的相关系数分别为0.59和0.54。结论中文PHQ-8 days具有良好的内部一致性和重测信度,较理想的结构效度、效标效度,条目简单,操作性强,可作为综合医院临床筛查抑郁的工具。     

中文版NGASR应用于住院抑郁症患者的信度和效度研究

目的:探讨护士用自杀风险评估量表(NGASR)应用于住院抑郁症患者的信度和效度。方法:对102例住院抑郁症患者进行中文版NGASR、MINI自杀分量表、Beck绝望量表(BHS)及汉密尔顿24项抑郁量表(HDRS-24)评定,计算NGASR的内部因子一致性信度、评定者一致性信度、重测信度及效标关联效度等。结果:NGASR内部一致性Cronbach'sα系数为0.667,两位评定者之间的一致性相关系数为0.995(P=0.000),重测信度为0.988(P=0.000);依据量表总分划分的自杀风险等级与专家意见进行符合率比较,显示总符合率达96%,两者之间准确率及一致性高;相关分析显示,中文版NGASR与MINI自杀分量表总分相关为0.818(P=0.000),与HDRS-24项总分相关为0.499(P=0.000),与BHS中的三个因子总分相关分别为-0.614(P=0.000)、0.723(P=0.000)、0.652(P=0.000)。结论:NGASR用于住院抑郁症患者中具有较好的信度和效度。     

生活质量测定量表简表在神经症患者中应用的信度及效度研究

目的:评价世界卫生组织生活质量测定量表简表(WHOQOL-BREF)在神经症患者中的信度和效度。方法:由专业医生对同济大学附属同济医院精神医学科门诊及住院初诊患者53例行健康状况调查问卷(SF-36),WHOQOL-BREF评定,在治疗的第4周予以重测。对量表的内部一致性、重测信度、劈半信度及效标关联效度等指标进行分析。结果:WHOQOL-BREF的Guttman劈半信度为0.840,Cronbach'sα系数为0.763,各维度的Cronbach'sα系数较好,重测后各项目的相关系数为0.348～0.761。WHOQOL-BREF各维度分与SF-36的各维度分除生理功能和生理职能,以及社会关系领域分和躯体疼痛、情感职能外,均呈明显相关。结论:WHOQOL-BREF具有较好的信度和效度,部分分量表能较好反映神经症患者的情绪状态,基本适用于神经症患者生活质量评价。     

糖尿病简明ICF核心要素量表在糖尿病肾病血液透析患者中应用的信效度分析

目的:检验糖尿病简明ICF核心要素量表在糖尿病肾病血液透析患者中应用的信度和效度。方法:将该量表应用于165例糖尿病肾病血液透析患者中,采用项目分析、结构效度、效标关联效度、内部一致性信度、重测信度以及评定者间信度对量表的信效度进行分析。结果:除"身体结构"维度中的条目"s550胰的结构"相关系数较低(r0.2),其余各条目得分与量表总分均相关(r=0.367~0.745,P0.01);探索性因子分析提取4个公因子,共解释了62.45%的总方差;效标关联效度为0.615(P0.01)。量表总的Cronbach’sα系数为0.838;重测信度为0.885;评定者间信度为0.905。结论:糖尿病简明ICF核心要素量表具有良好的信效度,适合在国内糖尿病肾病血液透析患者中进行临床应用。     

中文版重返工作准备度量表在乳腺癌患者中的信效度检验

目的:对重返工作准备度量表(readiness for return-to-work scale,RRTW)进行汉化,并检验中文版量表的信效度。方法:采用方便抽样的方法先后对一家医院的350例和三家医院的340例乳腺癌患者进行调查。应用SPSS 21.0和AMOS 21.0软件进行数据分析,以条目-总分Pearson相关性分析对中文版量表进行同质性检验,决断值(CR)分析条目间区分度,内容效度和结构效度(探索性因子分析和验证性因子分析)检验量表效度,Cronbach'sα系数检验量表信度。结果:中文版RRTW项目分析各条目-总分相关系数均在0.5以上,决断值检验结果差异均有显著性意义(P0.001);量表的内容效度为0.97,结构效度中探索性因子分析量表前后两部分分别得到4个和2个公因子,分别解释累计解释方差的74.23%和59.58%,四因子和二因子验证性因子分析所得结构方程模型的各指标整体拟合良好,标准化回归系数为0.61—0.83;量表各维度的Cronbach'sα系数分别为0.753—0.843,重测信度为0.797—0.828。结论:汉化后的中文版RRTW量表具有良好的信效度,可用于测量我国乳腺癌患者的重返工作准备度水平。     

简易平衡评定系统测试的汉化及在脑卒中患者中的信度

目的汉化简易平衡评定系统测试(mini-BESTest),测试中文版的信度。方法遵循翻译、逆向翻译、文化调适、预试验的程序,翻译及修订mini-BESTest。由2 名专业人员对61 例脑卒中患者进行mini-BESTest 测试;在首次评估48 h 后,选取其中30 例进行第二次测试。分别计算评定者间及重测组内相关系数(ICC)。计算量表总分和4 个维度Cronbach's α系数。结果测量者间ICC=0.856~0.978 (P<0.01),重测ICC=0.795~0.951 (P<0.01);量表总分和4 个维度间Cronbach's α=0.794~0.905,4 个维度两两之间的相关系数=0.742~0.827。结论中文版mini-BESTest对脑卒中患者具有较好信度。     

老年住院患者安全危险因素评估量表的编制及信效度检验

目的 进一步探讨自制老年住院患者安全危险因素评估量表的信度与效度.方法 采用自行设计的老年住院患者安全危险因素评估量表,该量表由5个分量表,27个条目构成,选取433例老年住院患者对量表进行测试.结果 各分量表的内部一致性Cronbach'sα信度系数为0.602~0.797,总量表的Cronbach'sα信度系数为0.809,分量表的重测信度Pearson相关系数为0.852~0.955,总量表的Pearson相关系数为0.953.因子分析法中5个公因子累积方差解释率为57.70%,每个条目的因子负荷都在0.4以上.预测效度中各分量表的得分的ROC曲线下面积为0.836~0.981,差异有统计学意义.结论 该量表具有良好的信度与效度,为量表的临床应用与推广提供依据.     

中文版改良躯干损伤量表在脑卒中患者中的信度与效度研究

目的:翻译挪威版改良躯干损伤量表(the Trunk Impairment Scale-modified to Norwegian Version,mTIS),并探讨其在脑卒中患者应用中的信度与效度,为其临床应用提供客观依据。方法:将挪威版mTIS翻译为中文版mTIS。共入组30例病例,在入组第一天,评定者A与B同时但独立对患者进行中文版mTIS量表评估,评定者A再对患者进行Fugl-Meyer量表的下肢运动部分(The Fugl-Meyer Assessment of Lower Extremity, FMA-LE)、改良Barthel指数(Modified Barthel Index, MBI)、Berg平衡量表(Berg Balance Scale,BBS)和脑卒中患者姿势评定量表(Postural Assessment Scale for Stroke Patient,PASS)评估。在入组第二天,评定者A再进行一次中文版mTIS评估。采用组内相关系数法(Intra-class Correlation Coefficient,ICC))分析评定者内部的重测信度和评定者间信度,采用Pearson相关系数法检测效度。结果:在信度研究中,评定者A与B之间的中文版mTIS总分、动态坐位平衡分量表得分、协调分量表得分的ICC分别为0.978,0.967,0.902,评定者A两次评定结果之间的中文版mTIS总分、动态坐位平衡分量表得分、协调分量表得分的ICC分别为0.971,0.969,0.901。在效度研究中,中文版mTIS得分与FMA-LE得分的相关系数r=0.806,P0.05;与MBI得分的相关系数r=0.802,P0.05;与BBS得分的相关系数r=0.734,P0.05;与PASS得分的相关系数r=0.775,P0.05。结论:中文版改良躯干损伤量表在脑卒中患者应用中具有良好的重测信度、评定者间信度和较好的效度。     

Vécu des adolescents dont l''un des parents est cérébrolésé : étude préliminaire

OBJECTIVE: To explore the impact of brain injury of a parent on adolescent behavioural and emotional symptoms and personal experience. PATIENTS AND SETTING: Eleven adolescents from 13 to 18 years old with a brain-injured parent with cognitive impairment. MAIN OUTCOME MEASURES: Multiple case report. Assessment of anxiety and depression on the R-CMAS scale and the BDI. Qualitative analysis of a semi-structured interview and of the family drawing. RESULTS: Pathological scores on the R-CMAS scale involved 36% of the cases and the BDI, 45%. Impulsivity involved 36% of cases, difficulties in learning at school 73%, and somatic symptoms 45%. Feeling of loneliness involved 64% of cases and difficulty for the adolescent to speak about feelings in the family 82%. The symbolic position of the brain-injured parent was maintained in all cases. In 45% of cases, the parent was unable to recognize the adolescent, and in 55%, some characteristics of the adolescent were linked to the illness of the parent. A feeling of insecurity pervaded all cases. The family drawing revealed abnormalities in the bodily representation of the family members, especially a lack of hands or a representation of amputated hands in 91% of the cases and unsteadiness of the family members, also represented as ghosts in 82% of cases. CONCLUSION: Living with a brain-injured parent increases depression disorders, a feeling of loneliness and insecurity in adolescents. The inability for the adolescent to recognize parent's personality and the identification with caracteristics of the parent due to the illness is worrying. Abnormalities in the bodily representation of the family members and their unsteadiness are characteristic signs.     

Électrostimulation périphérique et neurovessie

For many years peripheral electrical stimulation has been performed to treat urinary tract dysfunction in neurogenic patients. Numerous methods have been used, involving sacral roots as peripheral nerve and pelvic organs. All of them are not valuable today. Sacral neuromodulation, tibial posterior and pudendal nerve stimulation have been successful for treatment of neurogenic detrusor overactivity in the short/middle term. Methods and respective interest of the main procedures will be discussed.     

Asymétries chronométriques, cinétiques et cinématiques de l''initiation de la marche chez un sujet hémiplégique

OBJECTIVE: To investigate the temporal, kinetic and kinematic asymmetry of gait initiation in one subject with hemiplegia with an equinus varus foot. MATERIAL AND METHODS: A kinetic analysis with two AMTI force plates and a kinematic analysis with an ELITE optoelectronic system of gait initiation were performed in one subject with hemiplegia. RESULTS: The duration of the gait initiation phases was asymmetrical. The monopodal phase was shorter when the affected lower limb was supporting than when the healthy one was supporting. The propulsion resulted from the force exerted on the healthy lower limb. The distribution of body weight on the lower limbs was asymmetrical. Body weight support was more important on the healthy side than on the affected side. Maximal extension of the ankle on the hemiplegic side occurred during the swing phase. Ground clearance was increased by elevating the knee higher on the affected side than on the healthy side during the swing phase. Initial contact with the floor was performed with the foot flat on the affected side. CONCLUSION: This preliminary study has shown that gait initiation in one subject with hemiplegia was asymmetrical in kinetics and kinematics. The results concerning kinematics have not been reported previously for gait initiation in subjects with hemiplegia. The study of gait initiation should allow for better understanding postural and movement control strategies developed by patients with hemiplegia.     

La prééclampsie: Physiopathologie et perspectives de dépistage précoce

Preeclampsia is a complication of pregnancy characterized by hypertension, edema and proteinuria, beginning after 20 weeks of gestation. Six percent of the pregnant women in North America develop this disease, which is associated with increased morbidity and mortality for the mother and her baby. The physiopathology remains uncertain despite many research efforts. Actual hypotheses seek to explain the vasospasm that characterizes the disease. Among the many factors influencing vascular reactivity and possibly implicated are: the renin-angiotensin system, prostaglandins, progesterone and its metabolites, calcium, magnesium, digoxin-like immunoreactive substance(s), auricular natriuretic factor, substances secreted by platelets and leukotrienes. Prevention of the disease is limited by the absence of a biological or clinical marker with good sensitivity and appropriate specificity. Many biochemical or hematological parameters have been reported: uric acid, calcium, magnesium, proteinuria, blood iron, hematocrit, platelet count, antithrombin III, estrogen and progesterone. The combination of several tests could be superior to the use of each test individually, providing a better sensitivity and improving the positive predictive value. With early detection, new therapies for the prevention of the disease could be experimented on the higher risk women before the apparition of clinical symptoms or signs. Furthermore, those tests could be used in the study of the pathophysiology and in the choice of the best therapy.