Table of Content

15 December 2020, Volume 23 Issue 35

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Monographic Research

The Existing Problems and Suggestions of Primary Health Care Settings in Normalization of Epidemic Prevention and Control Infection in Novel Coronavirus　

ZHANG Dongying，YAO Mi，YANG Xin，LIN Kai，XIA Qiuling，LIU Mingyuan，GUO Fagang，ZHENG Jinping，ZHONG Nanshan

2020, 23(35):  4407-4411.  DOI: 10.12114/j.issn.1007-9572.2020.00.634

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In the prevention and control of infectious diseases in novel coronavirus，the primary health care settings played an important role in community epidemic prevention and control，which was the most effective defense line for external import and internal non-proliferation.Faced with the local outbreak or regional epidemic of novel coronavirus infection in the present and even in the future for a long time，primary health care settings need to normalize the epidemic prevention work and make up for the shortcomings in the prevention and control of the major epidemic in time，including：the environmental construction was not standardized，the emergency materials reserve was insufficient，the system construction was a mere formality，and the ability to build primary emergency teams was insufficient.In the future，it is suggested to strengthen the standardization of primary health care in terms of site environment，system improvement，team building，and primary emergency response capability，and attach importance to the labor value of primary health care professionals.


Clinical Characteristics of COVID-19 Deaths in Wuhan：an Analysis of 2 231 Cases　

CHENG Leiqun，JIANG Ming，ZHAO Liang，SHEN Xiaoling，ZHENG Ying，DING Jing，LIU Yaxiong，XU Yongzhe

2020, 23(35):  4412-4418.  DOI: 10.12114/j.issn.1007-9572.2020.00.589

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Background　The previous data on COVID-19 clinical features in Wuhan were mostly collected from a single hospital，with limited representation. There are lack of large-sample studies on COVID-19 deaths in the entire Wuhan area.Objective　To analyze the clinical characteristics of 2 231 COVID-19 deaths in Wuhan，so as to provide information for developing diagnostic and therapeutic projects and research of COVID-19.Methods　During January 9 to March 8，2020，we collected the essential information and summary of medical records of 2 231 COVID-19 deaths via reviewing the printed reports submitted by workers from medical affairs department from 66 hospitals in Wuhanwor15 districts〔Jiangadi District，Jianghan District，Qiaokou District，Hanyang District，Wuchang District，Qingshan District，Hongshan District，Caidian District，Jiangxia District，Dongxihu District，Wuhan Economic & Technological Development Zone （Hannan），Huangpi District，Xinzhou District，East Lake High-tech Development Zone and East Lake Scenic Area〕.The information we counted includes：symptom onset time，first visit time，admission time，diagnosis time，death time，past history，clinical symptoms and treatment measures.Results　Death cases mostly occurred in February.The average interval between the first symptom onset and the first medical visit was（4.3±5.5）days，between the first symptom onset and hospitalization was（9.2±7.5）days，and between the first medical visit and confirmed diagnosis was（6.9±7.6）days.Of the 2 231 deaths，1 465（65.67%） were men and 766（34.33%）were women.They died at an average age of （70.2±11.9）years，specifically，the youngest was 14 years，and the oldest was 100 years，1 863（83.51%） died at the age of over 60，and 36（1.61%）died at the age of less than 40.Underlying diseases were prevalent in 1 708 cases（76.56%），among which the top seven were hypertension，diabetes，heart disease，respiratory disease，cerebrovascular disease，chronic kidney disease，and malignant tumor.1 173（52.58%）were mechanically ventilated，547 of them had invasive mechanical ventilation，and 33 had ECMO.302（13.54%） received renal replacement therapy.283（12.68%）abandoned rescue.Conclusion　The shortage of medical resources caused low treatment efficiency in the early stage of the pandemic.With the improvement of the treatment capacity，the number of deaths gradually decreased.Male COVID-19 patients，over 60 years old，and with underlying diseases were related to higher risk of death.


Risk Factors and Predictive Scoring System Development for COVID-19 Death　

CHEN Ling，CHEN Jing，LIU Yuwei，DU Xuebei，PENG Li，JIN Yalei，WANG Haoxiang，ZHAO Yan

2020, 23(35):  4419-4424.  DOI: 10.12114/j.issn.1007-9572.2020.00.555

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Background　The COVID-19 has become a global epidemic.How to effectively treat it and reduce the fatality rate is still at exploratory stage.Identification of risk factors for death is critical to optimize treatment strategies for COVID-19.Objective　To investigate risk factors for COVID-19 death，and based on this，to develop a COVID-19 death predictive scoring system.Methods　Two hundred and seventy patients，who discharged or deceased with confirmed COVID-19 in Zhongnan Hospital of Wuhan University during January 1 to February 29，2020，were reviewed.Baseline data were obtained，including demographics，admission symptoms and vital signs，complications and laboratory test results.According to the clinical outcome，i.e.discharged and deceased，the patients were divided into recovery group and death group.Risk factors of death were explored by using multivariate logistic regression analysis，and used for the development of a predictive scoring system for death.Results　Two hundred and forty-five cases were finally included，including 212 discharged and 33 deceased during hospitalization.Factors independently associated with death were age ≥ 65 years〔OR=7.177，95%CI（1.715，30.038），P<0.05〕，SpO2≤93%〔OR=15.456，95%CI（3.343，71.450），P<0.05〕，BUN≥7 mmol/L〔OR=7.115，95%CI（1.550，32.652），P<0.05〕，PCT≥0.1 μg/L〔OR=23.895，95%CI（4.209，135.639），P<0.05〕.In predicting death due to COVID-19，the AUC of ASBP（A:age，S:SpO2，B:BUN，P:PCT） scoring system was 0.967〔95%CI（0.931，0.987）〕，and that of CURB-65 scoring system was 0.885〔95%CI（0.831，0.926）〕，showing a significant difference（Z=2.816，P<0.01）.5 was the maximal Youden Index for ASBP scoring system and was chosen as the cut-off value，with 0.871 sensitivity and 0.957 specificity.And 2 was the maximal Youden Index for CURB-65 scoring system and was chosen as the cut-off value，with 0.903 sensitivity and 0.735 specificity.Conclusion　Older age，lower SpO2，higher levels of BUN and PCT were independent risk factors for COVID-19 death，and the ASBP scoring system developed based these factors might be available for the assessment of death risk of COVID-19.


Clinical Characteristics of Overseas Imported and Local COVID-19 Cases in Hebei Province　

ZHAO Lei，QIN Hao，DAI Erhei，WANG Yuling，XU Zungui，SHI Xuehan，ZHANG Zhi，YANG Ming，FENG Caixia，XUE Jian

2020, 23(35):  4425-4429.  DOI: 10.12114/j.issn.1007-9572.2020.00.596

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Background　Under the increasingly severe situation of COVID-19 pandemic，Hebei Province has received a large number of individuals returned from abroad.Therefore，on the occasion of returning to work，production and school，it is imperative to effectively strengthen SARS-CoV-2 screening and management of overseas imported cases and to take actions to cut off the transmission channels to prevent the spread of SARS-CoV-2 from this group.Objective　To study the clinical characteristics of overseas imported and local COVID-19 cases in Hebei Province，to provide a reference for developing targeted programs to prevent the recurrence of the pandemic.Methods　28 patients with COVID-19（7 overseas imported and 21 local ）who were admitted to Shijiazhuang Fifth Hospital from January 21 to April 5，2020 were selected.The epidemiological characteristics，clinical manifestations，laboratory and imaging examinations of them were summarized and analyzed.Results　（1）The imported group included 5 men and 2 women，mostly were young adults〔4（57.1%）were 19-29 years〕，with an average age of （23.6±11.1） years.The local group included 14 men and 7 women，mostly were middle-aged and elderly adults〔19（90.5%）aged 30-72 years〕，with an average age of（43.6±19.7） years，mainly were infected with COVID-19 after family gatherings.（2）Among the imported cases，1 had fever，1 had diarrhea，and 5 had no clinical symptoms；6（85.7%）had common type COVID-19，1（14.3%）had severe type，no mild and critically severe types.Among the local cases，15 had fever，9 had cough，5 had sore throat，3 had fatigue，2 had muscle pain，and 1 had diarrhea；1（4.8%） had mild type COVID-19，15（71.4%）had common type，4（19.0%）had severe type，and 1（4.8%）had critically severe type.（3）The imported cases showed lower average cycle threshold（Ct） value of SARS-CoV-2 N gene（t=14.430，P<0.001） than the local cases.Moreover，the average Ct value of SARS-CoV-2 N gene and ORF1ab gene was also lower in the imported cases（t=17.856，P<0.001）.The prevalence of reduced CD4+ T lymphocytes was above 50.0% in both groups compared with the normal reference range value.The prevalence of reduced lymphocyte count and CD3+ T lymphocytes，and elevated C-reactive protein，aspartate aminotransferase，alanine aminotransferase and lactate dehydrogenase was higher than 40.0% in the imported cases.The prevalence of elevated C-reactive protein and lactate dehydrogenase was higher than 40.0% in the local cases.（4）The lung CT examination of two groups indicated that the lesions were mainly distributed in bilateral lung lobes，followed by unilateral unilobe，and then unilateral multiple lobes.Ground-glass opacity was the main image finding in the imported group，while ground-glass opacity and consolidation opacity were the main image findings in the local group.Conclusion　In Hebei Province，the imported COVID-19 cases showed milder symptoms，lower Ct values of SARS-CoV-2 N gene and ORF1ab gene and higher SARS-CoV-2 viral nucleic acids from nasopharyngeal swabs，which indicate that the virus from imported cases may be more contagious.Therefore，it is necessary to strengthen isolation，screening and early diagnosis of imported cases，so as to prevent the spread of disease as much as possible.


Establishment and Application of PCR-Time-of-flight Mass Spectrometer for SARS-CoV-2 Nucleic Acid Detection　

WANG Jun，ZHANG Dong，CHEN Qingqing，YU Junling，YANG Yi，QIAO Liang，SUN Yong

2020, 23(35):  4430-4435.  DOI: 10.12114/j.issn.1007-9572.2020.00.588

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Background　To contain the COVID-19 pandemic，laboratory test results are an important reference for making diagnosis whose accuracy is closely associated with the sensitivity and specificity of the detection method.RT-PCR is a general detection method for SARS-CoV-2，but its sensitivity is limited and depends on the content of virus.Optimizing PCR-Time-of-flight mass spectrometry （TOFMS） may improve the sensitivity of low virus content detection，which may be an effective supplement to the existing methods.Objective　To develop a PCR-TOFMS method for detecting SARS-CoV-2 nucleic acid based on Clin-ToF-II TOFMS system using matrix-assisted laser desorption/ionization（MALDI）principle，and evaluate its practical application value.Methods　186 samples were used as the data for developing a system of PCR-TOFMS，including 121 external quality assessment samples〔47（40 were SARS-CoV-2 positive and 7 were negative）from Shanghai Center for Clinical Laboratory，and 74（41 were SARS-CoV-2 positive and 33 were negative）from National Health Commission of the People's Republic of China〕，and 65（32 positive plasmids and diluted samples，28 samples of healthy people and 5 of ultrapure water as blank control） bought by our laboratory.Another 100 samples collected during January to February，2020，were used as the data for testing the performance of our system of PCR-TOFMS， including 80 samples of upper respiratory tract secretions（55 throat swab samples， and 25 sputum samples） of suspected COVID-19 cases collected clinically by Anhui's hospitals and sent to Anhui Provincial Center for Disease Control and Prevention for detection，and 20 throat swab samples of healthy people.The detection procedure for the system was developed， including PCR amplification， SAP digestion， single-base extension and mass spectrometry detection. Based on the positive plasmid，the template quantity was optimized.The diagnostic criterion for SARS-CoV-2 was determined according to the peak signal-to-noise ratio of 186 samples' results. The samples of 80 suspected COVID-19 cases and 20 healthy people were analyzed，and the results were compared with those by RT-PCR.Results　By optimizing the template conditions of PCR-TOF MS，the typical mass spectra of PCR-TOFMS was obtained when the template amount was 6 μl.The established RT-PCR reaction system could effectively detect the amplification of ORF1ab gene and nucleocapsid protein （N） gene of SARS-CoV-2 nucleic acid. In this study，the detection rate of PCR-TOFMS for clinically suspected cases was 90.00%，which was higher than 75.00% of RT-PCR. Meanwhile，the results showed that 25.00% of suspicious results were detected by RT-PCR，but no suspicious results were found by PCR-TOFMS. PCR-TOFMS had higher rates of detecting SARS-CoV-2 in sputum samples（100.00% vs 64.00%）and throat swab samples（85.45% vs 43.64%）of suspected COVID-19 cases than RT-PCR，but both of them did not find SARS-CoV-2 in negative samples.Conclusion　The combination of PCR and TOFMS technology makes the detection of SARS-CoV-2 target fragment expand exponentially，thereby improving the detection sensitivity of samples.In addition，MALDI-TOF MS technology has high accuracy and specificity through the detection and analysis of ion molecular weight，which also confirms that sputum sample is better than throat swab sample for detection.This method can be used as a supplement and collaboration of RT-PCR，which can make up for the false negative problem to a certain extent，thus reducing the clinical missed diagnosis rate，improving the detection efficiency，and shortening the time for pandemic situation research and judgment.


Factors Associated with Increased Risk of SARS-CoV-2 Infections in Diabetics　

GAO Jie，GAO Yun，ZHANG Mingfeng，AN Zhenmei，WU Yuelei，ZHANG Qin

2020, 23(35):  4436-4442.  DOI: 10.12114/j.issn.1007-9572.2020.00.494

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Novel coronavirus 2019 （COVID-19）is spreading worldwide in 2020. Previous studies showed that elderly diabetic patients are more susceptible to COVID-19 and have higher rates of severity and mortality，though the reasons for this are unclear yet. This research retrieved，the relevant articles in recent years and found that it may be related to the changes of lung structure and function， cellular and humoral immunity deficiency，angiotensin converting enzyme 2，obesity and inflammatory factors，hypercoagulability，oxidative stress，glycosylation，age and other factors in diabetic patients，but whether diabetes increases the susceptibility to COVID-19 needs to be confirmed by further research.


Efficacy of Decitabine Monotherapy in the Treatment of Moderate-to-high-Risk Myelodysplastic Syndrome and Acute Myeloid Leukemia　

LU Minqiu，BAO Li，CHU Bin，SHI Lei，GAO Shan，XIANG Qiuqing，FANG Lijun，WANG Yutong，LIU Xi，DING Yuehua

2020, 23(35):  4443-4447.  DOI: 10.12114/j.issn.1007-9572.2020.00.585

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Background　Patients with moderate to high-risk myelodysplastic syndrome（MDS） and elderly patients with acute myeloid leukemia（AML） have poor prognosis with poor tolerance of intensive conventional chemotherapy.Decitabine，a demethylated drug，may be a new promising option for them.Objective　To investigate the clinical efficacy and adverse reactions of decitabine monotherapy in the treatment of moderate-to-high-risk MDS cases and elderly cases of AML.Methods　Twenty patients （10 cases of moderate-to-high-risk MDS and 10 elderly cases of AML） who were admitted to Department of Hematology，Beijing Jishuitan Hospital from April 2016 to July 2019 were enrolled.All of them were treated with decitabine at 20 mg•（m2）-1•d-1×5 d.Follow-up was conducted once every 28 days starting from the first course of treatment till October 13，2019 or the patient's death.Routine blood test and bone marrow aspiration were performed for each follow-up.Results　Of the 20 patients，6 and 10 achieved complete response（CR） and partial response（PR），respectively，1 had stable disease（SD），1 had progressive disease（PD），and 2 died.The disease control rate was 85.0%（17/20），and the overall response rate was 80.0% （16/20）.Of the 18 elderly patients，6 and 8 achieved CR and PR，respectively，1 had SD，with a disease control rate of 83.3%（15/18），and an overall response rate of 77.8%（14/18），in particular，6 were aged over 70，but 5 of them reached CR and 1 reached SD.The rate of CR did not vary notably by diagnosis，sex，ECOG score，white blood cells，high-risk MDS，or having underlying disease（P>0.05）.There was significant difference in CR rate between those who received at least 3 courses of treatment and those did not（P<0.05）.The overall survival of 20 patients ranged from 2 to 27 months.The 1-year overall survival rate was 30.0%（6/20），and the 2-year survival rate was 20.0%（4/20）.Median progression-free survival was（14.1±3.4） months，and the median survival was（17.4±2.5） months.There were 15 cases（75.0%） of grade Ⅲ to Ⅳ myelosuppression，15 of pulmonary infection and 2 of bloodstream infection.Conclusion　Decitabine monotherapy may achieve high disease control rate in moderate-to-high-risk MDS cases and elderly cases of AML.And the main adverse reactions are myelosuppression and infection.


Association of MUC1 rs4072037 Polymorphism with the Progression and Prognosis of Connective Tissue Disease-associated Interstitial Lung Disease　

LONG Xiaoping，TANG Yanhua，XU Lihui，WANG Weizhong，LI Jianmin，XIE Lihu

2020, 23(35):  4448-4453.  DOI: 10.12114/j.issn.1007-9572.2020.00.584

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Background　Interstitial lung disease seriously affects the prognosis of patients with connective tissue disease（CTD）.Recent studies have suggested that Krebs von den Lungen-6（KL-6）secreted by human typeⅡ alveolar epithelial cells is a sensitive biomarker of interstitial lung disease.MUC1 rs4072037 polymorphism is related to individual differences in KL-6 levels，but there are no rs4072037 of MUC1 gene related data in patients with connective tissue disease-associated interstitial lung disease（CTD-ILD），and the relationship of rs4072037 of MUC1 gene with serum KL-6 levels is not clear.Objective　This study was aimed at investigating the correlation of MUC1 rs4072037 polymorphism with serum KL-6 and pulmonary function and its prognostic value in patients with CTD-ILD.Methods　We retrospectively studied 48 CTD-ILD inpatients（CTD-ILD group）and 13 inpatients with CTD（CTD group）recruited from Department of Rheumatology and Immunology，the First Affiliated Hospital of University of South China，and 30 healthy volunteers（control group）recruited from outpatient health examinees of the hospital from January 2015 to December 2018.We collected their lung function parameters〔FVC%pred，FEV1%pred，TLC%pred，diffusing capacity for carbon monoxide（DLCO%pred），PaO2，alveolar-arterial oxygenation gradient（A-aDO2）〕，and serum KL-6，LDH and MUC1 rs4072037 polymorphism.Kaplan Meier method was used to draw survival curves， and log rank test was used to evaluate the difference between survival curves.Cox proportional hazards model was used to explore factors independently associated with CTD-ILD.C- statistics analysis was used to analyze the testing power of the predictive model.Results　Compared with the control group，CTD and CTD-ILD groups had much lower FVC%pred，FEV1%pred and PaO2 and higher A-aDO2，serum KL-6 and LDH（P<0.05）.The DLCO%pred of the CTD-ILD group was lower than that of other two groups（P<0.05）.A-aDO2 in CTD-ILD group was higher than that in CTD group（P<0.05）.In CTD-ILD group，there were 22 cases with A/A genotype and 26 with A/G genotype，while in control group，there were 9 with A/A genotype，12 with A/G genotype，and 9 with G/G genotype，indicating significant intergroup difference in MUC1 rs4072037 polymorphism（χ2=16.325，P<0.001）.CTD-ILD patients with A/A genotype had higher serum KL-6 level〔（8.09±1.68）U/L vs（2.40±4.64） U/L〕（t=3.748，P=0.007）and LDH〔（372±40 ）U/L vs（266±23 ）U/L〕（t=2.124，P=0.030）than those with A/G genotype.CTD-ILD patients with A/G genotype had lower A-aDO2〔（35±3）mm Hg vs（45±4）mm Hg〕and but higher DLCO%pred〔（58%±3%）vs（40%±6%）〕than those with A/A genotype（t=2.377，2.778，P=0.027，0.012）.The cumulative disease progression rate of CTD-ILD patients with A/A genotype and those with A/G genotype was different（χ2=9.242，P=0.008）.Multivariate analysis with Cox proportional hazards model showed that，MUC1 rs4072037（G）was an influencing factor of the remission rate 〔HR=5.43，95%CI（1.2，25.6），P=0.025〕.C-statistics indicated that rs4072037（G）could predict the clinical remission rate in a model with covariates（P=0.021）.Conclusion　MUC1 rs4072037 polymorphism may be closely associated with serum KL-6，pulmonary function and prognosis in patients with CTD-ILD，and can predicte the clinical remission rate.


The Role of Lipocalin Type Prostaglandin D Synthase in Excessive Daytime Sleepiness in Patients with Narcolepsy Type 1

WANG Peipei，YAN Han，LI Qinghua，ZHANG Chi，DONG Xiaosong，AN Haiyan，LI Jing，ZHAO Long，HAN Fang

2020, 23(35):  4454-4458.  DOI: 10.12114/j.issn.1007-9572.2020.00.636

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Background　Prostaglandin D2 （PGD2） induces adenosine production through its receptor DP1 to produce a strong hypnotic effect.Recent studies have showed alteration of PGD2-DP1 pathway in narcolepsy patients and the key enzyme for PGD2 synthesis in central nervous system，lipocalin-type prostaglandin D synthase （L-PGDS），has been suggested to be involved in process of excessive daytime sleepiness in type 1 narcolepsy（NT1）.Objective　This study is to explore the levels of L-PGDS in cerebral spinal fluid （CSF） and peripheral circulation of NT1 patients，and the role of L-PGDS in EDS.Methods　Eligible participants were recruited from Peking University People's Hospital during December 2013 to December 2015，including 79 NT1 patients（NT1 group） who visited the Sleep Medicine Center，and 47（control group） who underwent leg surgery under spinal anesthesia.All NT1 patients finished multiple sleep latency test，with mean sleep latency and number of sleep-onset rapid eye movement periods during the test were calculated.CSF and serum L-PGDS levels，CSF hypocretin level and HLA-DQB1*0602 phenotype were measured in both groups.Results　Significant differences between two groups were observed in age，sex ratio，mean BMI，and the rate of HLA-DQB1*0602 positivity（P<0.05）.CSF hypocretin level in control group was higher than that in NT1 group（P<0.001）.Moreover，CSF L-PGDS was much lower in the control group （P=0.029），and so was the serum L-PGDS（P<0.001）.No correlations between CSF L-PGDS and CSF hypocretin were found in neither control group（rs=-0.179，P=0.229） nor NT1 group（rs=-0.160，P=0.159）.A significant positive correlation was noticed between age and CSF L-PGDS levels in both control group（rs=0.358，P=0.014） and NT 1 group（rs=0.267，P=0.017）.Such correlation was absent between age and serum L-PGDS（control group：rs=-0.251，P=0.088；NT1 group：rs=-0.058，P=0.612）.No correlations were observed between CSF L-PGDS and BMI（control group：rs=-0.097，P=0.521；NT1group：rs=0.122，P=0.283） and between serum L-PGDS and BMI（control group：rs=-0183，P=0.223；NT1 group：rs=0.188，P=0.098）.In a subgroup of 12 age-，gender- and BMI-matched pairs，CSF and serum L-PGDS levels remained higher in NT1 patients than in controls（P<0.05，respectively）.Conclusion　NT1 patients had elevated CSF and serum L-PGDS levels，suggesting L-PGDS may play an important role in the physiopathological process of excessive daytime sleepiness.


Benefit Finding and Influencing Factors in Patients with Early-stage Colorectal Cancer　

LI Zhiwei，LIU Zhunzhun，ZHANG Lanfeng

2020, 23(35):  4459-4464.  DOI: 10.12114/j.issn.1007-9572.2020.00.597

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Background　With the development of biopsychosocial approach used in medicine，the role of psychological factors in cancer rehabilitation has been widely concerned.Benefit finding（BF） is a key research area in positive psychology，mostly focusing on patients with breast cancer or multiple cancers，rarely involving those with colorectal cancer.Objective　To assess BF and associated factors in early-stage colorectal cancer patients in China.Methods　This study is a cross-sectional study.By convenient sampling method，326 early-stage colorectal cancer inpatients were recruited from two hospitals（Jiangyin People's Hospital and Nantong Tumor Hospital） in Jiangsu to attend a questionnaire survey.Measurement instruments include General Information Questionnaire，Chinese version of Benefit Finding Scale（evaluating benefit finding），Chinese version of Communication with Doctors Questionnaire（evaluating communication with doctors），Hospital Anxiety and Depression Scale（evaluating anxiety and depression），Revised Life Orientation Test（evaluating optimism） and Medical Coping Modes Questionnaire（evaluating the response characteristics of the disease，including facing，avoiding and yielding）.Logistic regression analysis was employed to identify the independent influencing factors of BF.Results　According to the Chinese version of disease benefit scale，patients with early colorectal cancer were divided into low BF level group 31 cases（9.5%，score <66 points），and 295 cases （90.5%，score≥66 points） in medium / high level group.Compared with moderate/high BF group，low BF group had lower prevalence of receiving surgery plus chemotherapy，and lower mean scores of Chinese version of Communication with Doctors Questionnaire and confrontation subscale of Medical Coping Modes Questionnaire as well as lower mean level of optimism（P<0.05）.Moreover，low BF group showed higher mean scores of Hospital Anxiety and Depression Scale and avoidance subscale of Medical Coping Modes Questionnaire and higher incidence of complications（P<0.05）.There were also significant differences in exercise frequency between the two groups（P<0.05）.Logistic regression analysis showed that surgery plus chemotherapy〔OR=3.294，95%CI（1.239，8.759）〕，no complications〔OR=5.867，95%CI（1.868，19.041）〕，optimism〔OR=1.569，95%CI（1.169，2.106）〕，confrontation coping 〔OR=1.477，95%CI（1.267，1.721）〕 were independently associated with BF（P<0.05）.Conclusion　Early-stage colorectal cancer patients in Nantong and Jiangyin had moderate/high BF on the whole.BF was significantly affected by confrontation coping，optimism，surgery plus chemotherapy and no complications.To improve the BF of these patients，frontline physicians and nurses may formulate and implement multidisciplinary and multi-platform intervention programs based on these associated factors of BF.


Factors Associated with Methimazole-induced Leucopenia in Early-phase Treatment of Graves' Disease　

MA Jingang，WEI Hongli，SHANG Heng

2020, 23(35):  4464-4469.  DOI: 10.12114/j.issn.1007-9572.2020.00.359

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Background　Metimazole is a commonly used drug in the treatment of Graves' disease （GD），and leukopenia is an adverse reaction that often occurs during medication with an incidence of about 10%.In severe cases，it can cause agranulocytosis，endangering the patient's life.Leukopenia is usually a precursor to the occurrence of agranulocytosis，so timely finding the factors associated with methimazole-induced leucopenia may improve the safety of medication.Objective　To identify the influencing factors of leukopenia induced by methimazole in early-phase treatment of GD，to prevent the occurrence of methimazole-induced leukopenia.Methods　580 newly diagnosed，untreated GD outpatients and inpatients were recruited from Endocrinology Department，Cangzhou People's Hospital from December 2015 to December 2017.During the first 3 months of oral methimazole treatment，the observation period of this study，those with and without leukopenia were included in the observation group （n=70），and control group （n=510），respectively，by the diagnostic criteria for leucopenia （peripheral leukocyte counts remained lower than 4.0×109/L）.Pre-treatment general conditions and laboratory test data were compared between the two groups.The statistically significant factors were included in the multivariate Logistic regression analysis to find out the influencing factors of leukopenia induced by methimazole.Results　There were significant differences between two groups in terms of distributions of gender，age ，clinical activity score for Graves' ophthalmopathy （GO），free thyroxine （FT4） elevation，and thyroid peroxidase antibody （TPOAb） elevation （P<0.05）.Multivariate Logistic regression analysis showed that female〔OR=2.083，95%CI（1.174，3.693）〕，age <20 years 〔20-40 years: OR=0.057，95%CI（0.028，0.117）；>40 years: OR=0.184，95%CI（0.102，0.334）〕，inactive GO 〔OR=1.809，95%CI（1.172，2.792）〕，active GO 〔OR=3.238，95%CI（1.723，6.085）〕，high-level FT4 〔OR=3.481，95%CI（1.779，6.809）〕，and moderate-level TPOAb 〔OR=2.620，95%CI（1.717，4.000）〕 were risk factors for methimazole-induced leukocytopenia in early-phase treatment of GD （P<0.05）.Conclusion　Female，age <20 years，GD with GO and active inflammatory response caused by autoimmune thyroid imbalance are risk factors for methimazole-induced leukocytopenia in early-phase treatment of GD.


Over Prolonged Hospitalization in Elderly Patients：Status Analysis and Prevention and Control Recommendations Based on a Survey　

YE Xia，JU Mei

2020, 23(35):  4470-4476.  DOI: 10.12114/j.issn.1007-9572.2020.00.282

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Background　Over prolonged hospitalization in elderly patients due to physical decline and characteristics of geriatric diseases has put great pressure on the resources of emergency beds in tertiary medical institutions.Under the current situation of shortage of medical resources，studying the status of over prolonged hospitalization in elderly patients is of great significance to promote the rational allocation of resources，and improve the effective utilization of medical resources as well as the elderly's satisfaction with medical services.Objective　To analyze the status and influencing factors of over prolonged hospitalization in elderly patients based on a survey，to provide evidence-based data for formulating prevention and control measures to shorten the length of hospitalization in this group.Methods　A retrospective design was adopted.By checking the information on the medical records homepage，data of 686 elderly patients（≥ 60 years） who hospitalized for more than 30 days during 2016 to 2018 in Chongzhou People's Hospital were collected and analyzed.Multiple linear regression analysis was used to identify the factors affecting the length of hospitalization in these patients.Results　During the period，these participants accounted for 0.66%（686/104 068） of the total cases discharged from the hospital，with hospitalized days accounting for 3.74%（32 982/881 872） of the total.Most of the participants〔343 cases（50.0%）〕hospitalized for 31 to 39 days，mainly in rehabilitation department 〔293 cases（42.7%）〕，with circulatory system disease as the most common disease〔247 cases（36.0%）〕，（7.7±3.4） complications on average，（4.5±1.7） systems affected by complications on average，mean MCIRS-G score of（24.8±4.0），chronic disease prevalence of 95.6%（656/686），（5.4±2.9） chronic diseases on average，and hypertension as the most common chronic disease〔515 cases（75.1%）〕.The results of multiple linear regression analysis showed that age（β=-5.057），rescue times（β=2.675），nosocomial infection（β=4.245） and MCIRS-G score（β=5.389） were important factors affecting the length of stay（P<0.05）.Conclusion　The factors influencing the length of stay in elderly patients include age，times of rescue，nosocomial infection and comorbidity burden.To shorten the length of stay in these patients，recommendations are put forward as follows:Constructing an integrated medical and nursing care system，developing the multidisciplinary collaborative diagnostic and therapeutic and care，strengthening the management of key geriatric diseases，attaching great importance to the development of geriatric medicine and improving hospital-based management of geriatric diseases.


Investigation of Anticoagulation Strategies in Nonvalvular Atrial Fibrillation Patients Aged 80 and Over　

CHEN Jingwen，PEI Linghua，CHEN Chao，WANG Shen，HUANG Shuwei

2020, 23(35):  4477-4482.  DOI: 10.12114/j.issn.1007-9572.2020.00.565

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Background　The proportion of anticoagulant therapy in elderly patients with nonvalvular atrial fibrillation is generally low.The actual situation of anticoagulation in this population is greatly different from the guideline and there is a lack of clinical evidence in the decision of anticoagulant regimens.Objective　The study aimed to investigate anticoagulant regimen use and prognosis in nonvalvular atrial fibrillation patients aged 80 and over.Methods　516 patients （≥80 years）with an initial diagnosis of nonvalvular atrial fibrillation or with a previous diagnosis but without anticoagulant therapy treated in the Second Affiliated Hospital of Zhejiang Chinese Medical University between September 2016 and September 2018 were selected.An analysis was performed on clinical data obtained via reviewing the electronic medical records in the hospital information system and follow-up data，including gender，age，smoking history，comorbidities 〔hypertension，diabetes，coronary artery disease，cardiomyopathy，heart failure，and chronic obstructive pulmonary disease（COPD）〕，types of atrial fibrillation（persistent，paroxysmal or permanent atrial fibrillation），history of ischemic stroke，history of hemorrhage，estimated glomerular filtration rate（eGFR），CHA2DS2-VASc score，HAS-BLED score，post-discharge anticoagulant regimen（warfarin，rivaroxaban，dabigatran or using no anticoagulant therapy），duration of anticoagulant treatment，use of antiplatelet drugs，adverse reactions（bleeding events，ischemic stroke，hemorrhagic stroke，and all-cause mortality）.The influencing factors of death，ischemic stroke and bleeding events were analyzed using binary Logistic regression.Results　Among the participants，137（26.6%）received anticoagulation therapy，including 21 received oral warfarin（4.1%），67 received oral rivaroxaban（13.0%），and 49 received oral dabigatran（9.5%）；379（73.5%）received non-anticoagulant therapy，including 266 received single antiplatelet agents（51.6%），53 received dual antiplatelet agents（10.3%），and 60 received no antiplatelet agent（11.6%）.Sex ratio，average age，prevalence of comorbidities（hypertension，diabetes，coronary artery disease，cardiomyopathy，heart failure，and COPD），prevalence of having a history of smoking，ischemic stroke or hemorrhage，and average eGFR，CHA2DS2-VASc score，and HAS-BLED score，and hemorrhage（mild，moderate，severe）showed no significant differences among participants used warfarin，rivaroxaban，dabigatran and those used no anticoagulant therapy（P>0.05），but ischemic stroke prevalence and all-cause mortality were significantly different（P<0.05）.There was no significant difference in the duration of anticoagulation treatment between three anticoagulation treatment groups（P>0.05）.Binary Logistic regression analysis showed that CHA2DS2-VASc score and anticoagulant regimen were associated with ischemic stroke（P<0.05）.Anticoagulant regimen was associated with death（P<0.05）.HAS-BLED score was associated with bleeding events（P<0.05）.Conclusion　 The prevalence of anticoagulant therapy was relatively low in this group of elderly patients with nonvalvular atrial fibrillation.Non-anticoagulant therapy（including oral antiplatelet agents）increased the risk of death and ischemic stroke，while warfarin showed similar safety and effectiveness to new oral anticoagulants without increasing the risk of bleeding and death.


Influence of Perceived Family Support and Type D Personality on Depression Prevalence in College Freshmen　

WANG Yanhong，LI Fugui，YE Liyuan，ZHOU Mingjie

2020, 23(35):  4482-4489.  DOI: 10.12114/j.issn.1007-9572.2020.00.227

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Background　Attention needs to be paid to the mental health among college freshmen，a group of people who are prone to anxiety，depression and other mental health problems due to adaptation to the environment of the new campus.Type D personality has been found to be a risk factor for depression in this group.However，most previous studies are cross-sectional，and according to which，it is difficult to determine whether personality negatively affects depression or vice versa.Moreover，the role of perceived family support has been ignored in freshmen's adaption to the new campus life.Objective　To investigate the role of perceived family support in the relationship between type D personality and depression in college freshmen.Methods　This study was carried out with a longitudinal design.By cluster sampling，1 428 freshmen admitted in 2017 were recruited from a college during October to December 2017.They received two questionnaire surveys，one was in October 2017，for investigating their demographic data，prevalence of depression assessed by the 9-item Patient Health Questionnaire （PHQ-9），prevalence of type D personality assessed by the 14-item Type D Scale（DS-14，consisting of negative affectivity and social inhibition domains），and the perceived family support assessed by the perceived family support domain in the Perceived Social Support Scale（PSSS），and another one was in December 2017，for investigating the prevalence of depression using the PHQ-9 again.The first one achieved a response rate of 94.54%（1 403 of the 1 428 cases returned questionnaires and 1 350 gave effective response），and the second one achieved a response rate of 89.12%（1 398 of 1 425 returned questionnaires and 1 270 gave effective response）.1 224 cases who effectively responded to both surveys were included for final analysis.Results　The prevalence of type D personality，and depression was 16.01%（196/1 224），and 11.68%（143/1 224），respectively.In correlation analysis，the score of negative affectivity or the score of social inhibition was positively associated with the PHQ-9 score（P<0.01）.The score of perceived family support was negatively correlated with that of negative affectivity，social inhibition and the PHQ-9 （P<0.01）.Logistic regression analysis revealed that both negative affectivity score（β=0.225，P<0.001） and social inhibition score（β=0.077，P<0.001） were positively associated with the PHQ-9 score.Perceived family support played a moderator role in the relationship between the negative affectivity score and PHQ-9 score （β=-0.052，P<0.05），and between the social inhibition score and PHQ-9 score（β=-0.328，P<0.05） .Conclusion　Type D personality may be associated with increased risk of depression in college freshmen，but its negative impact may be buffered by perceived family support.

Relationship Between Vitamin D Level and Attention Deficit Hyperactivity Disorder：a Meta-analysis　

CHEN Xianrui，HUANG Jianqi，CHEN Ling，WU Jinzhun，XU Jinping

2020, 23(35):  4490-4497.  DOI: 10.12114/j.issn.1007-9572.2020.00.554

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Background　In recent years，vitamin D has been reported to be possibly related to the onset of attention deficit hyperactivity disorder（ADHD）in studies.However，the results of different studies are not consistent，and there are few related systematic analyses.Objective　To analyze the relationship between ADHD and vitamin D level in children and teenagers.Methods　The databases of PubMed，EMBase，The Cochrane Library，CNKI，CBM，VIP and Wanfang Data Knowledge Service Platform were searched from inception to February 26，2019 to identify articles about the relationship of ADHD with vitamin D level in children and teenagers.The data，such as gender，age，serum 25-hydroxyitamin D（25（OH）D）levels，prevalence rates of insufficient or deficient serum 25（OH）D（defined as less than 30 μg/L），different serum 25（OH）D levels（< 10 μg/L，< 20 μg/L，10-30 μg/L，> 20 μg/L，>30 μg/L）were extracted from the included articles and the risk of bias was evaluated by two researchers，independently.Meta analysis was performed using RevMan 5.3 and Stata 12.0.Results　Finally，11 articles with 13 960 cases（2 305 cases of ADHD，and 11 655 healthy controls）were included.The results of meta-analysis showed that the mean serum 25（OH）D level in ADHD group was lower than that of healthy control group〔MD=-6.81，95%CI（-8.93，-4.69），P<0.000 01〕.The results of stratified analysis showed that the level of serum 25 （OH） D in ADHD group was lower than that in healthy control group （P< 0.000 01）.ADHD group showed higher prevalence rate of serum 25（OH）D <10 μg/L〔OR=-1.86，95%CI（1.53，2.26），P<0.000 01〕，lower prevalence rate of serum 25（OH）D>30 μg/L 〔OR=-0.20，95%CI（-0.31，-0.08），P=0.000 6〕，and higher prevalence rate of insufficient or deficient serum 25（OH）D level 〔OR=3.16，95%CI（1.75，5.73），P=0.000 1〕compared with the healthy control group.There were no statistically significant differences between the two groups in the prevalence rates of serum 25（OH）D ranged from 10 to 30 μg/L 〔OR=1.04，95%CI（0.90，1.22），P=0.58〕，serum 25（OH）D <20 μg/L〔OR=1.04，95%CI（0.50，2.18），P=0.92〕and serum 25（OH）D >20 μg/L〔OR=1.02，95%CI（0.44，2.37），P=0.97〕.ADHD group showed younger mean age〔OR=-0.37，95%CI（-0.71，-0.04），P=0.03〕，and higher male ratio compared with the healthy control group〔OR=2.24，95%CI（1.39，3.62），P=0.000 9〕.Conclusion　Children with ADHD had lower serum level of 25（OH）D than healthy children generally.ADHD group had higher prevalence rate of serum 25（OH）D level of 10 μg/L or 30 μg/L，but similar prevalence rate of serum 25（OH）D level of 20 μg/L compared with the control group.


Influencing Factors of Depression in Chinese College Students：a Meta-analysis　

ZHANG Rui，YANG Chenyun，ZHANG Yaodong

2020, 23(35):  4497-4502.  DOI: 10.12114/j.issn.1007-9572.2020.00.135

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Background　Epidemiological studies have shown that the incidence of depression in college students is higher than that in the general population.The incidence of depression in Chinese college students is 13.25%-79.90%，while that of Chinese general population is only 5%-6%.Severe depression not only affects the learning efficiency and interpersonal communication of college students，but even suicidal thoughts or behaviors may occur in serious cases.Objective　To explore the influencing factors of depression among Chinese college students，providing theoretical support and guidance for the prevention and control of depression in this group.Methods　We searched the databases of PubMed，The Cochrane Library，CNKI，CBM，WanFang Data and VIP for articles about the influencing factors of depression among Chinese college students published from 1998 to 2018 using related subject words with keywords.RevMan 5.3 over R was used to perform the meta-analysis.Both fixed effects model and random effects model were used for sensitivity analysis of the calculated results.Results　19 studies with 7 related factors were included.Analysis found that living arrangement 〔OR=0.58，95%CI（0.43，0.78）〕and family economic status〔OR=0.42，95%CI（0.24，0.73）〕were influencing factors of depression in Chinese college students（P<0.05），but gender 〔OR=1.07，95%CI（0.91，1.25）〕，household registration type 〔OR=1.06，95%CI（0.93，1.21）〕，only child or not 〔OR=1.00，95%CI（0.83，1.21）〕，love status 〔OR=0.99，95%CI（0.73，1.34）〕，grade〔OR=0.94，95%CI（0.82，1.07）〕 were not （P>0.05）.Conclusion　In Chinese college students，living with parents，and good family economic status are associated with decreased risk of depression，while gender，rural household，only child，and love status have not been found to be associated with depression.


Perceived Social Support in Stroke Survivors and Their Caregivers during Rehabilitation in the Community:a Qualitative Study　

CHEN Suyan，MEI Yongxia，ZHANG Zhenxiang

2020, 23(35):  4503-4507.  DOI: 10.12114/j.issn.1007-9572.2020.00.106

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Background　As the second leading cause of death in the world，stroke kills 5.5 million people in 2016.It causes heavy burdens to patients，their families and the society.Social support can reduce the anxiety，depression and other psychological pain of patients and their caregivers during rehabilitation，but the level of social support obtained by them is low.At present，there are so many quantitative studies about the social support.However，it is difficult to thoroughly know the experience of patients and caregivers.Objective　To investigate the perceived social support in stroke survivors and their caregivers during the rehabilitation in the community.Methods　 From September to December 2018，by using both purposive and snowball sampling，9 stroke survivor-caregiver dyads were selected from Linshanzhai Community，Zhengzhou City.Semi- structured face-to-face interviews were conducted with them and the results were analyzed with Colaizzi's phenomenological method.Results　 The interview results were classified into three themes:（1） Sources of perceived social support.From the perspective of stoke survivors，their social support came from the major family caregiver and other family members，friends and community healthcare workers.From the perspective of caregivers，their social support came from other family members，friends and neighbors.（2） Types of perceived social support.The types of social support obtained by stoke survivors included information，emotional and tool supports.The caregivers obtained emotional and information supports，and provided emotional and tool supports for stoke survivors.（3） Barriers to obtaining social support.From the perspective of stoke survivors，the barriers consisted of three internal factors（cognitive bias in seeking support，uncomprehended needs and depression），and two external factors（insufficient sources for support and lack of ways to access to support）.From the perspective of caregivers，the barriers consisted of three internal factors（weak awareness of seeking help，insufficient time and strong character），and two external factors（insufficient sources for support and lack of ways to access to support）.Conclusion　 To better promote the rehabilitation of the stroke survivors，healthcare providers in the community should provide continuous，effective and dynamic family-focused social support for stroke survivors and their family caregivers during the rehabilitation based on the evaluation results of their education level，clear needs and perceptions.


Implementation Effect of a Rehabilitation Nursing Scheme Developed Based on Transitional Care Model in Lung Cancer Patients　

DAI An，DU Jingjing，LIU Siyu，XIU Yanli，WANG Jingru，WANG Lu，LIAO Lei，WANG Qing，LIN Ying

2020, 23(35):  4508-4513.  DOI: 10.12114/j.issn.1007-9572.2020.00.322

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Background　The incidence of lung cancer remains high in China.With the improvement of surgical level and techniques，postoperative survival of lung cancer patients shows an increasing trend，but their postoperative quality of life and continuous rehabilitation care often fail to attract enough attention from medical workers and the patient's family members.Objective　To explore the effect of rehabilitation nursing based on the Transitional Care Model（TCM） in lung cancer patients.Methods　From September 2017 to June 2019，62 patients diagnosed with non-small cell lung cancer（NSCLC） who underwent video-assisted thoracoscopic surgery（VATS） in Department of Thoracic Surgery，Hongqi Hospital Affiliated to Mudanjiang Medical University were selected and were equally divided into the control group（n=31） and experimental group（n=31） by a random number table，receiving routine nursing，and rehabilitation nursing based on the TCM，respectively.The general information was recorded.The Chinese version of the EORTC QLQ-C30 was used to investigate the quality of life before surgery and 30 days after surgery.Hand-held spirometer was used to measure pulmonary parameters such as the forced expiratory volume in one second（FEV1），peak expiratory flow（PEF） and maximum voluntary ventilation（MVV）.A simulation ruler was used to measure patient nursing satisfaction level at 30 days after the operation.Results　At 30 days after the operation，the scores of physical function，role function，emotional function，cognitive function，social function，global health status，fatigue，nausea and vomiting，pain，dyspnoea，insomnia，loss of appetite，constipation and perceived financial impact of the disease in the two groups were still significantly different （P<0.05）.At 30 days after surgery，mean FEV1，PEF，and MVV were similar in both groups （P>0.05）.The mean satisfaction score of the experimental group was higher than that of the control group （P<0.05）.Conclusion　The rehabilitation nursing program developed based on the TCM may significantly improve the quality of life and patient satisfaction with nursing during hospitalization in lung cancer patients.


Evidence-based Nursing Care with Pestle Needle Therapy for Non-small Cell Lung Cancer with Cancer-related Fatigue：Report of One Case　

HU Yue，JIANG Yunlan，CHU Xin，YANG Shuyan，SHEN Yinli，TANG Xin

2020, 23(35):  4514-4518.  DOI: 10.12114/j.issn.1007-9572.2020.00.146

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Background　Cancer-related fatigue（CRF）is an important factor that affects the quality of life of cancer patients.Pestle needle therapy has the synthetic efficacy of acupuncture and massage，which is in line with the traditional Chinese medicine theory and idea of CRF intervention，but there is lack of first-hand clinical evidence of this therapy in CRF patients with first-line treatment.Objective　To evaluate the clinical effectiveness and safety of pestle needle therapy as a new type of intervention for CRF in a patient with non-small cell lung cancer.Methods　A patient with non-small cell cancer admitted to the Affiliated Hospital of Chengdu University of TCM on February 25，2019 was selected as the research object.Based on the idea of evidence-based nursing，clinical experience of pestle needle therapy and this CRF patient's subjective intention of treatment，the problems that may be encountered in pestle needle therapy for CRF were put forward，and were analyzed and addressed by referring to important articles that were retrieved.Then pestle needle therapy for CRF was implemented and the effect was evaluated.Results　A total of 7 important articles were included，all provided theoretical support for pestle needle therapy for CRF，but without first-hand studies.The program of pestle needle therapy was completed according to the patient's conditions，and the CRF status of the patient was evaluated.The results showed that，after receiving the pestle needle therapy，the CRF level and quality of life of the patient were effectively improved.However，when the therapy was stopped，the satisfactory effectiveness could not last for long.Conclusion　 In the treatment of CRF in this patient with non-small cell lung cancer，pestle needle therapy is safe and effective and feasible，and its persistent treatment may achieve long-term remission of CRF，which is expected to become a new TCM nursing intervention for CRF.


Research Progress of Body Composition Assessment in Nutritional Assessment of Tumor Patients　

HUA Hongxia，XU Qin，XU Xinyi，LU Jinling，ZHU Hanfei

2020, 23(35):  4519-4523.  DOI: 10.12114/j.issn.1007-9572.2019.00.807

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The incidence of nutritional risk and malnutrition in tumor patients in china is as high as 40%-80%，and there is no gold standard for nutritional assessment of tumor patients.At present，more and more attention has been paid to the assessment of body composition，and it also plays a certain role in the nutritional assessment，but there are many indicators，expression terms and measurement tools，which is easy to be confused.Therefore，based on the five-level model proposed by Wang in 1992，this paper reviews the application of commonly used indicators of body composition assessment in nutritional assessment of tumor patients，mainly including nutritional status assessment，nutritional intervention effect evaluation and the consistency of nutrition assessment tools in the diagnosis of malnutrition，in order to support the clinical application of body composition assessment in the nutritional assessment of tumor patients.Moreover，this paper also points out that in the future，researchers should explore more accurate indicators of body composition and the cut-off value for malnutrition diagnosis.In order to meet clinical needs，it is also necessary to clarify how body composition assessment should specifically guide the formulation of nutrition intervention programs.


Advances in Anthropometric Prediction of Cardiovascular Risk Factors　

LI Junqing，LEI Mengyuan，YANG Yanyan，LI Bo

2020, 23(35):  4524-4529.  DOI: 10.12114/j.issn.1007-9572.2019.00.747

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Risk factors of cardiovascular disease（CVD） include hypertension，smoking，dyslipidemia，diabetes，overweight/obesity，physical inactivity and unreasonable diet.In clinical practice，anthropometric indicators can be used to predict the risk factors of CVD and evaluate the therapeutic effect.These indicators include body mass index（BMI），waist circumference（WC），waist-to-hip ratio（WHR） and waist-to-height ratio（WHtR）.The focus of each measurement indicator is different.BMI is mostly used to evaluate systemic obesity，while WC focuses on abdominal obesity.WHR has a weak ability to predict CVD risk factors，and WHtR corrects height factors and the small differences between populations.So anthropometry is more advantageous to predict CVD risk factors.


Reliability and Validity of General Health Questionnaire-12 in Health Care Workers　

ZHONG Xiaogang，LIU Yiyun，PU Juncai，GUI Siwen，TIAN Lu，ZHOU Wei，WANG Haiyang，LI Pengfei，XIE Peng

2020, 23(35):  4530-4534.  DOI: 10.12114/j.issn.1007-9572.2019.00.776

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Background　Mental health problems are common in the health care workers.The General Health Questionnaire（GHQ-12） has been applied to the assessment of mental health status of multiple groups，while there is no relevant study has explored the reliability and validity of this scale among health care workers.Objective　To evaluate the reliability and validity of the GHQ-12 in health care workers.Methods　The neurology physician participated in the First National Neurologist Practice Survey conducted by the China Neurologist Association of Chinese Medical Doctor Association from September 2014 to March 2015 was regarded as research object，and the GHQ-12 was filled out.Total scores ≥ 4 were considered to be positive for mental health status，and the reliability and validity of GHQ-12 was tested.Results　A total of 10 065 questionnaires were distributed，and 6 111 questionnaires were recovery，of which，5 414 questionnaires are valid.The positive detection rate of mental health status of 5 414 subjects was 37.8%（2 048/5 414）.The Cronbach's α coefficient of the GHQ-12 scale was 0.887，and the Cronbach's α coefficient was 0.873-0.882 after deletion of the corresponding item，and the split-half reliability was 0.845.The correlation coefficient between the item score and the total score ranging from 0.499 to 0.727（P<0.05）.The exploratory factor analysis（EFA） contained 12 items with 2 factors and the factor load was 0.602-0.787.The cumulative variance interpretation rate was 54.961%.The confirmatory factor analysis（CFA） showed that the χ2/df value was 11.410.The NFI，CFI，IFI，GFI，TLI value were 0.927，0.933，0.933，0.944，0.917 respectively，and RMSEA was 0.076.Conclusion　GHQ-12 has a good reliability and validity for the measurement of mental health status of health care workers，which can reflect the mental health status of health care workers correctly.