1.Risk factors for bronchopulmonary dysplasia in twin preterm infants:a multicenter study
Yu-Wei FAN ; Yi-Jia ZHANG ; He-Mei WEN ; Hong YAN ; Wei SHEN ; Yue-Qin DING ; Yun-Feng LONG ; Zhi-Gang ZHANG ; Gui-Fang LI ; Hong JIANG ; Hong-Ping RAO ; Jian-Wu QIU ; Xian WEI ; Ya-Yu ZHANG ; Ji-Bin ZENG ; Chang-Liang ZHAO ; Wei-Peng XU ; Fan WANG ; Li YUAN ; Xiu-Fang YANG ; Wei LI ; Ni-Yang LIN ; Qian CHEN ; Chang-Shun XIA ; Xin-Qi ZHONG ; Qi-Liang CUI
Chinese Journal of Contemporary Pediatrics 2024;26(6):611-618
		                        		
		                        			
		                        			Objective To investigate the risk factors for bronchopulmonary dysplasia(BPD)in twin preterm infants with a gestational age of<34 weeks,and to provide a basis for early identification of BPD in twin preterm infants in clinical practice.Methods A retrospective analysis was performed for the twin preterm infants with a gestational age of<34 weeks who were admitted to 22 hospitals nationwide from January 2018 to December 2020.According to their conditions,they were divided into group A(both twins had BPD),group B(only one twin had BPD),and group C(neither twin had BPD).The risk factors for BPD in twin preterm infants were analyzed.Further analysis was conducted on group B to investigate the postnatal risk factors for BPD within twins.Results A total of 904 pairs of twins with a gestational age of<34 weeks were included in this study.The multivariate logistic regression analysis showed that compared with group C,birth weight discordance of>25%between the twins was an independent risk factor for BPD in one of the twins(OR=3.370,95%CI:1.500-7.568,P<0.05),and high gestational age at birth was a protective factor against BPD(P<0.05).The conditional logistic regression analysis of group B showed that small-for-gestational-age(SGA)birth was an independent risk factor for BPD in individual twins(OR=5.017,95%CI:1.040-24.190,P<0.05).Conclusions The development of BPD in twin preterm infants is associated with gestational age,birth weight discordance between the twins,and SGA birth.
		                        		
		                        		
		                        		
		                        	
2.Tocilizumab therapy for immune checkpoint inhibitor associated myocarditis: a case report.
Si Jin WU ; Xiao Hang LIU ; Wei WU ; Min QIAN ; Ling LI ; Li ZHANG ; Hua Xia YANG ; Mei GUAN ; Jian CAO ; Yi Ning WANG ; Gui Ren RUAN ; Na NIU ; Ying Xian LIU
Chinese Journal of Cardiology 2022;50(4):397-400
3.Xuebijing Injection Regulates Mitochondrial N-formyl Peptides/NLRP3 Inflammatory Pathway to Treat Severe Acute Pancreatitis in Rats
Yi XIAO ; Zhi-qiao FENG ; Gui-xian ZHANG ; Hong-sheng SHEN ; Wen-chang LI ; Xia LI ; Rui-fang GAO ; Hong-bin LIU
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(7):88-94
		                        		
		                        			
		                        			ObjectiveTo investigate the therapeutic effect of Xuebijing injection (XBJ) on sodium taurocholate (Na-Tc)-induced severe acute pancreatitis (SAP) in rats. MethodForty rats were randomly assigned into 5 groups: sham operation group, SAP model group, and low-, medium-, and high-dose (4, 8, 12 mL·kg·d-1, respectively) XBJ groups. SAP model was established by retrograde injection of Na-Tc (1 mL·kg-1) into the biliary and pancreatic ducts. XBJ was injected intraperitoneally 3 days before and 0.5 h after modeling. The ascitic fluid volume and the pancreas weight-to-body weight ratio were measured. The pathological changes of pancreatic tissue were observed via hematoxylin-eosin (HE) staining. The protein levels of formyl peptide receptor 1 (FPR1) and nucleotide-binding oligomerization domain-like receptor 3 (NLRP3) in pancreatic tissue were detected by immunohistochemistry. Western blot was employed to determine the expression levels of NADH-ubiquinone oxidoreductase chains 1-6 (MT-ND1, MT-ND2, MT-ND3, MT-ND4, MT-ND5, and MT-ND6) in rat plasma. ResultCompared with sham operation group, the SAP model group showcased increased ascitic fluid volume and pancreas weight-to-body weight ratio (P<0.05), serious lesions in pancreatic tissue, increased total pathological score (P<0.05), and up-regulated protein levels of FPR1 and NLRP3 in pancreatic tissue (P<0.05). The model group had lower MT-ND2 level (P<0.05) and higher MT-ND1, MT-ND3, and MT-ND6 levels in plasma (P<0.05) than the sham operation group, while MT-ND4 and MT-ND5 had no significant differences between the two groups. Compared with SAP model group, the XBJ treatment decreased ascitic fluid volume and pancreas weight-to-body weight ratio (P<0.01), ameliorated pancreatic lesions, and down-regulated the protein levels of FPR1 and NLRP3 in pancreatic tissue (P<0.01). The treatments, especially high-dose XBJ (P<0.01), down-regulated the expression of MT-ND1 (P<0.01), MT-ND3 (P<0.01), MT-ND6 (P<0.01), and MT-ND4 and did not change that of MT-ND5. ConclusionXBJ may antagonize partial mitochondrial N-formyl peptides and excessive inflammatory response mediated by FPR1/NLRP3 to treat SAP in rats. 
		                        		
		                        		
		                        		
		                        	
4.Effect of Mmu-circRNA_016901 on the Radiosensitivity of Bone Marrow Mesenchymal Stem Cells.
Jun-Hua ZHANG ; Xian-Hui WEN ; Rong HUANG ; Sai CHEN ; Feng-Xia LIU ; Rong GUI
Journal of Experimental Hematology 2020;28(3):1032-1037
		                        		
		                        			OBJECTIVE:
		                        			To explore the effect of mmu-circRNA_016901 on the regulation of radiation injury of bone marrow stem cells and its mechanism.
		                        		
		                        			METHODS:
		                        			Bone marrow stem cells were exposed to different dose of X-ray, then the expression level of mmu-circRNA_016901 in bone marrow cells treated with different doses of X-ray was detected. The luciferase reporter gene assay was used to confirm that miRNA1249-5p is the target of mmu-circRNA_016901, and RNA Binding Protein Immunoprecipitation was used to confirm that TGF-β3 is the targeted on miRNA1249-5p,the expression of TGF-β3 and cell proliferation were detected after the expression of mmu-circRNA_01690 was regulated.
		                        		
		                        			RESULTS:
		                        			When the irradiation dose<6 Gy, there were significant difference in the expression of mmn-circRNA-016901 after the bone marrow mesenchymal stem cells were treated by different doses of irradiation, which showed a statistically significant (P<0.05). The luciferase reporter gene detection and co-immunoprecipitation experiments confirmed that Mmu-circRNA_016901 could binds to miRNA1249-5p specifically, and overexpression of mmu-circRNA_016901 could regulate miRNA1249-5p negatively, which resulted in a significant increase in TGF-β3 expression and promoting of cell proliferation.
		                        		
		                        			CONCLUSION
		                        			mmu-circRNA_016901 affects the expression of TGF-β3 through miRNA1249-5p, and thus participates in the regulation of the radiation damage mechanism of bone marrow mesenchymal stem cells.
		                        		
		                        		
		                        		
		                        			Bone Marrow Cells
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		                        			Mesenchymal Stem Cells
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		                        			RNA, Circular
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		                        			genetics
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		                        			Radiation Tolerance
		                        			
		                        		
		                        	
5.Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China.
Yan MA ; Dong Shan ZHU ; Ren Bo CHEN ; Nan Nan SHI ; Si Hong LIU ; Yi Pin FAN ; Gui Hui WU ; Pu Ye YANG ; Jiang Feng BAI ; Hong CHEN ; Li Ying CHEN ; Qiao FENG ; Tuan Mao GUO ; Yong HOU ; Gui Fen HU ; Xiao Mei HU ; Yun Hong HU ; Jin HUANG ; Qiu Hua HUANG ; Shao Zhen HUANG ; Liang JI ; Hai Hao JIN ; Xiao LEI ; Chun Yan LI ; Min Qing LI ; Qun Tang LI ; Xian Yong LI ; Hong De LIU ; Jin Ping LIU ; Zhang LIU ; Yu Ting MA ; Ya MAO ; Liu Fen MO ; Hui NA ; Jing Wei WANG ; Fang Li SONG ; Sheng SUN ; Dong Ting WANG ; Ming Xuan WANG ; Xiao Yan WANG ; Yin Zhen WANG ; Yu Dong WANG ; Wei WU ; Lan Ping WU ; Yan Hua XIAO ; Hai Jun XIE ; Hong Ming XU ; Shou Fang XU ; Rui Xia XUE ; Chun YANG ; Kai Jun YANG ; Sheng Li YUAN ; Gong Qi ZHANG ; Jin Bo ZHANG ; Lin Song ZHANG ; Shu Sen ZHAO ; Wan Ying ZHAO ; Kai ZHENG ; Ying Chun ZHOU ; Jun Teng ZHU ; Tian Qing ZHU ; Hua Min ZHANG ; Yan Ping WANG ; Yong Yan WANG
Biomedical and Environmental Sciences 2020;33(12):893-905
		                        		
		                        			Objective:
		                        			Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.
		                        		
		                        			Methods:
		                        			A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( 
		                        		
		                        			Results:
		                        			Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks.
		                        		
		                        			Conclusion
		                        			Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
		                        		
		                        		
		                        		
		                        			Adult
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		                        			Aged
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		                        			COVID-19/virology*
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		                        			China/epidemiology*
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		                        			Comorbidity
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		                        			Female
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		                        			Humans
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		                        			Male
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		                        			Middle Aged
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		                        			Retrospective Studies
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		                        			Severity of Illness Index
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		                        			Treatment Outcome
		                        			
		                        		
		                        	
6. Effect of Modified Chaihu Shugantang Regulat miRNA-204 on Hippocampus Autophagy in Epileptic Mice
Shun-gui WANG ; Qian YU ; Hua-xia LI ; Huan LI ; Ling LU ; Xian-qiu LIAO ; Qiong WU ; Hua-qiong LI ; Ai-ling CHEN ; Li-mei DIAO ; Qian-chao HE ; Lun CAI ; Shuang LIANG
Chinese Journal of Experimental Traditional Medical Formulae 2019;25(22):1-7
		                        		
		                        			
		                        			 Objective: To observe the effect of modified Chaihu Shugantang on the expression of miRNA-204 in hippocampus of epileptic mice, and to explore its mechanism of neuroprotection. Method: The sixty mice were randomly divided into 6 groups:normal group, model group (pilocarpine 180 mg·kg-1), and modified Chaihu Shugantang group (7 g·kg-1·d-1), modified Chaihu Shugantang+miRNA-204 mimic group (7 g·kg-1·d-1+ 2 μL), modified Chaihu Shugantang+miRNA-204 inhibitor group (7 g·kg-1·d-1+2 μL), carbamazepine group (30 mg·kg-1·d-1),each was given intragastric administration for 2 weeks,using pilocarpine to cause epilepsy in mice, respectively, add flavor to Bupleurum after intragastric administration, inhibition and overexpression of miRNA-204, the mice were sacrificed and their hippocampus tissues were harvested.The indicators of each group were observed, Real-time quantitative PCR detecting system (Real-time PCR) was used to detect mouse hippocampal miRNA-204 expression, Western blot analysis of autophagy-related protein microtubule-associated protein light chain 3 (LC3), autophagy-associated marker protein 7 (ATG7) expression, hematoxylin pathological condition of hippocampus in each group was observed by hematoxylin-eosin(HE)staining.The autophagy of hippocampus in each group was observed by transmission electron microscopy. Result: Compared with normal group, the expression of miRNA-204 was significantly decreased in model group (P<0.01), the pathological changes in the hippocampal C1 area were the most obvious, the expression of ATG7, LC3Ⅱ/LC3Ⅰ was increased (P<0.01), and the autophagy was small. Compared with model group, the expression of miRNA-204 in the hippocampus of the modified Chaihu Shugantang group was increased (P<0.05), the pathological changes in the hippocampal C1 area were alleviated, the expression of ATG7, LC3Ⅱ/LC3Ⅰ was decreased (P<0.05), and the autophagy was small. The number of body decreased,the expression of miRNA-204 in hippocampus of modified Chaihu Shugantang+miRNA-204 mimic group was significantly increased (P<0.01), the pathological changes in hippocampal C1 area were the lightest, and the expression of ATG7, LC3Ⅱ/LC3I was decreased (P<0.01), the number of autophagosomes was the least.Compared with modified Chaihu Shugantang group, the above-mentioned indicators of modified Chaihu Shugantang+miRNA-204 inhibitor group had the same change trend and the change range decreased (P<0.05). Conclusion: Modified Chaihu Shugantang can improve the pathological changes of hippocampus in mice with epilepsy and play a neuroprotective role. The mechanism may be to increase the expression of miRNA-204 in hippocampus of mice with epilepsy, inhibit excessive autophagy of neurons and reduce apoptosis. 
		                        		
		                        		
		                        		
		                        	
7.Ratio of erythrocyte and plasma in massive blood transfusion.
Xian-Hui WEN ; Feng-Xia LIU ; Jun-Hua ZHANG ; Rong GUI
Journal of Experimental Hematology 2014;22(3):825-828
		                        		
		                        			
		                        			This study was purposed to explore the suitable ratio between fresh frozen plasma and erythrocyte by retrospective analysis of coagulation in patients with massive blood transfusion. The clinical data of 151 cases with massive blood transfusion from January 2011 to January 2013 were analyzed retrospectively. According to coagulation, patients were divided into coagulation normal group (138 cases) and coagulation dysfunction group (13 cases). Based on the ratio of 1:1 of fresh frozen plasma and erythrocyte, the patients were divided into high plasma group(2:1), medium plasma group (1:1) and low plasma (<1:1) subgroups. Coagulation was detected before and after 24 h of massive blood transfusion. The results showed that prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) were prolonged, fibrinogen (FIB) level decreased significantly (all P < 0.05) in the low plasma subgroup of coagulation normal group after massive blood transfusion 24 h; the high plasma and the medium plasma group of coagulation normal group had no significant changes in coagulation (P > 0.05); prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen level in the medium plasma and low plasma subgroup of coagulation dysfunction group after massive transfusion was still in abnormal levels (P > 0.05), coagulation function in high plasma subgroup was improved significantly (P < 0.05). It is concluded that the ratio of plasma to erythrocyte should be adjusted according to the patient's coagulation function during massive blood transfusion, the ratio between fresh frozen plasma and erythrocyte is recommended to be 2:1 in patients of coagulation dysfunction in order to improve the patient's coagulation function and to reduce the incidence of adverse event, the ratio of fresh frozen plasma to erythrocyte is recommended to be 1:1 in patients with normal coagulation so as to reduce the dilutional coagulopathy and hypervolemia of blood.
		                        		
		                        		
		                        		
		                        			Adult
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		                        			Aged
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		                        			Blood Coagulation
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		                        			Blood Coagulation Disorders
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		                        			prevention & control
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		                        			Blood Transfusion
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		                        			methods
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		                        			Erythrocytes
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		                        			Female
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		                        			Humans
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		                        			Male
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		                        			Middle Aged
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		                        			Plasma
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		                        			Retrospective Studies
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		                        			Transfusion Reaction
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		                        			Young Adult
		                        			
		                        		
		                        	
8.Efficacy and safety of integrative medical program based on blood cooling and detoxification recipe in treating patients with hepatitis B virus related acute-on-chronic liver failure: a randomized controlled clinical study.
Hui-Min LIU ; Xian-Bo WANG ; Yi-Xxin HOU ; Fang-Yuan GAO ; Feng-Xia SUN ; Yu-Yong JIANG ; Zhi-Yun YANG ; Hong-Bo DU ; Xiao-Jing WANG ; Gui-Qin ZHOU ; Yu-Ying YANG ; Rong-Bing WANG
Chinese Journal of Integrated Traditional and Western Medicine 2014;34(4):412-417
OBJECTIVETo evaluate the clinical efficacy and safety of integrative medical program based on blood cooling and detoxification recipe (BCDR) in treating patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) of heat-toxicity accumulation syndrome (HTAS).
METHODSAdopting randomized controlled clinical design, a total of 105 HBV-ACLF patients of HTAS were randomly assigned to the trial group (64 cases) and the control group (41 cases). Patients in the control group were treated with comprehensive Western therapy, while those in the trial group were treated with comprehensive Western therapy plus BCDR. All were treated for 8 weeks and followed up for 40 weeks. Effect and safety of the treatment were assessed, including fatality, liver functions [total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), and aspartate transaminase (AST)], and prothrombin activity (PTA) after treatment and at week 48 of follow-ups.
RESULTSAfter 8-week treatment, there was statistical difference in the overall fatality rate (15.63% vs 34.15%), the fatality rate in the mid-term (25.0% vs 64.7%), TBIL at week 8 (64.54 +/- 79.75), AST [at week 2: (178.97 +/- 44.24) U/L vs (288.48 +/- 58.49) U/L; at week 4: (61.65 +/- 27.36) U/L vs (171.12 +/- 89.11) U/L] and PTA [at week 4: (58.30 +/- 15.29) vs (42.56 +/- 15.27); at week 6: (60.77 +/- 20.40) vs (43.08 +/- 12.79)] (all P < 0.05). At week 48 of the followup, the fatality rate of the trial group (21.88%) decreased by 17. 14% when compared with that of the control group (39.02%; P < 0.05). No obvious adverse event occurred in the two groups during the 8-week treatment period.
CONCLUSIONBCDR could significantly reduce the mortality of HBV-ACLF patients.
Acute-On-Chronic Liver Failure ; drug therapy ; virology ; Adult ; Drugs, Chinese Herbal ; therapeutic use ; End Stage Liver Disease ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; drug therapy ; Humans ; Male ; Middle Aged ; Phytotherapy ; Young Adult
9.Effect of comprehensive control and prevention for chronic disease in demonstration plot of Chongqing.
Li QI ; Xian-bin DING ; De-qiang MAO ; Lian-gui FENG ; Yu-lin WANG ; Yan JIAO ; Chun-hua ZHANG ; Xiao-yan LÜ ; Hong LI ; Yi-yin XIA
Chinese Journal of Preventive Medicine 2013;47(3):260-264
OBJECTIVETo evaluate the effect of comprehensive control and prevention for chronic diseases in demonstration plot of Chongqing.
METHODSResidents were enrolled through multi-stage stratified random sampling method from 17 districts or counties which had successfully established demonstration plots and 21 districts or counties which had not established demonstration plots (non-demonstration plot for short) yet on May, 2012. Questionnaire was designed to survey awareness of health knowledge, health behaviors and utilization of health supportive tools. The results were analyzed by SPSS 15.0 software.
RESULTSWe investigated 15 108 residents, 6156 of which were in demonstration plot and others (8951) were not. The findings revealed the percentage of the people who were aware the national action of health lifestyle in demonstration plot and in non-demonstration plot were 44.4% (2734/6157) and 40.2% (3598/8951), respectively, and the awareness of the hypertension risk of too much sodium were 72.4% (4458/6156) and 67.5% (6042/8951), respectively, and the awareness of the cardinal vascular disease (CVD) risk of obesity and overweight were 77.2% (4753/6157) and 69.6% (6230/8951), respectively. About the residents' health behaviors in demonstration plot and in non-demonstration plot, the utilization rates of salt restriction scoop or pot were 23.5% (1447/6157) and 17.9% (1602/8951), and the utilization rates of oil restriction pot were 16.7% (1028/6157) and 11.8% (1064/8951), respectively. Totally, 33 of the 37 indexes were shown higher in demonstration plot than that in non-demonstration plot (P < 0.05).
CONCLUSIONThe chronic diseases comprehensive control and prevention in demonstration plot was more effective, and the remarkable improvement of health knowledge and behaviors level had been achieved in demonstration plot.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Chronic Disease ; prevention & control ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Surveys and Questionnaires ; Universal Precautions ; Young Adult
10.Development of national neglect norm for urban primary school students of China.
Jian-ping PAN ; Fei WANG ; Min LI ; Jing-qi CHEN ; Hui-ying ZHANG ; Gui-xiang WANG ; Gui-xiong GU ; Wei-wei GUO ; Yu-lin PENG ; Shu-hua SHI ; Guang-hu CHEN ; Hua-ni YI ; Ping FU ; Li XIA ; Hong YU ; Biao LU ; Zhi-xian DUAN ; Ying-xiong WANG ; Zhao-hui ZHONG ; Jian LI ; Lin WANG ; Chun-hong CAO ; Sha-sha LUO ; Song-jie ZHANG ; Hua ZHANG
Chinese Journal of Preventive Medicine 2013;47(2):129-134
OBJECTIVETo develop the national neglect norms for urban primary school students in China.
METHODSAccording to multi-stage stratified cluster sampling principle, 24 cities of 13 provinces (municipalities) in China were selected during December 1 to 31, 2008. A total of 1491 students in grade 1 - 3 and 2236 students in grade 4 - 6 were selected. Questionnaire was designed by authors and the final norms were determined through several statistical analysis methods, such as item analysis method, factor analysis method, reliability analysis method. The reliability analysis and validity analysis were used to test the stability and reliability of the norms. The evaluation criteria of the scale was determined by the percentile method, then the initial development of the norm was completed.
RESULTSThe two questionnaires of grade 1 - 3 and grade 4 - 6 students consisted of 55 and 57 items, respectively, whose item loadings were ranged from 0.301 to 0.687 and 0.321 to 0.730, which met the statistical requirements. For grade 1 - 3 students, the scale's total Cronbach α coefficients was 0.914, the total split-half reliability coefficients was 0.896, the Cronbach α coefficients of four level was above 0.737 except medical and social neglect, split-half reliability was ranged from 0.461 to 0.757; for grade 4-6 students, the scale's total Cronbach α coefficients was 0.916, split-half reliability was 0.883, except social neglect, the Cronbach α coefficients of other level was ranged 0.457 to 0.856, split-half reliability was ranged from 0.500 to 0.798. The total neglect cut-off score of the two scales grade 1-3 and 4-6 were 125 and 155, respectively.
CONCLUSIONThe structure of two norms was reasonable. The scales have good stability and reliability.
Child ; Child Abuse ; prevention & control ; statistics & numerical data ; China ; epidemiology ; Female ; Humans ; Male ; Reproducibility of Results ; Schools ; Students ; Surveys and Questionnaires
            
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