[Multicenter evaluation of the diagnostic efficacy of jaundice color card for neonatal hyperbilirubinemia].

Objective: To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice. Methods: Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate's parents used the JCard to measure jaundice at the neonate's cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson's correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis. Results: Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) µmol/L, with a range of 23.7-717.0 µmol/L. The JCard level was (221.4±77.0) µmol/L and the TcB level was (252.5±76.0) µmol/L. Both the JCard and TcB values showed good correlation (r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2 µmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0 µmol/L. The TcB value of 205.2 µmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 µmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 µmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 µmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 µmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 µmol/L (both P<0.05). Conclusions: JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 µmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 µmol/L).

[Comparison of Occupational Stress and Its Factors of Workers in An Oil Refinery].

Objective: To explore the differences of occupational stress and its factors between petroleum refining workers and support staffs, and to propose more targeted measures to promote the health of petroleum refining and petrochemical workers. Methods: A questionnaire survey was conducted among 353 petroleum refining workers and 189 employees in the logistics department using the occupational stress inventory revised edition (OSI-R) scale between June 13, 2017 and July 27, 2017. Results: Among the occupational factors, there were significant differences in the job requirements, work risk, job monotony, participation in the decision-making scores among the male workers between labor group and logistics group (P<0.01) . And for female workers in the chemical group and logistics group there were also differences in the value of work control, job requirements, work monotonous, work prospects, improvement of opportunity (P<0.05) . In the aspect of personality traits, the score of work psychological control in chemical group was higher than that of the logistics group, while the organization loyalty score was lower than that of the logistics group. Be-sides, there were significant differences between chemical group and logistics group in the score of A behavior, self-esteem and anxiety traits among female group (P<0.05) . In terms of mitigating factors, there was a significant difference in social support score between chemical group and logistics group among female workers (P<0.01) . Comparison of the two groups of psychological stress showed that the mental health and anxiety status of the chemical group and the logistics group showed a difference (P<0.05) , and female workers in the chemical group job satisfaction score lower than the logistics group, but the body Complaints score higher than the logistics group. Conclusion: The psychological stress response of petroleum refining workers is obviously more serious than the staff of logistics department, and there were significant differences between the two groups on occupational stress factors.

[Analysis on the relationship between Occupational Stress Factors and Psychological Stress Reaction among Petrochemical Workers].

Objective: To explore the relationship between occupational stress factors and psychological stress reaction among petrochemical workers, detecting the effects caused by the occupational stress and putting forward solutions to reduce the occupational stress degree. Methods: 392 petrochemical workers in Oil refining enterprise were included to conduct the evaluation of the occupational stress, correlation analysis and ridge regression were used to analyze the relationship between occupational stress and five aspects of psychological stress reaction and to detect the influencing factors. Results: Mission control, decision control, environmental control, resources control, promotion, and participation in decision making were positively correlated with job satisfaction (P<0.01) , technology utilization degree, work order tonality, job prospects were negatively correlated with job satisfaction (P<0.05) ; mission control, resource control, promotion, participation in decision-making were positively correlated with mental health (P<0.01) , work order tonality, job prospects were negatively correlated with mental health (P<0.05) ; load change risk, work, work order tonality, job prospects were positively correlated with depression (P<0.05) resource control, promotion opportunities were negatively correlated with depression (P<0.05) ; quantitative risk load, work, work order tonality, job prospects were positively correlated with anxiety (P<0.05) , the task control, promotion, and participation in decision-making were negatively correlated with anxiety (P<0.05) ; work, load change, work order tonality, risk scoring for job prospects were positively correlated with body complaint (P<0.01) , mission control, decision control, resource control were negatively correlated with body complaint (P<0.05) . Conclusion: Different stress factors make different effects in different psychological stress reaction, the main predictors and predictive power of each psychological stress reaction were not the same.

[Comparison of Vocational Exhaustion Positive Rate among Different Occupational Stress Groups].

Objective: To explore the statistical differences of the vocational exhaustion positive rate among various occupational stress factors, occupational stress reaction, personality characteristics and relieving factors, to lay a foundation for reducing occupational stress of the medical staffs. Methods: 656 medical staffs in Yangzhong and Chifeng hospitals were included to conduct the evaluation of the occupational stress and job burnout, analyze the differences among the various factors by comparing them. Results: Various levels of vocational exhaustion positive rate among different occupational stress factors, occupational stress reaction, personality characteristics and relieving factors show statistical difference (P<0.05) . Among occupational stress factors, the vocational exhaustion positive rate of high level groups of conflict in groups was the highest (73.4%) , among occupational stress reaction, the vocational exhaustion positive rate of high level groups of body complain was the highest (80.4%) , among personality characteristics, the vocational exhaustion positive rate of low level groups of self-esteem was the highest (74.4%) , among relieving factors, the vocational exhaustion positive rate of high level groups of family support was the highest (76.4%) . Conclusion: The vocational exhaustion rate of medical staffs show very high in the profession, comprehensive factors should be considered to create harmonious working atmosphere and to reduce vocational exhaustion positive rate of the medical staffs, to reduce the positive rate of vocational exhanstion in medical staffs.

[Clinical value of anti-liver/kidney microsomal-1 antibody in patients with liver disease].

Objective: To investigate the clinical and laboratory features of patients with liver disease and positive anti-liver/kidney microsomal-1 (anti-LKM-1) antibody, and to provide a reference for clinical diagnosis and differential diagnosis. Methods: The clinical data of patients with positive anti-LKM-1 antibody who were treated in our hospital from 2006 to 2016 were collected, and clinical and laboratory features were analyzed and compared. An analysis was also performed for special cases. Results: The measurement of related autoantibodies was performed for about 100 thousand case-times, and 15 patients were found to have positive anti-LKM-1 antibody. Among the 15 patients, 7 were diagnosed with type 2 autoimmune hepatitis (AIH) with an age of 11.0 ± 9.0 years and were all adolescents with acute onset; 8 were diagnosed with hepatitis C with an age of 51.5 ± 9.0 years, among whom 7 were middle-aged patients and 1 was a child aged 12 years, and all of them had an insidious onset. Compared with the patients with hepatitis C, the AIH patients had significantly higher levels of alanine aminotransferase (1 003.9 ± 904.3 U/L vs 57.0 ± 84.1 U/L, P < 0.05), aspartate aminotransferase (410.7 ± 660.3 U/L vs 34.9 ± 42.9 U/L, P < 0.05), and total bilirubin (98.0 ± 191.0 µmol/L vs 15.4 ± 6.0 µmol/L, P < 0.05). There was a reduction in immunoglobulin G after the treatment with immunosuppressant, compared with the baseline. Of all 8 patients with hepatitis C, 6 received antiviral therapy with interferon and ribavirin, and 5 out of them achieved complete response, among whom 4 had a reduction in the level of anti-LKM-1 antibody after treatment; however, a 12-year-old child developed liver failure after interferon treatment and died eventually. Conclusion: Positive anti-LKM-1 antibody is commonly seen in patients with type 2 AIH or hepatitis C, but there are differences between these two groups of patients in terms of age, disease onset, liver function, and the level of anti-LKM-1 antibody. The hepatitis C patients with a confirmed diagnosis and exclusion of autoimmune hepatitis can achieve good response to interferon under close monitoring, even if anti-LKM-1 antibody is positive. As for adolescent patients with hepatitis C and positive anti-LKM-1 antibody, the possibility of AIH should be excluded.