[A cross-sectional survey on the allocation of nursing human resources in burn centers in China].

Objective: To investigate the allocation of nursing human resources in burn centers in China. Methods: A cross-sectional survey was conducted. Using a self-designed questionnaire, a survey was carried out from January to March 2022 to investigate the January to December 2021 status of 39 burn centers in China that met the inclusion criteria based on six strategic regions and other regions, including the hospital grade and the region, the number of nurses and opening beds in the burn centers and burn intensive care units (BICUs), the age, working seniority in burn specialty, educational background, professional title, personnel employment, and turnover of nurses and training of newly recruited nurses in the burn centers. Results: This survey covered 30 provinces, municipalities, and autonomous regions in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan region of China). A total of 39 questionnaires were collected, all of which were valid. The 39 burn centers were located in 38 tertiary A hospitals and 1 tertiary B hospital, with 26 burn centers in strategic areas. The nurse/bed ratio of burn centers in the Greater Bay Area of Guangdong, Hong Kong, and Macao was the highest, while the nurse/bed ratio of burn centers in border ethnic minority area was the lowest. Except for the Chengdu-Chongqing Economic Circle, BICUs had been set up in burn centers in other regions. Among the 39 burn centers, the percentage of nurses aged 25 to 34 years was 51.21% (738/1 441), the percentage of nurses worked in burn specialty for less than 5 years was 31.16% (449/1 441), the percentage of nurses with bachelor's degree was 69.74% (1 005/1 441), and the percentage of nurses with nursing professional title was 44.14% (636/1 441), which were the highest. There were significant differences in the employment of nurses, the percentage of permanent nurses in burn centers in the collaborative development zone of Beijing-Tianjin-Hebei was 82.48% (113/137), while the percentage of permanent nurses in burn centers in important military strategic area was only 9.42% (34/361); the turnover rate of nurses was 9.03% (143/1 584), among which the turnover rate of nurses was 18.14% (80/441) in burn centers in important military strategic area. The training for newly recruited nurses in 39 burn centers was mainly based on the guidance of senior nurses and the pre-job education+specialist training. Conclusions: The burn nursing human resources in strategic areas in China are seriously insufficient and unevenly distributed, with unstable nurse team and lack of standardized specialist training. In particular, the nursing human resources in BICUs need to be equipped and supplemented urgently.

Quantitative assessment of the effects of human activities on phytoplankton communities in lakes and reservoirs.

Global algal blooms have been severely threatening safety of drinking water and development of socio-economy. Effective prevention and accurate control of algal blooms require a quantitative assessment of the influence of human activities and identification of priority areas. However, previous studies on the quantitative assessment of the effects of human activities on algal communities are lacking, severely hindering the effective and precise control of algal blooms. This paper proposes a quantitative assessment model to evaluate the impact intensity of human activities on phytoplankton. Applications showed that the proliferation of phytoplankton were more limited by nutrients such as total phosphorus and ammonia where waters are less influenced by human activities, yet were less limited by these nutrients where there are highly intensive human activities. The density of phytoplankton in waters increased with an increase in human activity intensity, particularly in concentrated agricultural areas, which are priority areas for the prevention and control of algal blooms. The methodologies can clearly identify key areas for algal bloom prevention and control and can provide scientific evidence for water and nutrient management throughout the world, reducing the risk of algal blooms and ensuring aquatic ecosystem health and potable water safety.

Modelling variability of quality of life scores: a study of questionnaire version and bilingualism.

BACKGROUND AND OBJECTIVES: Modelling variability of quality of life scores can not only improve our understanding of the characteristics of the measurement tools, but also shed light on sample size requirements. Although the English and Chinese versions of the Short Form 36 Health Survey (SF-36) are commonly considered equivalent, they have not been compared in terms of variability. Furthermore, bilingual and monolingual persons may differ in cognition and responses to questionnaires. METHODS: In a community-based survey of quality of life in Singapore, a society where both English and Chinese are widely used and bilingualism is prevalent, 2590 respondents answered either version of the SF-36. We studied the impact of questionnaire version and bilingualism on the variability of SF-36 scores by regression modelling, with adjustment for covariates. RESULTS: The Chinese version had smaller variances in the physical functioning (PF) and the physical component summary scores than the English version. The variance ratios (VRs) were respectively 0.32 and 0.60 (each p < 0.01), controlling for covariates. Bilingualism was not associated with variability in SF-36 scores except PF (VR = 0.78; p < 0.05). CONCLUSIONS: As a result of a smaller variance, using the Chinese version of SF-36 among bilingual Chinese people may require a smaller sample size than using the English version.

A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore.

Scaling assumptions and validity of the English (UK) and Chinese (HK) short form 36 health survey (SF-36) were assessed in a community-based survey of 5,503 Chinese, Malays and Indians in Singapore using the international quality of life assessment project approach of item and scale level validation. Missing data for SF-36 items and scales occurred in less than 1.0% of subjects. Item level validation of both versions generally supported assumptions underlying Likert scoring and hypothesised item-order clustering. Item level factor analysis supported the eight-scale structure of the SF-36. In scale level validation, SF-36 scale scores showed wide variability and acceptable internal-consistency reliability (Cronbach's alpha > 0.70 for six English and seven Chinese scales), conformed to hypothesised patterns and generally varied according to hypotheses in subjects known to differ in quality of life. Scale level factor analysis of both versions yielded very similar patterns of factor correlation, comparable to that found in Japan, but differing from that seen in Western populations. Taken together, these results support the validity of the English (UK) and Chinese (HK) SF-36 versions in the multi-ethnic Asian socio-cultural context of Singapore.

Biomarker risk assessment and bladder cancer detection in a cohort exposed to benzidine.

BACKGROUND: Cancer screening with highly sensitive, specific biomarkers that reflect molecular phenotypic alterations is an attractive strategy for cancer control. We examined whether biomarker profiles could be used for risk assessment and cancer detection in a cohort of Chinese workers occupationally exposed to benzidine and at risk for bladder cancer. METHODS: The cohort consisted of 1788 exposed and 373 nonexposed workers, followed from 1991 through 1997. We assayed urothelial cells from voided urine samples for DNA ploidy (expressed as the 5C-exceeding rate [DNA 5CER]), the bladder tumor-associated antigen p300, and a cytoskeletal protein (G-actin). Workers were stratified into different risk groups (high, moderate, and low risk) at each examination based on a predefined biomarker profile. For workers who developed bladder cancer, tumor risk assessment was analyzed from samples collected 6-12 months before the cancer diagnosis. The associations between risk group and subsequent development of bladder cancer were analyzed by Cox proportional hazards regression analysis and logistic analysis, after adjustment. All statistical tests were two-sided. RESULTS: Twenty-eight bladder cancers were diagnosed in exposed workers and two in nonexposed workers. For risk assessment, DNA 5CER had 87.5% sensitivity, 86.5% specificity, an odds ratio (OR) of 46.2 (95% confidence interval [CI] = 8.1 to 867.0), and a risk ratio (RR) of 16.2 (95% CI = 7.1 to 37.0); p300 had 50.0% sensitivity, 97.9% specificity, an OR of 40.0 (95% CI = 9.0 to 177.8), and an RR of 37.9 (95% CI = 16.8 to 85.3). The risk of developing bladder cancer was 19.6 (95% CI = 8.0 to 47.9) times higher in workers positive for either the DNA 5CER or p300 biomarkers than in workers negative for both biomarkers and 81.4 (95% CI = 33.3 to 199.3) times higher in workers positive for both biomarkers. G-actin was a poor marker of individual risk. CONCLUSIONS: Occupationally exposed workers at risk for bladder cancer can be individually stratified, screened, monitored, and diagnosed based on predefined molecular biomarker profiles.

Validation of the Chinese SF-36 for quality of life assessment in patients with systemic lupus erythematosus.

We studied the reliability and validity of the Chinese Short-Form 36 Health Survey (SF-36) in a cross sectional study of patients with systemic lupus erythematosus (SLE). Sixty-nine consecutive subjects completed a questionnaire containing the Chinese SF-36 twice within 14 d. Disease activity and damage were assessed using the British Isles Lupus Activity Group (BILAG) and SLICC/ACR Damage Index (DI) scales, respectively. Internal consistency was assessed using Cronbach's alpha, reliability using Spearman's correlation and repeatability coefficients, and relationships between SF-36, BILAG and DI scores using Spearman's correlation. The Chinese SF-36 showed high internal consistency (alpha = 0.72-0.91) and good reliability, with correlations exceeding 0.70 for 7 scales and mean scale score differences of < 2 points for 6 scales. SF-36 scores correlated weakly with BILAG scores (-0.27 to -0.41) and DI scores (-0.24 to -0.35), and subjects' mean SF-36 scores were 6-24 points lower than the general population, supporting construct validity of the SP-36. These data suggest that the Chinese SF-36 is a reliable and valid measure of quality of life in patients with SLE.

Validation of the MOS SF-36 for quality of life assessment of patients with systemic lupus erythematosus in Singapore.

OBJECTIVE: To assess the reliability and construct validity of the Medical Outcomes Study Short Form 36 Health Survey (SF-36) in a multiracial cohort of Asian patients with lupus in Singapore. METHODS: A cross sectional study was performed on 118 English speaking patients with lupus attending a specialist rheumatology unit between March and August 1996. Patients completed a questionnaire containing the UK standard version of the SF-36 twice within a 14 day period. All patients were assessed for disease activity using the British Isles Lupus Assessment Group score (BILAG), and for disease related damage using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (DI). Relationships between SF-36, BILAG, and DI scores were studied using Spearman's rank correlation. Internal consistency of the SF-36 was assessed using Cronbach's alpha, and stability using the repeatability coefficient of Bland and Altman. RESULTS: SF-36 subscales showed high internal consistency, with Cronbach's alpha coefficient ranging from 0.84 to 0.94. Test-retest reliability was acceptable, with Spearman's rank correlation >0.70 for all subscales except role-physical, and mean differences in test scores of <2 points for 5 of 8 subscales. SF-36 subscale scores were weakly correlated with BILAG scores (Spearman's p -0.37 to 0.15) and SLICC/ACR DI scores (Spearman's p -0.25 to 0.23), suggesting divergent construct validity of the SF-36. CONCLUSION: These data suggest the SF-36 is a reliable and valid measure of the quality of life of patients with lupus in Singapore.

Initial construct cross-cultural validation of the Short Form 36 for quality of life assessment of systemic lupus erythematosus patients in Singapore.

The objective of this study was to determine if the Short Form 36 (SF-36) Health Survey Questionnaire measures differences in quality of life between lupus patients and healthy controls in Singapore. A cross-sectional pilot study was conducted on consecutive English-speaking, female Chinese lupus patients seen at a Rheumatology unit. Healthy volunteers were recruited as controls during the same time period. All subjects completed the United Kingdom version of the SF-36. Lupus disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index and converted to a global score. Lupus-related damage was measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACRDI). The main outcomes measured were the mean SF-36 scale scores for lupus patients and healthy controls. Thirty-six lupus patients and 76 controls were included in the study. All subjects were English-speaking, Chinese female between 21 and 53 years of age. The mean age of patients and controls was 31.9 and 29.0 years respectively. Lupus patients had lower mean scale scores than controls for physical functioning (73.0 versus 89.7, P < 0.0027), bodily pain (71.0 versus 81.4, P < 0.027), physical role functioning (55.7 versus 89.5, P < 0.0001) and general health (47.4 versus 51.8, P < 0.05). Mean scale scores for vitality, social and emotional role function and mental health were similar in both groups. Ten patients had active disease (BILAG global scores of 3 to 14) and 13 patients had lupus-related damage (Damage Index scores of 1 to 7). These preliminary data suggest that the SF-36 Health Survey may be able to measure differences in quality of life between lupus patients and healthy controls in Singapore.

NSAID-induced gastrointestinal damage. Epidemiology, risk and prevention, with an evaluation of the role of misoprostol. An Asia-Pacific perspective and consensus.

The problem of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity was reviewed by members of the Asia Pacific League of Associations for Rheumatology (APLAR) in a consensus conference in September 1992. This paper by the participants presents the consensus conclusions incorporating knowledge from recent publications. There had been a high level of concern that much of the toxicity had resulted from extensive and indiscriminate prescribing of NSAIDs. The implementation of evidence-based guidelines was considered likely to be able to effect a substantial reduction in toxicity without significant loss of overall therapeutic benefit. The evidence from which such guidelines could be developed is critically appraised.

Approach to rheumatic diseases.

Rheumatic diseases are the most prevalent of the chronic painful disorders in the world today. The specialty of rheumatology is one of the most clinically orientated. Hence the approach to rheumatic diseases must be clinical. Proper history taking and physical examination including that of the musculoskeletal system cannot be overemphasized. Special attention must be paid to the skin, mucous membrane, the eyes, the gastrointestinal and genitourinary systems. Laboratory tests are meant to supplement a thorough history and physical examination and never in place of them. Because there is so much overlap in the clinical manifestations of the different rheumatic diseases, a precise diagnosis may be difficult in the early stages. Management goals must therefore be bipartite. Short term goal is aimed at symptomatic relief, gaining the patient's confidence and preventing disability. Long term goal requires the physician's attention to diagnosis and prognosis, drug toxicity, negotiating with the patient regarding an acceptable life-style and degree of relief and finally prolonging or protecting life. In fact the modern approach to health care delivery in rheumatic diseases must be based on the team concept. The team should consist of the physician/rheumatologist, the orthopaedic surgeon and a spectrum of arthritis health professionals composed of physical therapists, occupational therapists, nurses, psychologists, social workers, dietitians, bioengineers and administrators.