Development and validation of the geriatric trauma frailty index for geriatric trauma patients based on electronic hospital records.

BACKGROUND: Globally, geriatric patients are the dominant population requiring global medical care. We established a frailty index for geriatric trauma patients by retrospectively analysing electronic hospital records to identify patients with frailty characteristics and poor prognostic outcomes. METHOD: Data were obtained from 2016 US National Emergency Department Sample and Shanghai Trauma Emergency Medical Association (2015-18). Overall, 141,267 hospitalised geriatric trauma patients (age ≥ 65 years) were included. We used a three-step method to construct geriatric trauma frailty index (GTFI) based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes. Systematic cluster analysis was used. The accuracy of GTFI was verified in national validation cohort, and its applicability to Chinese patients was assessed in local validation cohort. RESULTS: In development cohort (n = 28,179), frail patients had longer lengths of stay and higher Charlson co-morbidity index than non-frail patients (18.2 ± 12.4 days, 5.59 ± 2.0 versus 5.3 ± 5.3 days, 5.33 ± 1.8, respectively). In national validation cohort (n = 113,089), frail patients had longer lengths of stay (8.5 ± 8.8 days versus 4.5 ± 3.1 days) and higher in-hospital mortality than non-frail patients (2,795, 11.69% versus 589, 0.66%). Areas under the curves for GTFI for length of stay (>14 days) and in-hospital mortality were 0.848 (0.841, 0.854) and 0.885 (0.880, 0.891) in national validation cohort, and were 0.791 (0.779, 0.804) and 0.903 (0.885, 0.922) in local validation cohort (n = 14,827). CONCLUSIONS: The GTFI helps hospitals and emergency departments to identify geriatric trauma patients with poor prognostic outcomes, and has been proven to be useful in China.

Validating the agreement between the geriatric trauma frailty index and four published frailty scores in the Chinese geriatric trauma population.

BACKGROUND: In the geriatric patient population, frailty significantly affects a patient's prognostic outcome. This study aimed to compare the consistency of our constructed geriatric trauma frailty index with previously published indexes. METHODS: The geriatric trauma frailty index (GTFI) was compared with four previously published frailty indexes, i.e., the hospital frailty risk score (HFRS), Fried index, trauma-specific frailty index (TSFI), and 11-item modified frailty index (mFI) using the Bland-Altman method, intraclass correlation coefficient (ICC), and kappa consistency test. The indexes were calculated based on data collected from 101 questionnaires and medical records from 101 geriatric trauma patients at a tertiary hospital in Shanghai. RESULTS: Among the 101 geriatric trauma patients, 64 (63.4%) were women, with a mean age of 71.18 (SD = 9.89) years and mean length of stay (LOS) of 7.51 (SD = 3.89) days. The mean scores of GTFI score(≥ 1.3045 as frail), Fried index score(≥3 items as frail), TSFI score(≥ 4 as frail), and mFI (≥ 3 as frail),were 0.86 (SD = 1.51), 0.76 (SD = 1.07), 1.76 (SD = 1.96), and 1.29 (SD = 1.17). respectively. The GTFI score had good consistency with the HFRS (ICC: 0.716, 95% confidence interval [CI]: 0.596, 0.799, kappa: 0.608, 95% CI: 0.449, 0.766), fair consistency with the TSFI (ICC: 0.407, 95% CI: 0.227, 0.562, kappa: 0.460, 95% CI: 0.239, 0.672), and poor consistency with the mFI (ICC: 0.286, 95% CI: 0.097, 0.455, kappa: 0.305, 95% CI: 0.069, 0.525) and Fried index score (ICC: 0.256, 95% CI: 0.063, 0.426, kappa: 0.188, 95% CI: - 0.028, 0.408). CONCLUSIONS: Different frailty indexes are based on different concepts of frailty and cannot be assumed to be interchangeable. There is still no gold standard for the current assessment methods of frailty, but it can be compared based on the understanding in terms of the concepts and measures used in each.

Dynamic Bayesian network for predicting physiological changes, organ dysfunctions and mortality risk in critical trauma patients.

BACKGROUND: Critical trauma patients are particularly prone to increased mortality risk; hence, an accurate prediction of their conditions enables early identification of patients' mortality status. Thus, we aimed to develop and validate a real-time prediction model for physiological changes, organ dysfunctions and mortality risk in critical trauma patients. METHODS: We used Dynamic Bayesian Networks (DBNs) to model complicated relationships of physiological variables across time slices, accessing data of trauma patients from the Medical Information Mart for Intensive Care database (MIMIC-III) (n = 2915) and validated with patients' data from ICU admissions at the Changhai Hospital (ICU-CH) (n = 1909). The DBN model's evaluation included the predictive ability of physiological changes, organ dysfunctions and mortality risk. RESULTS: Our DBN model included two static variables (age and sex) and 18 dynamic physiological variables. The differences in ratios between the real values and the 24- and 48-h predicted values of most physiological variables were within 5% in the two datasets. The accuracy of our DBN model for predicting renal, hepatic, cardiovascular and hematologic dysfunctions was more than 0.8.The calculated area under the curve (AUC) from receiver operating characteristic curves and 95% confidence interval for predicting the 24- and 48-h mortality risk were 0.977 (0.967-0.988) and 0.958 (0.945-0.971) in the MIMIC-III and 0.967 (0.947-0.987) and 0.946 (0.925-0.967) in ICU-CH. CONCLUSIONS: A DBN is a promising method for predicting medical temporal data such as trauma patients' mortality risk, demonstrated by high AUC scores and validation by a real-life ICU scenario; thus, our DBN prediction model can be used as a real-time tool to predict physiological changes, organ dysfunctions and mortality risk during ICU admissions.

Collaborative relationships in translational medical research among Chinese clinicians: an internet-based cross-sectional survey.

BACKGROUND: This study aimed to explore the collaborative relationship in translational medical research from the perspective of clinicians in China. The findings are expected to help practitioners optimize and experience the greatest advantages of collaboration. METHODS: We conducted a national internet-based survey from July 29 to October 12, 2020. Of the 806 responses, 804 were completed with valid responses (valid response rate = 99.8%). The collected data were presented as descriptive statistics and analyzed using nonparametric tests (including the Wilcoxon rank test and Kruskal-Wallis H test) and stepwise logistic regression. RESULTS: Of the 804 participants, 733 were either willing or very willing to collaborate in translational medical research. Clinicians' willingness was influenced by their current research type, role in current translational medical research, burdens of their present research, preferred partners for collaboration at the institutional or individual level, and preferences for independent or dependent relationships. CONCLUSIONS: Clinicians should evaluate their time, role, burdens, personal preferences for research relationships, and appropriate partners based on their current translational medical research and its goals, before deciding to collaborate.

Post-traumatic positive and negative psychological changes experienced by child and adolescent earthquake survivors in remote rural western China: a cross-sectional study six years after the Yushu earthquake.

Background: Yushu, Qinghai province is located in remote Tibetan plateau in Western China, struck by a disastrous earthquake in 2010. The study aimed to find out the positive and negative psychological changes and related risk factors of children and adolescents who had experienced Yushu earthquake, 6 years after it occurred. Methods: A cross-sectional research was adopted in the capital of Yushu Autonomous Prefecture in August 2016. The short form of the Changes in Outlook Questionnaire (CiOQ-S) was used, which is a 10-item self-report instrument consists of two subscales. A total of 591 valid questionnaires completed by local junior students were finally included in our study. Results: The mean scores of the positive and negative psychological changes were 19.28 and 13.08, respectively. The factors associated with positive psychological changes included high level of education, male gender, and uninjured in the earthquake. The factors associated with negative psychological changes included living in a pasture instead of downtown, injured during the earthquake, and not receiving psychological counselling. Conclusions: The current analysis tries to investigate the long-term psychological effects of earthquakes among children and adolescents, which aims to improve the psychological health status for child and adolescent survivors of similar events.

Dynamic statistical model for predicting the risk of death among older Chinese people, using longitudinal repeated measures of the frailty index: a prospective cohort study.

BACKGROUND: Frailty is a common characteristic of older people with the ageing process. We aimed to develop and validate a dynamic statistical prediction model to calculate the risk of death in people aged ≥65 years, using a longitudinal frailty index (FI). METHODS: One training dataset and three validation datasets from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were used in our study. The training dataset and validation datasets 1 to 3 included data from 9,748, 7,459, 9,093 and 6,368 individuals, respectively. We used 35 health deficits to construct the FI and a longitudinal FI based on repeated measurement of FI at every wave of the CLHLS. A joint model was used to build a dynamic prediction model considering both baseline covariates and the longitudinal FI. Areas under time-dependent receiver operating characteristic curves (AUCs) and calibration curves were employed to assess the predictive performance of the model. RESULTS: A linear mixed-effects model used time, sex, residence (city, town, or rural), living alone, smoking and alcohol consumption to calculate a subject-specific longitudinal FI. The dynamic prediction model was built using the longitudinal FI, age, residence, sex and an FI-age interaction term. The AUCs ranged from 0.64 to 0.84, and both the AUCs and the calibration curves showed good predictive ability. CONCLUSIONS: We developed a dynamic prediction model that was able to update predictions of the risk of death as updated measurements of FI became available. This model could be used to estimate the risk of death in individuals aged >65 years.

Health status of adolescents in the Tibetan plateau area of western China: 6 years after the Yushu earthquake.

BACKGROUND: An earthquake struck Yushu in Qinghai province of China on April 14, 2010, causing 2698 deaths and 12,135 injuries.The present study aimed to assess the health status, and associated determinants, of child survivors in the epicenter of the Yushu earthquake 6 years after the event. METHODS: A cross-sectional survey was performed among students from two junior schools in Yushu County. Descriptive statistics, t-tests, ANOVA, Wilcoxon rank sum tests, Kruskal-Wallis H tests and stepwise linear regression analysis were used for data analysis. RESULTS: The mean scores onmental component summary (MCS)and physical component summary (PCS) were 42.13 (SD 7.32) and 42.04 (SD 8.07), respectively. Lower PCS in the aftermath of an earthquake was associated with being trapped/in danger, injured to self, receiving no escape training while lowerMCS in the aftermath of an earthquake was associated with a lower grade level, not living with parents, fear during the earthquake, death in the family, and not receiving psychological counseling after the earthquake. CONCLUSIONS: In conclusion, the results of the present study help to expand our knowledge regarding the health status of child survivors 6 years after the Yushu earthquake. Our study provides evidence-based suggestions for specific long-term health interventions in such vulnerable populations.

Profile and procedures for fractures among 1323 fracture patients from the 2010 Yushu earthquake, China.

OBJECTIVES: The injuries caused by earthquakes are often complex and of various patterns. Our study included all fracture inpatients from the Yushu earthquake (1323 in total), to learn more about the incidence and distribution of fractures during earthquakes. METHODS: A retrospective study of the clinical characteristics of hospitalized fracture patients after the 2010 Yushu earthquake was conducted from December 20 to 25, 2010.We reviewed medical records of hospitalized patients who had been evacuated from the Yushu earthquake area between April 14 and June 15, 2010, from 57 hospitals, and also reviewed more than 100 documents assembled from daily medical rescue and disease prevention reports submitted by the frontline rescue organizations. RESULTS: In total, 78.0% of fracture patients were admitted to the hospital within 3 days after the earthquake. There were 1323 patients who presented with 1539 fractures. The most common fracture occurred in the lower limbs, followed by spinal, pelvic, and shoulder-upper limb fractures. The end of the thoracic vertebra and the lumbar vertebra were the high-risk sites for vertebral fractures. A total of 38 patients became paraplegic. A 2-level spatial clustering was detected among the 193 patients presenting with 2 fractures. CONCLUSIONS: Analysis profiles of the injuries and clinical features of patients with earthquake-related fractures will positively impact rescue efforts and the treatment of fracture injuries caused by possible future natural disasters. We should assemble orthopedic-related medications and surgical equipment, and allocate them promptly after a major earthquake.

Health-related quality of life for medical rescuers one month after Ludian earthquake.

BACKGROUND: An earthquake struck Ludian in Yunnan province of China on August 3, 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the quality of life and associated determinants among medical rescuers after Ludian earthquake. METHODS: A cross-sectional survey was performed among personnel from three hospitals that assumed rescue tasks in Ludian earthquake. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. RESULTS: The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 49.86 (SD = 6.01) and 35.85(SD = 6.90), respectively. Lower PCS in the aftermath of an earthquake was associated with non-military medical rescuers, elderly age, and being trapped/in danger while lower MSC in the aftermath of an earthquake was associated with non-military medical rescuers, young age, being female, being trapped/in danger and low education degree. CONCLUSIONS: In conclusion, our study demonstrates that medical rescuers are at risk for a lower HRQoL after exposure to Ludian earthquake. The results of this study help expand our knowledge of health-related quality of life among medical rescuers after the Ludian earthquake.

A meta-analysis of risk factors for depression in adults and children after natural disasters.

BACKGROUND: A number of studies have shown a range of negative psychological symptoms (e.g. depression) after exposure to natural disasters. The aim of this study was to determine risk factors for depression in both children and adults who have survived natural disasters. METHODS: Four electronic databases (PubMed, Embase, Web of Science, and PsychInfo) were used to search for observational studies (case-control, cross-sectional, and cohort studies) about depression following natural disasters. The literature search, study selection, and data extraction were conducted independently by two authors. Thirty-one articles were included in the study, of which twenty included adult participants and eleven included child participants. Summary estimates were obtained using random-effects models. Subgroup analysis, sensitivity analysis, and publication bias tests were performed on the data. RESULTS: The prevalence of depression after natural disasters ranged from 5.8% to 54.0% in adults and from 7.5% to 44.8% in children. We found a number of risk factors for depression after exposure to natural disasters. For adults, the significant predictors were being female ;not married;holding religious beliefs; having poor education; prior trauma; experiencing fear, injury, or bereavement during the disaster; or losing employment or property, suffering house damage as a result of the disaster. For children, the significant predictors were prior trauma; being trapped during the disaster; experiencing injury, fear, or bereavement during the disaster; witnessing injury/death during the disaster; or having poor social support. CONCLUSIONS: The current analysis provides evidence of risk factors for depression in survivors of natural disasters. Further research is necessary to design interventions to improve the mental health of survivors of natural disasters.

Medical services provided on the 'Harmonious Mission-2017' Peace Ark from China.

INTRODUCTION: The Chinese Naval ship Peace Ark provided humanitarian medical services to people in eight low-income countries in Africa and Asia during the 2017 "Harmonious Mission'. The expedition lasted 155 days. Our study aimed to analyse the details of the medical services provided including outpatient care, medical patrol, operations, examinations and medications. METHOD: The patient demographic data and medical information were extracted from electronic medical records. The diagnoses and procedures aboard were coded by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The sociodemographic data of the medical staff aboard were collected via questionnaire. Descriptive statistics and statistical software (SAS, V.9.4) were used to analyse the data. RESULTS: In total, 115 Chinese military medical personnel participated in the mission, completing a total of 50 758 outpatient visits, 10 232 medical patrols and 252 operations. The five most frequently used outpatient departments were ophthalmology, general surgery, general internal medicine, orthopaedics and traditional Chinese medicine. The five most common operations were lipoma excision, cataract extraction, skin tissue removal (such as warts and cysts), pterygium transposition and herniorrhaphy. CONCLUSIONS: Our study revealed the medical services in demand during the 'Harmonious Mission-2017'. It is essential to report their experiences so that future ventures can provide medical services more effectively.

The impact of school life and family involvement on Western China junior high school students' wellbeing at multidimensional levels.

BACKGROUND: The focus of students' health concerns has gradually progressed from the single factor of physical health to comprehensive health factors, and the physical and mental health of students are now generally considered together. This study focuses on exploring the status of junior high school students' physical health and their subjective health assessment with the major societal factors that affect students' lives: School Life and Family involvement. In addition, we explore the main factors influencing students' subjective health. METHODS: A cross-sectional survey was conducted with 190 Tibetan junior high school students in the Maozhuang Township. The intentional sampling was used to choose the research object. The structured questionnaire comprised four parts, namely social and demographic information, family condition, school life, and subjective health quality which was assessed by PROMIS (Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System). RESULT: The average height and weight of boys and girls are statistically different (p-values of 0.026 and 0.044, respectively), but there is no statistically significant difference in BMI (Body Mass Index) between boys and girls (p-value of 0.194). The average values of the five dimensions of depression, anger, anxiety, fatigue, and peer relationships in the PROMIS of the research subjects were 58.9 ± 5.3, 53.3 ± 8.0, 58.1 ± 7.3, 52.8 ± 8.0, 39.3 ± 6.6. In the demographic dimension, the grade was the main factor influencing anger (p < 0.01) and fatigue (p < 0.01), while gender was related to peer relationships (p = 0.02). In the family dimension, the father's educational level was related to peer relationships (p = 0.05), while the family financial situation was related to depression (p = 0.01). In the school life dimension, relationship with classmates was found to affect anger (p = 0.05), while homework was related to anxiety (p = 0.02) and fatigue (p = 0.05). CONCLUSION: the physical health index BMI and subjective health evaluation of students are worse than students of more developed areas in China. Their family environment and school life all have varying degrees of impact on the five subjective health outcomes. There are differences in gender and grade level. The government and society need to pay more attention to the physical and mental health of students in remote and underdeveloped areas and improve their health through a student nutrition plan and the establishment of mental health offices.

A comparative examination of the health status of earthquake-affected and non-earthquake-affected adolescents in Yushu.

Background: Yushu, Qinghai Province, which is located in the remote Tibetan Plateau in western China, was struck by a disastrous earthquake in 2010. Methods: This study aimed to compare the health status of adolescents who had (Exp-Group) and had not (Non-Group) experienced the Yushu earthquake, 7 years after it occurred; additionally, group-specific predictors of health status were identified. A cross-sectional study was adopted among students from two junior schools in Yushu, whereby two groups were compared. Descriptive statistics, t-tests, Wilcoxon rank-sum tests, Kruskal-Wallis H tests, and stepwise linear regression were used to analyze data. Results: Exp-Group scored higher than Non-Group on Physiological Component Summary (PCS) but not on Mental Component Summary (MCS). Among Exp-Group participants, lower PCS scores were predicted for "house damaged," "injured," "family member injured," and "family member or friend dead." Lower MCS scores were predicted by "family member or friend dead." Among Non-Group participants, PCS scores were predicted by "residence" and "family member or friend dead." Lower MCS scores were predicted by "not living with parents." Conclusion: Lower PCS and MCS scores of Exp-Group adolescents mainly contributed to earthquake-related injuries, while lower PCS and MCS scores of Non-Group are related to poor living conditions and the fact of the left-behind child.

The impact of frailty on posttraumatic outcomes in older trauma patients: A systematic review and meta-analysis.

BACKGROUND: Frailty is a risk factor for mortality among the elderly. However, evidence from longitudinal studies linking trauma and frailty is fragmented, and a comprehensive analysis of the relationship between frailty and adverse outcomes is lacking. Therefore, we conducted a systematic review and meta-analysis to examine whether frailty is predictive of posttraumatic results including mortality, adverse discharge, complications, and readmission in trauma patients. METHODS: This systematic review was registered with the PROSPERO international prospective register of systematic reviews. Articles in PubMed, Embase, and Web of Science databases from January 1, 1990, to October 31, 2019, were systematically searched. Articles in McDonald et al.'s study (J Trauma Acute Care Surg. 2016;80(5):824-834) and Cubitt et al.'s study (Injury 2019;50(11):1795-1808) were included for studies evaluating the association between frailty and outcomes in trauma patients. Cohort studies, both retrospective and prospective, were included. Study population was patients suffering trauma injuries with an average age of 50 years and older. Multivariate adjusted odds ratios (ORs) were calculated through a random-effects model, and the Newcastle-Ottawa Quality Assessment Scale was used to assess studies. RESULTS: We retrieved 11,313 entries. Thirteen studies including seven prospective and six retrospective cohort studies involving 50,348 patients were included in the meta-analysis. Frailty was a significant predictor of greater than 30-day mortality (OR, 2.41; 95% confidence interval [CI], 1.17-4.95; I = 88.1%), in-hospital and 30-day mortality (OR, 4.05; 95% CI, 2.02-8.11; I = 0%), postoperative complications (OR, 2.23; 95% CI, 1.34-3.73; I = 78.2%), Clavien-Dindo IV complications (OR, 4.16; 95% CI, 1.70-10.17; I = 0%), adverse discharge (OR, 1.80; 95% CI, 1.15-2.84; I = 78.6%), and readmission (OR, 2.16; 95% CI, 1.19-3.91; I = 21.5%) in elderly trauma patients. Subgroup analysis showed that prospective studies (OR, 3.06; 95% CI, 1.43-6.56) demonstrated a greater correlation between frailty and postoperative complications. CONCLUSION: Frailty has significant adverse impacts on the occurrence of posttraumatic outcomes. Further studies should focus on interventions for patients with frailty. Given the number of vulnerable elderly trauma patients grows, further studies are needed to determine the accuracy of these measures in terms of trauma outcomes. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level IV.

A Meta-Analysis of Risk Factors for Post-Traumatic Stress Disorder (PTSD) in Adults and Children after Earthquakes.

PTSD is considered the most common negative psychological reactions among survivors following an earthquake. The present study sought to find out the determinants of PTSD in earthquake survivors using a systematic meta-analysis. Four electronic databases (PubMed, Embase, Web of Science, and PsycInfo) were used to search for observational studies about PTSD following earthquakes. The literature search, study selection, and data extraction were conducted independently by two authors. 52 articles were included in the study. Summary estimates, subgroup analysis, and publication bias tests were performed on the data. The prevalence of PTSD after earthquakes ranged from 4.10% to 67.07% in adults and from 2.50% to 60.00% in children. For adults, the significant predictors were being female, low education level or socio-economic status, prior trauma; being trapped, experiencing fear, injury, or bereavement during the disaster. For children, the significant predictors were being older age, high education level; being trapped, experiencing fear, injury, or bereavement, witnessing injury/death during the earthquakes. Our study provides implications for the understanding of risk factors for PTSD among earthquake survivors. Post-disaster mental health recovery programs that include early identification, on-going monitoring, and sustained psychosocial support are needed for earthquake survivors.

Comparison of the Ability to Predict Mortality between the Injury Severity Score and the New Injury Severity Score: A Meta-Analysis.

BACKGROUND: Description of the anatomical severity of injuries in trauma patients is important. While the Injury Severity Score has been regarded as the "gold standard" since its creation, several studies have indicated that the New Injury Severity Score is better. Therefore, we aimed to systematically evaluate and compare the accuracy of the Injury Severity Score and the New Injury Severity Score in predicting mortality. METHODS: Two researchers independently searched the PubMed, Embase, and Web of Science databases and included studies from which the exact number of true-positive, false-positive, false-negative, and true-negative results could be extracted. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies checklist criteria. The meta-analysis was performed using Meta-DiSc. Meta-regression, subgroup analyses, and sensitivity analyses were conducted to determine the source(s) of heterogeneity and factor(s) affecting the accuracy of the New Injury Severity Score and the Injury Severity Score in predicting mortality. RESULTS: The heterogeneity of the 11 relevant studies (total n = 11,866) was high (I² > 80%). The meta-analysis using a random-effects model resulted in sensitivity of 0.64, specificity of 0.93, positive likelihood ratio of 5.11, negative likelihood ratio of 0.27, diagnostic odds ratio of 27.75, and area under the summary receiver operator characteristic curve of 0.9009 for the Injury Severity Score; and sensitivity of 0.71, specificity of 0.87, positive likelihood ratio of 5.22, negative likelihood ratio of 0.20, diagnostic odds ratio of 24.74, and area under the summary receiver operating characteristic curve of 0.9095 for the New Injury Severity Score. CONCLUSION: The New Injury Severity Score and the Injury Severity Score have similar abilities in predicting mortality. Further research is required to determine the appropriate use of the Injury Severity Score or the New Injury Severity Score based on specific patient condition and trauma type.

A Comparative Study of Scientific Publications in Health Care Sciences and Services from Mainland China, Taiwan, Japan, and India (2007-2014).

In this study, we aimed to compare the quantity and quality of publications in health care sciences and services journals from the Chinese mainland, Taiwan, Japan, and India. Journals in this category of the Science Citation Index Expanded were included in the study. Scientific papers were retrieved from the Web of Science online database. Quality was measured according to impact factor, citation of articles, number of articles published in top 10 journals, and the 10 most popular journals by country (area). In the field of health care sciences and services, the annual incremental rates of scientific articles published from 2007 to 2014 were higher than rates of published scientific articles in all fields. Researchers from the Chinese mainland published the most original articles and reviews and had the highest accumulated impact factors, highest total article citations, and highest average citation. Publications from India had the highest average impact factor. In the field of health care sciences and services, China has made remarkable progress during the past eight years in the annual number and percentage of scientific publications. Yet, there is room for improvement in the quantity and quality of such articles.

The Technical Efficiency of Earthquake Medical Rapid Response Teams Following Disasters: The Case of the 2010 Yushu Earthquake in China.

PURPOSE: Performance assessments of earthquake medical rapid response teams (EMRRTs), particularly the first responders deployed to the hardest hit areas following major earthquakes, should consider efficient and effective use of resources. This study assesses the daily technical efficiency of EMRRTs in the emergency period immediately following the 2010 Yushu earthquake in China. METHODS: Data on EMRRTs were obtained from official daily reports of the general headquarters for Yushu earthquake relief, the emergency office of the National Ministry of Health, and the Health Department of Qinghai Province, for a sample of data on 15 EMRRTs over 62 days. Data envelopment analysis was used to examine the technical efficiency in a constant returns to scale model, a variable returns to scale model, and the scale efficiency of EMRRTs. Tobit regression was applied to analyze the effects of corresponding influencing factors. RESULTS: The average technical efficiency scores under constant returns to scale, variable returns to scale, and the scale efficiency scores of the 62 units of analysis were 77.95%, 89.00%, and 87.47%, respectively. The staff-to-bed ratio was significantly related to global technical efficiency. The date of rescue was significantly related to pure technical efficiency. The type of institution to which an EMRRT belonged and the staff-to-bed ratio were significantly related to scale efficiency. CONCLUSIONS: This study provides evidence that supports improvements to EMRRT efficiency and serves as a reference for earthquake emergency medical rapid assistance leaders and teams.

Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: A neglected problem.

A comprehensive study was conducted 8 months after the 2010 Yushu earthquake to assess the prevalence of posttraumatic stress disorder (PTSD) among medical rescuers and the rescuers' quality of life. Additionally, the study examines differences between local and supporting forces, as well as the relationship between PTSD and lower quality of life (QoL), and the risk factors for both. A total of 338 rescuers (including 123 local rescuers and 215 supporting ones) were randomly selected from Yushu County (the epicenter) and Xining City using multistage systematic sampling. Two standardized instruments, the PTSD Checklist-Civilian Version (PCL-C) and the Chinese version of the WHOQOL-BREF, were used to evaluate the prevalence of PTSD and obtain the rescuers' QoL. Being between 40 and 50 years old, a nurse, Tibetan, having been in serious danger or having received mental health training before this earthquake were significantly and independently associated with PTSD symptoms. Compared with supporting rescuers, local rescuers were more likely to develop PTSD and to report a lower QoL. Additional mental health services and training should be available to at-risk medical rescuers and groups to ensure they are adequately prepared for relief efforts and to maintain their mental health after assistance in disaster relief.