Research on Developing an Assessment Scale for Tourism Experience Elements of Ancient Shu Road Heritage Trail

Cultural ancient roads,known in Chinese as gudao,serve as heritage trails that carry historical exchanges across various regions in China.Due to their extensive preservation,wide geographical distribution,diverse thematic variations,and considerable tourist appeal,these paths have emerged as representative heritage trails,increasingly transforming into a novel tourism product experience that is highly favored by tourists and recognized by government authorities.However,research on ancient roads for tourism in China currently lacks a systematic theoretical framework,as well as relevant policies,regulations,and standards to guide their practical development.Therefore,there is a pressing need to draw upon international best practices and conduct foundational research to develop an experience element system that aligns with the perceptions,behaviors,and consumption characteristics of Chinese tourists,thereby advancing theoretical exploration in this field.This study focuses on the representative Ancient Shu Road as a case study and employs a mixed-method approach that integrates qualitative and quantitative research.It aims to construct a tourist-centric scale for the experience elements of ancient road tourism while analyzing the interactive relationship between these experience elements and tourist needs.This study addresses a significant gap in the development of indicator systems for domestic studies of ancient road tourism experiences.Ultimately,the study establishes a comprehensive scale that encompasses three core categories—trail resources and environment,facilities and services,and modes of tourism activities—along with eight primary dimensions:core resources,surrounding cultural environment,surrounding natural environment,tourism reception facilities and services,infrastructure and support services,information facilities and information services,and outdoor and recreational activities.This scale consists of thirty-two specific items,providing a robust reference for future research endeavors.Additionally,the study proposes specific development strategies related to key mechanisms,spatial configuration,and facility construction to enhance the overall development of ancient road tourism.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

Efficacy of Children Neuropsychological and Behavioral Scale in Screening for Autism Spectrum Disorders through a Combination of Developmental Surveillance

Objective This study aimed to explore the clinical value of Children Neuropsychological and Behavioral Scale-Revision 2016(CNBS-R2016)for Autism Spectrum Disorder(ASD)screening in the presence of developmental surveillance.Methods All participants were evaluated by the CNBS-R2016 and Gesell Developmental Schedules(GDS).Spearman’s correlation coefficients and Kappa values were obtained.Taking GDS as a reference assessment,the performance of the CNBS-R2016 for detecting the developmental delays of children with ASD was analyzed with receiver operating characteristic(ROC)curves.The efficacy of the CNBS-R2016 to screen for ASD was explored by comparing Communication Warning Behavior with Autism Diagnostic Observation Schedule,Second Edition(ADOS-2).Results In total,150 children aged 12–42 months with ASD were enrolled.The developmental quotients of the CNBS-R2016 were correlated with those of the GDS(r=0.62–0.94).The CNBS-R2016 and GDS had good diagnostic agreement for developmental delays(Kappa=0.73–0.89),except for Fine Motor.There was a significant difference between the proportions of Fine Motor,delays detected by the CNBS-R2016 and GDS(86.0%vs.77.3%).With GDS as a standard,the areas under the ROC curves of the CNBS-R2016 were above 0.95 for all the domains except Fine Motor,which was 0.70.In addition,the positive rate of ASD was 100.0%and 93.5%when the cut-off points of 7 and 12 in the Communication Warning Behavior subscale were used,respectively.Conclusion The CNBS-R2016 performed well in developmental assessment and screening for children with ASD,especially by Communication Warning Behaviors subscale.Therefore,the CNBS-R2016 is worthy of clinical application in children with ASD in China.

Development and psychometric evaluation of the Ethical Behavior for Thai Nurses Scale

Background:Ethical problems in the nursing profession are mostly found in the undesirable ethical behavior(EBE)of nurses.If there is no concern about these problems,it may negatively affect the quality of nursing care,patients’safety,and trust in the nursing profession.In assessing nurses’EBE,it is important to develop an instrument that reflects the actual EBE of nurses.Objectives:To develop and evaluate the psychometric properties of the Ethical Behavior for Thai Nurses Scale(EBTNS).Methods:The construct definition,5 sub-constructs,43 items,and the hypothesized model were synthesized and generated from a comprehensive literature review and existing research instruments by using document analysis.The EBTNS was verified for content validity by 4 experts.Of the 43 items,37 items were retained for psychometric testing.The construct validity was tested by using second-order confirmatory factor analysis(CFA).The EBTNS was tested on 1500 professional nurses working at tertiary,secondary,and primary hospitals in 6 regions(the central,northern,northeast,eastern,western,and southern)of Thailand.Proportional quota sampling was applied to recruit participants.Results:The hypothesized model fitted the empirical data.All 37 first-order indicators and 5 second-order sub-constructs showed significantly standardized factor loadings and effect sizes.The standardized factor loadings of 37 first-order indicators ranged from 0.58 to 0.89,and the construct reliabilities were moderate to substantial(R2=0.34-0.79).The 5 second-order sub-constructs displayed the standardized effect sizes,ranging from 0.81 to 0.96,and accounted for 65%-96%of the total explained variance.In addition,the construct validity was supported by convergent validity and discriminant validity.It also satisfied Cronbach’s alpha coefficients of 5 sub-constructs from 0.87 to 0.94,and a full scale was 0.97.Conclusions:The psychometric properties of the EBTNS are acceptable.This instrument has the potential to be used for evaluating and monitoring to prevent ethical problems of Thai nurses.

Development and psychometric evaluation of the nurse behavior toward confirmed and suspected HIV/AIDS patients (NB-CSHAP) scale

There is a scarcity of literature discussing nurses’ behaviors toward caring for suspected or confirmed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. The development of a scale specific to measure nurses’ behaviors will allow health institutions to assess the disposition of their nurses in terms of HIV care. This study aims to present the rigors of developing and validating a reliable instrument to contextualize these nurses’ behaviors. This study utilized a sequential exploratory mixed method design to develop the NB-CSHAP scale. Thematic analysis was done on the qualitative data from the interviews with persons living with HIV/AIDS (PLHA) from which items were selected to be included in the scale. Exploratory factor analysis was utilized to extract the factors and Cronbach’s alpha was used to assess the reliability of the instrument. Four factors were extracted and are categorized as either caring or discriminatory behaviors. These include: (1) service-oriented, (2) openhanded, (3) perceptive, and (4) discriminatory. The scale has an internal consistency of 0.73. The scale shows acceptable psychometric properties, hence can be used to assess the nurses’ behaviors in caring for confirmed or suspected HIV clients. The scale may be used by health institutions to determine the quality of the patient care provided by their nurses to clients with confirmed or suspected HIV .

Development of a frailty scale for elderly people in China

Objective：The aim of this study was to develop a frailty scale for the elderly in China and to examine its reliability and validity.Methods：The method of convenient sampling was used to select 375 elderly individuals in different communities of Tianjin,China.EuroQpl-5D was used to evaluate the criterion validity.Cronbach＇s αcoefficients,correlation analysis,exploratory factor analysis,criterion-related validity,and internal consistency were used to evaluate the reliability and validity of the scale.To evaluate the test—retest reliability,30 old people were re-evaluated after 2 weeks.Results：The final version of the frailty scale（FI-35） consisted of 35 items.Eleven factors were extracted by a principal factor analysis and varimax rotation,with a cumulative contribution of 86.00%.Eleven dimensions were positively correlated（r = 0.130-0.541,P 〈 0.01）.Cronbach＇s α coefficient was 0.952,and the alpha coefficients of 11 dimensions ranged from 0.730 to 0.992.The test-retest reliability was0.874 for the total scale.The split-half reliability of the scale was 0.808.Structural equation modeling was used to perform a confirmatory factor analysis,and various parameters were all acceptable.Conclusions：FI-35 met the requirement of scale development and showed good reliability and validity;thus,it can be used as an efficient frailty measurement tool for Chinese elderly.

Cost Climate Survey Scale in Construction:Development and Empirical Research

To develop the cost climate survey scale( CCSS) used in construction enterprises,the design concepts,principles and the process diagrams of CCSS are proposed.Through questionnaire investigation and expert interviews,314 projects are established and the CCSS that is made up of 7 dimensions framework and 30 levels is preliminarily determined.After categorized merger,pre-test analysis and multiple items refining,16 projects of CCSS are eventually compiled.In order to verify the credibility and validity of the CCSS,200 employees in Qinhuangdao construction company as the samples are tested.SPSS 21.0 is used to analyze the reliability,validity and rationality of level divisions,and Amos 22.0 is for analyzing the degree of model adaptation in this survey.Finally,the current cost climate situation of the construction site in the company is evaluated,the deficiencies of the cost culture of the construction site are pointed out.This study shows that strengthening the cost knowledge training has a significant positive effect on the cost climate cognition of the employees.Nevertheless,accumulation of work experience has a dual impact on that.The CCSS is not only an important foundation for the cost climate research and its theoretical development,but also the premise of the cost climate quantitative research.An appropriate CCSS,to some extent,can reflect the cognitive level of all kinds of employees in one enterprise and cost savings degree of the enterprise in a certain time.The development of CCSS reflects the originality and interactivity,and fills a blank of the CCSS in construction,which is considered to be an effective tool for cost climate research in construction.

Development and Initial Validation of the Personal and Social Responsibility Scale in Physical Education Settings

This study aims to develop a valid instrument measuring personal and social responsibility in physical education settings that is suitable for Chinese high school students age 14 and above.This instrument consists of eight aspects,which builds upon the levels of responsibility in Hellison’s(2011)[9]Teaching Personal and Social Responsibility Model(TPSR).The eight aspects in the measurement include goal,responsibility,respecting the rights and feelings of others,participation and effort,self-direction,caring,and value.The validation of the measurement was conducted based on the responses from 1091 high school students in Macao,China.The convergent and discriminant validity tests and a maximum likelihood confirmation factor analysis were performed using AMOS 21.The Bollen-Stine bootstrapping model was applied to adjust nonnormality data.Results supported a good validity and reliability of the items in the instrument.

Hospital-acquired insomnia scale:A validity and reliability study

BACKGROUND Sleep breathing,one of the basic human needs,is a physiological need that affects cardiac functions,body temperature,daily vitality,muscle tone,hormone secretion,blood pressure,and many more.In the international literature,studies reported that patients have had sleep problems in the hospital since the 1990s,but no measurement tool has been developed to determine the causes of hospitalacquired insomnia in individuals.These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing.Although patients generally experience hospital-acquired sleep problems,there is no measurement tool to determine hospital-acquired sleep problems.These features show the originality of the research.AIM To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.METHODS A personal information form,hospital-acquired insomnia scale(HAIS),and insomnia severity index(ISI)were used to collect research data.The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022.The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage.Exploratory factor analysis and confirmatory factor analysis(CFA)analyses were performed using the SPSS 20 package program and the analysis of moment structure(AMOS)package program.Equivalent forms method used.RESULTS The HAIS consisted of 18 items and 5 subscales.The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783.The scale explained 58.269%of the total variance.The items that constitute the factors were examined in terms of content integrity and named as physical environmental,psychological,safety,socioeconomic,and nutritional factors.CFA analysis of the 5-factor structure was performed in the AMOS package program.The fit indices of the obtained structure were examined.It was determined that the values obtained from the fit indices were sufficient.A significant correlation was determined between the HAIS and the ISI,which was used for the equivalent form method.CONCLUSION The HAIS is a valid and reliable measurement tool for determining patients’level of hospitalacquired insomnia.It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

Towards a profile-based writing scale for a local post-admission ESL writing assessment

Post-admission language tests tend to have a restricted range of proficiency levels among test-takers due to considerations made during the admission selection process.Although range restriction can present challenges for proficiency-focused assessment,it can also bring opportunities to zoom in on fine-grained performance profiles of test-takers.This study reports on the validation of a profile-based rating scale for an ESL writing placement test in a US university.The profile-based rating scale was created by employing a three-staged,hybrid scale development approach,to provide not only accurate placement decisions but also fine-grained diagnostic information regarding ESL students’writing performance profiles.The scale strikes a balance between argument development and lexico-grammar,to better account for the range of writing performances among test-takers.To gather validity evidence for the profile-based rating scale,this study employs a sequential,mixed-methods approach to examine the quality of test-taker performances across profiles and rater perceptions on the scale.Nine certified raters were recruited to conduct independent evaluations of lexicogrammar and argumentation on a sample of 150 test-taker performances.These evaluations were subjected to many-facet Rasch measurement analysis to examine the differences across writing performance profiles included in the rating scale.Next,semi-structured,follow-up interviews were conducted with the raters,to complement the quantitative findings on the usability and effectiveness of the scale.The findings provide supportive evidence for the validity of the profile-based rating scale.I argue that by focusing on performance profiles,post-admission language tests can strengthen the alignment across curriculum,instruction,and assessment in ESL writing programs.

Development of Elementary School Teachers＇ Self-Regulated Learning Exploratory Factor Scale

Self-regulated learning （SRL） is one of the precious ways in teachers＇ professional development, and its operation level includes different factors. With studies abroad and our preliminary investigation as base, this study developed a scale to test the factors SRL includes. According to the result of 905 teachers working in elementary school by exploratory factor analysis, the SRL for elementary teachers is consisted of its sociality （it included selecting leads and seeking for instructing）, its motivation（it included self-improvement and self-excelling）, its methods（it included strategy use and habitual behavior）, and its outcomes（it included extensive reading and teachers＇ professional development）. All the result indicated Teachers＇ SRL Scale had clear factor structure, good reliability and validity. It can be used to test the current operating situation of SRL for teachers working in elementary school.

Towards Lessening Learners’Aversive Emotions and Promoting Their Mental Health:Developing and Validating a Measurement of English Speaking Demotivation in the Chinese EFL Context

While a plethora of studies has been conducted to explore demotivation and its impact on mental health in second language(L2)education,scanty research focuses on demotivation in L2 speaking learning.Particularly,little research explores the measures to quantify L2 speaking demotivation.The present two-phase study attempts to develop and validate an English Speaking Demotivation Scale(ESDS).To this end,an independent sample of 207 Chinese tertiary learners of English as a Foreign Language(EFL)participated in the development phase,and another group of 188 Chinese EFL learners was recruited for the validation of the scale.Exploratory Factor Analysis(EFA)and Confirmatory Factor Analysis(CFA)were employed to determine the factor structure of the scale.The EFA results revealed a six-factor solution with Teacher-related Factors in Learning Spoken English(TFLSE),Interest and Valence in Learning Spoken English(IVLSE),Self-efficacy in Learning Spoken English(SELSE),Negative Peer Influence in Learning Spoken English(NPILSE),Undesirable Environment for Learning Spoken English(UELSE),and Negative Influence of Assessment and Learning Materials in speaking class(NIALM).In the validation phase,Confirmatory Factor Analysis(CFA)was performed to validate the internal structure of the scale.The CFA results showed that the model fits the data well.Overall,the ESDS is a robust and trustworthy psychometric tool that could be utilized to examine L2 speaking demotivation.Implications for diminishing EFL learners’demotivation,lessening their aversive emotions and promoting their mental health are also discussed.

维生素D治疗全面性发育迟缓患儿的临床疗效研究

背景 除了某些有明确病因的代谢性疾病导致的全面性发育迟缓(GDD),康复治疗是GDD的主要治疗方式;维生素D通过影响神经营养因子在调节神经细胞的发育和分化方面发挥着重要的神经保护作用;但目前关于补充维生素D对GDD患儿临床疗效的研究开展较少。目的 探讨补充不同剂量的维生素D对GDD患儿康复治疗的临床效果。方法 于2020年9月—2022年6月选取在郑州大学第三附属医院康复医学科首次住院就诊的120例GDD患儿为研究对象,采用随机区组化的方法将其分为常规组(38例)、400 U组(37例)和1 200 U组(35例)。常规组仅进行常规康复治疗;400 U组在常规康复治疗的基础上给予口服400 U/d维生素D;1 200 U组在常规康复训练的基础上给予口服1 200 U/d维生素D。收集3组患儿的性别、就诊年龄等基本资料;于入院时(治疗前)及第3个疗程末(治疗后)行血清25羟维生素D[25(OH)D]水平检测和Gesell发育量表评估[评估适应能力、大运动能力、精细运动能力、语言能力和社交能力5个能区的发育商(DQ)];记录发生在患儿住院期间不良事件的次数,并对上述资料进行分析比较。结果 3组患儿性别、居住地、出生季节、分娩方式、就诊年龄、出生体质量、出生胎龄、主要就诊原因比较,差异均无统计学意义(P>0.05)。治疗前,3组患儿25(OH)D水平、Gesell量表各能区DQ值比较,差异均无统计学意义(P>0.05);治疗后,1 200 U组患儿血25(OH)D水平、Gesell量表大运动能力、精细运动能力、语言能力DQ值高于常规组(P<0.05)。第1、2疗程期间,3组患儿不良事件发生率比较,差异无统计学意义(P>0.05);第3疗程期间,1 200 U组患儿不良事件发生率低于常规组及400 U组(P<0.05)。结论 补充1 200 U维生素D对GDD患儿的康复疗效有益,且能减少康复期间不良事件的发生率。

鄂尔多斯盆地庆城油田长7页岩油储层多尺度裂缝三维地质建模

页岩油储层普遍发育多尺度天然裂缝,天然裂缝是页岩油储层主要的储集空间和渗流通道,多尺度天然裂缝分布规律制约着页岩油气储层高效开发。本文以鄂尔多斯盆地庆城油田长7页岩油储层为例,结合地表露头、岩心、薄片、测井和地震等资料,在划分多尺度裂缝的基础上,明确了多尺度裂缝的发育特征,形成了多尺度裂缝建模方法,建立了典型区块X井区长71储层多尺度裂缝三维离散网络模型。根据蚂蚁体叠后地震属性明确了大尺度裂缝分布特征,用确定性方法建立了大尺度裂缝地质模型;结合储层地质力学方法和常规测井裂缝解释结果,建立了中、小尺度裂缝发育强度约束体,然后以发育强度约束体为约束,协同中、小尺度裂缝参数,采用随机建模方法分别建立了中、小尺度裂缝地质模型。最终将大、中、小尺度裂缝网络模型融合形成多尺度裂缝网络模型,并建立裂缝等效属性模型。结果表明X井区长71大尺度裂缝发育于该区东北部,中尺度裂缝和小尺度裂缝多发育于该区西部、西南部和东北部大尺度裂缝发育位置。建立的多尺度裂缝模型与单井裂缝发育规律和实际生产动态数据吻合,可为庆城地区X井区页岩油气增储上产提供地质依据。

Safety and effective developing nuclear power to realize green and low-carbon development

This paper analyzes the role of nuclear power of China's energy structure and industry system. Comparing with other renewable energy the nuclear power chain has very low greenhouse gas emission, so it will play more important role in China's low-carbon economy. The paper also discussed the necessity of nuclear power development to achieve emission reduction, energy structure adjustment, nuclear power safety,environmental protection, enhancement of nuclear power technology, nuclear waste treatment, and disposal, as well as nuclear power plant decommissioning. Based on the safety record and situation of the existing power plants in China, the current status of the development of world nuclear power technology, and the features of the independently designed advanced power plants in China, this paper aims to demonstrate the safety of nuclear power. A nuclear power plant will not cause harm either to the environment and nor to the public according to the real data of radioactivity release, which are obtained from an operational nuclear plant. The development of nuclear power technology can enhance the safety of nuclear power. Further, this paper discusses issues related to the nuclear fuel cycle, the treatment, and disposal strategies of nuclear waste, and the decommissioning of a nuclear power plant, all of which are issues of public concern.

Infanib量表和Gesell发育量表在儿童运动发育评估中的一致性研究

目的探讨infant neurological international battery(Infanib)量表和Gesell发育量表在高危儿运动发育评估中的一致性。方法2022年5月至2023年4月,以在本院就诊的132例高危儿为研究对象,同时使用Infanib量表和Gesell发育量表评估其运动发育,通过计算Kappa值判断评估结果的一致性。结果132例中有111例(84.09%)儿童的Infanib量表和Gesell发育量表评估结果一致,均被评估为正常儿的有90例,而均被评估为境界儿(可疑)或发育迟缓的有21例。Infanib量表和Gesell发育量表在大运动发育商方面的一致性为0.57。在<4月龄、4~8月龄和>8月龄儿童中,二者的评估一致性分别为0.62、0.67和0.41。在足月高危儿中,Infanib量表和Gesell发育量表评估结果的一致性为0.61;在早产高危儿中,二者的评估一致性为0.32。结论Infanib量表和Gesell发育量表的评估一致性整体较好,但在>8月龄儿童和早产高危儿中的一致性偏低。建议根据患儿月龄、出生情况有针对性地选取不同量表进行评估,以准确反映儿童运动发育的真实水平。

Development of a Tool for Assessment of Post-Myocardial Infarction Fatigue

Introduction: After treatment for myocardial infarction (MI) quite a few persons will experience different symptoms, including fatigue, during the recovery phase. The aim of the present study was to construct the multidimensional Post-Myocardial Infarction Fatigue (PMIF) scale, based on empirical data gathered in coronary heart disease contexts. Methods: The construction of the post-MI fatigue scale was conducted in seven steps, ending in a psychometric evaluation of the internal structure of the scale, using confirmatory factor analysis, as well as testing of convergent and discriminant validity, using correlational analysis, in a sample of 141 persons treated for MI. Results: The results showed that the PMIF scale represents three dimensions: physical, cognitive and emotional fatigue. It was also found that the scale is suitable for summing the items to obtain a total score representing a post-MI global fatigue dimension. Conclusion: The PMIF is a brief and easily completed scale for identifying persons experiencing post-MI fatigue. Early identification of fatigue, together with health behavior support, might prevent progression toward a more severe state of fatigue.

序贯化发育干预对出生胎龄34周及以前早产儿早期神经运动发育的影响

目的探讨序贯化发育干预计划对出生胎龄≤34周早产儿早期神经运动发育的影响。方法回顾性分析2018年10月至2022年2月在南通大学附属江阴医院新生儿重症监护室(NICU)住院并在该院和江阴市妇幼保健院儿童保健门诊建立健康档案随访至校正6月龄的120例出生胎龄≤34周早产儿的临床资料。根据不同干预方法将其分为观察组(60例)和对照组(60例)。对照组采用常规发育干预:在NICU住院期间采用母乳或早产儿配方奶粉喂养,未进行初乳口腔护理、口腔运动干预、袋鼠护理相关措施,出院后按常规发育规律进行门诊随访指导训练。观察组采用序贯化发育干预:在NICU住院期间采用母乳或早产儿配方奶粉喂养的基础上进行初乳口腔护理、口腔运动干预、袋鼠护理相关措施,出院后复诊时按计划进行全身运动质量评估(GMs)及20项神经运动检查,根据检查结果指导个体化家庭干预。采用0~6岁儿童发育行为评估量表对两组早产儿校正6月龄的发育商结果进行评估。结果两组早产儿出生胎龄、出生体重、出生身长、出生头围,以及性别、宫内发育迟缓、胎膜早破、剖宫产、母亲妊娠期糖尿病、多胎、重度窒息、中重度支气管肺发育不良、颅内出血(Ⅲ~Ⅳ级)、有创机械通气的分布比较差异均无统计学意义(P>0.05)。校正6月龄,观察组早产儿发育商评分明显高于对照组[(79.36±7.12)分vs.(75.96±6.93)分,t=2.647,P<0.05],其中两组的大运动[(86.93±9.06)分vs.(83.67±8.31)分]、精细运动[(80.44±7.46)分vs.(76.63±7.86)分]、适应能力[(76.81±8.39)分vs.(71.95±10.98)分]、社会行为[(76.09±9.01)分vs.(72.68±6.93)分]评分均明显高于对照组(t值分别为2.052、2.725、2.722、2.316,P<0.05),而两组的语言评分比较差异无统计学意义[(77.31±9.50)分vs.(74.84±9.45)分,t=1.423,P>0.05)]。校正6月龄,两组早产儿的体重、身长比较差异均无统计学意义(P>0.05),但观察组头围发育较对照组更好[(42.88±0.74)cm vs.(42.58±0.85)cm,t=2.117,P<0.05]。结论序贯化发育干预有助于促进早产儿早期大运动、精细运动、适应能力及社会行为的发育,对于改善小孕周早产儿神经运动发育预后有重要意义,其在基层医院早产儿儿童保健实施中具有推广意义。

352例婴幼儿神经和心理发育的影响因素分析

目的分析婴幼儿神经心理发育情况及其影响因素,为后续研究提供依据。方法选取2020年1-6月于上海市嘉定区迎园医院儿童保健门诊体检的352名0~36月龄婴幼儿作为研究对象,采用Gesell发育量表测试婴幼儿的智能,比较不同性别和户籍婴幼儿发育商(DQ)和不同月龄下不同性别婴幼儿DQ,采用单因素及多因素Logistic回归分析婴幼儿神经和心理发育的影响因素。结果不同性别、户籍婴幼儿粗动作、细动作、应物能、言语能、应人能DQ值及总DQ值比较差异均无统计学意义。25~30月龄女童粗动作、言语能、应人能DQ值及总DQ值均高于男童,差异有统计学意义(P<0.05),但不同性别细动作、应物能比较差异均无统计学意义;其他月龄不同性别婴幼儿粗动作、细动作、应物能、言语能、应人能DQ值及总DQ值比较差异均无统计学意义。单因素分析结果显示,顺产、母亲孕期精神状况好、使用电子产品的婴幼儿DQ值均高于非顺产、母亲孕期精神状况一般、未使用电子产品的婴幼儿,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,顺产、使用电子产品、母亲孕期精神状况好是婴幼儿神经心理发育的有利因素(P<0.05)。结论婴幼儿不同性别不同户籍各发育能区DQ值和总DQ值无显著差异,需加强关注引导25~30月龄婴幼儿,顺产、母亲孕期精神状态、使用电子产品与婴幼儿智能发育相关,婴幼儿抚育需整个家庭共同配合。

磁共振弥散张力成像在早产儿脑白质损伤及神经发育预后评估中的应用

目的探讨磁共振(MRI)弥散张力成像(DTI)在早产儿脑白质损伤(WMI)及神经发育预后评估中的应用价值。方法选择早产儿149例,均行头部MRI+DTI检查,记录感兴趣区(ROI)各向异性分数(FA)、表观弥散系数(ADC)值,根据检查结果将早产儿分为WMI组40例、nWMI组109例,并按检查时纠正胎龄分为33~34周、35~36周、≥37周,比较WMI组与nWMI组各胎龄FA值、ADC值。39例早产儿在纠正月龄约6个月时用格塞尔(Gesell)发育量表评估发育情况,其中适应性行为发育落后18例、个人-社会行为发育落后16例、大运动行为发育落后21例、精细运动行为发育落后25例、语言行为发育落后19例,Spearman相关法分析FA值、ADC值与Gesell发育量表评分的相关性。结果nWMI组不同纠正胎龄阶段各ROI的FA值均高于WMI组(P均<0.05)。纠正胎龄33~34周,WMI组侧室旁白质、胼胝体膝部白质的ADC值高于nWMI组(P均<0.05);纠正胎龄35~36周,WMI组胼胝体膝部、内囊后肢ADC值高于nWMI组(P均<0.05);纠正胎龄≥37周,WMI组半卵圆中心白质、脑室旁白质、胼胝体膝部及内囊后肢白质ADC值高于nWMI组(P均<0.05)。大运动发育落后早产儿脑室旁白质的ADC值与Gesell发育量表评分呈负相关(r=-0.594,P<0.05),认知行为发育落后早产儿内囊前肢的ADC值与Gesell发育量表评分呈负相关(r=-0.524,P<0.05)。结论DTI检查的内囊前肢、后肢及脑室旁白质FA值可反映早产儿WMI情况,脑室旁白质ADC值可反映其大运动发育情况。