Structural equation modeling analysis of influencing factors of psychological distress in young and middle-aged patients with stroke / 中华行为医学与脑科学杂志

Objective:To explore the influencing factors of psychological distress in middle-aged and young stroke patients to provide evidence for improving the mental health of the patients and guiding clinical psychological nursing interventions.Methods:A cross-sectional survey was conducted on 447 middle-aged and young patients with stroke hospitalized in four hospitals in Tianjin from March 2022 to January 2023.Various assessment scales were employed, including a general data questionnaire, distress thermometer, numerical rating scale, family APGAR index, perceived social support scale, general self-efficacy scale, Herth hope index, self-rating anxiety scale and self-rating depression scale.Statistical analyses were performed using encompassing descriptive statistics, Wilcoxon Mann-Whitney test, Kruskal Wallis test, Spearman correlation analysis, and structural equation modeling of SPSS 25.0 and AMOS 24.0.Results:The psychological distress score of middle-aged and young stroke patients was 1(1, 2). Age( Z=-5.497), marital status( Z=-2.755), number of children( H=25.448), co-residents( H=14.389), occupation( H=34.889), per capita monthly family income( H=19.105), hospitalized caregivers( H=23.794), stroke type( H=23.308), course of disease( H=10.649), number of chronic diseases( H=8.021), daily self-care ability( H=128.439), eating status( H=41.904), physical status( H=49.786), excretion status( H=112.736), dressing ability( H=63.036), nutritional status( H=15.514), organ injury status ( H=23.797)and edema status( Z=-4.307)affected the psychological distress of middle-aged and young stroke patients, and the differences were statistically significant (all P<0.05). Correlation analysis showed that psychological distress were positively correlated with pain(1(1, 1)), anxiety(36(27, 53)) and depression(31(27, 58)) ( r=0.390, 0.525, 0.591, all P<0.001), while were negatively with family caring degree(10(10, 10)), perceptive social support(72(67, 74)), general self-efficacy(35(29, 38)) and hope level(41(36, 45)) ( r=-0.200, -0.464, -0.647, -0.675, all P<0.01). Results of the structural equation model of the influencing factors of psychological distress in middle-aged and young stroke patients showed that a total of 5 common factors were extracted, which were named support system, daily activities, disease condition, general condition and physical burden.Disease condition and physical burden had direct positive effects on psychological distress ( β=0.385, 0.204, both P<0.05). Support system, daily activities and general situation had direct negative effects on psychological distress ( β=-0.332, -0.262, -0.258, all P<0.05). Conclusions:The influencing factors of psychological distress in middle-aged and young stroke patients are disease status, support system, daily activities, general conditions and physical burden, which can provide theoretical basis for nurses to carry out active and effective prevention and nursing intervention on psychological distress in middle-aged and young stroke patients.

Relationship between self-perceived noise intensity and sleep quality in noise-exposed workers—A mediating role of negative emotions / 环境与职业医学

Background Studies on the relationships of environmental noise exposure with negative emotions and sleep quality have long been reported. Self-perceived noise intensity is not only related to environmental noise exposure, but also reflects an individual's susceptibility to noise; however, few studies on self-perceived noise intensity, negative emotions, and sleep quality have been reported, and it is not clear whether negative emotions play a mediating role in the relationship between self-perceived noise intensity and sleep quality. Objective To analyze the mediating role of negative emotions (anxiety, depression, and stress) in the relationship between self-perceived noise intensity and sleep quality in noise-exposed workers, and to provide a scientific basis for addressing psychological problems and sleep quality induced by noise exposure. Methods Stratified cluster sampling was used to select noise-exposed workers from a large equipment manufacturing plant in Chengdu from May to June 2023, and demographic characteristics were investigated using a self-designed general information questionnaire; self-perceived noise intensity was reported by the study subjects as the noise intensity of their workplaces; sleep quality was synthesized from three indicators: night sleep duration, self-perceived sleep quality, and sleep-related symptoms; the Anxiety-Depression-Stress Scale (DASS-21 scale) was used to evaluate anxiety, depression, and stress of a worker. Structural equation modeling was used to analyze the pathways of negative emotions (anxiety, depression, and stress) between self-perceived noise intensity and sleep quality. Results The positive rates of negative emotions were 33.1% (anxiety symptoms, 215/649), 26.0% (depression symptoms, 169/649), and 14.0% (stress symptoms, 91/649), respectively in a total of 649 noise-exposed workers. Self-perceived noise intensity was positively correlated with sleep quality score (r=0.218, P<0.001) and negative emotions (anxiety, depression, and stress) (r=0.167, 0.145, 0.167, P<0.001); sleep quality score was positively correlated with negative emotions (anxiety, depression, and stress) (r=0.512, 0.447, 0.513, P<0.001). The results of path analysis showed that the negative emotions (anxiety, depression, and stress) partially mediated between self-perceived noise intensity and sleep quality (β=0.123，P<0.001). Self-perceived noise intensity was positively correlated with negative emotions and sleep quality, and there was a path of self-perceived noise intensity → negative emotion → sleep quality (P<0.001), and the mediating effect accounted for 42.71%. Conclusion The positive rates of anxiety, depression, and stress are high among the noise-receiving workers in this manufacturing industry, and negative emotions characterized by anxiety, depression, and stress partially mediate the relationship between self-perceived noise intensity and sleep quality.

Current status of hand hygiene practices among primary healthcare workers and its influencing factors / 上海预防医学

ObjectiveTo investigate the current status and influencing factors of hand hygiene practices among primary healthcare workers， and to provide a reference for improving hand hygiene behavior in primary healthcare institutions. MethodsA self-designed questionnaire was used to conduct a survey among medical staff of seven community health service centers in Jiading District， Shanghai， using a cluster random sampling method. The data collected were subjected to descriptive statistics， reliability and validity tests， correlation analysis， and structural equation model fitting. ResultsA statistical difference in hand hygiene compliance was found among medical staff with varying occupational types and educational levels （P<0.05）， and medical staff in clinical departments exhibited higher levels of hand hygiene compliance （P<0.05）. In the health belief model， among the core variables， healthcare workers’ perceived benefits， perceived barriers， and self-efficacy had a direct impact on hand hygiene behavior， with direct effect values of 0.341， -0.152， and 0.234， respectively. Meanwhile， cues to action and perceived severity of COVID-19 infection indirectly affected hand hygiene behavior， with an indirect effect value of 0.066 and 0.062， respectively. ConclusionHealthcare workers generally exhibit a high degree of hand hygiene compliance， but there are variations in hand hygiene scores among healthcare workers with different characteristics. Enhancing healthcare worders’ perception of benefits， action cues， and self-efficacy while reducing perceived barriers can effectively improve their hand hygiene behavior.

Impact of parental efficacy in doctor-patient communication on rehabilitation outcomes for children with autism spectrum disorder / 中国康复理论与实践

ObjectiveTo explore the potential influencing factors and complex pathways affecting rehabilitation effect for children with autism spectrum disorder (ASD) from the perspective of parental efficacy in doctor-patient communication, and to provide evidence for improving the quality of rehabilitation service for children with ASD. MethodsAn anonymous face-to-face questionnaire survey was conducted to collect general demographic information of parents of children with ASD at designated rehabilitation institutions in Gansu province. The data included parental efficacy in doctor-patient communication, parental compliance of treatment and children's rehabilitation outcomes were collected. A structural equation model was used to explore the impact mechanism of parental communication efficacy on the rehabilitation outcomes of children with ASD. ResultsData from 519 parents at 37 rehabilitation institutions across 13 cities/counties in Gansu province were collected. Significant positive correlations were found between parental efficacy in doctor-patient communication, doctor-patient relationships, parental compliance with treatment and rehabilitation outcomes for children with ASD (P < 0.05). Through structural equation model analysis, the standardized direct effect of children with ASD from parents' doctor-patient communication efficacy was 0.151 (P = 0.023). The mediating effect of doctor-patient relationship and parental compliance with treatment were 0.160 (P = 0.001) and 0.111 (P = 0.001), respectively, with a chained mediating effect of 0.035 (P = 0.001). The pathway "parental efficacy in doctor-patient communication → doctor-patient relationship → ASD child's rehabilitation outcome" accounted for the highest proportion of the total mediating effect, at 52.29%. ConclusionParental doctor-patient communication efficacy may positively impact on the rehabilitation outcomes of children with ASD directly, and indirectly through the doctor-patient relationship and parental compliance with treatment. Rehabilitation institutions should focus on fostering parental communication skills and enhancing high-quality and humanized rehabilitation services.

Path analysis of quality of life in stroke patients based on structural equation model / 中华护理杂志

Objective To construct a structural equation model to analyze the effect of various factors on the quality of life in stroke patients.Methods In this cross-sectional study,a total of 657 stroke patients from 2 ter-tiary A hospitals in Shanghai were enrolled as investigation subjects via convenience sampling methodology.General information questionnaire,Sense of Coherence Scale-13,Perceived Social Support Scale,Medical Coping Modes Questionnaire,National Institutes of Health Stroke Scale,Self-Esteem Scale and Stroke-Specific Quality of Life were utilized as the investigating tools;Mplus 7.4 was used to construct a structural equation model.Results The aver age score of quality of life in stroke patients was(178.30±30.30);neurological status,self-esteem were negatively cor-related with quality of life(P＜0.05);sense of coherence,social support,coping style were positively correlated with quality of life(P＜0.05);sense of coherence,taking a confrontational approach for coping,yielding and neurological status had a direct impact on quality of life(path coefficients were 0.471,0.169、0.135,-0.089,P＜0.05);social sup-port,self-esteem,sense of coherence and neurological status had an indirect impact on quality of life(path coefficients were 0.232,0.108,0.058,-0.058,P＜0.001).Conclusion The quality of life in stroke patients is influenced by multi-ple factors interactively,and sense of coherence is an important factor affecting the quality of life;adopting a confron-tational approach as coping styles,good social support and high self-esteem can improve the level of quality of life.

Analysis of the relationship between management capability of general practice team leaders and the team performance in community health service centers based on structural equation model / 中华全科医师杂志

Objective:To analyze the relationship between capacity of general practice team leaders and the team performance in community health service centers.Methods:This study was a cross-sectional study. A questionnaire survey was conducted between November and December 2022, among general practice team leaders and general practitioners (GPs) from 18 community health service centers in the urban and suburban areas of shanghai selected by stratified sampling method. The personal information questionnaire, leadership of general practice team leader questionnaire,and work performance scale of general team members were used for the survey. The relationship between leadership of general practice team leaders and team performance was analyzed based on structural equation model (SEM).Results:A total of 944 questionnaires were distributed and 856 valid ones were returned with a response rate of 91.0%, including 110 general practice team leaders and 749 were GPs. The SEM analysis showed that some dimensions of the management ability of the general practice team leader had significant effect on the employee organization loyalty (organizational management: β=0.37, teaching and research management: β=-0.29, strategy and cultural construction: β=0.23, personal quality: β=0.11) and work performance (special business management: β=0.95, organizational management: β=0.54) (all P<0.05); and employee organization loyalty played a partial mediator role in relationship between leadership of general practice team leaders and work performance with a mediating effect of 39.50%. Conclusion:The management ability of the general practice team leader directly affect or indirectly affect the work performance of team members through team members′ organizational loyalty.

Factors affecting medical device management in COVID-19 pandemic / 中华医院管理杂志

Objective:To explore the factors affecting the management of medical devices in the COVID-19 pandemic, and to provide guidance for the management of medical devices in public health emergencies.Methods:A total of 184 hospitals caring COVID-19 patients in Jiangsu, Zhejiang, Shanghai, Anhui and Shandong were selected, and clinical engineers were randomly sampled. A self-compiled questionnaire was used to conduct an online survey on factors affecting medical device management during the COVID-19 pandemic from August to December 2021.The index system of influencing factors of medical device management during the COVID-19 pandemic was determined through an exploratory factor analysis, and then the structural equation model was used to verify the rationality and scientificity of the index system, while the relative weight method was used to calculate the weight of the index system.Results:277 valid questionnaires were recovered. Through the exploratory factor analysis, an index system of influencing factors of medical device management was established, which consisted of such level-indexes as the human factor, device factor, material factor, method factor, and environment factor, as well as 17 level-2 indexes. The fitness-indexes of the second-order structural equation model were finally fitted as follows: the chi-square to freedom ratio was 2.606, the approximate root mean square error was 0.076, and the value of value-added adaptation index, non-standard adaptation index and comparative adaptation index were 0.921, 0.903 and 0.920, respectively. The weights of the method factor, human factor, device factor, material factor and environment factor of the level-1 indexes were 0.216, 0.191, 0.175, 0.274 and 0.144, respectively. Such factors as manpower, regulations and institutional processes, and information technology ranked top three among the 17 level-2 indexes, which were 0.090, 0.082 and 0.080 respectively.Conclusions:The influencing factor model of medical device management during the COVID-19 pandemic in this study is ideal; human factors and method factors are the influencing factors deserving high priority in medical device management during the COVID-19 pandemic. Ensuring sufficient human resources, improving laws, regulations and processes, as well as enhancing information management level are breakthroughs expected in medical device management.

Research on the driving mechanism of residents′ willingness to participate in tiered medical care based on harmonious management theory / 中华医院管理杂志

Objective:To construct and validate a theoretical model of residents′ willingness to participate in tiered medical care based on harmonious management theory, providing reference for promoting the tiered medical care system and aiding governmental decision-making.Methods:Based on the harmonious management theory and literature review, a model capturing residents′ propensity to engage in tiered medical care was formulated. Using convenience sampling method, a questionnaire survey was conducted on 2 067 residents from 24 communities in Zhejiang province from April to May 2022. Descriptive statistical analysis was conducted on the survey results, and multilevel linear regression and structural equation modeling were used to analyze the driving mechanism of residents′ willingness to participate in tiered medical care.Results:The willingness rate of residents to participate in tiered medical care was 69.7%, which was at an average level. Regression insights highlighted the positive influence of policy support perception ( β=0.170, P<0.01), awareness of management mechanisms ( β=0.093, P<0.01), cognitive attitudes ( β=0.102, P<0.01), and trust levels ( β=0.244, P<0.01) on residents′ participation willingness. In contrast, resource allocation perceptions lacked a significant effect ( β=0.065, P>0.05). The structural equation model revealed that cognitive attitudes played a mediating role in the " policy system perception → participation willingness" and " management mechanism perception → participation willingness" pathways, with effect sizes of 0.030 and 0.039, respectively. Trust levels also mediated these paths, with effect sizes of 0.039 and 0.045, and entirely mediated the " resource allocation perception → participation willingness" path, registering an effect size of 0.053. Conclusions:The harmonious management theory can be used to explain the formation mechanism of residents′ willingness to participate in tiered medical care. The government and medical institutions urgently need to further improve residents′ awareness of tiered medical care, focus on enhancing residents′ trust, and further improve policies and management measures such as financial investment, medical insurance reimbursement, and referral systems.

Study on the Relationship between Five-state Personality and Cattell's 16 Personality Factors Based on Structural Equation Model / 中医杂志

ObjectiveTo explore the relationship between five-state personality and Cattell's 16 personality factors. MethodsA total of 913 students recruited from Beijing University of Chinese Medicine from November 2020 to January 2021 were assessed by using the Five-state Personality Test Form and the 16 Personality Factors Questionnaire （16PF）. The five-state personality scores were compared with national norms and gender differences were examined. Additionally， a structural equation model was established and the model fit was assessed using comparative fit index （CFI）， Tucker-Lewis index （TLI）， and root mean square error of approximation （RMSEA）. The five-state personality （Taiyang， Shaoyang， Yin-yang balance， Shaoyin and Taiyin） was used as individual outcome variables while the 16PF factors was employed as predictor variables. Based on standardized parameter estimation results， we explored the relationships between the five-state personality and 16PF. ResultsA total of 913 students were recruited， and 756 valid samples were obtained after excluding unqualified questionnaires. Among these， the scores of Taiyang， Shaoyang and Taiyin in the 756 school students were significantly lower than the national norms， while the scores of Yin-yang balance was significantly higher （P＜0.05 or P＜0.01）. The scores of Taiyang， Shaoyang， Yin-yang balance and Shaoyin were significantly higher than in males compared to females （P＜0.05 or P＜0.01）. Regarding the relationship between the dimensions of five-state personality and 16PF， the model demonstrated a good fit with CFI and TLI values of 0.993 and 0.980， respectively， and an RMSEA value of 0.027. The 16PF factors， including dominance， social boldness， vigilance， rule-consciousness， tension， and emotional stability， positively predicted the Taiyang personality traits， while privateness and apprehension negatively predicted the Taiyang personality traits （P＜0.05 or P＜0.01）. For Shaoyang personality traits， factors such as liveliness， social boldness， dominance， and tension positively predicted them， while rule-consciousness， apprehension， and privateness negatively predicted Shaoyang perso-nality traits （P＜0.05 or P＜0.01）. In the case of Yin-yang balance personality traits， perfectionism， rule-consciousness， emotional stability， and self-reliance positively predicted them， while apprehension negatively predicted Yin-yang balance personality traits （P＜0.05 or P＜0.01）. Regarding Shaoyin personality traits， perfectionism， emotional stability， self-reliance， rule-consciousness， and vigilance positively predicted them， while dominance， social boldness， and liveliness negatively predicted Shaoyin personality traits （P＜0.01）. Apprehension， tension， vigilance， and self-reliance positively predicted Taiyin personality traits， while social boldness， rule-consciousness， and intelligence negatively predicted Taiyin personality traits （P＜0.05 or P＜0.01）. ConclusionThere is a significant correlation between five-state personality test and 16PF with 16PF factors capable of predicting five-state personality factors. The five-state personality demonstrates scientific validity and effectiveness.

Effect of mental health on tobacco use among adolescents in rural Sichuan： mediation of life satisfaction / 上海预防医学

ObjectiveTo understand the current situation of tobacco use among rural adolescents in Sichuan Province and its influencing factors， to explore the relationship between smoking behavior and psychosocial influencing factors of rural adolescents in Sichuan Province， and to provide a scientific basis for the prevention and control of smoking among rural adolescents. MethodsAn "Adolescent Health Questionnaire" was used as the survey tool to investigate 2 671 students in the 8th and 11th grades of two township middle schools in Zizhong County， Sichuan Province. The structural equation model in Mplus 7.0 was used to analyze the relationship between adolescent tobacco use behavior， mental health， and life satisfaction. ResultsAmong the surveyed adolescents， 28.3% （756/2 671） had tried tobacco products， and 9.5% （255/2 671） had used tobacco products in the past 30 days. The prevalence of tobacco use was higher among boys （16.6%） than girls （3.5%）， and among 11th grade students （21.9%） compared to 8th grade students （7.3%）， with statistically significant differences （χ2=131.99 and 4.24， both P<0.05）. The current tobacco use rate increased with the increase in monthly allowance （χ2=46.96， P<0.05）. The structural equation model of smoking behavior showed that mental health had a positive and direct impact on smoking behavior， and an indirect impact on smoking behavior through living environment satisfaction. Living environment satisfaction had a negative and direct impact on smoking behavior with the mediating effect accounting for 19.2% of the total effect. The non-standardized mediating effect of mental health on smoking behavior through life environment satisfaction and its 95%CI were 0.007 （0.002‒0.012）. ConclusionAdolescent smoking behavior is a complex psychosocial behavior， and the situation of adolescent tobacco use in rural areas in Sichuan is severe. There is a correlation between adolescent tobacco use behavior and psychosocial influencing factors. Psychosocial influencing factors can predict adolescents’ tobacco use behavior. Attention should be paid to the important role of psychosocial influencing factors when intervening in rural adolescents’ smoking behavior.

Structural equation model analysis of substance addiction, T lymphocyte subsets and depression in methamphetamine withdrawal patients / 中华行为医学与脑科学杂志

Objective:To investigate the relationship between substance addiction, T lymphocytes and depression in methamphetamine (MA) withdrawal patients.Methods:A total of 105 men who met the inclusion criteria were selected from compulsory isolation drug rehabilitation center of Baini lake, Hunan Province.All participants were suveyed by desires for drug questionnaire(DDQ) and self-rating depression scale (SDS), and the function of T lymphocyte subsets were detected by flow cytometry.All data were managed and analyzed using the SPSS 21.0 and AMOS 21.0 statistical software packages.Results:(1) The respondents were mainly junior high school or below (81.9%), unmarried and divorced (67.6%), unemployed (55.2%), hot suction (47.6%), and careless friends (32.4%), and 67.7% of MA abstinence had depressive symptoms. (2) SDS was positively correlated with desire and intention(DI), negative reinforcement (NR) and CD8+ %( r=0.408-0.897, all P<0.01), while negatively correlated with medication control, CD3+ %, CD4+ %, and CD4+ /CD8+ ( r=-0.792--0.263, all P<0.01). DI had significant positive correlation with CD8 + %( r=0.216, P<0.05), and negative correlation with CD4+ /CD8+ ( r=-0.217, P<0.05). NR had significant positive correlation with CD8 + %( r=0.259, P<0.05), and had significant negative correlations with CD3+ %, CD4+ %, and CD4+ /CD8+ ( r=-0.275-0.200, all P<0.05). Medication cotrol had a significant negative correlation with CD8+ %( r=-0.363, P<0.05), and significant positive correlations with CD4+ % and CD4+ /CD8+ ( r=0.288, 0.261, both P<0.05). (3)The model fitting index showed that DI, NR and medication control had significant direct effects on T lymphocyte subsets (all P<0.05). DI, medication control and T lymphocyte subsets had significant direct effects on self-evaluation of depressive symptoms (all P<0.05). NR, DI and medication control indirectly affected depressive symptoms through T lymphocyte subsets (all P<0.05). There were three path relationships: ① DI indirectly affected SDS via T lymphocyte subsets; ② Medication control indirectly affected SDS via T lymphocyte subsets; ③ NR indirectly affected SDS via T lymphocyte subsets. Conclusion:The structural equation model suggests that the degree of addiction in MA abstinence affecting depressive mood may be related to hypofunctional T lymphocyte subsets and provide methods for the prevention and treatment of drug addiction.

Influencing factors of community hospice care service needs of the elderly based on structural equation model / 中华健康管理学杂志

Objective:To analyze the influencing factors of community hospice care service needs of the elderly based on structural equation model.Methods:A multi-stage sampling method was used to survey 564 elderly people from 40 community health service centers in four districts of Chaoyang District in Beijing from September to November 2020 with a self-designed questionnaire. The survey content included three dimensions: tendency characteristics (population characteristics, health beliefs), enabling resources and demand factors. The chi-square test and rank sum test were used to analyze the influencing factors of the community hospice care needs of the elderly. At the same time, based on Anderson theory, structural equation model was used to analyze the action path and effect size of the influencing factors.Results:Registered residence, occupation, understanding of community elderly care services, recognition of community medical convenience, recognition of community health services in reducing family burden, recognition of community health services in improving their own health, understanding of community hospice care services, mean monthly income of their families, degree of income satisfaction, self-paid medical expenses of the previous year, living status, acceptance of community medical expenses, satisfaction with the number of community medical staff, self-assessment of health status, whether the elderly was ill in the last two weeks and the number of chronic diseases and etc affected the needs of the elderly for community hospice care services (all P<0.05). In the three dimensions of Anderson model, enabling resources had a direct effect, and could also be affected by demand factors indirectly, the total effect value was 0.404; demand factors had direct impact, and the effect value was 0.193; propensity characteristics exerted impact indirectly through enabling resources and demand factors, and the total effect value was 0.176. Among them, the acceptance of community health service fees in the enabling resource dimension has the greatest impact (FL=0.535), the number of chronic disease in the demand factor dimension had the greatest impact (FL=1.018), and the recognition of community health service in reducing family burden in the propensity characteristic dimension had the greatest impact (FL=0.612) (all P<0.05). Conclusions:There are various factors and action paths that affect the needs of community hospice care services for the elderly. Among them, the acceptance of community health service fees, the number of chronic disease, and the recognition of community health service in reducing family burden have a greater impact.

Mediating role of resilience in relationship between occupational stress and depression of staff of centers for disease control and prevention / 环境与职业医学

Background Since the outbreak of the COVID-19 epidemic, staff of the centers for disease control and prevention (CDC) have been burdened with heavy epidemic prevention control, and excessive occupational stress can cause depression and other psychological problems. Objective To explore the status of occupational stress, resilience, and depression of CDC staff and potential relationships between them. Methods From December 2020 to April 2021, a survey was conducted at provincial and municipal levels, and the stratified cluster sampling method was used at county (district) level to select a total of 3514 samples. Their occupational stress, resilience, and depression status were evaluated using the Chinese Effort-Reward Imbalance Scale (ERI), the Chinese Connor-Davidson Resilience Scale (CD-RISC), and the Patient Health Questionnaire (PHQ-9). Independent sample t test, analysis of variance, χ2 test, Pearson correlation analysis, and mediation test (structural equation model) were conducted. Results The positive rate of occupational stress was 34.29% in the CDC staff, the resilience score was 66.28±15.32, and the positive rate of depression was 48.58%. Significant differences were found in the positive rates of occupational stress among different groups of gender, age, education background, marital status, administrative duty, weekly exercise frequency, chronic disease prevalence, and participation in epidemic control (P<0.05); in the resilience scores among different groups of gender, age, administrative duty, weekly exercise frequency, chronic disease prevalence, and participation in epidemic control (P<0.05); in the positive rates of depression among different groups of gender, age, educational background, personal monthly income, weekly exercise frequency, chronic disease prevalence, and participation in epidemic control (P<0.05). Occupational stress was negatively correlated with resilience (r=−0.165, P<0.01). Resilience was negatively correlated with depression (r=−0.383, P<0.01). Occupational stress was positively correlated with depression (r=0.343, P<0.01). The structural equation embracing a partial mediating effect of resilience on the relationship occupational stress and depression was established, and the partial mediating effect was 0.039, accounting for 10.46% of the total effect. Conclusion High positive rates of occupational stress, reduced resilience, and depression are shown among CDC staff in the context of the COVID-19 epidemic, and resilience partially mediates the effect of occupational stress on depression. The study findings suggest that improving resilience may reduce occupational stress and depression in CDC staff.

Analysis of influencing factors of quality of life of patients with pneumoconiosis in Chongqing based on a structural equation model / 中国职业医学

@#Objective To analyze the influencing factors of quality of life of patients with occupational pneumoconiosis in Methods Chongqing using a structural equation model. A total of 1 181 pneumoconiosis patients in Chongqing were selected - as the research subjects using convenient sampling method. The Chinese version of the SF 36 Scale was used to investigate the quality of life of the patients. Amos 24.0 software was used to construct a structural equation model reflecting the quality of life of Results ， （ ），（ ） （ ）， patients. The scores of physical health mental health and quality of life were 61.7±18.5 68.7±20.5 and 64.7±16.8 respectively. The scores of the eight dimensions of the quality of life of the research subjects were lower than that of the （ P ） Chongqing City municipal and national norms all <0.01 . Multiple linear regression results showed that personal monthly ， ， ， income pneumoconiosis stage complications employment status and smoking were the influencing factors of the quality of life （ P ） ， of pneumoconiosis patients all <0.05 . The results of the structural equation model showed that the stage of pneumoconiosis ， ， complications personal monthly income and pulmonary rehabilitation treatment could directly affect the physical and mental （ P ） ， health of the research subjects all <0.05 . In addition the stage of pneumoconiosis and complications indirectly affected the （ P ）Conclusion physical and mental health of patients by affecting pulmonary rehabilitation treatment all <0.05 . The structural equation model can be used to verify the influencing factors of the quality of life of patients with occupational pneumoconiosis. ， Complications personal monthly income and pneumoconiosis stage are the main factors affecting the quality of life of patients with occupational pneumoconiosis.

Reliability and validity of the solitude behavior scale for short version / 中华行为医学与脑科学杂志

Objective:To develop a suitable solitude behavior scale for short version(SBS-S).Methods:A total of 2 484 valid data were collected from college students in Tianjin city and Shandong province.Based on the exploratory structural equation model(ESEM) and generalized partial credit model(GPCM) of item response theory, the SBS-S was developed.A total of 100 college students in Guizhou province were tested twice at intervals of two months to calculate the test-retest reliability of the SBS-S.R language Mplus 8.0 and SPSS 24.0 software were used for the data analysis.Results:According to the results of ESEM and GPCM model, 18 items were deleted. After deleting the above questions, 16 items (four items under each dimension) and four dimensions(positive solitude, eccentricity, social avoidance and loneliness) were retained. The coefficient of Cronbach's α was above 0.75. The results of confirmatory factor analysis showed that the structure model of the SBS-S was fitting well, and the index was ( χ2/ df=4.74, TLI=0.92, CFI= 0.95, SRMR =0.05, RMSEA=0.06). According to the results of SPSS, the test-retest reliability was above 0.60.Big-five persondlity, social support and self-esteem were regarded as criterion related validity. The results showed that positive solitude had positive correlations with extraversion, conscientiousness, agreeableness, openness and self-esteem( r=0.07, 0.25, 0.15, 0.26, 0.09, all P<0.05). Eccentricity and social avoidance had negative correlations with extraversion, conscientiousness, agreeableness, social support and self-esteem( r=-0.25, -0.22, -0.45, -0.16, -0.36, all P<0.05; r=-0.26, -0.09, -0.06, -0.18, -0.36, all P<0.05), and had positive correlations with neuroticism( r=0.25, 0.32, both P<0.05). Loneliness had negative relation with extraversion, conscientiousness, agreeableness and self-esteem( r=-0.08, -0.11, -0.08, -0.33, all P<0.05), and had positive correlations with neuroticism( r=0.33, P<0.05). Conclusion:The SBS-S has good psychometric characteristics and can be used to evaluate the solitude behavior of individuals.

Analysis of influencing factors of hyperlipidemia in areas of Ningxia based on structural equation model / 公共卫生与预防医学

Objective To explore the influencing factors of hyperlipidemia in 18-80 years old in Ningxia by structural equation model, and to analyze the direct and indirect effects of influencing factors of hyperlipidemia, so as to provide a basis for the formulation of prevention and treatment measures. Methods A total of 925 patients with hyperlipidemia from a chronic disease survey in 4 counties of Ningxia in April 2017 were selected as the case group (n=925), and residents without hyperlipidemia matched by sex and age were selected as the control group (n=925). A self-designed questionnaire was used to investigate the two groups of subjects. SPSS 22.0 software was used to conduct single factor T or Z test or χ2 test for the possible influencing factors of hyperlipidemia, and Amos22.0 was used to construct structural equation model. Results The structural equation model showed that physiological condition had the greatest effect on hyperlipidemia, and the standardized regression coefficient was -0.351. The second was the monitoring of three key blood indicators (three-high indicators), and the total effect value was 0.082, while personal condition and dietary status had no direct influence on the prevalence of hyperlipidemia. Conclusion Physiological status is the most important factor affecting the prevalence of hyperlipidemia in 18 ~ 80 years old in Ningxia, followed by the monitoring of the three-high indicators. In the future, residents should be encouraged to strengthen health management, especially people with overweight, high uric acid, high blood glucose and hypertension, to control the level of blood lipids and reduce the incidence of hyperlipidemia.

Exploration of the relationship between sleep quality and negative life events and coping styles in adolescents based on structural equation model / 四川精神卫生

ObjectiveTo explore the correlation of sleep quality with negative life events and coping styles in adolescents based on structural equation modeling， and to provide references for improving the adolescents' sleep quality. MethodsFrom December 2021 to May 2022， a total of 767 junior middle school students from three schools in Chongqing were enrolled， and assessed using Pittsburgh Sleep Quality Index （PSQI）， Adolescent Self-rating Life Events Checklist （ASLEC） and Simplified Coping Style Questionnaire （SCSQ）. Then the structural equation model was applied to discuss the correlation of sleep quality with negative life events and coping styles in adolescents. ResultsA total of 222 adolescents （28.94%） were found to have sleep disorders. PSQI score was positively correlated with ASLEC score and negative coping dimension score of SCSQ （r=0.612， 0.590， P<0.01）， and negatively correlated with positive coping dimension score of SCSQ （r=-0.435， P<0.01）. The structural equation model of the relationship between negative life events， coping styles and sleep quality denoted that negative life events exhibited both direct and indirect positive effects on sleep quality （β=0.448， 0.322， P<0.05）， positive coping style had direct negative effects on sleep quality （β=-0.368， P<0.05）， and negative coping style had direct positive effects on sleep quality （β=0.442， P<0.05）. ConclusionNegative life events and negative coping style cause adverse effects on adolescents' sleep quality， while positive coping style exerts positive effects on adolescents' sleep quality.

Conocimientos sobre tabaco y sus riesgos a la salud en Costa Rica: un análisis estructural / Knowledge about tobacco and its health risks in Costa Rica: structural analysis

Resumen Objetivo: Identificar factores asociados al conocimiento sobre el tabaco y los riesgos de su consumo basados en la "Encuesta global de tabaquismo en adultos" realizada en Costa Rica durante el 2015. Métodos: Estudio epidemiológico, observacional de tipo transversal con representación nacional (n = 8 607). Con la base de datos de la "Encuesta global de tabaquismo en adultos", se diseñó un modelo de ecuaciones estructurales y se construyó la variable latente: conocimientos. Como determinantes del conocimiento se usaron las variables: sociodemográficas, económicas, fumado, cesación, exposición a la publicidad y a la información sobre los peligros de fumar incluidas en la encuesta. Resultados: El conocimiento sobre el tabaco y los riesgos del consumo aumentó con la edad, fue superior en hombres y en zonas urbanas. Los fumadores tuvieron menos conocimientos sobre el fumado pasivo y más sobre enfermedades. Conclusiones: La Encuesta global de tabaquismo en adultos permitió medir el nivel de conocimiento sobre los riesgos asociados al tabaco y estudiar sus determinantes socioeconómicos.

Abstract Objective: To identify tobacco knowledge and consumption risk determinants based on the Global Adult Tobacco Survey carried out in Costa Rica in 2015. Methods: Cross-sectional study using a multi-stage cluster sample, nationally representative of Costa Rica (n = 8 607). A structural equation model was conducted. A latent endogenous (dependent) variable called knowledge was constructed. Exogenous (independent) observed variables were: sociodemographic factors, household wealth, prior smoking, cessation attempt, exposure to advertising and to information on the dangers of smoking included in Global Adult Tobacco Survey. Results: Knowledge about tobacco and the risks of consumption increased with age, it was higher in men and in urban areas. Smokers had less knowledge about passive smoking and more about diseases. Conclusions: Global Adult Tobacco Survey allowed to measure the level of knowledge about the risks associated with tobacco and study its socioeconomic determinants.

Study on the Medication Compliance of Children with Tic Disorder Based on the Theory of Protective Motivation / 中国药房

OBJECTIVE：To study the current status and influencing factors of medication compliance in children with tic disorder（TD），and to provide reference for improving medication compliance in TD children. METHODS：The questionnaire was designed according to the protection motivation theory. The cross-sectional study was adopted to conduct questionnaire survey among TD children in West China Second Hospital of Sichuan University from Jan. 2018 to Dec. 2019. The structural equation model was established according to the theoretical assumptions，and the maximum likelihood method was used to estimate the model；multiple linear regression analysis was carried out for the factors with significant influence in the single factor analysis，and path analysis and intermediary effect test were carried out. RESULTS：A total of 317 patients with TD were included，the mean age was（8.38±2.54）years，and the mean course of disease was（3.19±2.46）years. Average medication compliance scores was （5.70±1.69），among which 15.1％ was low compliance，37.5％ moderate compliance，and 47.3％ high compliance. Multivariate linear regression analysis showed that comorbidities（β＝0.124，SE＝0.167，P＝0.011），education level of the main guardian（β＝ 0.236，SE＝0.110，P＜0.001），quality of life（β＝0.399，SE＝0.112，P＜0.001）and the types of drugs taken（β＝0.166，SE＝ 0.047，P＝0.001）were the factors affecting medication compliance of children with TD. Structural equation model analysis showed that severity（β＝0.295，95％CI：0.103-0.493），external return（β＝0.830，95％CI：0.662-1.002），self-efficacy（β＝0.200，95％CI： 0.057-0.353），susceptibility（β＝0.220，95％CI：0.084-0.352）and quality of life（β＝0.353，95％CI：0.211-0.500）had a direct positive impact on medication compliance. Quality of life mediated between external returns and compliance variables（intermediary effect accounted for 13.9％ of the total effect value）. CONCLUSIONS：Children with TD have low medication compliance. It is recommended that pediatricians in medical institutions at all levels to manage the medication compliance of patients with TD from the severity，susceptibility，external returns and self-efficacy，so as to improve patients and guardians’awareness of the severity and susceptibility of disease and medication non-adherence，weaken external returns and increase self-efficacy，and ultimately improve medication compliance of patients

Impact of health literacy on patient experience of outpatients in China and its mechanism / 北京大学学报(医学版)

OBJECTIVE@#To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism.@*METHODS@#The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience.@*RESULTS@#A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P < 0.001), also indirectly affected by health literacy (β=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173.@*CONCLUSION@#The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.