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Latent structure of irritable bowel syndrome symptom severity

World Journal of Gastroenterology 2015年第1期21卷 292-300页

作者： Fabian Jasper Boris Egloff Andrea roalfe Michael Witthft Department of Psychological Diagnostics University of Salzburg5020 SalzburgAustria Department of Personality Psychology and Diagnostics University of Mainz55099 MainzGermany Primary Care Clinical Sciences University of BirminghamEdgbastonBirmingham B15 2TTUnited Kingdom Department of Health Psychology University of Mannheim68161 MannheimGermany

AIM: To investigate the latent structure of an irritable bowel syndrome(IBS) symptom severity scale in a population of healthy ***: The Birmingham IBS symptom questionnaire which consists of three symptom specific scales(diarrhea,constipation,pain) was evaluated by meansof structural equation *** compared the original 3-factor solution to a general factor model and a bifactor solution in a large internet sample of college students(n = 875).Statistical comparisons of competing models were conducted by means of χ2 difference *** the evaluation of model fit,we examined the comparative fit index(CFI) and the Root Mean Square Error of Approximation(RMSEA).RESULTS: Results clearly favored a bifactor model of IBS symptom severity(CFI = 0.99,RMSEA = 0.05) which consisted of a strong general IBS somatization factor and three symptom specific factors(diarrhea,constipation,pain) based on the subscales of the Birmingham IBS symptom *** fit indices of the competing one factor model(CFI = 0.85,RMSEA = 0.17) and three factor model(CFI = 0.97,RMSEA = 0.08) were clearly inferior.χ2 difference tests showed that the differences between the models were indeed significant in favor of the bifactor model(P < 0.001).Correlations of the four latent factors with measures of pain sensitivity,somatoform dissociation,fatigue severity,and demographic variables support the validity of our bifactor model of IBS specific symptom ***: The findings suggest that IBS symptom severity might best be understood as a continuous and multidimensional construct which can be reliably and validly assessed with the B-IBS.

关键词： Irritable bowel syndrome Bifactor Gastrointestinal

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高血压的目标和自我监测:随机对照试验和成本效益分析

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世界核心医学期刊文摘(心脏病学分册) 2006年第2期 17-18页

作者： McManus R .J. Mant J. roalfe a. 王亭忠 Department of Primary Care and General Practice University of Birmingham Birmingham B15 2TT United Kingdom

Objectives: To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs. Design: Randomised controlled trial. Setting: Eight general practices in south Birmingham. Participants: 441 people receiving treatment in primary care for hypertension but not controlled below the target of< 140/85 mm Hg. Interventions: Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care(blood pressure monitoring by their practice). Main outcome measures: Primary outcome: change in systolic blood pressure at six months and one year in both intervention and control groups. Secondary outcomes: change in health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences of method of blood pressure monitoring, and costs. Results: 400(91% ) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months(mean difference 4.3 mm Hg(95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year(mean difference 2.7 mm Hg(-1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls(as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care(￡ 251(＄ 437; 364)(95% confidence interval ￡ 233 to ￡ 275) versus ￡ 240(￡ 217 to ￡ 263

关键词：自我监测高血压随机对照试验

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非溃疡性消化不良的HP根除治疗(摘要)

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循证医学 2003年第2期3卷 120-121页

作者： Moayyedi P Soo S Deeks J Delaney B Harris A Innes M Oakes R Wilson S roalfe a Bennett C Forman D 郭云蔚

1 背景幽门螺杆菌(helicobacter pylori,HP)是消化性溃疡的主要病因,而HP在非溃疡性消化不良的作用机制尚未完全明确。2 目的评估HP根除治疗对非溃疡性消化不良患者消化不良症状和生活质量分数的影响。

关键词：非溃疡性消化不良 HP根除治疗幽门螺杆菌感染安慰剂

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N-末端proBNP分析在典型高危人群中诊断左心室收缩功能障碍的可靠性

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世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 19-19页

作者： Hobbs F.D.R. Davis R.C. roalfe a.K. 张明娟 Dept. of Prim. Care and Gen. Pract. Prim. Care Clin. Sciences Building University of Birming ham Birmingham B15 2TT United KingdomProf.

Objective: To determine the performance of a new NT-proBNP assay in co mpariso n with brain natriuretic peptide (BNP)-in identifying left ventricular systolic dysfunction (LVSD) in randomly selected community populations. Methods: Blood s amples were taken prospectively in the community from 591 randomly sampled indiv iduals over the age of 45 years, stratified for age and socioeconomic status and divided into four cohorts (general population; clinically diagnosed heart failu re; patients on diuretics; and patients deemed at high risk of heart failure). D efinite heart failure (left ventricular ejection fraction (LVEF)40 pmol/l had 80 %sensitivity, 73%specificity, 5%positive predictive value (PPV), 100%negativ e predictive value (NPV), and an area under the receiver-operator characteristi c curve (AUC) of 76%(95%confidence interval (CI) 46%to 100%). For BNP to dia gnose LVSD, a cut off level of >33 pmol/l had 80%sensitivity, 88%specificity, 10%PPV, 100%NPV, and AUC of 88%(95%CI 75%to 100%). Similar NPVs were found for patients randomly screened from the three other populations. Conclusions: B oth NT-proBNP and BNP have value in diagnosing LVSD in a community setting, wit h similar sensitivities and specificities. Using a high cut off for positivity w ill confirm the diagnosis of LVSD but will miss cases. At lower cut off values, positive results will require cardiac imaging to confirm LVSD.

关键词：左心室收缩功能 N-末端proBNP 高危人群脑钠素利尿治疗临床诊断采集血样阴性预测值阳性预测值实验室分析

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高血压的治疗目标和自我监测:随机对照试验和费用效益分析

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英国医学杂志中文版 2005年第6期8卷 382-382页

作者： R J McManus J Mant A roalfe R A Oakes S Bryan H M Pattison F D R Hobbs 杜昕

目的：评价在初级保健中，让高血压患者自己掌握降压治疗目标并进行自我监测是否会改善患者的血压控制，同时评价这一干预措施对患者的保健方式、焦虑情绪、降压药物应用和治疗费用的影响以及患者愿意选择的治疗方式。设计：随机对照临... 详细信息

目的：评价在初级保健中，让高血压患者自己掌握降压治疗目标并进行自我监测是否会改善患者的血压控制，同时评价这一干预措施对患者的保健方式、焦虑情绪、降压药物应用和治疗费用的影响以及患者愿意选择的治疗方式。设计：随机对照临床试验。背景：英国伯明翰南部的8个全科医生诊所。参加者：441例在初级保健中接受治疗，但血压水平尚未控制在140/85 mmHg以下的高血压患者。干预：干预组患者自己掌握降压治疗目标，有测量血压的工具，如患者的血压水平多次高于目标值，他们可以去请教全科医生或护士。对照组患者接受常规治疗(血压监测由医生完成)。主要的观察指标：初级终点：6个月和1年后干预组和对照组收缩压的变化。次级终点：健康生活方式的改变、焦虑情绪、降压药物的应用、治疗费用以及患者愿意采用哪种血压监测方式。结果：400例患者(91%)完成了1年的随访。在入选6个月后，干预组收缩压显著降低，平均相差4.3 mmHg(95%可信区间0.8 mmHg ～ 7.9 mmHg)，但1年后，两组间的差别消失，平均相差2.7 mmHg(-1.2 mmHg ～ 6.6 mmHg)。舒张压水平、焦虑、健康生活方式和服用降压药物数在两组间没有显著差别。干预组患者体重下降高于对照组(体重指数下降)，就诊的次数低于对照组。干预组患者的治疗费用并不显著高于对照组[干预组251英镑，合437美元或364欧元(95%可信区间233～275英镑)对240英镑(217～263英镑)]。结论：进行血压自我监测的患者在6个月后血压轻度降低，并达到了显著性差异，但血压降低持续的时间不到1年。自我监测血压可以被患者很好的接受，这样做不会加重患者的焦虑情绪，也不会显著增加患者的治疗费用。让患者自己监测血压是可行的，血压控制水平与接受常规血压监测者相当。

关键词：高血压患者治疗目标费用效益分析随机对照试验自我监测初级保健血压控制保健方式干预措施焦虑情绪

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