Yipeng Lv

Post-traumatic psychological changes among survivors of the Lushan earthquake living in the most affected areas

The primary objective of our study was to investigate both the negative and positive psychological changes following the Lushan earthquake, and to explore the factors associated with psychological changes. Multi-stage random sampling was used to select respondents from Lushan County, Sichuan Province, China. A simplified Chinese version of the short form of Changes in Outlook Questionnaire (CiOQ-S) was used to assess psychological changes in earthquake survivors. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. A total of 4972 respondents were investigated in the cross-sectional study. The mean scores of the positive and negative psychological changes were 26.61 and 8.12, respectively. The factors associated with positive psychological changes included ethnic minority, high level of education, high household income, not injured in the earthquake, not trapped during the earthquake, and having experienced the Wenchuan earthquake. The factors associated with negative psychological changes included female gender, ethnic minority, low household income, history of diseases, injured during the earthquake, and trapped during the earthquake. The current analysis helps expand our knowledge of the negative and positive psychological changes that may occur following an earthquake experience.

Medical Efforts and Injury Patterns of Military Hospital Patients Following the 2013 Lushan Earthquake in China: A Retrospective Study

The aim of this paper is to investigate medical efforts and injury profiles of victims of the Lushan earthquake admitted to three military hospitals. This study retrospectively investigated the clinical records of 266 admitted patients evacuated from the Lushan earthquake area. The 2005 version of the Abbreviated Injury Scale (AIS-2005) was used to identify the severity of each injury. Patient demographic data, complaints, diagnoses, injury types, prognosis, means of transportation, and cause of injury were all reviewed individually. The statistical analysis of the study was conducted primarily using descriptive statistics. Of the 266 patients, 213 (80.1%) were admitted in the first two days. A total of 521 injury diagnoses were recorded in 266 patients. Earthquake-related injuries were primarily caused by buildings collapsing (38.4%) and victims being struck by objects (33.8%); the most frequently injured anatomic sites were the lower extremities and pelvis (34.2%) and surface area of the body (17.9%). Fracture (41.5%) was the most frequent injury, followed by soft tissue injury (27.5%), but crush syndrome was relatively low (1.2%) due to the special housing structures in the Lushan area. The most commonly used procedure was suture and dressings (33.7%), followed by open reduction and internal fixation (21.9%).The results of this study help formulate recommendations to improve future disaster relief and emergency planning in remote, isolated, and rural regions of developing countries.

Analysis of Factors Influencing Inpatient and Outpatient Satisfaction with the Chinese Military Health Service

Background Relatively few articles have focused on exploring factors influencing soldiers’ overall satisfaction and differences between inpatients’ and outpatients’ satisfaction, particularly in the Chinese army. Elucidating factors influencing military inpatient and outpatient care separately and analyzing their differences may provide more information for the healthsystem. Methods The Revised China National Health Service Survey questionnaire was used in the survey. The questionnaire included 5 sections and 32 items concerning demographic, inpatient, and outpatient characteristics and perception variables for both inpatients and outpatients. Bivariate and multivariate techniques were used to reveal relationships between satisfaction and the variables assessed. Results Outpatients’ and inpatients’ overall satisfaction rates were 19.0% and 18.5%, respectively. The strongest determinant of outpatients’ satisfaction was satisfaction with doctor’s communication regarding therapeutic regimen followed by length of military service, level of trust in medical staff, and disease severity. Determinants of inpatients’ satisfactionincludedstaff categories, satisfaction with environment, and satisfaction with medical quality. Conclusion The factors influencing military outpatients’ satisfaction differed from those of inpatients. Exploring the causes of satisfaction and dissatisfaction with military health institutions is important in their fulfillment of their responsibility to maintain soldiers’ health.

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.

Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model

Objectives Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. Methods This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Results Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. Conclusion The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

Pattern and spectrum of tornado injury and its geographical information system distribution in Yancheng, China: a cross-sectional study

Objectives Few studies of tornado injuries have considered differences related to damage levels and Enhanced-Fujita (EF) scale ratings. This study aimed to evaluate the pattern, spectrum and geographical distribution of injuries related to the Yancheng tornado and provide guidelines for effective emergency medical strategies. Setting The study was conducted at three hospitals which treated patients with injuries related to the tornado in Yancheng, China. Participants We obtained the records of 451 patients with tornado-related injuries. Of these, 401 valid trauma medical records were included; 50 other records were excluded for insufficient information. Informed consent was obtained from all patients by telephone. Main outcome measures We analysed patients’ injury sites and types and used the abbreviated injury scale (AIS) to standardise injury severity. Geographical information system and non-parametric tests were used to analyse the effects of geographical factors on casualties. Results Women, middle-aged/elderly individuals (age>45 years) and children/adolescents (<18 years) accounted for 51.62%, 77.30% and 12.47% of injured patients, respectively. This caused a dumbbell-shaped age distribution. Head (46.63%), body surface (39.90%) and lower-limb (29.43%) injuries were common, as were soft-tissue injuries (90.77%), fractures (38.90%) and organ damage (19.70%). Minor injuries (AIS=1) were common (60.85%), whereas critical/fatal injuries (AIS≥5) were very rare (2.50%). Although the densities of injury varied among damage levels and EF ratings for different areas, area-wise differences in injury severity (AIS scores) were not significant (p>0.05). Conclusion We recommend the use of helmets to prevent head injuries caused by tornadoes and suggest prioritising the treatment of high-risk head and multiple-organ injuries. Additionally, medical rescuers should follow the ‘same quality and different quantity’ principle: the injured in all affected areas should receive equal attention, but numbers of medical personnel should be allocated based on the level of effects from the tornado.

Comparison of influencing factors on outcomes of single and multiple road traffic injuries: A regional study in Shanghai, China (2011-2014)

Introduction To identify key intervention factors and reduce road traffic injury (RTI)-associated mortality, this study compared outcomes and influencing factors of single and multiple road traffic injuries (RTIs) in Shanghai. Methods Based on the design of National Trauma Data Bank, this study collected demographic, injury, and outcome data from RTI patients treated at the four largest trauma centers in Shanghai from January 2011 to January 2015. Data were analyzed with descriptive statistics, univariate analysis, and hierarchical logistic regression analysis. Results Among 2397 participants, 59.4% had a single injury, and 40.6% had multiple injuries. Most patients’ outcome was cure or improvement. For single-RTI patients, length of stay, body region, central nervous system injury, acute renal failure, multiple organ dysfunction syndrome, bacterial infection, and coma were significantly related to outcome. For multiple-RTI patients, age, admission pathway, prehospital time, length of stay, number of body regions, body region, injury condition, injury severity score, and coma were significantly related to outcome. Conclusions Emergency rescue in road traffic accidents should focus on high-risk groups (the elderly), high-incidence body regions (head, thorax, pelvis) and number of injuries, injury condition (central nervous system injury, coma, complications, admission pathway), injury severity (critically injured patients), and time factors (particularly prehospital time).

Investigating Lushan Earthquake Victims’ Individual Behavior Response and Rescue Organization

Research concerning the impact of earthquake victims’ individual behavior and its association with earthquake-related injuries is lacking. This study examined this relationship along with effectiveness of earthquake rescue measures. The six most severely destroyed townships during the Lushan earthquake were examined; 28 villages and three earthquake victims’ settlement camp areas were selected as research areas. Inclusion criteria comprised living in Lushan county for a longtime, living in Lushan county during the 2013 Lushan earthquake, and having one’s home destroyed. Earthquake victims with an intellectual disability or communication problems were excluded. The earthquake victims (N (number) = 5165, male = 2396) completed a questionnaire (response rate: 94.7%). Among them, 209 were injured (5.61%). Teachers (p < 0.0001, OR (odds ratios) = 3.33) and medical staff (p = 0.001, OR = 4.35) were more vulnerable to the earthquake than were farmers. Individual behavior was directly related to injuries, such as the first reaction after earthquake and fear. There is an obvious connection between earthquake-related injury and individual behavior characteristics. It is strongly suggested that victims receive mental health support from medical practitioners and the government to minimize negative effects. The initial reaction after an earthquake also played a vital role in victims’ trauma; therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help played key roles in emergency, medical rescue efforts.

Study on the Health Status and Health Service Utilization of the Elderly of a Remote and Poor Village in a Mountainous Area in Jinzhai, Anhui

Background: Despite the rapid development of China’s economy, a number of poor areas in China continue to exist. The health status of the elderly in the poor areas is a matter of concern. This study aims to explore the status of the elderly in terms of their health status, health service needs, and utilization among rural residents of a remote and poor village in a mountainous area in Jinzhai, Anhui. Furthermore, this study aims to explore the differences between the nation rural area average level and the remote and poor village in the mountainous area in terms of health status and health service utilization. Methods: Cluster sampling was used to obtain the sample. A total of 110 elderly people were selected from the village, and face-to-face interviews were conducted with questionnaires by trained investigators to collect data. Results: All items except vision, language disability, and self-care disability were found to be higher than the national average level. In terms of mental health, Zishu Village has a ratio of 44.1% for the symptoms of anxiety and depression, which is higher than the average for the national rural areas. The two-week prevalence rate, prevalence of chronic diseases, and non-hospitalization rate of those who need hospitalization (%) in Zishu Village was 62.7%, 88.2%, and 47.6% respectively, which was higher than the rural values of the National Survey (2008). Most of the outpatient visits were to the village clinics, while the hospitalizations were mainly to county hospitals. The two-week visiting rate was 24.1%, which was lower than 2008. The hospitalization rate in Zishu Village was 10.8%, which is similar to the level of 2008. Conclusions: The health level and the utilization of health services of the people in Zishu Village, Jinzhai, are generally lower than the national average. Financial difficulties continue to remain the major factor affecting the utilization of hospitalization services of this remote and poor village in Jinzhai, Anhui.

Modeling Location and Distribution of Medical Support Institutions

This chapter contains four parts. In order to understand the modeling of the location and distribution of medical rescue institutions, this chapter presents an introduction to the location and distribution optimization of medical supporting institutions, the data resource used in location and distribution optimization of medical support institutions model, construction of the location and distribution optimization of medical support institutions model, and analysis of the location and distribution optimization of medical support institutions model. The first section presents the background, objective, and significance as well as the technical route and design. The second section describes the utilization of the current data resource and data source from field surveys. The third section illustrates the parameters of the location and distribution optimized model of medical support institutions and construction of the location and distribution optimized model of medical support institutions. The last section provides a systemic simulation and describes the utilization of the location and distribution optimization of medical support institutions model. The summary discusses the optimized location and distribution plan of medical rescue institutions, distribution optimization of medical institutions in regional forces, and distribution optimization of medicine supply institutions in regional joint service forces.