关注童年期不良经历代际效应?拓宽儿童身心健康研究视野

在充分评估童年期不良经历(adverse childhood experiences, ACEs)影响个体身心健康的基础上,父母ACEs对子代健康的作用成为当下关注的热点。基于ACEs代际健康效应的视角,重点梳理父母ACEs与儿童身心健康的关联以及潜在社会心理学和生物学机制,并提出若干研究方向,鼓励开展早期干预以打破虐待经历和健康问题的代际循环。     

童年不良经历青少年执行功能现状及影响因素研究进展

童年不良经历(ACEs)作为全球性的公共卫生问题，可严重损害青少年的执行功能，导致抑制控制失调、工作记忆受损和认知灵活性障碍。执行功能失常可显著增加青少年精神病理学和健康危险行为的风险，从而给自身和社会造成巨大的经济负担。本研究通过对ACEs青少年的执行功能现状及其影响因素进行综述，旨在为ACEs青少年执行功能的改善和提高提供参考依据，促进其身心健康发展。     

童年期不良经历与终身健康

童年期不良经历不仅危害个体短期的身心健康,甚至会给终身健康带来不良影响。童年期不良经历对健康造成影响的证据可追溯到1900年,然而纵观童年期不良经历的研究历程,世界上最为全面和系统分析童年期不良经历远期健康效应的研究仍是1998年美国FELLITI博士等发起的"童年期不良经历研究(adverse childhood experiences study,ACEs)"。因此本文将对ACEs的背景、方法、主要研究成果及其应用情况进行综述,为国内学者开展童年期不良经历研究提供借鉴。     

健康管理与可控的健康危险因素

健康管理指一种对个人或人群的健康危险因素进行全面监管的过程。本文对健康管理的基本概念和步骤、健康危险因素评价方法及慢性病中的主要可控危险因素进行了综述,并探讨了危险因素的控制及对健康改善的影响。     

成都市居民健康危险因素评价

健康危险因素评价是一种可以用于个体健康教育也可以用来进行人群危险因素分布及影响因素研究的预防疾病方法。本文应用这一方法对411名30～59岁不同职业人群危险因素及危险水平进行了分析,发现许多危险来自于不良行为生活方式,通过键康教育可以改变。并且指出了可改变的主要危险因素及应重点防治的高危人群。     

从健康危险因素的内涵和评价看健康管理的实质

近年来,我国健康管理行业发展迅速,出现了很多新的理论和实践成果。尽管在健康管理实践中,与健康危险因素相关的健康评估技术已经得到广泛应用。然而,对于健康危险因素、健康危险因素评价等基本概念的探讨,以及二者与健康管理之间关系的讨论仍然较少。本文力图通过文献研究,从健康危险因素的定义、分类及评价等方面来探讨健康管理的实质这一基础性的问题。     

健康危险行为对武警军官自评健康状况影响

目的 探讨吸烟、饮酒等健康危险行为对武警军官自我评价健康状况的影响.方法 采用横断面调查的方式,对2068名武警军官进行健康危险行为调查,分析具有不同健康危险行为军官的自评健康状况的差异.结果 自评健康为很好、好、一般、差的军官分别占调查人群的28.296,43.1%,25.3%,3.4%.年龄、职别、文化程度、婚姻状况等影响军官的自评健康状况,差异均有统计学意义(均P＜0.01).在9类健康危险行为中,重度饮酒、体重异常、体力活动缺乏、睡眠不足和心理压力过大等5个危险因素明显降低军官的自评健康状况(P＜0.01).多分类Logistic回归分析表明,具有1,2,3个和3个以上健康危险行为者的自评健康状况为差的风险分别是无危险行为者的1.12,1.25,1.32,1.39倍(P＜0.01).结论 特定危险因素和军官自评健康状况显著相关,且危险因素的聚集可明显降低军官的自评健康.     

测评健康危险因素，做好疗养人员的健康教育

目的：了解体检疗养人员的健康危险因素，以便为健康教育提供科学的依据。方法：对368例体检疗养人员进行了健康因素测评，并进行实际年龄、评价年龄、增长年龄的对照研究，对单项危险因素对健康教育状况的影响进行分析，对二种健康教育的满意率进行比较。结果：部队干部的健康教育明显优于地方政府和厂矿企业职工。部队干部、政府机关工作人员和厂矿企业职工的评价年龄分别是41．4岁、44．5岁、43．0岁。平均增长年龄分别为40．5岁、40．0岁、41．0岁，单项危险因素对健康状况的影响为吸烟1．56、酗酒1．32岁、缺乏锻炼1．11岁。结论：通过健康测评，可以更有的放矢地进行健康教育，提高了健康教育的效果和满意率。     

危险因素研究中偏倚与混杂的控制

健康管理是对个体或群体的健康进行全面监测、分析、评估、提供健康咨询和指导以及对健康危险因素进行干预的全过程。因此,确定影响健康的危险因素非常重要。危险因素是指流行病学层次的病因,是使疾病发生概率（风险）增加或升高的因素。     

“健康管理”的必要性和可行性

“健康管理”是指对个体或群体的健康进行全面监测，找出影响健康的危险因素，就如何避免或减轻健康危险因素的危害进行健康咨询、指导和生活行为方式的干预，以此达到少得病的目的。     

Factors Associated With Health Care Access and Outcome

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and Whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and Whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.     

Relationship Between Frequency and Intensity of Physical Activity and Health Behaviors of Adolescents

BACKGROUND: While studies have determined the importance of physical activity in advancing health outcomes, relatively few have explored the relationship between exercise and various health behaviors of adolescents. The purpose of this study is to examine the relationship between frequency and intensity of physical activity and both health risk and health promoting behaviors of adolescents. METHODS: Data were collected from 822 students attending a large, diverse suburban high school in northeast Florida using a self-administered survey. Multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) tests examined differences on mean health behavior measures on 3 exercise frequency levels (low, medium, and high) and 2 intensity levels (vigorous physical activity [VPA] and moderate physical activity [MPA]). RESULTS: Results showed adolescents engaged in high levels of VPA used marijuana less frequently (p = .05) and reported heavy use of marijuana less frequently (p = .03); consumed greater numbers of healthy carbohydrates (p < .001) and healthy fats in their diets (p < .001); used stress management techniques more frequently (p < .001); and reported a higher quality of sleep (p = .01) than those engaged in low levels of VPA. Fewer differences were found on frequency of MPA and health behaviors of adolescents. CONCLUSIONS: These findings suggest that adolescents who frequently participate in VPA may be less likely to engage in drug use, and more likely to participate in a number of health promoting behaviors. Longitudinal and experimental studies are needed to determine what role frequent VPA may play in the onset and maintenance of health enhancing and protecting behaviors among adolescent populations.     

Neighborhood conditions are associated with maternal health behaviors and pregnancy outcomes

Women residing in neighborhoods of low socioeconomic status are more likely to experience adverse reproductive outcomes; however, few studies explore which specific neighborhood features are associated with poor maternal health behaviors and pregnancy outcomes. Based upon our conceptual model, directly observed street-level data from four North Carolina US counties were used to create five neighborhood indices: physical incivilities (neighborhood degradation), social spaces (public space for socializing), walkability (walkable neighborhoods), borders (property boundaries), and arterial features (traffic safety). Singleton birth records (2001-2005) were obtained from the North Carolina State Center for Vital Statistics and maternal health behavior information (smoking, inadequate or excessive weight gain) and pregnancy outcomes (pregnancy-induced hypertension/pre-eclampsia, low birthweight, preterm birth) were abstracted. Race-stratified random effect models were used to estimate associations between neighborhood indices and women's reproductive behaviors and outcomes. In adjusted models, higher amounts of physical incivilities were positively associated with maternal smoking and inadequate weight gain, while walkability was associated with lower odds of these maternal health behaviors. Social spaces were also associated with inadequate weight gain during pregnancy. Among pregnancy outcomes, high levels of physical incivilities were consistently associated with all adverse pregnancy outcomes, and high levels of walkability were inversely associated with pregnancy-induced hypertension and preterm birth for Non-Hispanic white women only. None of the indices were associated with adverse birth outcomes for Non-Hispanic black women. In conclusion, certain neighborhood conditions were associated with maternal health behaviors and pregnancy outcomes.     

Relationships Between Youth Sport Participation and Selected Health Risk Behaviors From 1999 to 2007

BACKGROUND: How adolescents spend their out-of-school time represents one of the most important factors for predicting positive youth development. Sport participation relates to many beneficial outcomes. However, current economic conditions threaten high school sport programs around the United States. This investigation examined relationships by year between sport participation and numerous health risk behaviors among high school students. METHODS: Data were derived from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveys administered every 2 years from 1999 through 2007. Items assessed were sport participation, vigorous physical activity, dietary habits, weight loss, sexual activity, interpersonal violence and suicidality, and substance use. Multiple logistic regression analyses were used to examine relationships between sport participation and each health behavior. Interaction effects tested whether relationships varied by year, sex, age, and/or race/ethnicity. RESULTS: Analyses revealed some consistencies across years in relationships between sport participation and health risk behaviors for both sexes. However, most relationships varied by race/ethnicity. Among White students, sport participation related to multiple positive health behaviors. Conversely, African American, Hispanic, and Other athletes showed fewer positive health behaviors and some negative behaviors. CONCLUSIONS: Findings suggest that participation in organized sports affords many health benefits to most adolescents, but relates to some negative health behaviors in certain subgroups. Information regarding sport participation and health risk behaviors among subgroups across years can inform school policy, practice, and future research.     

Relationship between physical disabilities or long-term health problems and health risk behaviors or conditions among US high school students

BACKGROUND: This study explores the relationship between self-reported physical disabilities or long-term health problems and health risk behaviors or adverse health conditions (self-reported engagement in violent behaviors, attempted suicide, cigarette smoking, alcohol and other drug use, sexual activity, physical activity, dietary behaviors, self-reported overweight [based on height and weight], physical health, and mental health) among US high school students. METHODS: Data were from the Centers for Disease Control and Prevention's 2005 national Youth Risk Behavior Survey, a cross-sectional paper-and-pencil survey collected from a representative sample of public and private high school students (grades 9 through 12) in the United States. RESULTS: Significantly more students with physical disabilities or long-term health problems than without described their health as fair or poor and reported being in a physical fight, being forced to have sexual intercourse, feeling sad or hopeless, seriously considering and attempting suicide, cigarette smoking, using alcohol and marijuana, engaging in sexual activity, using computers 3 or more hours per day, and being overweight (for all, p < or = .05). For none of the health risk behaviors analyzed were the rates significantly lower among students with physical disabilities or long-term health problems than among other students. CONCLUSIONS: Young people who live with physical disabilities or long-term health problems may be at greater risk for poor health outcomes. Public health and school health programs, with guidance from health care providers, need to work with these adolescents and their families to develop and implement appropriate interventions, with particular emphasis on promoting mental health.     

The Conceptual and Empirical Link Between Health Behaviors,Self Reported Health,and the Use of Home Health Care in Later Life

ABSTRACT

The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.     

Positive Youth, Healthy Adults: Does Positive Well-being in Adolescence Predict Better Perceived Health and Fewer Risky Health Behaviors in Young Adulthood?

Purpose

To examine the prospective, longitudinal associations between positive well-being during adolescence and health outcomes in young adulthood, using a large, nationally representative sample of youth.

Methods

On the basis of the data from the first three waves of the National Longitudinal Study of Adolescent Health, we examined positive well-being during adolescence (averaged across Waves I-II) as a predictor of perceived young adult general health and risky health behaviors (Wave III). Each model included a full set of health and demographic baseline covariates. Missing values were assigned using multiple imputation methods (n = 10,147).

Results

Positive well-being during adolescence was significantly associated with reporting better perceived general health during young adulthood, independent of depressive symptoms. Positive well-being was also significantly associated with fewer risky health behaviors in Wave III, after adding all covariates, including depressive symptoms and baseline risky health behaviors.

Conclusion

Few studies of adolescent health have examined positive psychological characteristics, tending to focus instead on the effect of negative mood states and cognitions on health. This study demonstrates that positive well-being during adolescence predicts better perceived general health and fewer risky health behaviors during young adulthood. Aligned with the goals of the positive youth development perspective, promoting and nurturing positive well-being during the transition from childhood to adolescence may present a promising way to improve long-term health.     

Women's Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.     

Racial disparities in health and health behaviors among gay,lesbian, bisexual and heterosexual men and women in the BRFSS-SOP

ABSTRACT

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.

Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n?=?557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.

Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR?=?3.92) and bisexual (OR?=?4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.

Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.     

据管理方意向分析医改对职工卫生服务需求行为的影响

通过分析医保管理机构管理者和医疗机构医保管理者对医改前后职工卫生需求行为的变化及其相关影响因素显示,现行的医保政策有利于控制医疗费用的过快增长,医改政策实施后,职工的卫生服务需求行为趋向合理化,但对供方行没有显著影响,从而影响了需方行为和费用控制效果,管理方不规范操作作对职工卫生服务需求行为也有显著影响。