农村留守儿童处境不利问卷的修订

目的：以国发[2016]13号文件定义的留守儿童为被试，对2011年发表的《留守儿童家庭处境不利问卷》进行修订。方法：综合新近文献、访谈及开放式问卷调查结果，对原问卷的维度结构进行删减与补充，在此基础上形成初始问卷。使用2541名留守儿童数据对初始问卷进行信效度分析，形成33个条目构成的最终问卷。结果：留守儿童处境不利问卷由缺少父母关爱、监管不力、家庭气氛冷清、生活照顾不周、学习管理不善、缺少沟通、家庭应对能力差、歧视知觉等8个维度组成，共解释总变异的59.22%；验证性因素分析结果支持八因素模型；问卷总分及各维度与孤独感、消极情绪、不良行为均呈显著正相关，与主观幸福感、积极情绪、亲社会行为均呈显著负相关；留守儿童在8个维度上的得分均显著高于非留守儿童。问卷及各维度的Cronbach’s α系数为0.69～0.90；重测信度为0.71～0.87。结论：修订后的留守儿童处境不利问卷信效度良好，可用于相关测量。     

农村留守儿童心理资本问卷的编制

目的:编制适用于农村留守儿童的心理资本问卷。方法:基于对留守儿童、监护人和教师的访谈结果并参照已有相关文献,编制了初始问卷。预测被试和正式被试分别为133名和704名农村留守儿童。通过项目分析、效度分析和信度分析,形成25个条目构成的最终问卷。结果:农村留守儿童心理资本是由自立顽强、明理感恩、宽容友善、自信进取、乐观开朗五个一阶因素组成的二阶单因素模型;问卷总分、维度得分与西方心理资本各要素均呈显著正相关;问卷高分组儿童的情绪、行为与学业适应水平均显著优于中间组和低分组儿童;问卷与维度的Cronbachα系数在0.65~0.88之间,重测信度在0.78~0.85之间。结论:自编问卷的信效度基本达到心理测量学要求。     

安徽农村留守儿童校园人际关系的特点

目的:探讨安徽农村留守儿童校园人际关系的特点。方法:采用分层整群抽样的方法抽取安徽省皖南、皖北5个县的14所农村普通乡镇中小学生2561人。应用自编"一般情况调查问卷"、"农村留守儿童问卷"及"校园人际关系量表"对研究对象进行测评。结果:留守儿童校园人际关系差于非留守儿童,其在反映积极校园人际关系维度上的得分低于非留守儿童(P0.05)。不同类型留守儿童的校园人际关系:初二年级在不和谐同学关系和利己行为的维度上得分最高(F=19.086,13.037;P0.01);和谐师生关系、学校暴力两个维度随着年级的升高而下降,不和谐师生关系随着年级的升高而上升(P0.01);男孩差于女孩(P0.05);独生子女仅在不和谐同学关系维度上差于非独生子女(t=0.329,P0.05)。结论:农村留守儿童校园人际关系差于非留守儿童,留守儿童中男生、高年级学生、独生子女留守儿童校园人际关系状况相对较差。     

农村留守儿童与城市儿童主观幸福感之比较

目的:分析比较农村留守儿童与城市儿童主观幸福感的差异。方法:采用青少年主观幸福感量表对139名儿童进行问卷调查。结果:农村留守儿童的总体生活满意度显著低于城市儿童(F=9.200,P0.01),农村留守儿童体验到的积极情感显著低于城市儿童(F=5.075,P0.05);父母一方外出的农村留守儿童的总体生活满意度(t=2.168,P0.05)、积极情感体验(t=2.05,P0.05)显著高于父母均外出的留守儿童,父母一方外出的留守儿童体验到的消极情感显著低于父母均外出的留守儿童(t=-2.403,P0.05)。结论:农村留守儿童与城市儿童主观幸福感均处于中等偏上水平,且存在显著差异;留守类型影响留守儿童的主观幸福感水平。     

家庭社会经济地位、心理资本对农村留守儿童自尊的影响

目的:探讨家庭社会经济地位、心理资本对农村留守儿童自尊的影响。方法:采用家庭社会经济地位(SES)问卷、农村留守儿童心理资本问卷、自尊问卷,对971名农村儿童进行施测。结果:农村留守儿童在SES、心理资本各维度与自尊上的得分均显著低于非留守儿童;在控制性别作用后,家庭SES以及心理资本四维度(自立顽强、明理感恩、宽容友善、自信进取)对留守儿童自尊均有显著正向预测性;自立顽强、乐观开朗、自信进取对家庭SES与自尊的正向预测关系均有调节作用。结论:家庭社会经济地位和心理资本对农村留守儿童自尊发展存在交互影响。     

农村留守儿童家庭功能与心理适应的关系

目的:探讨留守儿童家庭功能与心理适应的关系。方法:采用家庭亲密度/适应性量表、抑郁量表、积极/消极情感量表、社交焦虑量表和生活满意度量表对492名农村儿童进行测查。结果:单、双留守儿童的家庭亲密度(F=3.05,P0.05)、家庭适应性(F=2.88,P0.05)、积极情感(F=12.19,P0.01)和生活满意度(F=4.66,P0.01)的得分均显著低于一般儿童,抑郁(F=8.42,P0.01)、社交焦虑(F=11.48,P0.01)的得分则显著高于一般儿童;留守儿童的家庭亲密度、家庭适应性与其生活满意度、积极情感均呈显著正相关;其中,家庭亲密度对生活满意度(β=2.78,P0.01)、家庭适应性对积极情感(β=2.59,P0.01)有正向预测效应。结论:留守儿童家庭适应性和亲密度可能是影响其积极情感、生活满意度的重要因素。     

不同类型留守儿童生活满意度及主观幸福感的差异比较

目的:为考察留守经历对儿童的影响及不同类型留守儿童之间生活满意度和主观幸福感的差异。方法:以湖北省8~15岁的留守儿童为主要调查对象,采用方便取样的方法在留守儿童集中的学校及留守儿童托管中心集中施测。结果:(1)在不同类型儿童主观幸福感的比较中,留守儿童的主观幸福感最低,曾留守儿童次之,非留守儿童最高,差异均达到显著水平(F=96.561,P=0.001);(2)不同类型留守儿童中,母亲单独外出留守儿童的家庭、学校、学业、自由和总体生活满意度及主观幸福感显著低于父亲单独外出和双亲外出留守儿童(F=7.68,3.39,9.37,6.01,3.54,13.51;P0.05);(3)在双亲外出的情况下,由学校及托管中心监护的留守儿童主观幸福感显著高于祖辈监护和其他亲戚监护(F=7.264,P=0.001)。结论:留守经历会对留守儿童的生活满意度及主观幸福感产生很大影响,应采取有效措施保障留守儿童的生活质量,提高他们的生活满意度及主观幸福感。     

重庆市农村留守儿童亲子疏离状况及影响因素

目的:探讨重庆市农村留守儿童亲子疏离状况及影响因素。方法:采用自编一般情况调查表、青少年亲子疏离感问卷(IAP)、父母与同伴依恋量表(IPPA)中文简表、青少年生活事件量表(ASLEC)、青少年心理弹性量表(RSCA)对1099名儿童进行便利抽样调查。结果:留守儿童亲子疏离总分、母子疏离及父子疏离得分均显著高于非留守儿童(t=8.04,7.93,5.54;P0.001)。多元线性回归结果显示,亲子依恋、心理弹性、父母未离异、与母亲高频率沟通(每天)是留守儿童亲子疏离的保护因素(β=-0.08～-0.78,P0.05);而生活事件、家庭居住条件拥挤、父母强制型教养方式、与父母沟通时间短(每次5分钟以内)、父母中有人令孩子非常害怕是留守儿童亲子疏离的危险因素(β=0.06～0.72,P0.05)。结论:留守儿童亲子疏离水平高于非留守儿童。因此,增强留守儿童亲子依恋和心理弹性,减少父母离异发生,提高留守状态下亲子沟通的频率和时间,帮助其有效应对生活事件,改善家庭居住条件,改变父母强制型教养方式以及减少其对父母的畏惧感均可能减少留守儿童亲子疏离的发生。     

农村留守儿童生活质量状况及影响因素

目的:了解农村留守儿童生活质量并探讨其影响因素。方法:采用儿童少年生活质量量表(CQOL)和自编的一般情况调查表对901名农村中小学生进行调查与分析。结果:有16.5%的留守儿童生活质量处于差和较差等级,且留守儿童生活质量在总分及各维度上显著低于非留守儿童(t=-1.979,-2.647,-2.052,-2.406,-2.042;P0.05)。经多元回归分析发现,成绩、与父母联系频率、和照顾者聊天频率、照顾者管教程度均影响其社会心理功能得分(t=3.849,-3.402,-2.943,-2.678,4.008;P0.05),成绩影响其生理心理健康得分(t=2.580,P0.01),父母受教育程度与和照顾者聊天频率影响其生活环境得分(t=-3.727,4.478,P0.001),与父母联系频率、和照顾者聊天频率、父母期待获得的学历、照顾者的受教育程度影响其生活质量满意度得分(t=-2.749,-4.474,3.117,2.655;P0.05),与父母联系频率、和照顾者聊天频率、照顾者管教程度、照顾者的受教育程度、父母期待获得的学历、父母受教育程度影响其生活质量总分(t=-3.067,-4.098,-2.789,4.089,2.334,2.655;P0.05)。结论:农村留守儿童生活质量低于非留守儿童,学习成绩、与父母联系频率、和照顾者聊天频率、照顾者管教程度、照顾者的受教育程度、父母期待获得的学历、父母受教育程度等因素都在一定程度上影响留守儿童生活质量。     

父母参与问卷(缩减版)在学前儿童父母群体中的修订

目的:对Fantuzzo等人编制的父母参与问卷(缩减版)进行本土化修订,使其适用于我国学前儿童父母这一群体。方法:分别以962名学前儿童的父亲和母亲为被试对父母参与问卷(缩减版)进行项目可理解性检验、项目分析、效度分析和信度分析。结果:20个项目具有良好的区分度,各项目与总分的相关在0.55-0.78之间。探索性因素分析共提取3个因子,支持原问卷的维度划分;验证性因素分析表明,模型拟合良好;以儿童的语言及认知、社会能力为效标发现,各维度与效标显著正相关,相关系数在0.10-0.36之间。信度分析表明,3维度的Cronbach’sα系数在0.88-0.94之间,分半信度在0.83-0.94之间,重测信度在0.38-0.59之间。结论:修订后的父母参与问卷(缩减版)在父亲、母亲群体中均具有良好的信效度,适于考察我国学前儿童父母参与的情况。     

Rural general practitioners'' experience of the provision of out-of-hours care: a qualitative study.

BACKGROUND: Published research into the provision and utilisation of out-of-hours services shows long-term trends towards decreasing personal commitment among general practitioners (GPs). However, the on-call commitments of rural GPs remain especially onerous. There has been little research relating to either rural out-of-hours services or the implications of such services for the families of the providers. AIM: To explore and describe how rural GPs in Ireland perceive and experience out-of-hours care provision. DESIGN OF STUDY: A qualitative study was conducted with 10 rural GPs and their spouses in their homes or practices using one-to-one in-depth interviews. SETTING: Ten general practices in rural Ireland. METHOD: The interviews were guided by an interview schedule that was based on pertinent themes that had emerged from previous relevant literature. The interviews were audiotaped, transcribed, and analysed for themes and issues. RESULTS: Results indicated that rural GPs experience a wide variety of satisfactions from work related to the provision of out-of-hours care. However, the large proportion of time committed to out-of-hours care greatly infringes on their social and family life. The key stressors identified related to organisational system difficulties, especially with regard to locum cover, and unrealistic patient expectations. The stressors were mainly expressed as lack of time off, restrictions on family life, and interruptions. CONCLUSION: System difficulties, such as difficulty with obtaining locums and rota extension, need to be addressed at an organisational level. Patient expectations of the role of the rural GP have significant implications for practitioners and their families.     

Asthma prevalence and morbidity among rural Iowa schoolchildren

BACKGROUND: There are conflicting findings about the prevalence of asthma among farm and nonfarm children. OBJECTIVES: We sought to estimate asthma prevalence and morbidity and determine differences between farm and nonfarm children. METHODS: The study population consisted of all children aged 6 to 14 years enrolled in 10 school districts in 2 noncontiguous rural Iowa counties from 2000 through 2002. The mailed parental screening questionnaire included the International Study of Asthma and Allergies in Childhood core questionnaire, items from the Functional Severity Index, and items on physician diagnosis and medication and urgent care use. RESULTS: The response rate was 86.6%. The 12-month prevalence of wheeze was 19.1%. Self-reported physician diagnosis of asthma was reported by 13.4%. On multivariable analysis controlling for age, sex, and county, children who lived on farms were less likely than those who lived in town to have ever wheezed (odds ratio, 0.71; 95% CI, 0.58-0.87) or to have wheezed during the past year (odds ratio, 0.77; 95% CI, 0.60-0.98). However, this protective association with farming was only observed in one of the study counties. Among those who wheezed, farm and nonfarm children were equally likely to have been given a diagnosis of asthma and had comparable morbidity. CONCLUSION: By using a standardized questionnaire with a high response rate in this large, rural, population-based study, asthma prevalence rivaled that in large Midwestern cities. Unmeasured risk factors might account for the apparent protective effect in Keokuk County. These findings cast doubt on a protective effect of rural life for the development of childhood asthma.     

脑卒中患者及家庭照料者生活满意度及其影响因素研究

目的：通过对脑卒中患者及其主要家庭照料者生活满意度的评估，了解其生活质量及有关影响因素，为临床心理干预、提高患者及其照料者生活质量提供依据。方法：调查对象为８９名脑卒中患者、８９名照料者以及１７８名正常对照组，采用生活质量综合自评问卷（ＧＱＯＬＩ）作为生活质量评定工具，病人组在常规住院治疗一个月后进行评定。结果：脑卒中患者与照料者的主观生活满意度均显著差于对照者；患者及照料者主观生活满意度下降的原因主要与自身客观生活状态、对生活的期望值及家庭成员的生活满意度有关。结论：作者据此提出在加强躯体药物治疗的基础上，临床心理干预应设法降低受试过高的生活期望值，提高生活满意度，以达到更满意的疗效。     

A Comparative Study to Assess the Awareness of Palliative Care Between Urban and Rural Areas of Ernakulum District, Kerala, India

Aim:

To assess the knowledge and attitude toward palliative care among people residing in urban and rural areas.

Materials and Methods:

This cross-sectional study was conducted among 185 urban and 165 rural households. Senior-most member of the household present was interviewed using a questionnaire. Only those people who have heard about palliative care were included in the study.

Results:

Out of 350 people, 47 (13.4%) have heard about palliative care. Of these 38 (20.5%) belonged to urban and 9 (5.4%) belonged to rural areas (P < 0.0001).Twenty-nine (15.7%) participants in urban and 7 (4.2%) in rural areas had some knowledge about palliative care (P = 0.0002). Source of information for 25 (53.2%) participants was newspapers followed by television 17 (36.2%). Thirty-three (86.8%) participants in urban and 7 (77.8%) in rural areas felt that palliative care helps in improving quality of life. Twenty (52.6%) participants in urban and 4 (44.4%) participants in rural areas felt that palliative care can be better provided at homes than hospitals. Thirty (78.9%) urban participants felt that bad news about the patient''s condition needs to be told to the patient first and then to their family members. In case of rural participants majority 7 (77.8%) said vice versa (P = 0.0039).

Conclusion:

Overall awareness of palliative care was poor. This calls for large-scale awareness campaigns. As home-based palliative care was preferred by many, home visits by care providers and training of family members of patient''s needing palliative care needs to be practiced widely.     

湖南省城乡部分老年人口自杀流行学研究

目的 :描述湖南省城乡 1990 -1998年部分老年人口自杀流行学特征 ,为老年人口自杀预防以及降低老年自杀率提供科学依据。方法 :根据湖南省卫生厅生命统计资料 ( 1990 -1998年 ) ,对部分老年人口自杀状况进行统计分析 ,并以湖南省城区 (长沙市天心区 )、农村 (浏阳县 )两地为代表 ,着重描述两地流行学特征。结果 :自 1990 -1998年九年来 ,湖南省老年人口自杀率均有上升趋势 (天心区Y =8 76± 2 88X ,p<0 0 0 1;浏阳县Y =77 45 0± 1 697X ,p =0 0 5 )。老年人口平均自杀率城区为 2 4 4/10万 (天心区 2 2 1/10万 ) ,农村为 88 9/10万 (浏阳县 88 3 /10万 )。城区、农村两地男女自杀率比例分别为 1∶1和 1 4∶1。两地自杀方式城区多以服毒服药、自缢、跳楼为主 ,农村则多以服毒服药、自缢、自溺为主。城区、农村两地自杀原因城区多以久病厌世、家庭纠纷以及精神疾病为主 ,农村则多以家庭纠纷、久病厌世、生活困难为主。结论 :社会、经济环境可能是老年人自杀的最重要的诱发因素 ,尤其在农村地区老年人有更突出的心理问题 ,他们需要更多的医学关怀和社会的关注。     

Long-term retention of graduates from a program to increase the supply of rural family physicians.

PURPOSE: To determine the long-term retention of rural family physicians graduating from the Physician Shortage Area Program (PSAP) of Jefferson Medical College. METHOD: Of the 1,937 Jefferson graduates from the classes of 1978-1986, the authors identified those practicing rural family medicine when their practice location was first determined. The number and percent of PSAP and non-PSAP graduates practicing family medicine in the same rural area in 2002 were then identified, and compared to the number of those graduates practicing rural family medicine when they were first located in practice 11-16 years earlier. RESULTS: After 11-16 years, 68% (26/38) of the PSAP graduates were still practicing family medicine in the same rural area, compared with 46% (25/54) of their non-PSAP peers (p = .03). Survival analysis showed that PSAP graduates practice family medicine in the same rural locality longer than non-PSAP graduates (p = .04). CONCLUSIONS: These results are the first to show long-term rural primary care retention that is longer than the median duration. This outcome combined with previously published outcomes show that the PSAP represents the only program that has resulted in multifold increases in both recruitment (eight-fold) and long-term retention (at least 11-16 years). In light of recent national recommendations to increase the total enrollment in medical schools, allocating some of this growth to developing and expanding programs similar to the PSAP would make a substantial and long lasting impact on the rural physician workforce.     

Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs

BACKGROUND: In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India. METHOD: Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period. RESULTS: A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time. CONCLUSIONS: Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.     

中学生生活事件与抑郁的关系

目的：探讨中学生具体生活事件和抑郁状况的关系。方法：采用青少年生活事件量表和中学生抑郁量表对558名中学生进行问卷调查。结果：除个别生活事件项目外，青少年生活事件量表中的多数项目均与中学生抑郁呈显著正相关；生活事件与抑郁的回归分析表明，学习负担重，受人歧视冷遇，不喜欢上学，家庭经济困难，与同学或好友发生纠纷，升学压力，被盗或丢失东西，考试失败或不理想，受批评或处分，生活习惯明显变化，恋爱不顺利或失恋，被罚款等12类生活事件进入了对抑郁的回归方程，对抑郁的预测作用较大。结论：中学生生活事件与其抑郁存在广泛的正相关关系。12项生活事件对中学生抑郁有较大的预测作用。     

Illness fears in the general population

OBJECTIVES: Because relatively little is known about illness fears, we sought to estimate the prevalence, risk factors, and morbidity associated with such fears in the community. METHODS: We conducted a brief telephone survey of persons aged 40 to 65 years from randomly selected households in the Johnson County, Iowa, area. Respondents were asked whether a series of illness and medical care items made them no more nervous, somewhat more nervous, or much more nervous than other people. Those who reported more discomfort were asked to what extent this interfered with medical care or caused impairment or distress. Information about demographic and health characteristics was also obtained. RESULTS: Five hundred persons, 62% of those contacted, responded to the survey. A factor analysis revealed four fear dimensions: illness/injury, medical care, blood/needle, and aging/death. Five percent of respondents reported much more nervousness in relation to at least four of six illness/injury items, 4% indicated that such fears interfered with their medical care, and 5% reported some negative effect on their life. Similarly, 5% of respondents reported much more nervousness in relation to at least two of four medical care items. Illness/injury fears were somewhat more common in persons with lower income and education and in those with medical conditions. CONCLUSIONS: This survey shows that fears of illness and medical care are common in the general population and indicates that lower socioeconomic status and experience with illness are associated with these fears. The findings also suggest that interference with care occurs among those with the strongest fears.