Rational care or rationing care? The case of cervical screening across the United Kingdom

In 2003, The National Health Service Cervical Screening Programme (NHSCSP) in England modified its recommendation by increasing the age at which to begin screening from 20 to 25. This was on the grounds that normal changes in the cervix before the age of 25 are often identified during screening as being abnormal, resulting in many young women receiving unnecessary treatment at both a significant psychological cost to the patient and a financial cost to the service. In 2011, the cervical screening programme in Northern Ireland was also amended followed closely by Scotland in late 2012. Some 10 years later, Wales finally altered cervical screening policy in January 2013 and now invite women for an initial screen at the age of 25, in line with the rest of the United Kingdom (UK).     

青少年网络行为与主观幸福感的关系研究

目的：研究青少年网络行为与主观幸福感的关系。方法：采用主观幸福感量表和网络行为量表测量了692名大学和高中学生。结果：①青少年主观幸福感总体水平较高，但生活满意度、积极情感、消极情感水平较低；青少年网络行为处于正常水平；②总体主观幸福感、生活满意度、消极情感在网络成瘾和非网络成瘾之问存在显著差异。但在积极情感维度上差异不显著；③网络行为对总体主观幸福感、生活满意度、消极情感作出显著预测，但预测力较微弱。结论：青少年网络行为对其主观幸福感产生了微弱的影响。     

离异家庭青少年不良心理行为综合干预对照研究

随着我国家庭离异率上升 ,离异家庭子女的心理卫生问题日益引起注意。董奇、周敏娟等对离异家庭儿童的再适应状况作了多因素相关研究[1- 3] 。国外对这一群体干预研究已较深入[4 ,5] ,国内干预研究尚缺乏。本课题在影响离异青少年再适应的前期研究[2 ,3] 基础上 ,与学校联合对 30例存在心理卫生问题的离异家庭青少年进行为期 12— 18个月的综合心理干预 ,以考察干预模式的可行性和有效性。1　对象和方法1.1　研究对象1999— 2 0 0 1年 ,在二所中学和心理门诊 12 4例离异子女中 ,选取ＳＣＬ— 90和 /或社交回避苦恼量表多个因子分显著高出常…     

厌学青少年视听整合功能分析及对心理咨询的指导作用

目的分析厌学青少年大脑的视听整合功能及对咨询的指导作用。方法设研究组和对照组。两组统一使用大脑整合连续视听测试仪对其学习过程中大脑综合控制反应能力和注意能力及相关因子进行评定,根据测量结果排除注意缺陷,而后对两组非注意缺陷者进行视听整合因素分析。结果研究组中42%的厌学青少年整合视听功能达到注意缺陷诊断。研究组中的非注意缺陷者中的相关因子与对照组相比,其大脑整合信息的综合控制力和整合过程中的视听觉中的谨慎性、一致性、毅力和注意稳定性、视觉的警醒性、听觉速度均与对照组存在显著差异(P<0.01)。尤其是听-动速度因子和视觉警醒因子异常占研究组的61%和33%。结论厌学青少年中生物性影响因素较多。尤其是听觉速度和视觉警醒因子,可能是导致早期学习兴趣下降和不良行为的重要因子。应早期发现,通过策略训练达到纠正和弥补及替代。     

中国乡村汉族青少年体表面积发育的区域差异

目的 探讨中国乡村汉族青少年体表面积发育的区域差异。 方法 以2010年中国学生体质与健康调研报告中30个省市乡村汉族107745名（男生53857人,女生53888人）青少年的身高、体质量资料,以Stevenson和DuBois公式计算男女性体表面积值。选择7～18岁12个年龄段身高、体质量和体表面积3项指标的36个参数,利用方差最大正交旋转进行因子分析,将各指标参数的均值转化为因子分。以因子分作样本间Q聚类分析(Ward法),将男女各30个样本归纳成若干类别,用三次方多项式模型拟合上述各类体表面积发育曲线。 结果 3项指标（身高、体质量和体表面积）能较好综合概括不同区域群体生长发育的差异;男女生均聚合成3类;男生可分为发育较高组和较低组,女生可分为发育较高组、中间组和较低组;各类群体间生长发育存在差异性。结论 中国乡村汉族青少年体表面积既有相似性,又有差异性,总体上呈现出北高南低、东高西低的发育格局,但全国女生体表面积发育差距缩小,中东部及沿海省市有超越北方的趋势。     

Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force

The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long‐Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.     

Contraception for teenagers and young adults with cancer

Adolescence can be an extremely stressful time for all concerned. When this period is then compounded by the development of cancer, formidable and seemingly insurmountable problems may be perceived. Cancer in adolescence is relatively uncommon, with an annual incidence rate in western populations of approximately 150–200 per million. Five-year survival of patients diagnosed around 1990 exceeded 70% in the United Kingdom (UK) and United States of America (USA), and adolescents with cancer are likely to remain fertile. Further advances in therapeutic modalities are creating a generation of adolescents and young adults with cancer who can now aspire to the same sexual and reproductive activities as their healthy peers. This then raises the issue of avoidance of undesired pregnancy during and after treatment. This article aims to address the contraceptive needs of adolescents and young adults undergoing treatment for cancer.     

Acute spontaneous subdural hematoma in a teenager

A teenager with a history of sudden onset of headache and vomiting is described. Computed tomography revealed an acute subdural hematoma in the right temporaparietal region, causing marked compression of the right ventricular system and a shift of midline structures to the left. No operation was carried out because the symptoms and neurological signs were slight enough to allow monitoring by means of close clinical and neuroradiological investigations. Within 18 days the hematoma resolved spontaneously and completely. There was no history of trauma or any objective sign of trauma about the face or head, and radiography of the skull showed no fracture. We are not aware of any other report of a spontaneous subdural hematoma which did not require surgery. This feature makes our case unique. In addition, comparable cases in the literature are reviewed and the etiological possibilities of spontaneous subdural hematoma are discussed.     

青少年精神活性药物滥用行为危险因素分析

目的探讨青少年精神活性药物滥用行为的危险因素，为制定预防青少年药物滥用措施提供依据。方法以广州市600例青少年药物滥用者作为病例组，按性别、年龄1：2配对选取1200例正常青少年作照组，进行病例对照研究，通过单因素和多因素条件Logistic回归分析筛选主要危险因素。结果多因素Logistic回归分析显示：青少年药物滥用行为有6个主要危险因素和1个保护因素，他们是：父母药物滥用情况、学习成绩、缺课情况、暴力行为、自觉孤独、家庭关系和与父母交流情况，其OR值分别为：2．752，1．291，1．296，1．232，1．241，3．348和0．549。结论青少年是药物滥用行为预防和控制的重点人群，良好的家庭环境、父母正确的教育方式及健康的学校、社会环境是防治青少年药物滥用行为的重要因素。     

青少年海洛因依赖者人格特征与家庭环境的相关性

目的：探讨青少年海洛因依赖者的人格特点、家庭环境模式，及其家庭环境因素对青少年的影响。方法：以16—19岁初次吸毒海洛因依赖者60例为研究组，同年龄段在校就读学生60例为正常对照组；以艾森克人格（成人）问卷（EPQ），家庭环境量表中文版SPSS11.0统计进行均数、χ^2t检验及相关性检验。结果：青少年海洛因依赖者多为内向不稳定型（21例）、高精神质（7．13±3．21）、高神精质（14．29±5．91）；其家庭环境亲密度（5.49±2．29）、成功性（5.18±2.19）、知识性（4．07±1．83）、娱乐性（4．36±2．18）、组织性（5.14±2．22）、道德性（5．24±1．81）得分显著低于对照组，而家庭环境亲密度和组织性与人格有高度相关性（P〈0．01）。结论：家庭环境对青少年的人格有重要的影响，特别是家庭环境中的亲密度和组织性。