学龄儿童行为问题与伤害关系的前瞻性队列研究

目的 探讨学龄儿童行为问题与伤害发生之间的关系。方法 整群抽取马鞍山市区三所小学的2005名学龄儿童，以研究开始时经Rutter儿童行为问卷评定的有、无行为问题的学龄儿童分别作为暴露与非暴露两个队列，开展为期一年伤害发生情况的随访观察，用非参数检验法分析两队列儿童伤害发生率有无差异，并用多分类有序反应变量的logistic回归模型分析儿童伤害的影响因素。结果 儿童伤害发生率为42．51％，有行为问题组儿童伤害年发生率为64．87％，无行为问题组儿童伤害年发生率为38．85％，两组间差异有显著性(u=-6．054，P=0．000)。不同类型的行为问题儿童伤害发生率分别为：违纪(A)行为66．99％，神经症(N)行为67．41％，混合性(M)行为61．40％，不同行为组间两两比较差异无显著性(A行为与N行为间比较u=-0．052，P=0．958；A行为与M行为间比较u=-0．400，P=0．689；N行为与M行为间比较u=-0．364，P=0．716)。多因素分析结果提示，儿童伤害的影响因素为儿童行为问题、儿童出生时母亲年龄、母亲孕期不良因素、母亲文化程度、家庭防范措施及儿童上学家长接送。其中儿童的行为问题是儿童伤害发生的主要影响因素。结论 学龄儿童中有行为问题者是发生伤害的高危人群，在制订伤害干预措施时，应尤其重视儿童行为问题的预防及控制，以达到理想的干预效果。

A prospective cohort study on injuries among school-age children with and without behavior problems

Objective To study the annual incidence of injuries and the relationship between behavior problems and injuries among school-age children. Methods A prospective cohort study on injuries for 1-year follow-up period was conducted among 2 005 school-age children selected by cluster sampling from three primary schools in Maanshan city. They subjects were divided into two groups with or without exposure according to behavior problems rated by the Rutter Child Behavior Questionnaire at the beginning of the study. Nonparametric test was performed to analyze the differences in injuries between the two groups of children, and the influential factors for injuries were analyzed with multi-classification ordinal response variable logistic regression model. Results The overall incidence rate for injuries in school-age children was 42.51 %, while among children with and without behavior problems were 64.87 % and 38.85 %, respectively.There were significant differences between the two groups ( u =-6.054 , P = 0.000 ). However, the incidence rates of injuries in school-age children with antisocial (A) behavior, neurotic (N) behavior and mixed (M) behavior were 66.99 %, 67.41 % and 61.40 %, respectively. No significant differences were found among them ( u A,N =-0.052 , P = 0.958 ; u A,M =-0.400 , P = 0.689 ; u N,M =-0.364 , P = 0.716 ). Mutivariate analysis indicated that injuries in school- age children were associated with children behavior problems, maternal age at childbirth, bad conditions during mother pregnancy, education background of mother, prevention measures for safety at home and the child accompanyed to fravel between school and home by adults. Behavior problems of children seemed to be the major risk factors for injuries. Conclusion Children with behavior problems represented a significant risk group for injuries among school-age children. When planning intervention strategies on injuries, behavior problems should be emphasized to ensure optimal effectiveness of intervention.