黑龙江省孤独症谱系障碍儿童就诊康复及养护现状

了解黑龙江省孤独症谱系障碍(autism spectrum disorder,ASD)儿童就诊、康复和养护现状,为完善ASD康复教育体系及政策的制定提供科学依据.方法 分层整群抽取黑龙江省8所孤独症康复教育机构,采用自拟的"ASD儿童康复教育现状及需求调查表"对357名ASD儿童主要照顾者进行现况调查.结果 ASD儿童发现行为异常的平均年龄为(31.08±12.96)月,首次就诊的平均年龄为(35.88±13.20)月,确诊为ASD的平均年龄为(38.64±13.20)月,开始康复的平均年龄为(43.56±16.08)月.3岁前被确诊以及3岁前到康复机构接受训练的儿童分别占39.0%和32.0%.非户口所在地(异地)康复儿童比例为47.3%,每周康复时间20 h及以上的ASD儿童占73.4%.因儿童的康复问题,父、母工作受影响的比例分别为34.5%,67.8%,差异有统计学意义(χ2=226.32,P<0.01).调查对象享受政府惠民项目资金支持的ASD家庭占41.2%.结论 黑龙江省ASD儿童确诊时间有延迟,早期康复的患者占比较低,孤独症儿童康复教育资源分布存在明显的地区差异,政府惠民救助项目支持的覆盖率还有待提高.     

中国2~6岁孤独症儿童家庭直接经济负担研究

  目的  探索学龄前孤独症(autism spectrum disorder, ASD)儿童家庭康复相关的支出。  方法  以中国2~6岁ASD儿童家庭为对象,使用互联网问卷调查其家庭康复情况及支出情况,利用χ2检验和方差分析进行各类支出的组间比较。  结果  调查收集到3 880例2~6岁ASD儿童样本。ASD儿童家庭直接康复干预支出平均7 339.48元/月,折合88 073.76元/年,占家庭总收入85.56%;总支出9 677.87元/月,折合116 134.44元/年,占家庭总收入127.38%。对于低收入家庭来说,其总支出占家庭收入的比重为210%,中等收入为97%,高收入为56%,三组之间差异均有统计学意义(均有P < 0.05)。对于不同严重程度的ASD儿童来说,低功能儿童的家庭康复干预支出占比更高,为97%(χ2 =8.297, P＜0.001)。  结论  ASD儿童家庭经济负担重,尤其是低收入家庭和低功能儿童家庭。     

我国三省(市)食品安全监管资源现状及分析

目的 :通过对上海市、四川省和甘肃省三地食品安全监管部门进行现场实证调查,分析其监管现状,为食品安全监管提供参考。方法 :采用方便抽样的方法选取上海市、四川省和甘肃省三地进行实证调查,收集当地食品企业基本情况、食品安全监管人员的数量、年龄、文化程度等基本信息资料,并进行分析和研究。结果 :四川省常住人口约为8 185万人,全省持证餐饮服务单位共计14.6万家,而实际的监管人员总数仅为1 548人,平均每人负责监管94家企业。上海市食品安全监管人员的学历相对较高,本科和研究生学历分别占到了69.10%和17.92%。四川省食品安全监管人员的学历总体相对较低,大专及以下学历为57.11%,本科为41.54%,研究生仅为1.36%。2013年的食品安全监管体制改革后,甘肃省食品安全监管部门监管人员数量明显增加。市州级行政机构监管和稽查执法机构人员均增加50%左右,检验检测机构人员增加比例高达90%;区县级行政监管人员约增加2/3,稽查执法机构增加近一倍,检验检测机构从原来的仅有15人增加至647人,为原来的43.13倍。结论 :我国食品安全监管人员编制和数量仍相对不足;监管人员学历相对较低;基层食品监管的人员大多为非食品相关专业;食品安全监管财政投入尚不能满足所需;监管手段较为单一;监管过程尚需建立有效监督机制和激励机制;企业自律性尚待提升。     

黑龙江省孤独症谱系障碍儿童家庭经济负担现状

了解黑龙江省孤独症谱系障碍(autism spectrum disorder,ASD)儿童在就诊及康复治疗过程中的卫生费用支出情况及对家庭造成的经济负担,为相关部门制定帮扶政策提供依据.方法 采用自拟调查问卷对黑龙江省5个地市12所康复机构的314名ASD儿童的主要抚养人进行调查和访谈.结果 黑龙江省ASD儿童年均康复治疗总费用为6.44万,其中城镇为6.38万元,农村为6.53万元,差异无统计学意义(P>0.05).农村患儿交通膳食费用、房屋租住费用均高于城镇患儿(P值均<0.05).ASD儿童康复治疗总费用占家庭收入的平均比例为193.7%,其中城镇为173.9%,农村为219.6%,农村明显高于城镇(Z=-3.250,P<0.01).无论城乡,康复训练、交通膳食2项支出占收入(85.1%,98.2%;54.4%,79.9%)和支出(33.0%,32.4%;21.5%,26.7%)比例最大,其次为房屋租住、就诊和药物治疗.调查对象中有118名(37.6%)享受惠民补助.结论 ASD儿童康复治疗费用给患儿家庭造成严重的经济负担.应该进一步扩大本地区惠民补助的覆盖率、提高救助金额,最大限度减轻ASD患儿所带来的经济负担和精神压力.     

孤独症谱系障碍儿童感觉异常特征分析

目的 分析孤独症谱系障碍(ASD)儿童感觉异常特征，为ASD儿童早期诊断、科学干预提供参考依据。方法 采用横断面调查，于2021年8月—2022年2月收集南通市康复机构训练的234名ASD儿童作为受试对象，采用简化版感觉特征问卷(SSP)进行调查。结果 234名ASD儿童中有感觉特征总分异常的儿童有128名，异常率54.7%。其中可能异常58名(24.8%),明显异常70名(29.9%),7个维度中听觉过滤异常率最高，达到82.1%;其次依次为力量低下/虚弱、运动敏感、味觉/嗅觉敏感、低反应/寻求感觉、视觉/听觉敏感、触觉敏感，感觉异常总发生率为91.0%。不同性别、年龄ASD儿童SSP量表得分比较差异无统计学意义(t=1.200、1.124,P>0.05);男童感觉异常率为56.8%,高于女童(47.1%),差异有统计学意义(χ²=6.882,P<0.05);不同年龄组患儿感觉异常特征分布差异无统计学意义(χ²=0.454,P>0.05)。结论 感觉加工异常在ASD儿童中普遍存在，且在男性患儿中表现更明显。     

海南省0～6岁孤独症、脑瘫、智力低下儿童康复情况分析

目的 调查海南省0～6岁儿童孤独症(ASD)、脑性瘫痪(CP)、智力低下(MR)流行特征及康复干预现状。方法 于2015年9月-2016年9月期间,在海南省采用分层整群随机抽样原则,抽取18个市县全体常住儿童作为调查对象,以问卷形式进行流行病学调查,疑似对象逐一诊断并对明确诊断者进行就诊史和接受康复训练情况的问卷调查,采用Epi Data 3.2建立数据库,选用SPSS 17.0进行统计学分析。结果 实际共调查了全省18个市县的38 267名儿童,诊断为ASD 235人,MR 229人,CP 80人,共计544人。曾接受康复训练的儿童236人(43.4%);ASD、MR、CP三类儿童接受康复训练的比率分别为58.30%、20.08%、66.25%;接受训练治疗患者中男生占48.06%,女生占28.79%。结论 海南省三类儿童接受康复训练重视程度为脑瘫及孤独症高于智力低下;发育异常儿童中男生在接受康复训练的比例上显著高于女生;城市接受康复训练的比例高于三类县;康复干预现状有待进一步改善,可作为进一步研究三类儿童防治工作的基础性资料。     

孤独症谱系障碍儿童感觉特征与行为问题的相关性

  目的  了解孤独症谱系障碍(autism spectrum disorder, ASD)儿童感觉特征情况,并探索其与行为问题的关联,为ASD儿童早期诊断、综合干预提供参考依据。  方法  采用横断面调查,于2021年9月至2022年2月收集南通市康复机构训练的193名ASD儿童作为受试对象,采用简化版感觉特征问卷(SSP)、Conners父母用症状问卷(PSQ)对患儿进行问卷调查。  结果  193名ASD儿童中感觉特征总分异常的儿童有106名,异常率为54.9%,其中可能异常45名(23.3%),明显异常61名(31.6%),7个维度中听觉过滤异常率最高,达到85.0%,其余依次为力量低下/虚弱、运动敏感、味觉/嗅觉敏感、低反应/寻求感觉、视觉/听觉敏感、触觉敏感,感觉异常总发生率为93.3%。不同感觉异常程度ASD儿童PSQ得分中品行问题、学习问题、心身障碍、冲动多动、焦虑和多动指数6个维度比较差异均有统计学意义(H值分别为38.89,38.90,19.53,46.34,34.54,54.90,P值均 < 0.01),并且随着ASD儿童感觉异常加重,PSQ各维度得分均提高;SSP总分与PSQ中品行问题、学习问题、心身障碍、冲动多动、焦虑和多动指数6个维度均呈负相关(r值分别为-0.53,-0.50,-0.32,-0.55,-0.43,-0.61,P值均 < 0.01)。  结论  ASD儿童普遍存在感觉异常,且随着感觉异常的加重行为问题表现越明显,ASD儿童感觉异常与行为问题呈正相关,在今后的诊疗过程中要更多关注ASD儿童的感觉异常特征。     

孤独症儿童家庭养育环境特征及与神经心理发育相关性

目的 描述孤独症谱系障碍(ASD)儿童和发育迟缓儿童家庭养育环境分布差异,分析ASD儿童家庭养育环境与发育评估结果的相关性。方法 选取2018年1月—2020年8月在马鞍山市妇幼保健院儿童心理保健科就诊的ASD儿童(n=42)和发育迟缓儿童(n=48)为研究对象。两组儿童均要求完成Gesell发育量表评估,同时要求家长填写《家庭养育环境量表》。结果 本研究中家庭养育环境整体评价结果中“不良环境”33例,占36.7%。其中ASD组家庭养育“不良环境”12例,占28.6%,低于发育迟缓组(43.8%)。ASD儿童“情感温暖”不良的检出率高于发育迟缓组儿童(Z=2.490,P<0.05),家庭养育环境其他维度两组间差异无统计学意义(P>0.05)。此外,家庭养育环境不良的ASD儿童其适应性行为评分均数偏低(F=3.662,P<0.05)。结论 ASD儿童的养育环境促进应受到关注,家庭干预和家长教育可能促进改善其康复效果。     

2000-2016 年中国儿童孤独症谱系障碍患病率Meta分析

目的 运用Meta分析方法了解我国儿童孤独症谱系障碍(ASD)的流行现状。方法 检索2000-2016年在中国期刊全文数据库(CNKI)、万方数据资源系统(Wanfang data)、维普数据库(VIP)及PubMed中收录的有关中国儿童ASD患病率研究的文献。采用STATA 12.0软件进行数据合并估算患病率,并对性别和城乡因素进行亚组分析。结果 共纳入21篇文献,样本量215 700人,患病人数462人,合并患病率为0.24%(95%CI:0.18～0.29)。根据不同性别、城乡进行亚组分析,男性患病率0.35%(95%CI:0.26～0.44),女性患病率为0.07%(95%CI:0.05～0.10),差异有统计学意义(χ² =116.303,P＜0.001)。城市患病率0.17%(95%CI:0.08～0.26),乡村患病率0.09%(95%CI:0.05～0.12),差异无统计学意义(χ²=1.686,P=0.200 4)。结论 儿童ASD呈逐年上升趋势,应建立统一、规范的ASD患病率调查研究方法来进行ASD的流行病学研究,为加大对儿童ASD防治及进一步研究提供基础资料和参考。     

孤独症谱系障碍与发育性语言障碍2~3岁儿童Gesell测评结果分析

目的 分析2~3岁儿童孤独症谱系障碍(ASD)与发育性语言障碍(DLD)的Gesell发育特征,为早期诊断和干预提供依据。方法 回顾性分析2020年3月—2021年3月,明确诊断为ASD(n=78)、DLD(n=80)的2~3岁儿童,通过Gesell婴幼儿发育量表对每个儿童进行发育水平测评,并对两组儿童5个能区发育水平分布情况进行统计,分析ASD、DLD儿童的Gesell发育特征。结果 1)ASD组儿童平均发育商得分均低于DLD组儿童。除大运动能区外,ASD组儿童适应性、精细运动、语言、个人-社交能区间发育水平均低于DLD组,差异有统计学意义(t=16.043、6.208、14.219、10.811,P＜0.001)。2)语言、个人-社交发育比较:ASD组儿童的语言发育水平以重度、中度障碍为主(48.72%、33.33%),DLD组儿童的语言发育水平以轻度障碍为主(77.5%)。ASD组儿童50%的个人-社交分布在轻度障碍区域,无1例正常;DLD组儿童的个人-社交发育商68.75%分布在轻度障碍区域,30%处于正常或边缘水平。结论 除大运动能区外,ASD儿童其余能区平均发育水平均低于DLD儿童。熟悉ASD、DLD儿童的Gesell发育特征,对ASD、DLD儿童的早期识别、康复及教育计划的制定和预后具有重要的意义。     

医疗机构推诿艾滋病病毒感染者/艾滋病病人应对策略

通过分析非定点医疗机构推诿艾滋病病毒感染者和艾滋病病人的表现形式和发展过程,认为:政策落实不到位、监督机制不健全、定点医疗机构诊疗能力弱、非定点医疗机构维护自我利益、相关保障机制不健全等是医疗机构推诿的主要原因。在分析的基础上,提出了解决的策略:完善政策、提高定点医疗机构的诊疗能力、加强培训、完善防护措施、健全补偿机制、加强与病人的沟通、加大监督力度。     

Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

ABSTRACT: BACKGROUND: The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. METHODS: The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention) against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. RESULTS: Results showed significant increases in health-service coverage at the district level (p = <0.05) in the intervention teams compared to the comparison teams. Similarly, there were significant increases in the number of client visits at the facility level in the intervention group versus comparison facilities (P < 0.05). CONCLUSIONS: Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.     

2002-2009年上海市公共卫生机构经济运行状况分析

结合上海市卫生总费用核算数据,分析了上海市疾病预防控制机构和卫生监督机构2002-2009年的收入与支出及人员经费状况等,指出存在的问题并提出政策建议。     

Assessment of the hepatitis B birth dose vaccination program,Papua New Guinea, 2014

IntroductionPapua New Guinea (PNG) implemented hepatitis B birth dose (BD) vaccination in 2005 yet since that time coverage has remained low, allowing mother-to-child transmission to occur. We conducted a field assessment of the BD vaccination program to develop strategies for improving the BD coverage.MethodsWe selected five provinces with higher hepatitis B prevalence and five with lower prevalence based on the results of a 2013 hepatitis B serological survey. Within each province, we interviewed district and provincial health officers, health workers, village volunteers, and caregivers from ten randomly selected health facilities. Data were collected on knowledge, practice, vaccine management and data recording/reporting. To identify enabling factors and barriers, we compared health facilities with higher BD coverage with those with lower coverage, and compared caregivers whose children received BD with those whose children did not.ResultsOverall timely BD coverage was 31% and BD vaccination was taking place in 81% of sampled health facilities. Lack of cold chain and vaccine were the major reasons for not providing the BD. Insufficiencies in supervision, vaccine management, community outreach, and data management were identified as obstacles to achieving high timely hepatitis B BD coverage. Good supervision, knowledge of hepatitis B and hepatitis B vaccination, antenatal care including information about the hepatitis B BD, provision of vaccine refrigerators in maternity wards, and outreach vaccination for home deliveries were associated with higher timely BD coverage.DiscussionSeveral steps will likely be effective in improving BD coverage: strengthening training and supervision among health workers and officers, educating caregivers on the benefits of the BD and delivery in health facilities, improving vaccine management, and improving data quality. Considerable effort and leadership will be needed to achieve these steps.     

The Strengthening Washington D.C. Families Project: A Randomized Effectiveness Trial of Family-Based Prevention

The Strengthening Washington DC Families Project (SWFP) examined implementation fidelity and effectiveness when a selective, evidence-based prevention program was implemented with a sample of 715 predominantly African American families across multiple settings in an urban area. Using a true experimental design, this study reports on the differential effectiveness of four conditions (child skills training only, parent skills training only, parent and child skills training plus family skills training, and minimal treatment controls) in reducing child antisocial behavior and its precursors. Major challenges with recruitment and retention of participants and uneven program coverage were documented. No statistically significant positive effects for any of the program conditions were observed, and a statistically significant negative effect on child reports of Negative Peer Associations was observed for children of families assigned to the family skills training condition. Two marginally significant findings were observed: Child's positive adjustment favored families assigned to family skills training condition relative to minimal treatment and child training only, and family supervision and bonding was lower for children in family skills training than in the other three conditions. Hypotheses about potential explanations for the weaker than expected effects of this program are offered, as are thoughts about the infrastructure necessary to successfully implement family strengthening programs and the future of prevention science.     

结构化教学法对孤独症谱系障碍儿童康复效果的影响研究

目的 通过比较结构化教学(TEACCH)康复训练与常规康复训练对孤独症谱系障碍(ASD)儿童的康复治疗效果差别,指导以后ASD儿童的康复治疗方案。方法 将2015年3月—2016年12月于临沂市人民医院儿童康复科就诊行康复训练的80例ASD儿童随机分为TEACCH治疗组和常规康复治疗组,分别比较两组ASD患儿在康复治疗开始前、训练3个月后及6个月后的功能改善情况,应用PEP-3进行全面的发育评估。结果 TEACCH治疗组和常规康复治疗组患者在康复治疗3个月及6个月后较开始训练前功能均有提高,训练3个月后,TEACCH治疗组在情感表达(t=2.264)、非语言行为特征(t=2.706)、语言行为特征(t=2.210)、个人自理(t=3.328)、适应行为(t=2.090)及总体行为特征(t=2.706)等方面较常规康复治疗组有提高,差异均具有统计学意义(P＜0.05);康复训练6个月后TEACCH治疗组患者在认知(t=2.552)、语言理解(t=2.699)、情感表达(t=2.649)、非语言行为特征(t=2.524)、语言行为特征(t=2.605)、个人自理(t=3.129)、适应行为(t=2.055)及总体行为特征(t=2.583)等方面较常规康复治疗组有提高,差异均具有统计学意义(P＜0.05)。结论 专业的康复训练对于ASD儿童的康复均有促进作用,结构化教学对于ASD儿童发育水平的提高具有更好的促进作用。     

The effect of physician training on treatment of respiratory infections: evidence from rural Egypt

A three-round survey of child mortality, morbidity and treatment conducted in rural lower Egypt in 1990-91 found relatively poor treatment practices for respiratory infections. Only about 56 per cent of children with a respiratory infection received appropriate treatment. Antibiotics were prescribed for more than half of all mild coughs and colds, but were not prescribed for a quarter or more of serious cases. A training program for government physicians conducted midway through the survey improved treatment practice slightly in government facilities. However, training alone is unlikely to improve treatment much. Better supervision, and information campaigns focused directly on mothers, are suggested as necessary components of a successful project.     

上海市某区社区卫生服务中心康复医学医护人员现状调查分析

目的 为配置和有效利用康复医学人力资源,以满足人民对社区康复日益增长的需要,对上海市某区社区卫生服务中心的康复医学医护人员现状进行调查.方法 对上海市某区社区卫生服务中心进行全覆盖的问卷调查.结果 上海市某区社区卫生服务中心存在社区康复专业医师缺乏;康复治疗师与医师配比失衡等问题.结论 为卫生行政部门制定适用社区卫生服务中心康复医学科标准,加强社区康复医学医护人员引进与培养提供政策依据.