179例0～4岁儿童死亡原因分析

采用婴儿死亡率指数(IMI)及可预防性死亡指数(PDI)来评价、分析179例城乡0～4岁儿童的死亡原因与死亡率水平。在文化、经济发达的城市IMI明显低于农村地区,PDI呈负值(-10.27),儿童的主要死因为内源性疾病。农村地区PDI为13.4,儿童的死因以外源性疾病为主。为降低儿童死亡率制定政策和措施提供科学依据。     

降低儿童死亡率干预措施在广西农村的应用与评价

本文采用婴儿死亡率指数及可预防性死亡指数两个指标，分析评价１９９２年－１９９４４上对广西崇左县实施降低儿童死亡率干预措施的成效。ＩＭＩ从未实施干预措施的１９９２年的６４位，下降到１９９３年－１９９４年的５５位和５６位，分别下降９位次和８位次，ＰＩＤ也分别下降９位次和８位次。     

0～3岁儿童系统管理率与婴儿及新生儿死亡率的关系

目的研究0～3岁儿童系统管理率与婴儿及新生儿死亡率的关系.方法采用回顾性研究的方法,对苏州市1989～2000年的7岁以下儿童保健工作年报表及婴儿死亡监测个案、0～4岁儿童死亡监测个案和月报表进行分析.结果儿童系统管理率与婴儿及新生儿死亡率呈负相关;1989～1994年苏州市0～3岁儿童系统管理率呈下降趋势,婴儿死亡率却呈上升趋势,1995～2000年苏州市0～3岁儿童系统管理率逐年上升,婴儿死亡率逐年下降;新生儿死亡率与婴儿死亡率变化趋势相似.结论要降低婴儿及新生儿的死亡率,除了分析并控制病因以外,还要做好儿童的系统管理工作,加强宣传,并且应用对健康有利的促进性干预措施,促进儿童的健康成长.     

婴幼儿死亡水平新指标的评价

本文介绍了评价婴儿和儿童死亡水平的两个指标IMI和PDI。这两个指标比IMR和C MR能更合理、直观地比较不同时期、不同地区的死亡水平,并把某些死因比例关系同死亡水平结合起来描述,对卫生管理工作者有重要的参考价值。     

河南省ARI监测县0～4岁儿童死亡动态分析

通过河南省ARI监测县0～4岁儿童两年来死亡登记的结果显示0～4岁儿童、婴儿、新生儿的平均死亡率分别为M．45％、38．83We、29．13％。死亡儿童的年龄主要集中在新生儿时期。肺炎由第一位死因下降为第二位死因。死前就医1994年、1995年分别提高28．74％和19．24％。死在家中途中的比例1994年、1995年分别下降39．44％、33．7％。以上结果果表明ARI是适合我国国情、能挽救儿童生命，降低死亡率的行之有效的适宜技术，应全面推广应用。     

0～3岁儿童系统管理率与婴儿及新生儿死亡率的关系

目的：研究0～3岁儿童系统管理率与婴儿及新生儿死亡率的关系。方法：采用回顾性研究的方法，对苏州市1989～2000年的7岁以下儿童保健工作年报表及婴儿死亡监测个案、0～4岁儿童死亡监测个案和月报表进行分析。结果：儿童系统管理率与婴儿及新生儿死亡率呈负相关；1989～1994年苏州市0～3岁儿童系统管理率呈下降趋势，婴儿死亡率却呈上升趋势，1995～2000年苏州市0～3岁儿童系统管理率逐年上升．婴儿死亡率逐年下降；新生儿死亡率与婴儿死亡率变化趋势相似。结论：要降低婴儿及新生儿的死亡率．除了分析并控制病因以外，还要做好儿童的系统管理工作，加强宣传，并且应用对健康有利的促进性干预措施，促进儿童的健康成长。     

北京市东城区2008-2016年5岁以下儿童死亡情况分析

目的分析北京市东城区5岁以下儿童死亡率及主要死亡原因,为降低5岁以下儿童死亡率及制定相应的干预措施提供依据。方法对2008-2016年北京市东城区5岁以下儿童死亡数据进行分析,用动态数列比较死亡率在时间上的发展变化趋势。结果 2016年北京市东城区新生儿死亡率(NMR)、婴儿死亡率(IMR)、5岁以下儿童死亡率(U5MR)分别为1. 28‰、2. 39‰、2. 39‰。2008-2016年NMR、IMR、U5MR总体呈下降趋势,年平均下降率分别为6. 22%、5. 47%、7. 05%。年龄构成情况,婴儿死亡占5岁以下儿童死亡比例为90. 97%。新生儿死亡占婴儿死亡比例为64. 12%,早期新生儿占新生儿死亡比例为66. 67%。2008-2016年5岁以下儿童死亡死因前3位依次为:先天性心脏病(17. 36%),早产和低出生体重(13. 89%),出生窒息(10. 42%)。结论 9年间北京市东城区5岁以下儿童死亡率呈波浪式下降趋势,降低5岁以下儿童死亡率重点应放在婴儿,尤其早期新生儿的护理、营养和诊治疾病上。应加强孕前及孕期保健、围生期保健,提高产科质量,以减少先天性心脏病及早产的发生。加强产儿科合作,提高新生儿复苏技术,以减少因出生窒息造成的死亡。     

宜春市5岁以下儿童死亡分析

目的:掌握宜春市5岁以下儿童死亡情况,为制定干预措施提供依据。方法:对1995~2004年宜春市管辖的10个县(区)5岁以下儿童死亡监测资料进行分析。结果:2004年新生儿死亡率为10.31‰,婴儿死亡率为15.73‰,5岁以下儿童死亡率为21.08‰,与1995年相比,新生儿死亡率下降61.20%,婴儿死亡率下降69.87%,5岁以下儿童死亡率下降66.45%。10年期间,5岁以下儿童前5位死因依次为:肺炎、出生窒息、早产、意外窒息、溺水。结论:10年监测工作,效果显著,死亡率下降速度较快。加强对基层妇幼保健人员AR I标准病案管理及新生儿窒息复苏适宜技术培训,是降低5岁以下儿童死亡率的有力措施。     

2007-2010年张家港塘桥地区5岁以下儿童死因分析

目的 了解5岁以下儿童的死亡特点,探讨减少儿童死亡的干预措施.方法 分析2007-2010年张家港市塘桥卫生管理服务中心登记在册的5岁以下儿童死亡报告卡.结果 5岁以下儿童年均死亡率为11.0‰,其中婴儿死亡率7.4‰,新生儿死亡率5.7‰.前3位死因分别是早产、溺水和先天性心脏病.结论 塘桥镇5岁以下儿童死亡率与全国相比处于较低水平,儿童医疗保健水平较高.     

湖北省1991～2001年5岁以下儿童死亡监测结果分析

目的分析湖北省5岁以下儿童死亡率的变化趋势和潜在寿命损失年数,评价干预措施的效果.方法采用线形回归模型分析5岁以下儿童死亡率的变化趋势,并利用5岁以下儿童死亡率指数、婴儿死亡率指数和可预防性指数评价干预措施的效果.结果湖北省2001年5岁以下儿童死亡率为28.37‰,婴儿死亡率为23.24‰,与1991年相比具有明显的下降趋势.主要死因分别为肺炎、出生窒息、早产低出生体重和意外窒息.5岁以下儿童和婴儿潜在寿命损失率(PYLL‰)分别为190.34年/千人和1731.22年/千人.可预防性指数在1991年的基础上分别下降15和13位次.结论5岁以下儿童主要死因是潜在寿命损失的最主要原因,必须大力开展儿童死亡的监测与干预工作.     

先天性梅毒婴儿生长发育状况分析

目的分析先天性梅毒婴儿体格、智能发育状况。方法对74例先天性梅毒患儿在婴儿期进行体格发育评价和智能、运动发育测试,获得体格发育指标、智能发育指数(MDI)及心理运动发育指数(PDI),并对其中的各种相关因素进行分析。结果先天性梅毒患儿体格发育及智能、运动发育的评定值总体偏低。多因素分析结果显示,梅毒患儿出生时的体重、孕周与体格发育有明显关联;围产期疾病的严重程度、贫血程度、胎龄及其父母的文化程度与MDI和PDI有关联。结论先天性梅毒婴儿有生长发育落后的情况,应加强随访监测,及早进行干预,提高此群体的远期生活质量。     

早产低出生体重婴幼儿智力和运动发育纵向随访研究

【目的】 探讨早产低出生体重对6~24月龄儿童智力和运动发育的影响及随年龄而变化的趋势。 【方法】 观察组:早产低出生体重儿86例;正常对照组115例,采用纵向随访方法,在儿童6月、12月、18月和24月龄时,应用Bayley婴幼儿发育量表进行评估,结果用智力发育指数(mental development index,MDI)和运动发育指数(psychomotor development index,PDI)、以及校正年龄后的智力和运动发育指数(MDIJ和PDIJ)表示。 【结果】 早产组在6月、12月、18月及24月龄时MDI及PDI均低于正常对照组,差异有统计学意义(P＜0.05)。经校正年龄后,与对照组相比,早产组6月龄MDIJ略高(P=0.017),差异有统计学意义,其余年龄段差异无统计学意义;校正后的PDIJ在多数年龄段仍然落后于对照组,差异有统计学意义。24月龄时早产组MDI、PDI仍＜85者各有9例(10.5%)、10例(11.6%)。 早产组24月龄MDI与父母亲文化水平、MDIJ6、PDIJ6和PDIJ12呈显著相关(r=0.387~0.664,P＜0.05),运动发育与母亲年龄、父亲文化、MDIJ6、PDIJ6、MDIJ12和PDIJ12呈显著相关(r=0.473~0.672,P＜0.05)。 【结论】 早产低出生体重对婴幼儿的智力和运动发育有明显的不利影响,但随年龄的增长智力发育指数与正常儿童的差距缩小。     

早产儿早期神经运动发育纵向随访

目的 探讨早产对婴幼儿智力、运动发育及视觉认知能力的影响,为开展早产儿早期干预提供依据。方法 采用纵向随访方法,选取曾在本院新生儿科住院的55例早产儿(其中:极早产儿 25例,中晚期早产儿30例)作为研究组,40例正常足月儿作为对照组,应用Bayley-Ⅱ婴幼儿发育量表在12月龄、18月龄、24月龄和36月龄时进行评估,用智力发育指数(Mental Developmental Index,MDI)、运动发育指数(Psychomotor Developmental Index,PDI)和视觉项目通过率表示。结果 极早产儿各校正月龄MDI、PDI均较正常足月儿落后(P＜0.05);中晚期早产儿仅在校正12月龄和24月龄MDI得分与对照组存在显著性差异(P＜0.05),各校正月龄PDI得分与对照组无显著性差异(P＞0.05)。极早产儿组视觉项目通过率为46.3%,中晚期早产儿为61.5%,对照组为74.4%。 结论 早产对婴幼儿的智力、运动及视觉认知发育存在显著负面影响,在极早产儿中尤为明显,应尽早实施早期干预,促进早产儿发育。     

贝莉婴儿发育量表在上海地区的修订

应用贝莉婴儿发育量表(BSID)对上海地区947名2～30月龄儿进行发育测试,发现智能发育指数(MDI)和精神运动发育指数(PDI)的均值和标准差与理论值相差甚远,因此,我们认为,BSID不完全适用于上海地区儿童的发育评价。通过重新计算各项目的发育龄,对项目进行重编排,我们发现修订后的BSID,项目的折半信度、测试者间信度与再测信度均较高,应用修订后的量表,小儿的MDI和PDI的均教和标准差也接近理论值。提示:修订后的BSID对上海儿童有较高的准确性和可靠性。     

The frailty hypothesis revisited: mainly weak children die of measles.

It has been suggested that measles infection mainly kills frail children who are likely to die anyhow of other infections. If that were true, the proportion of frail children should increase after the introduction of measles vaccination and post-measles mortality compared with mortality in uninfected children should increase when the case fatality declines and frail children are no longer dying of measles. The latter deduction was investigated in Niakhar, Senegal, where the measles case fatality has declined markedly. Measles has been studied in Niakhar during 12 years from 1983 to 1994. We compared long-term mortality after measles infection in periods with both high and low case fatality. The acute measles case fatality rate (CFR) declined from 6.5% in 1983-1986 to 1.5% in 1987-1994, an age-adjusted decline of 66% (RR=0.34 (0.19-0.58)). Between 1983-1986 and 1987-1994, mortality in the first year after measles infection declined by 35% (RR=0.65 (0.37-1.16)), the pattern being the same in the second and third year after infection (RR=0.63 (0.33-1.21)). This reduction could not be related to introduction of immunization, treatment of measles with Vitamin A, or prophylactic use of antibiotics. Controlling for age, immunization, and season, the decline in post-measles mortality was similar to the fall in non-measles-related mortality between the two periods (mortality rate ratio=0.72 (0.64-0.80)). Since the mortality decline in survivors of measles was as large as the decline in mortality among uninfected children, reduction in acute measles mortality did not lead to accumulation of frail children. We doubt measles infection ever eliminated mainly weak children; it always killed a broad spectrum of children, most of whom were "fit to survive". Hence, it seems unlikely that measles vaccination has contributed to the survival of more frail children.     

No improvement in weight-for-age of young children in southern Senegal, 1969-1992, despite a drastic reduction in mortality. Evidence from a growth monitoring programme

BACKGROUND: Undernutrition is associated with an increased risk of death among young children in developing countries. Infant and child nutritional status and mortality were monitored in a rural area of Casamance, Senegal. METHODS: Analysis of weight measurements taken at 3-24 months of age during routine growth monitoring in the community's private dispensary 1969-1992 (3912 children, 4642 child-years) and of mortality rates of children estimated from maternal recall for 1960-1985 and yearly census 1985-1995. RESULTS: Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates decreased from 312 to 127 and from 201 to 68 per 1000, respectively. About 90% of resident children attended growth monitoring in 1985-1992. Mean weight-for-age was at a minimum at 15 months of age (-1.60 z-scores [SD: 0.95]); the prevalence of underweight was 33.2% (95% CI: 31.5, 34.9). The latter increased significantly over time, both when comparing all years of follow-up (P for trend <0.01) and over three pre-defined time periods (28.6, 34.6, and 35.0% in 1969-1974, 1975-1984, and 1985-1992, respectively, P for trend <0.05). Mean weight-for-age decreased over time in infancy and in the second year of life. CONCLUSION: No improvement in nutritional status was found among young children 1969-1992 despite a drastic decrease in mortality. Focused public health interventions such as vaccinations and malaria prevention probably did not enhance weight-for-age. Paradoxically, growth monitoring may have been more helpful in improving health than growth.     

Malignant pleural mesothelioma incidence and mortality in Tuscany in 1988-1999

In the period 1988-1999, the Tuscan Mesothelioma Registry (ARTMM) recorded 436 cases of pleural malignant mesothelioma (MMP); 81% were males. The Tuscan MMP incidence rate (age standardized on European population; per 100,000 per year), was 0.97 in 1988-1993, 1.64 in 1994-1999 for males; 0.22 and 0.23 for females, respectively. In the period 1988-1999 the Tuscan Mortality Registry (RMR) recorded 676 pleural cancer (TMP) deaths (ICD IX 163; 464 in males). In the periods 1988-1993 and 1994-1999 Tuscan TMP mortality rate (per 100,000 per year) was 1.54; 1.70 for men; 0.46 and 0.53 for women, respectively. The highest incidence and mortality rates for males were recorded in Massa Carrara (MMP incidence in the period 1994-1999: 5.20) e Livorno (MMP incidence in the period 1994-1999: 4.64) provinces. In order to study differences between incidence and mortality for males, an analysis of distribution of incident MMP cases and TMP deaths by municipality in Tuscany was carried out. It is usually assumed for projections of MMP mortality that the ratio of MMP mortality to TMP mortality is 1:1. However, in order to evaluate more precisely projections of MMP mortality, the exact ratio was calculated for men. In the period 1994-1999, 82% (154/188) of the male MMP deaths were correctly coded as TMP deaths in the RMR; 60% (154/256) of male TMP deaths were definite MMP cases, as they were recorded in ARTMM. The ratio of MMP mortality to TMP mortality is, therefore, 0.73:1 (0.60/0.82) for males in Tuscany.     

Estimates of smoking-attributable deaths at ages 15-54, motherless or fatherless youths, and resulting Social Security costs in the United States in 1994

BACKGROUND: Deaths of parents often harm their children, taxpayers, and society, for decades. So we estimated the smoking-attributable (SA) counts and percentages (SA%) of U.S. 1994 deaths at child-rearing ages; youths (ages <18) left motherless or fatherless; and resulting Social Security Survivors Insurance taxes. DESIGN: U.S. 1994 age/sex/education-specific total and SA death counts were estimated using death certificate data and standard CDC SAMMEC methods (with added injury mortality), respectively. We separately summed (a) total and (b) SA age/sex/education-specific death counts times their average number of youths per adult (cumulative fertility, adjusted for infant mortality). We then multiplied the SA and total bereft youth counts by their average duration of Survivors Insurance, and calculated the SA cost of youth Survivors Insurance. RESULTS: In 1994, smoking caused an estimated 44,000 male and 19,000 female U.S. deaths at ages 15-54, leaving 31,000 fatherless and 12,000 motherless youths. On December 31, 1994, the SA prevalences [count (SA%)] of fatherless or motherless youths were an estimated 220,000 (17%) and 86,000 (16%), respectively. Resulting Survivors Insurance costs were about $1.4 (sensitivity range: $0.58-3.7) billion in 1994. CONCLUSIONS: Smoking causes many U.S. deaths at ages 15-54, youth bereavements, and Survivors Insurance costs. Reductions in smoking may greatly reduce those deaths, bereavements, and taxpayer and societal costs.     

沈阳市居民近十年膳食结构和健康状况变化分析

对沈阳市１９８４～１９９４年居民食物消费，儿童体格发育和某些营养相关慢性疾病死亡率的调查资料进行分析，结果表明，膳食质量明显改善，谷物人年均消费量由１９８４年１４１．０ｋｇ降至１９９４年１２５．２ｋｇ，动物性食物由４０．０ｋｇ增至５９．１ｋｇ。增加幅度较大的是蛋类、牛羊肉、禽肉和鱼类，占总增加额的９５．３％，猪肉增加最少，仅占４．７％。这些食物消费变化反映食物结构调整政策是合理的和有效的。１９９３～１９９４年平均理想膳食模式（ＤＤＰ）评分已达１０３。十年间学生体格发育明显改善，７岁男女学童身高平均增加３．６７ｃｍ和４．４５ｃｍ，体重增加１．０６ｋｇ和３．２３ｋｇ。１２岁儿童的身高和体重增加值大于７岁儿童。因此，１２岁即初中入学时儿童的生长率作为营养监测的指标更为敏感。但某些疾病如糖尿病、冠心病和脑卒中死亡率分别增加了１３１．０％、９０．３％和２５．４％。这可能与脂肪所提供能量占总食物能量比例逐年增加有关。脂肪消费量的迅速增加应引起重视。解决居民膳食中钙严重不足（５４．３％ＲＤＡ），谷物钙强化可能是有效的和可行的途径。