医疗保险患者住院医疗费用分布特点

目的：分析医疗保险住院患者系统疾病费用分布特点。方法：对某医院2003—2006年构成前10个系统疾病医保出院患者进行统计,报告其住院总费用、例数、均数、标准差、中位数、最小值、第5百分位数、第25百分位数、第75百分位数、第95百分位数、最大值,并计算各系统第95百分位数以上的平均费用,累计费用及占总费用比例。结果：疾病医疗费用呈非正态分布。第95百分位数以上5％大额病例费用,占全部患者总住院费用比例达21．5％～29．9％。结论：医疗保险患者医疗费用的分布有其特殊性;医疗费用定额支付标准应根据疾病医疗费用分布特点和医疗服务需求强度制定。     

传染病预警基线值的探讨研究

[目的]早期识别和探查传染病暴发流行,提高突发公共卫生事件应对能力. [方法]以痢疾、甲肝为例,利用2001～2005年历史数据,对传染病历史平均发病水平予以定量化,采用移动平均法建立不同百分位上预警值以及预警控制图,确定合理预警基线值. [结果]计算传染病在P25,P50,P75不同百分位数上的预警值,根据疾病发病分布特点,以"第75百分位数"作为预警基线值,以"第90百分位数"作为预警控制线. [结论]采用移动平均法可以较好表达传染病在不同百分位上的预警界值,合理预警基线值确定为P75.     

中国7～18岁学龄儿童青少年腰围界值点研究

目的 根据儿童不同腰围水平罹患心血管疾病的危险,研究中同学龄儿童青少年腰围的适宜界值点.方法 利用受试者工作特征曲线(ROC)法分析从全国汇总的65 898名7～18岁学龄儿童青少年腰围及其相关代谢指征数据,探索预测心血管疾病的腰围最佳界值点.结果 儿童青少年腰围值小于第75百分位数(P75)时,收缩压、舒张压、血糖、总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平以及血压升高率、血糖升高率、血脂异常率随腰围变化趋势不明显,当腰围大于P75后,上述指标逐渐增加,从P90开始,增加趋势明显,高密度脂蛋白胆固醇的变化趋势相反.ROC曲线结果表明,预测血压增加的腰围最佳界值点为P75;预测至少两项心血管疾病危险因素聚集的最佳界值点为P90.与腰围低于P75,的儿童青少年相比,在腰围处于P75～P90者中至少聚集两项心血管疾病危险因素的比例增加了1倍,腰围大于P90者中该比例则增加了5倍.按体重指数分类标准分层后,儿童青少年血压升高率仍然随腰围增加而显著增加.结论 建议将中国儿童青少年腰围的年龄别性别P7,和P90作为儿童青少年心血管病危险开始增加和明显增加的界值点.     

体育专业大学生心理卫生状况及个性特征的调查分析

用心理健康调查表和修订的艾森克个性问卷（EPQ）对220名体育专业大学生进行心理健康状况调查。结果显示：有27．7％－32．7％的学生存在不同程度的心理问题；神经症倾向检出率为11．4％；神经症分布以强迫症为多；心理问题组学生P分、N分及E分数值均高于正常组，而L分低于正常组。     

青岛农村青少年行为问题及其影响因素的研究

目的：了解农村青少年的行为问题状况及其影响因素。方法：采用Achenbach儿童行为量表和自编的行为问题影响因素问卷,调查12～16岁农村青少年752名。结果：农村青少年行为问题的检出率为18．75％±1．42％,男性检出率为20．09％±1．94％,女性的检出率为16．98％±2．09％。男性检出率较高的因子有：分裂样、体诉、敌意性、违纪,其主要影响因素有：父亲参与娱乐性赌博、父亲健康状况、父亲酗酒、母孕期喷洒农药、与父母关系、幼儿期疾病及母亲性格。女性检出率较高的因素有：体诉、残忍、不成熟、分裂样。主要影响因素包括：家中有无电视、母亲在家居住状况、母亲健康状况、婴儿期疾病。结论：农村青少年行为问题的发生是多种因素相互作用的结果,应采取综合措施进行防治。     

青少年情绪和行为问题与生活事件的相关性

目的 发现影响青少年情绪和行为问题的有关生活事件，为干预提供依据。方法 采用现场调查方法，以青少年自评量表（YSR）和青少年生活事件量表（ASLEC）作为评定工具；就诊组为2002年7月至2004年3月在四川大学华西医院心理卫生中心就诊的585例小学5年级以上（11～18岁）合作患者；非就诊组为按整群抽样的成都市1280名学生中与就诊组性别、年龄、父亲职业匹配的585人组成；数据分析用方差膨胀因子诊断法排除自变量之间存在共线性后，以YSR得分为因变量，采用线性逐步回归分析方法拟合线性回归模型。结果 就诊组YSR得分高于非就诊组，就诊组情绪和行为问题多于非就诊组；就诊组进入回归模型自变量偏回归系数为0．124～0．418，非就诊组进入回归模型自变量偏回归系数为0．104～0．388；人际关系不良、学习压力、受惩罚、健康适应差可以增加青少年情绪和行为问题。结论 对青少年进行情绪和行为问题干预时，注意指导青少年人际关系应对、帮助缓解学习压力、以成长目标为导向、减少惩罚的教育方式、提高社会适应等措施，以减少青少年情绪和行为问题发生，促进情绪和行为问题康复。     

兰州市3～12岁儿童BMI肥胖标准参考值

目的:探讨兰州市3～12岁儿童超重、肥胖BMI正常参考值。方法:采用随机整群分层抽样方法,选择兰州市区城市人口为主的4所小学和5所幼儿园3～12岁男女儿童3 200人进行体格测量。计算BMI百分位数分布,通过拟合BMI界值模型,最终确定兰州市学龄前及学龄儿童肥胖、超重BMI界值。结果:建立了兰州市3～12岁儿童超重、肥胖BMI正常参考值。按照本研究初拟界值判断,兰州市7、9、10、12岁组儿童超重问题最突出,每10人当中至少有1人超重;3～6岁儿童超重、肥胖随年龄增大而上升,其中在5岁期间增长幅度迅速增大;10岁组肥胖比例最高。结论:本研究各年龄组儿童除9岁和10岁男童超重、肥胖BMI界值在P80和P90百分位数,其余各组儿童主要集中在P85和P95百分位数。兰州市3～12岁儿童超重检出率女童高于男童(男童8.57%,女童9.39%),男童肥胖检出率高于女童(男童6.07%,女童4.32%),男女童在超重和肥胖检出率上并不总是男童高于女童。     

中国成人体质指数分布状况

根据 1992年第 3次全国营养调查资料 ,选取了 44 485例 2 0～ 6 0岁成人 ,对体质指数 (BMI)的性别、年龄分布进行了分析 ,并采用百分位数法对超重及肥胖的BMI界值进行了探讨。结果表明 ,我国成人BMI呈对数正态分布 ,均数为 2 2 1± 3 0 ,第 5 0、85和 95百分位数分别为 2 1 6、2 4 9和 2 7 4,其中第 85百分位数非常接近WHO推荐的超重界值 ,第 95分位数低于WHO肥胖的界值。BMI分布在年龄、性别、城乡之间都存在较大的差异。因此 ,作者建议在确定界值时应考虑性别、年龄的影响 ,并与发病率和死亡率、体脂含量等相联系     

重点中学学生心理健康状况研究

目的调查笔者所在城市重点中学学生心理健康状况。方法采用症状自评量（SCL-90）表，随机抽样笔者所在城市两所重点中学12～18岁学生508人进行问卷调查。结果心理问题检出率18．1％，心理问题主要表现依次为强迫、人际关系敏感、敌对、偏执、抑郁、焦虑等。男女生检出率差异无统计学意义（P〉0．05），但SCL-90中女生抑郁、焦虑、恐怖因子分明显高于男生，而男生敌对、偏执因子分明显高于女生，差异均有统计学意义（P〈0．05）；初高中学生心理问题检出率分别为9．98％与14．14％差异均有统计学意义（P〈0．05）。结论重点中学学生心理问题突出，值得关注。     

广西北海市青少年心理问题发生率现状研究

【目的】了解北海市青少年心理问题现状，进一步分析心理问题发生原因和影响因素，为制定干预措施提供依据。【方法】采用症状自评量（SCL-90）表，随机抽样中学12～18岁学生2048人进行问卷调查。【结果】青少年心理问题检出率11．6％，主要表现为强迫、人际关系敏感、敌对、偏执、抑郁等。男、女生心理问题检出率差异无显著性（P〉0．05），初、高中生心理问题检出率差异有显著性（P〈0．05）。【结论】北海市青少年心理问题发生率略低于国内及广西其他城市，但针对检出的心理问题，尤其是高中生心理问题，应引起教育部门和社会共同关注。     

上海市2000-2014年中小学生身体素质变化趋势

研究上海市2000-2014年7~18岁儿童青少年身体素质状况及变化趋势,为改善学生体质健康水平提供依据.方法 采用LMS法拟合上海市2000,2005,2010和2014年7~18岁儿童青少年身体素质指标的P50百分位数曲线,分析变化规律及性别差异.结果 握力、50 m跑及坐位体前屈(女)指标成绩P50各年龄段均有所提高(P值均<0.05),其中男、女生握力分别平均提高3.13,3.15 kg,女生坐位体前屈平均提高0.8 cm.立定跳远、斜身引体(男)、引体向上(男)、l min仰卧起坐(女)、50 m×8往返跑、l000m跑(男)、800 m跑(女)及坐位体前屈(男)指标成绩P50均有所下降(P值均<0.05),其中立定跳远男、女生分别平均下降11.0,8.59 cm,耐力跑成绩男、女生分别下降2.75,2.32 s.结论 上海市儿童青少年下肢爆发力、肌肉耐力、有氧耐力出现下降趋势,需采取针对性的应对措施.     

Mental Disorders in Self-Cutting Adolescents

PurposeSelf-cutting as a form of self-harm is common in general population adolescents. The aim of this study was to investigate the prevalence of mental disorders and associated factors among self-cutting community-dwelling adolescents.MethodsA sample of adolescents who reported current self-cutting (n = 80) was drawn from a large sample of community adolescents (n = 4205). Of these 80 individuals, 44 consented to further detailed assessment. An age- and gender-matched control subject was selected for each study subject. Data collection included Structured Clinical Interviews for DSM-IV-TR, the Beck Depression Inventory, the Alcohol Use Disorders Identification Test (AUDIT), and the Youth Self-Report for adolescents aged 11–18 years (YSR).ResultsMajor depressive disorder (63% vs. 5%), anxiety disorders (37% vs. 12%), and eating disorders (15% vs. 0%) were more common among self-cutting girls (n = 41) than among controls. None of the self-cutting boys (n = 3) had a DSM-IV-TR Axis I mental disorder. In multivariate model, the presence of major depressive disorder, the AUDIT score and the YSR internalizing subscale score were the factors that were independently associated with the presence of self-cutting in girls.ConclusionsMajor depressive disorder, signs of alcohol misuse, and internalizing behavior strongly associate with self-cutting in community-dwelling adolescents, especially in girls.     

Mental health, quality of life, and nutritional status of adolescents in Dhaka, Bangladesh: comparison between an urban slum and a non-slum area

This study aims to clarify the quality of life (QOL), mental health, and nutritional status of adolescents in Dhaka city, Bangladesh by comparing non-slum areas and slums, and to find the factors associated with their mental health problems. A sample of 187 boys and 137 girls from non-slum areas, and 157 boys and 121 girls from slums, between 11-18 years old were interviewed with a questionnaire consisting of a Bangla translation of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF), Self Reporting Questionnaire (SRQ), Youth Self-Report (YSR) and other questions. The height and weight of the respondents were measured. All significant differences in demographic characteristics, anthropometric measures, and WHOQOL-BREF were found to reflect worse conditions in slum than in non-slum areas. Contrarily, all differences in SRQ and YSR were worse in non-slum areas for both genders, except that the "conduct problems" score for YSR was worse for slum boys. Mental states were mainly associated with school enrollment and working status. Worse physical environment and QOL were found in slums, along with gender and area specific mental health difficulties. The results suggest gender specific needs and a requirement for area sensitive countermeasures.     

Central adiposity in Brazilian schoolchildren aged 7-10 years

Waist circumference (WC) is a measure of central adiposity related to elevated risk factor levels in children and adolescents. The aim of the present study was to describe WC percentiles in 7- to 10-year-old Brazilian children and to compare frequencies of obesity and overweight as defined by BMI and frequencies of excess and at risk of abdominal adiposity as defined by WC to the corresponding age and sex data from British references. A representative sample of 2919 schoolchildren of the city of Florianopolis (southern Brazil) was examined. Smoothed WC percentiles were derived using the least mean square method. Frequencies of overweight and obesity and of excess and at risk of abdominal adiposity were assessed using the 91st and 98th centiles of the British references as cut-off points. WC increased with age in both boys and girls, with higher values for boys at every age and percentile level. Nutritional status categories of children assessed by the 91st and 98th British BMI and WC centiles showed moderate agreement (weighted kappa = 0.58). Overweight was more frequent in Brazilian than British children: 15.1 % of girls and 20.1 % of boys were above the 91st percentile of the 1990 BMI for age British references. About one-quarter (22.0 % of girls and 26.9 % of boys) exceeded the 91st percentile of WC British references. The present data could be used to compare WC in children in other populations and may serve as a baseline for future studies of temporal trends in WC in Brazil.     

Time trends in eating disturbances in young Greek migrants

OBJECTIVE: The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established. METHOD: Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX). RESULTS: At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria. CONCLUSION: Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.     

Prevalence of the Wish to be of the Opposite Gender in Adolescents and Adults with Autism Spectrum Disorder

Several studies have suggested an overrepresentation of (symptoms of) autism spectrum disorder (ASD) among individuals with gender dysphoria. Three studies have taken the inverse approach in children with ASD and showed increased parent report of the wish to be of the opposite gender in this group. This study compared the self-reported wish to be of the opposite gender (one item of the Youth Self-Report [YSR] and the Adult Self-Report [ASR]) of 573 adolescents (469 assigned boys and 104 assigned girls) and 807 adults (616 assigned males and 191 assigned females) with ASD to 1016 adolescents and 846 adults from the general population. Emotional and behavioral problems were measured by the DSM-oriented scales of the YSR and ASR. In addition, the Children’s Social Behavior Questionnaire and the Adult Social Behavior Questionnaire were used to measure specific subdomains of the ASD spectrum to test whether specific subdomains of ASD were particularly involved. Significantly more adolescents (6.5%) and adults (11.4%) with ASD endorsed this item as compared to the general population (3–5%). In adolescents, assigned girls endorsed this item more than assigned boys. No significant gender differences were found in the adults with ASD. In addition, on all DSM-oriented scales of both the YSR and ASR, adolescents and adults with ASD who endorsed the gender item had significantly higher scores compared to those without. There were no significant associations between endorsement of the gender item and any specific subdomain of ASD, providing no evidence for a sole role of one of the ASD subdomains and endorsement of the wish to be the opposite gender.     

Prevalence of the metabolic syndrome in Chinese adolescents

Since national figures on the occurrence of metabolic syndrome among Chinese adolescents are lacking, this study aims to estimate its prevalence and distribution among Chinese youngsters. The 2002 China National Nutrition and Health Survey is a nationally representative cross-sectional study. Applying the criteria for US adolescents, we estimated the prevalence of metabolic syndrome among 2761 adolescents aged 15 to 19 years. The prevalence of metabolic syndrome among Chinese adolescents overall was 3.7 % (10 % in US adolescents). It was 35.2 %, 23.4 % and 2.3 % among adolescents who were overweight (BMI > or = 95th percentile), at risk of overweight (BMI between 85th and 95th percentile) and normal weight (BMI below the 85th percentile), respectively. Urban boys had the highest rate (5.8 %) compared with girls and rural youngsters. Among adolescents who had a BMI > or = 85th percentile and one or two parent(s) with metabolic syndrome, the prevalence was 46.4 %. A total of 96 % of overweight adolescents had at least one and 74.1 % overweight adolescents had at least two abnormalities of metabolic syndrome. Based on these figures, it is estimated that more than three million Chinese adolescents have metabolic syndrome. Both overweight and metabolic syndrome prevalence among adolescents are still relatively low in China, but the prevalence of metabolic syndrome among Chinese overweight adolescents is similar to those living in the USA.     

上海市2000-2014年中小学生体质量指数变化趋势

了解2000-2014年上海市学龄儿童青少年体质量指数(BMI)的变化趋势,为儿童青少年超重、肥胖判别标准研制及预防干预提供参考.方法 选取2000,2005,2010,2014年4次全国学生体质与健康调研中7~18岁儿童青少年作为研究对象.应用最小均方(Least Mean Square,LMS)法探讨不同性别、年龄组儿童青少年BMI的变化趋势.结果 14年间学生BMI P85低年龄组差异比较小,随年龄增加差异逐渐增大,青春期后有减小的趋势,男生平均增加2.1百分点,女生平均增加1.3百分点.学生BMI增长主要集中在中等和高百分位数,尤其是P90后,差值逐渐增大.7~11,12~15岁男生在P5o后差值均逐渐增大,P95分别达2.0,3.2百分点,其中12岁男生从23.4 kg/m2增加到26.8 kg/m2,14岁女生从24.0 kg/m2增加到25.9 kg/m2.与WGOC标准相比,2014年男生BMI P85,P95均较高,而女生BMI P85 10岁之前高于WGOC标准,从11岁开始与WGOC标准基本相一致.2014年上海市7~18岁儿童青少年超重、肥胖检出率分别为15.4%,9.1%,较2000年总体均呈上升趋势,分别上升6.4,5.2百分点.结论 BMI分布高百分位的个体比低百分位个体的变化更大.在肥胖防治工作中,加强对群体BMI曲线的监测分析,对适时调整宏观调控战略意义重大.     

A comparison of distribution curves of body mass index from Brazil and the United States for assessing overweight and obesity in Brazilian adolescents.

OBJECTIVE: To assess the validity of recommendations for use of the 85th and 95th percentiles of body mass index (BMI) of the population in the United States of America as a screening tool to assess overweight/obesity in adolescents. METHODS: We investigated the relation between BMI and percent body fat in 1,540 adolescents (717 males and 823 females) aged 10 to 17.9 years old from a private high school in Niterói, a city in the state of Rio de Janeiro, Brazil. We used bioelectric impedance, with the appropriate equations for adolescents, to estimate percent body fat, which served as the gold standard (30% for girls and 25% for boys) to calculate the sensitivity and specificity of the 85th and 95th percentiles of the United States and Brazilian distribution curves of BMI. RESULTS: Sensitivity and specificity were high (above 80%) for the Niterói boys, except for the 85th percentile of the Brazilian curve (specificity = 61.8%) and for the 95th percentile of the United States curve (sensitivity = 55.4%). For the Niterói girls, the 85th- and 95th-percentile BMI cutoff points, from both the United States and Brazilian curves, showed low sensitivity, and that sensitivity decreased with age. Specificity was high for the girls, and much higher than it was for the boys. CONCLUSIONS: These data suggest that using BMI to screen for overweight/obesity in adolescents can generate a high percentage of false-positives for Niterói boys and an even higher percentage of false-negatives for Niterói girls. A more universal approach to using anthropometric measures to screen for overweight/obesity should be developed, preferably linked to stages of maturation.     

Physical health,mental health,and behaviour problems among early adolescents in foster care

Background Adolescents with chronic illness in the general population are at increased risk of mental health and behaviour problems. Depression is also associated with delinquency. Adolescents in foster care are more at risk for chronic illness and mental health issues. We investigated whether adolescents in long‐term foster care with chronic illness have associated higher rates of internalizing and externalizing problems and delinquency. We also investigated if depression mediates the relationship between physical health and externalizing behaviours. Methods Data are from the National Survey of Child and Adolescent Well‐Being; adolescents age 11 and older residing in long‐term foster care (n= 188). Children whose caregivers reported on the occurrence of a chronic illness were compared using anova on internalizing and externalizing subscale scores and total scores of the Youth Self Report (YSR) and Child Behavior Checklist (CBCL), and modified Self‐Report of Delinquency (MSRD) scores of delinquency and total number of delinquent acts. Bootstrapping analyses were used to test our hypothesis that depressive symptoms (Children's Depression Inventory) function as a mediator. Results Adolescents with a chronic illness reported greater internalizing (YSR: F= 7.069, P= 0.009; CBCL: F= 4.660, P= 0.032) and externalizing (YSR: F= 5.878, P= 0.016; CBCL: F= 3.546, P= 0.061) problems, a greater number of delinquent acts (6.66, F= 5.049, P= 0.026) and heightened overall delinquency (F= 5.049, P= 0.026). Depression significantly mediated the effects of overall health on delinquency (95% CI, 0.03–1.76). Conclusions It is important to consider the complex interrelationships between physical health, mental health, and behaviour for adolescents in foster care. These findings support the need for comprehensive services for these youths, including specialized assessments and collaboration between protective services and healthcare systems.