云南省2015-2019年5岁以下儿童死亡及潜在减寿年数的地区差异研究

背景　过去几十年里中国政府为降低5岁以下儿童死亡取得了明显成效，但城乡之间仍存在差异。 目的　分析云南省不同地区2015-2019年5岁以下儿童主要死亡原因和减寿情况。方法　按2017年贫困发生率将云南省129个区（县）划分为深度贫困、一般贫困和非贫困三类地区；以云南省疾病预防控制中心“中国疾病预防控制信息系统”的“人口死亡信息登记管理系统”为数据来源，采用死亡率、死因构成比、潜在减寿年数、减寿率、平均减寿年数5个健康测量指标对2015-2019年云南省5岁以下儿童死亡报告数据进行统计描述；采用Poisson回归模型估计云南省各类地区死亡率的变化趋势；采用卡方检验比较各类地区5岁以下儿童死亡地点在不同年份间的差异。结果　云南省5岁以下儿童死亡率呈下降趋势，变化幅度为-28.23%，年均变化为-7.60%〔95%CI（-8.52%，-6.76%）〕。深度贫困地区、一般贫困地区和非贫困地区的5岁以下儿童死亡率变化幅度分别为-29.51%、-13.34%、-42.66%，年均变化分别为-6.95%〔95%CI（-8.51%，-5.45%）〕、-3.15%〔95%CI（-4.59%，-1.69%）〕、-13.76%〔95%CI（-15.38%，-12.10%）〕。5岁以下儿童在深度贫困地区的主要死亡地点为家中，但有下降趋势；一般贫困地区和非贫困地区的主要死亡地点为医疗机构，亦有下降趋势。贫困地区5岁以下儿童死亡地点在不同年份间的构成比较，差异有统计学意义（P<0.05）。云南省5岁以下儿童2015年和2019年的前三位死因均为出生产伤和窒息、下呼吸道感染及先天性心脏异常，但平均减寿年数值较高的主要为出生低体质量及出生产伤和窒息。结论　云南省5岁以下儿童死亡率在三类地区均呈下降趋势。但鉴于贫困与非贫困地区间仍存在差异，以及早死带来的寿命损失，未来仍需进一步采取干预措施，持续提升脱贫地区的卫生服务能力，同时强化围生期保健和意外死亡的防控。     

Diarrheal deaths in American children. Are they preventable?

We reviewed national mortality data for 1973 through 1983 to assess the importance of diarrheal diseases as a cause of preventable childhood death in the United States. An average of 500 children aged 1 month to 4 years died each year with diarrhea reported as the cause of death. These diarrheal deaths were most common among children who were younger than 1 year of age, black, and living in the South, and were most common during the winter. In Mississippi, review of fatal cases of diarrhea identified maternal factors--black race, young age, unmarried status, low level of education, and little prenatal care--to be most associated with diarrheal death in the child. Fifty percent of these deaths occurred after a child had reached a medical facility. Our findings suggest that diarrheal deaths may be preventable and that targeted interventions could contribute to improved child survival in the United States.     

高职院校贫困大学生人格问卷调查分析

目的了解高职贫困医学生的心理健康状况,为贫困生的心理健康教育提供依据。方法采用大学生人格问卷（UPI）对某高职医学院135名贫困生进行调查,并与215名非贫困生进行比较。结果可能存在不同程度心理问题的贫困生占48.89%,非贫困生为44.45%,差异无统计学意义（P〉0.05）;在选择率大于30%的项目上,在第22、57、44题上贫困生选择率显著高于非贫困生（P〈0.05）;在关键项目选择上,贫困生与非贫困生在第8、16题选择上差异有统计学意义,贫困生选择率高于非贫困生（P〈0.01）。结论贫困生的心理健康状况基本正常;在对贫困生进行心理健康教育时,应充分考虑其家庭因素的影响,同时注重贫困生的情绪调节、自我意识完善、人际交往训练等。     

Estimates of the number of motherless youth orphaned by AIDS in the United States.

OBJECTIVE--To estimate the number of youth in the United States who have been or will be left motherless by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, in order to project the need for family supports, age-appropriate foster and congregate care, and mental health and social services. DESIGN--Orphans are defined as youth whose mothers (the usual caregiving parent) die of HIV/AIDS-related causes. A mathematical model was constructed to estimate the number of such motherless youth. Cumulative fertility rates were applied to the number of reported AIDS deaths (1981 through 1990) and projected deaths (1991 through 1995) of adult women less than 50 years old. The results were adjusted for underreporting of HIV/AIDS-related mortality, pediatric AIDS deaths, infant mortality, ethnic and racial variation in fertility, and decreased fertility associated with late-stage HIV disease. Estimates were made for the number who were children (less than 13 years of age), adolescents (13 to 17 years of age), or young adults (18 years of age or older) at the time of their mothers' death. RESULTS--By the end of 1995, maternal deaths caused by the HIV/AIDS epidemic will have orphaned an estimated 24,600 children and 21,000 adolescents in the United States; unless the course of the epidemic changes dramatically, by the year 2000, the overall number of motherless children and adolescents will exceed 80,000. In 1991, an estimated 13% of US children and 9% of adolescents whose mothers died of all causes were children of women who died of HIV/AIDS-related diseases. These proportions will surpass 17% and 12%, respectively, by 1995. The vast majority of these motherless youth will come from poor communities of color. CONCLUSIONS--A large and rapidly growing number of American youth are being orphaned by the HIV/AIDS epidemic. Unless increased attention and resources are devoted to this vulnerable population, a social catastrophe is unavoidable.     

非贫困大学生的贫困心理现象不容忽视

贫困心理现象不是贫困大学生特有的,非贫困生中也存在贫困心理现象。非贫困生的贫困心理是其对贫困的错误认识造成的,在错误的思想影响下,他们出现一些错误的行为。假贫困生的产生与其高于贫困生的基本生活需求、奢侈生活、攀比心理以及贫困生审查工作漏洞等有关。解决办法是加强贫困生的界定研究,完善审查制度,建立特殊校园经济区以及加强思想政治和心理健康教育等。     

Selected measures of health status for Mexican-American, mainland Puerto Rican, and Cuban-American children

The 1987 National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (1982 through 1984) were used to assess the health status of Mexican-American, mainland Puerto Rican, and Cuban-American children by examining the prevalences of pregnancy outcomes and chronic medical conditions. The low-birth-weight rate among Hispanics (7.0%) compared favorably with that of non-Hispanic whites (7.1%) despite the greater poverty and lower levels of education among Hispanics. When examined by Hispanic subgroup, however, significant differences were present, with mainland Puerto Ricans having the highest prevalences of low-birth-weight infants. Premature births were more common among all three Hispanic subgroups than among non-Hispanic whites. Mexican-American and Cuban-American children had a similar prevalence of (3.9% and 2.5%, respectively) chronic medical conditions compared with non-Hispanic white children; Puerto Rican children had a higher prevalence of chronic medical conditions (6.2%). When assessed by these health status indicators, Hispanic children seem to have a health status similar to non-Hispanic white children. However, mainland Puerto Rican children seem at greater risk for poor health, reflecting the US Hispanic population's heterogeneity. Health programs targeted at US Hispanics should appropriately consider these group differences.     

The burden of asthma in Australia

In 1997, 27% of Australian children had current wheeze, and this is increasing by 1.4% per year. The prevalence of wheeze among adults is lower and appears to be stable. The prevalence of persistent asthma (wheezing episodes with abnormal airway function between episodes) in children has increased from 5% to 9% in the past 20 years. In adults, the prevalence is 5%-6%. Up to 80% of adults with persistent asthma have abnormal lung function. Asthma deaths in Australia have fallen 28% since peaking in 1989, but the mortality rate is still twice that of England.     

Adolescent all-terrain vehicle deaths in West Virginia, 1990-1998

West Virginia had the third highest number of ATV-related deaths and the highest death rate among all states from 1990-98. Adolescents were identified as a particularly high-risk ATV user group. Fatality data from the U.S. Consumer Product Safety Commission indicated that one-quarter (25 of 101) of the state's ATV-related deaths occurred among children 16 and younger. Only one victim was wearing a helmet at the time of their fatal crash and nearly 70% of the victims were males. The average years of potential life lost was 64.2. WV's adolescent death rate of 0.67 per 100,000 was 5 times higher than the national rate. Young ATV drivers exacerbate the inherent dangers associated with ATVs through poor judgment and risk-taking. Health care providers should utilize "teachable moments" to emphasize ATV safety to their young patients and their parents, but more importantly, adults must become role models by embracing and teaching practical preventive measures.     

Injuries and deaths associated with off-road recreational vehicles among children in Manitoba.

Injuries and deaths associated with off-road recreational vehicles are of increasing concern in North America. We reviewed all hospital admissions and deaths attributed to these vehicles in Manitoba from April 1979 to April 1985 among children 16 years of age or younger. Of the 693 hospital admissions and deaths 480 were associated with motorbikes, snowmobiles or all-terrain vehicles (ATVs). The incidence of injuries resulting from snowmobile and dirtbike accidents remained stable over the study period; however, there was an almost exponential increase in the number of admissions because of ATV-related injuries. There were 21 deaths during the study period. Preventive measures through legislation are necessary to reduce the numbers of injuries and deaths; these include mandatory registration, licensing and enhanced safety regulations.     

Acute hemiplegia of childhood.

Acute hemiplegia of obscure cause occurred in 28 children: 13 had had prolonged seizures and a high temperature (considered to have been the direct cause of the brain damage); 5 had had brief seizures, a lower temperature and a depressed level of consciousness; and 10 had a nonfebrile onset of hemiplegia and were found to have vascular abnormalities. Most of the first group were retarded and epileptic at long-term follow-up, as were about half of the second group, whereas children in the third group were of normal intelligence and epilepsy was uncommon among them. Hemiplegia persisted at follow-up in most of the children in each group, the proportion being at least in the third group; if cerebral angiography had demonstrated carotid stenosis or occlusion there was usually poor recovery from the hemiplegia. Bilateral changes on plain skull films or pneumoencephalograms were associated with mental retardation. Failure to control prolonged seizures accompanied by a high temperature predisposes to brain damage; therefore, early and vigorous management is essential.     

康奈尔健康问卷在医学生身心健康研究中的应用

目的探讨医学生身心健康的现状,为制定针对医学生的身心健康防治措施提供依据。方法用康奈尔健康问卷对某高校709名医学生进行调查,用总分法与精神症状评分法两种方法计分并进行数据统计。结果①18.34%的医学生存在身心健康障碍。②男女医学生身心健康水平差异有统计学意义（P〈0.05）。③不同年级、不同地区的医学生身心健康水平差异均有统计学意义（P〈0.05）。④父母文化程度对子女身心健康无显著影响（P〉0.05）。⑤躯体症状与精神症状呈显著正相关（r=0.57,P〈0.01）。结论医学生身心健康状况整体良好,但女生、大学新生、毕业生及来自农村的学生其身心障碍的发生率较高。     

Mortality and life-years lost due to alcohol: a comparison of acute and chronic causes

OBJECTIVES: (i) To estimate the numbers of deaths and person-years of life lost (PYLL) due to high-risk alcohol consumption in Australia during 1997, using current estimates of consumption. (ii) To compare the number of deaths and PYLL due to acute conditions associated with bouts of intoxication and chronic conditions associated with long-term misuse of alcohol. METHODS: All Australian deaths during 1997 related to conditions considered to be partially or wholly caused by high-risk alcohol consumption were extracted from the Australian Bureau of Statistics Mortality Datafile and adjusted by alcohol aetiologic fractions calculated for Australia in 1997. A life-table method was used to estimate the PYLL for deaths from alcohol-caused conditions. MAIN OUTCOME MEASURES: Numbers of all deaths and PYLL due to chronic and acute alcohol-related conditions. RESULTS: Of the 3290 estimated alcohol-caused deaths in 1997, chronic conditions (eg, alcoholic liver cirrhosis and alcohol dependence) accounted for 42%, acute conditions (eg, alcohol-related road injuries and assaults) for 28% and mixed (chronic and acute) for 30%. Of the 62914 estimated potential life years lost, acute conditions were responsible for 46%, chronic for 33% and mixed for 21%. The average number of years of life lost through deaths from acute conditions was more than twice that from chronic conditions, because the former mostly involved younger people. CONCLUSIONS: In view of the societal burdens imposed by premature deaths, more effective public health strategies are needed to reduce the harm associated with occasional high-risk drinking (as well as sustained high-risk drinking), especially among young people.     

Asthma mortality: comparison between New Zealand and England

Causes for the high mortality from asthma in New Zealand were investigated by comparing deaths from asthma in caucasian subjects aged 15-64 in New Zealand with those from asthma in the same age group in two regions in England. There were no significant differences in the accuracy of death certification. The verified asthma mortality in New Zealand (4.2/100,000) was over twice that in England. Many characteristics of patients and management, including poor compliance with treatment and deficiencies in long term and emergency care, were qualitatively similar in the two countries. New Zealand had an apparently higher rate of non-preventable deaths from asthma, suggesting a greater severity of asthma in New Zealand. In both countries, however, most deaths were associated with poor assessment, underestimation of severity and inappropriate treatment (over-reliance on bronchodilators and underuse of systemic corticosteroids), and delays in obtaining help. A greater frequency of some of these deficiencies in management remains a possible additional explanation for part of the excess mortality in New Zealand.     

Suicidal behaviour and risk factors in children and adolescents in Jamaica

Suicidal attempts and ideation were examined in children attending child and adolescent mental health clinics in the Kingston Metropolitan Area during October 1998 to September 1999. The case records of fifty-seven 6-18 year-olds were selected for review in order to identify social and familial factors that place Jamaican children and adolescents at risk for suicidal behaviour. In addition, in order to examine the consistency of risk factors, data from child and adolescent mental health clinics were compared over a ten-year period between 1989 and 1999. The results indicated that having a poor relationship with the primary caregiver was significantly associated with suicidal behaviour (p < 0.01) as well as experiencing abuse (p < 0.05). These children also tended to externalize their behaviours (p < 0.01). The findings suggest that, over the ten-year period, Jamaican children seem to be more readily talking about, contemplating and attempting, suicide. The importance of managing intrafamilial issues affecting children is highlighted.     

Dog bite-related fatalities from 1979 through 1988

By combining data from the National Center for Health Statistics and computerized searching of news stories, we identified 157 dog bite-related fatalities that occurred in the United States from 1979 through 1988. Of the 157 deaths, 70% occurred among children who were less than 10 years of age. The death rate for neonates was almost 370 times that of adults who were 30 to 49 years of age. Pit bull breeds were involved in 42 (41.6%) of 101 deaths where dog breed was reported, almost three times more than German shepherds, the next most commonly reported breed. The proportion of deaths attributable to pit bulls increased from 20% in 1979 and 1980 to 62% in 1987 and 1988. Pit bull attacks were almost twice as likely to be caused by strays as attacks by other breeds. Extrapolated estimates suggest 183 to 204 dog bite-related fatalities from 1979 through 1988. To prevent such deaths, we recommend stronger animal control laws, public education regarding dog bites, and more responsible dog ownership. Parents and physicians should be aware that infants left alone with a dog may be at risk of death.     

Mentally abnormal offenders: manner of death

A 23 year follow up of deaths in a population of mentally disordered patients was carried out, and a typical case history is reported. A quarter (71) of the deaths reported were unnatural, verdicts of suicide or accidental death or open verdicts having been recorded. For men in most age groups the proportion of deaths by suicide was two to three times greater than in the general population in 1982; the rate among those aged 25-29 was five times that in the general population. Differences in the rate of unnatural death among diagnostic categories of mental illness were not significant, but the proportion of unnatural deaths among the mentally handicapped will probably eventually be lower than that among psychotic offenders or those with personality disorders. Violent death occurs at an older age in those with affective disorders. Social isolation and alienation add to the handicap of mental disorder in this group of people, and these sometimes difficult but always vulnerable patients must continue to be offered asylum other than prison.     

肾病儿童诊治过程中的医患沟通

肾病综合征作为儿科常见的肾小球疾病,具有病程长、容易反复或复发的特点,从而影响患儿的身心健康。面对疾病．大多数家属或患儿会出现不同程度的心理应激。结合临床实例探讨肾病患儿及其家属的心理应激特点,通过有效沟通、人文关怀和临床技术指导,具有针对性的进行心理干预,增强对疾病诊治的依从性,使患儿及其家属以良好的心态、规范而持续的家庭护理配合医护人员,达到预期的临床治疗目的。     

云南省某贫困县农村留守儿童意外伤害的影响因素

目的 探讨某县农村留守儿童意外伤害的现状及危险因素,为制定相关干预措施提供依据.方法采用分层整群随机抽样的方法,抽取某县5所中小学共2 909名学生为研究对象,以问卷形式收集留守儿童意外伤害发生的情况,并利用观察法和访谈法辅助问卷调查,分析其危险因素.结果 本次调查留守儿童1 630名,意外伤害发生率为555人(34.0%),高于非留守组的354人(27.7%),差异有统计学意义(P<0.05).留守儿童前5位的伤害类型为跌落伤228人(14.0%),烧烫伤91人(5.6%),锐器伤59人(3.6%),咬伤49人(3.0%),砸伤26人(1.6%).多因素Logistic回归分析表明低年龄、学校开展户外活动及交通拥挤为留守儿童意外伤害发生的危险因素.结论 留守儿童意外伤害已经成为不可忽视的社会问题,应针对意外伤害发生的危险因素开展综合干预.     

Malnutrition, measles, mortality, and the humanitarian response during a famine in Ehiopia

CONTEXT: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. OBJECTIVES: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. DESIGN AND SETTING: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. PARTICIPANTS: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. MAIN OUTCOME MEASURES: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m(2) among adults and older persons. RESULTS: Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/10 000 per day (95% confidence interval [CI], 2.4-3.8/10 000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10 000 per day (95% CI, 5.4-8.2/10 000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% CI, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m(2)) among adults aged 18 to 59 years was 22.7% (95% CI, 17.9%-27.5%). CONCLUSIONS: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.