2006-2010年北京市通州区儿童伤害监测结果分析

目的了解北京市通州区儿童伤害发生的特点和流行规律,为制定干预措施提供科学依据。方法对2006—2010年北京市通州区3家监测哨点医院首诊儿童伤害病例资料进行分析。结果 2006—2010年共发生儿童伤害4856例,其中男童3177例(65.42%),女童1679例(34.58%);3月和6～7月是一年中伤害高发月,9～11时和15时是一天中伤害高发时段;儿童伤害前5位致伤因素依次为跌倒/坠落(37.72%)、动物伤(29.26%)、钝器伤(12.68%)、非机动车车祸(6.45%)、刀/锐器伤(6.22%);伤害地点主要为家中(49.42%)、学校与公共场所(25.58%)、公路/街道(14.68%)、公共居住场所(6.49%)、体育和运动场所(1.69%);主要伤害部位依次为上肢(35.61%)、下肢(32.33%)和头部(23.54%)。结论男童伤害发生率高于女童,跌倒/坠落和动物伤(尤其是犬伤)是目前儿童伤害防范的重点,溺水和机动车车祸是重要的儿童死因。建议在家庭和学校加大有关伤害的宣传,提高家长与全社会的监管力度。     

A national program for injury prevention in children and adolescents: The injury free coalition for kids

Injury is the leading cause of death and a major source of preventable disability in children. Mechanisms of injury are rooted in a complex web of social, economic, environmental, criminal, and behavioral factors that necessitate a multifaceted, systematic injury prevention approach. This article describes the injury burden and the way physicians, community coalitions, and a private foundation teamed to impact the problem first in an urban minority community and then through a national program. Through our injury prevention work in a resource-limited neighborhood, a national model evolved that provides a systematic framework through which education and other interventions are implemented. Interventions are aimed at changing the community and home environments physically (safe play areas and elimination of community and home hazards) and socially (education and supervised extracurricular activities with mentors). This program, based on physician-community partnerships and private foundation financial support, expanded to 40 sites in 37 cities, representing all 10 US trauma regions. Each site is a local adaptation of the Injury Free Coalition model also referred to as the ABC’s of injury prevention: A, “analyze injury data through local injury surveillance”; B, “build a local coalition”; C, “communicate the problem and raise awareness that injuries are a preventable public health problem”; D, “develop interventions and injury prevention activities to create safer environments and activities for children”; and E, “evaluate the interventions with ongoing surveillance.” It is feasible to develop a comprehensive injury prevention program of national scope using a voluntary coalition of trauma centers, private foundation finaccial and technical support, and a local injury prevention model with a well-established record of reducing and sustaining lower injury rates for inner-city children and adolescents.     

艾滋病防治领域公民社会组织外部社会资本与组织绩效研究

目的:分析艾滋病防治领域中公民社会组织外部社会资本对组织绩效的影响。方法:采用多阶段分层抽样与整群抽样,对8省艾滋病防治领域212个公民社会组织进行现场调查,采用多元logistic回归统计分析。结果:组织外部社会资本中共同愿景和网络会影响组织的结构绩效(OR=3.23,95%CI:1.77~5.88)、OR=2.21,95%CI:1.21~4.02);共同愿景会影响组织的执行绩效(OR=4.17,95%CI:2.23~7.78);共同愿景和组织的财务绩效成正相关(OR=2.97,95%CI:1.60~5.51);共同愿景、网络、支持分别与组织文化绩效存在正向关联(OR=2.04,95%CI:1.09~3.85)、(OR=2.02,95%CI:1.09~3.76)、(OR=3.34,95%CI:1.79~6.23);共同愿景和网络会影响组织的综合绩效(OR=14.56,95%CI:6.83~31.06)、(OR=2.23,95%CI:1.11~4.48)。结论:艾滋病防治领域社会组织的外部社会资本会影响组织绩效,组织和政府应该大力开发组织的外部社会资本来提高组织绩效。     

1990年与2013年中国0~14岁儿童伤害疾病负担分析

目的 分析1990年与2013年中国0~14岁儿童伤害疾病负担及变化情况。方法 利用2013年全球疾病负担中国及中国分省数据,采用死亡率和伤残调整寿命年（DALY）率等指标,分析1990年与2013年中国0~14岁儿童伤害疾病负担及变化情况。结果 2013年中国0~14岁儿童伤害死亡数为73 766人、死亡率为29.46/10万、DALY率为2 449.36/10万。男童伤害疾病负担各项指标均高于女童。各年龄组随着年龄增加伤害疾病负担逐渐降低。0~14岁儿童伤害死亡率和DALY率前5位地区均依次为新疆维吾尔自治区、西藏自治区、甘肃省、青海省和宁夏回族自治区。0~14岁儿童伤害死亡率和DALY率前三位伤害类型均为溺水、道路交通伤害和暴露于机械性力量。与1990年相比,0~14岁儿童伤害疾病负担各项指标均有明显下降,男童下降程度略低于女童,各年龄组也有不同程度下降,除宁夏回族自治区、云南省和重庆市以外,其余各地区0~14岁儿童伤害疾病负担均有不同程度的改善。结论 近年来中国0~14岁儿童伤害疾病负担有较明显改善,但伤害仍是中国0~14岁儿童面临的重要健康威胁之一。4岁以下男童的伤害疾病负担仍较严重,溺水和道路交通伤害是1~14岁儿童死亡的主要原因,部分地区需要进一步加强0~14岁儿童伤害防控工作。     

2001-2010年我国伤害预防病例对照研究及队列研究文献质量评价

目的评价2001-2010年我国公开发表的伤害预防病例对照研究和队列研究文献的质量。方法文献来源于四个主要的中文数据库和两个英文数据库。采用Newcastle-Ottawa-Scale（NOS）工具分别对纳入的伤害预防病例对照研究和队列研究文献进行方法学质量评价。结果 2001-2010年我国伤害预防病例对照研究和队列研究文献分别有84篇和13篇。病例对照研究中,职业人员和儿童青少年分别占45.2%和36.9%,伤害类型中,多种伤害占71.4%。队列研究中,儿童青少年占46.2%,伤害类型中,多种伤害占92.3%。病例对照研究的方法学质量得分均在5分及以上,平均（6.1±0.7）分;但研究在＂暴露因素的确定＂、＂无应答率＂以及＂病例的确定是否恰当＂条目上得分较低。队列研究的方法学质量得分以6分和7分为主,平均（6.3±0.9）分;但研究在＂结局指标的评价＂条目上得分较低。结论我国的伤害病例对照研究和队列研究数量较少,研究人群以儿童青少年和职业人员为主,伤害类型以多种伤害为主,质量相对较高。     

不同儿童发展纲要时期下中国儿童伤害死亡率变化趋势

目的 对1990-2017年发布的3个中国儿童发展纲要时期,我国儿童伤害死亡率变化趋势进行描述分析。方法 利用全球疾病负担2017中国<18岁儿童伤害死亡率数据描述全国及各省（自治区、直辖市）、不同性别儿童的伤害死亡率变化趋势。结果 1990-2017年,我国政府先后制定并实施了3个儿童发展纲要。前2个纲要未能对儿童伤害防控提出明确目标,第3个纲要中纳入了一项可量化考评的目标。我国<18岁儿童伤害死亡率在这3个纲要时期分别下降了26.07%、40.68%和26.48%。不同性别儿童伤害死亡率在这3个时期均有不同幅度下降。31个省（自治区、直辖市）儿童伤害死亡率在3个时期的变化趋势有所不同。结论 1990-2017年,我国儿童伤害死亡状况得到明显改善。不同时期的儿童发展纲要对我国儿童伤害防控都具有重要的政策保障和推动作用。在未来国家儿童发展政策制定中,应继续加强对儿童伤害防控领域的重视。     

2017年我国6个省份28个县（区）儿童道路交通伤害流行状况

目的:了解我国6个省份28个县（区）儿童道路交通伤害流行状况,并提出预防建议。方法:采用普查的方法,于2017年对6个省份28个县（区）61个乡镇/街道（社区）特定年龄段儿童的道路交通伤害发生情况进行问卷调查。结果:共调查204 628名儿童,发生908人次（0.44%）道路交通伤害,未上幼儿园儿童的道路交通伤害发生率...     

Child pedestrians: The role of parental beliefs and practices in promoting safe walking in urban neighborhoods

The purpose of this study was to describe parents’ child pedestrian safety practices, knowledge, risk perceptions, and beliefs. We surveyed 732 parents from four elementary schools in urban neighborhoods that differed in income, and child pedestrian injury risks. Findings indicated that most parents taught their children street safety. Few (16%) knew basic pedestrian safety facts; 46% believed children younger than 10 years could safely cross streets alone; 50% believed a child pedestrian crash was likely. Parents in lower income neighborhoods reported the highest rates of unpleasant walking environments and concerns about drug dealers, crime, violence, and trash. We conclude that education should focus on children’s risk, developmental capabilities, and supervision needs. Promoting physical activity in urban neighborhoods, especially lower income ones, must address concerns about the physical and social environment.     

中国伤害防控工作面临的主要挑战与应对策略

随着中国经济的持续快速发展,伤害在20世纪后期就已成为威胁中国居民健康的重要疾病之一,其死因顺位排名一直靠前。尽管中国政府已将伤害防控工作纳入《“健康中国2030”规划纲要》《健康中国行动(2019―2030年)》《中国儿童发展纲要(2021―2030年)》等国家健康发展规划,但与中国总体卫生健康事业的快速发展相比,国内伤害防控工作发展速度滞后于传染性疾病和慢性非传染性疾病防控工作。目前,我国伤害防控工作面临的主要挑战包括：(1)伤害预防立法不完善,执法力度待加强;(2)缺乏牵头部门协调全国伤害防控工作;(3)缺乏专业队伍落实日常伤害预防工作;(4)伤害预防研究缺乏必要的支持。针对这些挑战,作者提出了相应的应对策略。     

儿童行人交通伤害流行特征及影响因素

根据国际疾病分类第10版本(ICD-10),行人交通伤害是一种运输事故伤害(V01-V99),编码为V01-V09.儿童行人交通伤害定义为15岁及以下的儿童行人发生的交通伤害.在大多数发达国家,儿童行人交通伤害是儿童死亡的主要原因.     

The process and impact of implementing injury prevention projects in smaller communities in New Zealand

It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10 000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.     

中国31个省级儿童发展纲要中非故意伤害防控目标与策略的比较分析

目的:展示《中国儿童发展纲要（2011-2020年）》和同时期31个省（自治区、直辖市）的儿童发展纲要中非故意伤害防控目标及策略的具体内容与异同点,并提出相关建议 。方法:采用内容分析法,对所有儿童发展纲要中符合定义的非故意伤害防控目标和策略文本进行提取、编码和分类,同时结合伤害“5E”策略框架对策略文本分类进行主题构...     

2006-2009年安徽省0～14岁儿童伤害监测资料分析

目的了解安徽省0-14岁儿童伤害发生情况和分布特征,为制定伤害的预防控制策略提供科学依据。方法对2006-2009年安徽省7市（县）的监测点医院0-14岁儿童伤害病人的监测数据进行整理、分析。结果 2006-2009年共报告35 169例儿童伤害病例,男女性别比为2.10∶1;0-14岁儿童伤害发生1天中以10点和17点最多;伤害以跌倒/坠落、交通事故和钝器伤为主;各性别、年龄组和地点的伤害原因不同;以非故意伤害为主,大多数为轻度伤;伤害的多发部位为头部、上肢和下肢,重度伤害中头部常见。结论伤害严重影响着0-14岁儿童的健康,应该采取多部门合作的方式,有针对性的开展儿童伤害干预措施。     

Clinical assessment instruments in the treatment of child abuse and neglect

Accurate assessment is essential for effective practice #opWodarski, 1981#cp. In child welfare, where assessments must depend on direct as well as indirect evidence, data on parental attitudes toward the victim, problem behaviors within the family constellation, and possible compromising psychopathologies can be obtained through the use of standardized scales. A variety of objective measures pertinent to the assessment of child abuse and neglect are now available that can be used by practitioners with minimal disruption in terms of time, energy, cost, and ease of administration. The purpose of this article is to review a variety of instruments that child welfare workers, specifically, and practitioners involved in children's services, in general, can use in the assessment of child abuse and neglect.     

Back injury prevention programs: A critical review of the literature

Back schools are increasingly utilized as an injury prevention strategy employed at the worksite. Yet, evidence of the efficacy of back schools is limited and controversial. A review of the literature showed variance in methodologies and consequently, outcomes. Outcome measures used include physical capacity, functional abilities, costs, lost time, absenteeism, perception of pain, lifting performance, attitudes, and job satisfaction. In many studies, lack of randomization and control was found to be a limitation in experimental design. Studies which used the behavioral approach of measuring lifting behavior lacked followup and evidence of long-term effects. The type of education and feedback or reinforcement was an important issue not well-defined in the literature. A variety of hypothetical mechanisms were described as contributing to the outcome of back injury prevention programs. Additional controlled research is necessary to determine the specific mechanisms of change in an effort to further improve outcome in this area.     

Effect of educating mothers on injury prevention among children aged <5 years using the Health Belief Model: a randomized controlled trial

Objectives

To assess the effect of the Health Belief Model (HBM) on the education of mothers for promoting safety and preventing injury among children aged <5 years.

Study design

Randomized controlled trial.

Methods

This study was conducted in Hamadan City, West Iran in 2012. One hundred and twenty mothers participated in this study, divided into intervention and control groups (60 mothers in each group). The intervention group participated in an educational programme consisting of four 1-hour sessions twice per week. The education programme was based on the HBM. The participants of both groups were evaluated before the intervention and two months after the intervention using a questionnaire. The validity and reliability of the questionnaire were tested with a pilot study. The questionnaire consisted of three parts: demographic characteristics; knowledge, practices and HBM constructs (perceived sensitivity, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy); and history of recent injuries to the child. Student's t-test was used to compare the mean differences, and P < 0.05 was considered to indicate significance.

Results

None of the 120 participants dropped out of the study. The mean differences in knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy and practices after the intervention, between the two groups, were 3.98, 3.57, 3.97, 1.57, −7.08, 0.82, 2.95 and 2.47, respectively. All differences were statistically significant (P = 0.001).

Conclusions

Educational programmes based on the HBM can be used as an effective approach in planning and developing preventive programmes for injury prevention and safety promotion in children aged <5 years.     

The Dutch heart health community intervention 'Hartslag Limburg': results of an effect study at organizational level

BACKGROUND: 'Hartslag Limburg', a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviours. This article presents the results of the effect evaluation study of the community intervention at the organizational level. Organizational changes were an intermediate goal of the Hartslag Limburg community intervention, as these are assumed to be a prerequisite for changes at the individual level. METHODS: A baseline-post-test control group design was used. The baseline measurement was conducted in 1998 and the post-test measurement in 2001. At baseline, 700 organizations were selected in the Maastricht region, and 577 in a control region. All organizations that were potentially significant agents in health-promoting activities were included. Data on organizational involvement in health-promoting activities were gathered by means of structured questionnaires, and sent to organization representatives by mail. RESULTS: The overall post-test percentage of organizations involved in at least one activity relating to physical activity was higher in the Maastricht region than in the control region. Furthermore, the number of activities per organization involved in activities relating to healthy eating, smoking behaviour or physical activity was higher in the Maastricht region than in the control region at post-test. CONCLUSIONS: This study provided valuable information about organizational involvement in health-promoting activities, as well as important information to consider in future research in this area. Due to the limitations of the study, the importance of measuring change at different social levels in community-based programmes, and the scarcity of effect studies of community interventions at the organizational level, further research on this subject is warranted.     

Childhood injury prevention advice: a survey of health professionals responses to common scenarios

AIM: To determine the responses of health professionals when asked at what age a child could safely engage in a number of common activities and scenarios. METHODS: Eleven scenarios reflecting everyday activities were adapted from the BBC book Play it Safe. Questionnaires were completed by a convenience sample of health professionals. Respondents were asked to give the minimum age they felt a child could safely engage in each of the activities. The literature was searched for an evidential basis for answers to the activities and scenarios posed. RESULTS: A total of 215 questionnaires were completed. For all questions there was a spread in responses of at least 9 years. Recommended answers were found in the literature for six of the scenarios, however, in only four of these was this confirmed to have an evidential basis. Fifty-four per cent of responses were at least 2 or more years from these recommended answers. DISCUSSION: Injury prevention advice needs to be consistent and, where possible, evidentially based. Health professionals often need to rely on their own opinions to provide advice. This survey shows opinions vary and highlights the need for evidence-based guidelines for parents and professionals.