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近年来儿童保健医学在与许多学科交叉的领域取得了较大的进展,特别是与内分泌学科及神经心理学科交叉的领域进展迅速。1儿童单纯性肥胖儿童单纯性肥胖已经成为危害儿童生存质量的重要疾病。近年来,肥胖相关的胰岛素抵抗-代谢综合征和如何干预儿童肥胖、预防成年疾病成为关注的重点。1.1肥胖-胰岛素抵抗-代谢综合征代谢综合征是以胰岛素抵抗为特征的疾病,主要表现为肥胖、高血压、血脂异常、高血糖和胰岛素抵抗。目前无论是从代谢综合征角度研究肥胖,还是从肥胖的角度研究代谢综合征,都有证据表明肥胖与胰岛素抵抗-代谢综合征密切相关。孙文…     

儿童保健医学进展

1　临床的拓展1.1　保健对象范围的扩大　以往儿童保健只是针对正常儿童定期的体格检查和评价,对一些残疾儿童诸如脑瘫、语言障碍、智能迟缓、广泛发育障碍等保健缺乏相应的保健措施或干预方法,误认为这是临床儿科医生的服务对象。如今,这一观念已发生改变,意识到儿童保健的对象应该是全部儿童,随此而出现的是对残疾儿童的保健内容,除了沿袭以往对健康儿童的方法之外,也重视了残疾儿童在保健中的特殊需求,例如对脑瘫患儿运动功能的康复训练[1] 。目前,根据不同地区、不同等级的儿童保健临床定位,已开展了一些临床的特殊服务,如发育迟缓儿童…     

小儿急诊医学进展

我国小儿急诊医学发展迅速,成绩巨大。10年前一项调查显示,ICU住院患儿病死率为12.5%,现已下降至4.6%。取得这样的成绩,至少与以下因素有关:(1)急诊专业人员培训力度加大,业务水平普遍提高;(2)仪器设备增加,过去仅少数ICU拥有床旁X光机,血气分析仪,中心供氧,现在60%~70%的ICU配备了这些设备;(3)开展新技术,如近一半ICU已应用肺表面活性物质治疗新生儿呼吸窘迫综合征,24%的ICU开展NO吸入疗法[1]。现将近5年小儿急诊医学主要进展简述如下。1小儿危重病例评分客观评估患儿病情严重程度对现代医学发展有重要意义。评估疾病严重程度是一…     

儿童保健医学进展

儿童保健医学是促进儿童生长和维护儿童健康 ,保障儿童生命质量和生活质量的医学学科。为促进医学信息的交流和儿童保健医学的发展 ,本文就 2 0 0 2年我国儿童保健医学的主要进展作一简述。1　生长发育生长发育是儿童期基本的生命现象 ,是一个连续、动态的发展过程。现阶段 ,我国儿童生长发育水平的地区不平衡性仍较明显。北京市双榆树地区 0～ 3岁婴幼儿的年龄别体重 (WFH )、年龄别身高 (HFA)的均值及其增长值与WHO的标准值基本一致。刘黎明等的研究表明 ,农村 0～18个月婴幼儿的WFA、HFA、身高别体重 (WFA)的Z值随年龄的增长呈下…     

Financing health care for disabled children

Information about health care use, charges, and out-of-pocket expenses is critical to the development of an equitable and efficient treatment system for disabled children. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used, and differences in use, charges, and out-of-pocket expenses for children with and without limitations in their activities due to chronic health problems are described. The results indicate that children limited in their activities used more medical services than other children, especially hospital-based services and services provided by health professionals other than physicians. Charges and out-of-pocket expenses were two to three times higher on average for disabled children, compared with other children. Charges and out-of-pocket expenses were also skewed; 10% of the sample children accounted for more than 60% of total charges and out-of-pocket expenses for the disabled population. The skewed distribution of out-of-pocket expenses suggests that financial burdens are unevenly shared by families of disabled children. Several public policy options designed to result in a more equitable distribution of financial risks are discussed.     

Managed care and children with special health care needs

The implementation of managed care for children with special health care needs is often associated with apprehension regarding new barriers to health care services. At times, these barriers may overshadow opportunities for improvement. This statement discusses such opportunities, identifies challenges, and proposes active roles for pediatricians and families to improve managed care for children with special health care needs.     

Challenges in long-term health care for children.

More children with chronic conditions are surviving than in previous times, and many have serious and significant ongoing health care needs. This paper reviews 1) the population characteristics of children with chronic health conditions in terms of the epidemiology and their sociodemographic profiles; 2) the implications of children's development on their needs, on caretaker roles and responsibilities, on the concept of medical necessity, and on service systems; 3) financing issues and service options for long-term care; and 4) strengths and limitations of existing mechanisms for monitoring the quality of services provided. The following discussion highlights the need for 1) improved data on the numbers of children who need and receive different types of long-term care; 2) better coordination of services and creation of a workable system; 3) a child-specific standard of medical necessity in defining service eligibility; 4) better support systems for families caring for children with long-term needs in non institutional settings; and 5) improved consistency in the mechanisms for financing of care for these children. More attention also should be focused on developing ways of monitoring the quality of long-term care provided. Addressing these needs would go a long way toward improving the quality of long-term care for infants, children, and adolescents.     

Primary health care for Indo-Chinese children in Australia

This study reports the detailed analysis of 61 consecutive presentations by recent immigrants from Indo-China to the Casualty Department of a modern Australian Children's Hospital. The parents/guardians were interviewed either in the Casualty Department or in their homes. Indo-Chinese children coming to a Casualty Department manifested the same age distribution and spectrum of illnesses that is seen in the general Australian paediatric population. However, significantly fewer presentations to hospital occurred due to accidents/trauma when the group was compared with the general population attending the Casualty Department. Only 21% of the Vietnamese and Cambodian families can communicate satisfactorily with hospital staff without interpreter help. Fifty-one per cent of parents reported that they did not have enough English for a medical interview without an interpreter. Twenty-eight per cent did not have enough English to communicate at all. Parents of Vietnamese children reported that on occasions they had not sought medical care for their children because of language difficulties. Many families do not know that an Interpreter Service is available, and many believe that access to such a service is available only through a doctor. Many of these children also use traditional Chinese remedies in the context of their contemporary Australian lives. We have found no evidence that this practice causes late presentation with deleterious effects, or any evidence that it compromises modern 'Western' treatment.