Occupational risk factors for urothelial carcinoma: agent-specific results from a case-control study in Germany. MURC Study Group. Multicenter Urothelial and Renal Cancer

BACKGROUND: This multicentre population-based case-control study was conducted to estimate the urothelial cancer risk for occupational exposure to aromatic amines, polycyclic aromatic hydrocarbons (PAH), and chlorinated hydrocarbons besides other suspected risk factors. METHODS: In a population-based multicentre study, 1035 incident urothelial cancer cases and 4298 controls matched for region, sex, and age were interviewed between 1991 and 1995 for their occupational history and lifestyle habits. Exposure to the agents under study was self-assessed as well as expert-rated with two job-exposure matrices and a job task-exposure matrix. Conditional logistic regression was used to calculate smoking adjusted odds ratios (OR) and to control for study centre and age. RESULTS: Urothelial cancer risk following exposure to aromatic amines was only slightly elevated. Among males, substantial exposures to PAH as well as to chlorinated solvents and their corresponding occupational settings were associated with significantly elevated risks after adjustment for smoking (PAH exposure, assessed with a job-exposure matrix: OR = 1.6, 95% CI: 1.1-2.3, exposure to chlorinated solvents, assessed with a job task-exposure matrix: OR = 1.8, 95% CI: 1.2-2.6). Metal degreasing showed an elevated urothelial cancer risk among males (OR = 2.3, 95% CI: 1.4-3.8). In females also, exposure to chlorinated solvents indicated a urothelial cancer risk. Because of small numbers the risk evaluation for females should be treated with caution. CONCLUSIONS: Occupational exposure to aromatic amines could not be shown to be as strong a risk factor for urothelial carcinomas as in the past. A possible explanation for this finding is the reduction in exposure over the last 50 years. Our results strengthen the evidence that PAH may have a carcinogenic potential for the urothelium. Furthermore, our results indicate a urothelial cancer risk for the use of chlorinated solvents.     

Analgesics and laxatives as risk factors for cancer in the efferent urinary tract--results of the Berlin Urothelial Carcinoma Study]

A retrospective case-control study (1990-1995), the Berlin Urothelial Cancer Study (BUS), examined analgesics and laxatives as risks for the induction of urothelial cancer in renal pelvis, ureter and bladder. Especially for renal pelvis cancer could observe substance and dose specific risk of compound analgesics. The analgesic substances Phenacetin, Paracetamol, Acetylsalicylic acid (ASA) and Pyrazolones were assessed. Besides a risk of contact laxatives (chemical or anthranoide ingredients) for urothelial cancer was found, not yet described. The highest risk shows the anthranoide plant Senna. Thus this study confirms the risk of specific analgesic ingredients and found an evidence for a new risk of contact laxatives. As both, analgesics and contact laxatives, are typical OTC--("Over the counter") products, a severe controlling is demanded and for laxatives further studies are needed.     

老年人吸烟、饮酒与脑卒中的流行病学研究

目的 研究吸烟、饮酒及其他危险因素与脑卒中及其分型的关系。方法 对象为北京市万寿路地区60岁以上老年人群的分层随机抽样样本。共调查2096人，分析吸烟、饮酒及其他危险因素与脑卒中的关系。结果 单因素分析时吸烟的OR值为1.17(95％CI:1.01～1.35)。饮酒在男性脑卒中及脑梗塞的OR值(95％CI)分别是0.69(0.51～0.94)、0.71(0.52～0.98)；调整其他主要因素后，吸烟致脑卒中、脑出血的相对危险性OR值(9596CI)分别为1.19(1.02～1.39)、1.53(1.03～2.27)；饮酒似为脑卒中的保护因素，OR值(95％CI)为0.78(0.61～0.99)。另外与脑卒中有显著相关的危险因素包括年龄、收缩压、高密度脂蛋白、高血压、冠心病、糖尿病、高血脂、脑卒中家族史。结论 吸烟是脑卒中的危险因素，适量饮酒对其似有保护作用。     

厦门市不同吸烟类型与其他危险因素致肝癌效应修饰作用

目的 评价不同类型吸烟暴露的单独效应,并分析吸烟在肝癌发病中的效应修饰作用.方法 采用病例对照研究方法,对345例肝癌病例和961例健康对照进行危险因素调查,采集血液标本进行HBsAg、抗-HCV和黄曲霉毒素(AFB1)白蛋白加合物等含量的检测,针对潜在的危险因素应用多元logistic回归分析评价调整的危险比(AOR)和95%CI.结果 女性被动吸烟暴露与肝癌有关联(AOR=2.35,95%CI:1.19～4.07);男性规律的吸烟与肝癌有关联(AOR=2.27,95%CI:1.14～3.31).在男性,吸烟与慢性乙肝病毒感染有正相关交互作用,交互效应超额相对危险比(RERI)为98.70,归因交互效应百分比(AP)为81.0%(u=2.11,P=0.02);在女性,吸烟与血清AFB1白蛋白加合物浓度有正相关交互作用,交互效应RERI为2.69,归因交互效应AP为50.0%(u=2.60,P=0.01).结论 吸烟与肝癌的关联性有性别差异,尤其是在慢性病毒感染和具有较高浓度的AFB1白蛋白加合物浓度的人群中应控制吸烟.     

Cigarette smoking, body mass and other risk factors for fractures of the hip in women

Determinants of hip fractures were assessed using data from a network of hospital-based case-control studies from northern Italy. For the present analysis, cases were 209 women with fractures of the hip/proximal femur (aged 29 to 74, median age 62) admitted to a network of teaching and general hospitals in the greater Milan area; controls were 1449 women, aged 25 to 74 (median age 55), admitted for non-traumatic, acute conditions to the same network of hospitals. There was a strong direct association with smoking, the relative risk (RR) being significantly and similarly elevated both in ex- and in current smokers (RR 1.7 and 1.5 respectively) which rose to 2.4 for 25 or over cigarettes per day. The risk was associated with duration of smoking and apparently greater in post-menopausal women. Two factors showed significant inverse associations with hip fractures: relative weight, with relative risks of 0.5, 0.4 and 0.3 in subsequent categories of body mass index as compared with thinner ones, and the use of oestrogen replacement treatment (multivariate RR = 0.4, 95% confidence interval (CI): 0.2-1.1). No association was observed with education or social class, selected indicator foods or alcohol consumption (RR for the highest consumption level = 1.0). The effects of smoking and body mass index appeared independent: compared with never smoking heavier women, the RR for smoking thin women was 4.6. Thus, this case-control study of hip fractures in a predominantly post-menopausal population of Italian women showed a strong association with smoking and appreciable protection from heavier body mass index and the use of oestrogen replacement treatment.     

Estimating health-adjusted life expectancy conditional on risk factors: results for smoking and obesity

Background  

Smoking and obesity are risk factors causing a large burden of disease. To help formulate and prioritize among smoking and obesity prevention activities, estimations of health-adjusted life expectancy (HALE) for cohorts that differ solely in their lifestyle (e.g. smoking vs. non smoking) can provide valuable information. Furthermore, in combination with estimates of life expectancy (LE), it can be tested whether prevention of obesity and smoking results in compression of morbidity.     

Active smoking, passive smoking, and breast cancer risk: findings from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk

Background

Evidence is lacking regarding the relationship between cigarette smoking and breast cancer in Japanese women. We examined the association between breast cancer incidence and active and passive smoking in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk.

Methods

Our study comprised 34,401 women aged 40-79 years who had not been diagnosed previously with breast cancer and who provided information on smoking status at baseline (1988-1990). The subjects were followed from enrollment until December 31, 2001. Cox proportional-hazards models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between breast cancer incidence and tobacco smoke.

Results

During 271,412 person-years of follow-up, we identified 208 incident cases of breast cancer. Active smoking did not increase the risk of breast cancer, with a HR for current smokers of 0.67 (95% CI: 0.32-1.38). Furthermore, an increased risk of breast cancer was not observed in current smokers who smoked a greater number of cigarettes each day. Overall, passive smoking at home or in public spaces was also not associated with an increased risk of breast cancer among nonsmokers. Women who reported passive smoking during childhood had a statistically insignificant increase in risk (HR: 1.24; 95% CI: 0.84-1.85), compared with those who had not been exposed during this time.

Conclusion

Smoking may not be associated with an increased risk of breast cancer in this cohort of Japanese women.Key words: Smoking, Breast Neoplasms, Risk, Cohort Studies     

Reproductive factors, smoking, and the risk for rheumatoid arthritis

Risk factors for rheumatoid arthritis were examined in a cohort of 121,700 female nurses aged 30-55, followed in the Nurses' Health Study. Baseline information on reproductive variables, cigarette smoking, obesity, and other variables was obtained in 1976 and updated every 2 years. Cases of rheumatoid arthritis were defined by standardized questionnaire and review of medical records. During 883,187 person-years of follow-up, 217 new cases of rheumatoid arthritis were identified (115 had definite rheumatoid arthritis and 102 had "undifferentiated polyarthritis"). When compared with women who experienced menarche at age 13 years, the age-adjusted relative risk of rheumatoid arthritis among women with early menarche was 1.9 (95% confidence interval, 0.9-2.4). There were, however, no significant associations between parity, age at birth of the first child, menopause, or obesity and the incidence of rheumatoid arthritis. Cigarette smokers had a slight apparent increase in the risk of rheumatoid arthritis. Among current smokers, the age-adjusted relative risk for RA rheumatoid arthritis was 1.3 (0.9-2.1); among former smokers, the relative risk was 1.5 (0.9-2.3).     

Smoking,drinking, and other life style factors and cognitive function in men in the Caerphilly cohort

STUDY OBJECTIVES: To examine the cognitive function in a large, ongoing cohort study of older men, and to identify associations with social and lifestyle factors. DESIGN: A cross sectional study of cognitive function was conducted within the Caerphilly Prospective Study of Heart Disease and stroke. SETTING: The Caerphilly Study was originally set up in 1979-83 when the men were 45-59 years of age. Extensive data are available on a wide range of lifestyle and other factors of possible relevance to cognitive decline. Associations between some of these and cognitive function are reported. PARTICIPANTS: A representative sample of 1870 men aged 55-69 years. MAIN RESULTS: Age, social class, medication, and mood were found to be powerful determinants of performance. Self report data on the involvement of the men in leisure pursuits were examined by factor analysis. This indicated that the more intellectual leisure pursuits are the most strongly linked with performance. A measure of social contact showed a weak positive association with the test scores. Current cigarette smokers gave lower test cognitive function scores than either men who had never smoked, or ex-smokers. There was however no evidence of any gradient in function with the total lifetime consumption of tobacco. The disparity between these two data sets suggests that there had been prior selection of men who had originally started to smoke, but more particularly selection of those who later quit smoking. There was no significant association between alcohol consumption and cognitive function, though ex-drinkers had markedly lower test scores than either current drinkers or men who had never drunk alcohol. This seemed probably to be a consequence of an high prevalence of illness among the ex-drinkers. CONCLUSIONS: Age and social class show strong associations with cognitive function. Leisure persuits and social contact are also both positively associated. Neither tobacco smoking nor the drinking of alcohol seem to be associated with cognitive function, though there is evidence suggestive of self selection of both men who had never smoked and ex-smokers.       

Source of drinking water and other risk factors for dental fluorosis in Sri Lanka

This study was done to describe the association between source of drinking water and other potential risk factors with dental fluorosis. Prevalence of dental fluorosis among 518 14-year-old students in the south of Sri Lanka was 43.2%. The drinking water sources of the students were described and fluoride samples were taken. There was a strong association between water fluoride level and prevalence of fluorosis. Tea drinking before 7 years of age was also an independent risk factor in a multivariate analysis. Having been fed with formula bottle milk as an infant seemed to increase the risk although the effect was not statistically significant. No clear effects could be found for using fluoridated toothpaste, occupation of the father, and socio-economic status. Drinking water obtained from surface water sources had lower fluoride levels (median 0.22 mg l(-1)) than water from deep tube wells (median 0.80 mg l(-1)). Most families used shallow dug wells and these had a median fluoride value of 0.48 mg l(-1) but with a wide range from 0.09 to 5.90 mg l(-1). Shallow wells located close to irrigation canals or other surface water had lower fluoride values than wells located further away. Fluoride levels have to be taken into account when planning drinking water projects. From the point of view of prevention of dental fluorosis, drinking water from surface sources or from shallow wells located close to surface water would be preferable.     

Hepatitis B and C among Berlin dental personnel: incidence, risk factors, and effectiveness of barrier prevention measures

A study of 215 Berlin dentists and 108 dental assistants recruited at the 1997 Berlin Dental Society meeting assessed their occupational risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. HBV vaccine coverage, and barrier prevention methods used. Among dentists, 7% (95% CI 4-11) and 0.5% (95% CI 0-3) had serological evidence of previous HBV and HCV infection, respectively. Similar figures for dental assistants were 1% (95% CI 0-5) and 0% (95% CI 0-4). Only 74% of dentists and 63% of dental assistants reported HBV vaccination. Approximately half always used gloves, eye glasses, or face masks. HBV unvaccinated dentists whose patients had HBV risk factors had a greater risk of HBV infection; those who always wore face masks were at lower risk (OR 0.2, 95% CI 0.02-0.98). These data indicate that among Berlin dentists, the HCV risk was lower than that of HBV and that face masks may have lowered the risk of HBV. The use of eye glasses or gloves did not appear to lower the risk of HBV acquisition in this population.     

E-cigarette use among women of reproductive age: Impulsivity,cigarette smoking status,and other risk factors

IntroductionThe study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant.MethodSurvey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24–44 years from the US. Half (n = 400) reported current, daily smoking and half (n = 400) reported smoking < 100 cigarettes lifetime. Participants completed questionnaires regarding sociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and e-cigarette use were examined using logistic regression.ResultsDaily cigarette smoking was associated with greater impulsivity, lower education, past illegal drug use, and White race/ethnicity. E-cigarette use in the overall sample was associated with being a cigarette smoker and greater education. E-cigarette use among current smokers was associated with increased nicotine dependence and quitting smoking; among never smokers it was associated with greater impulsivity and illegal drug use. E-cigarette use was associated with hookah use, and for never smokers only with use of cigars and other nicotine products.ConclusionsE-cigarette use among women of reproductive age varies by smoking status, with use among current smokers reflecting attempts to quit smoking whereas among non-smokers use may be a marker of a more impulsive repertoire that includes greater use of alternative tobacco products and illegal drugs.     

Occupational and other risk factors for hand-grip strength: the Honolulu-Asia Aging Study

Background

In certain occupations, including farm work, workers are exposed to hazardous substances, some of which are known to be toxic to the nervous system and may adversely affect muscle strength. Measurement of hand‐grip strength may be useful for detecting neurotoxic exposure.

Methods

The authors studied 3522 participants of the Honolulu Heart Program and the Honolulu‐Asia Aging Study to determine whether occupational exposures to pesticides, solvents, and metals assessed at exam I (1965–68) are associated with hand‐grip strength at exam IV (1991–93) and change in hand‐grip strength over 25 years. Correlation, analysis of variance and covariance, and linear regression were used to evaluate the associations.

Results

At exam IV, participants ranged in age from 71–93 years; mean hand‐grip strength was 39.6 kg at exam I and 30.3 kg at exam IV. Over 25 years, the decline in hand‐grip strength was an average of 8–9 kg for all exposures. Hand‐grip strength was inversely associated with age and glucose but directly associated with cognitive function, BMI, and haemoglobin level. No other exposures were associated with hand‐grip strength.

Conclusion

This study did not provide evidence that occupational exposure to pesticides, solvents, and metals adversely affected hand‐grip strength in this population, but confirmed other important associations with hand‐grip strength.     

Alcohol drinking, tobacco smoking, and anthropometric characteristics as risk factors for thyroid cancer: a countrywide case-control study in New Caledonia

Exceptionally high incidence rates of thyroid cancer are observed in New Caledonia, particularly in Melanesian women. To investigate further the etiology of thyroid cancer and to clarify the reasons of this elevated incidence, the authors conducted a countrywide population-based case-control study in this multiethnic population. The study included 332 cases with histologically verified papillary or follicular carcinoma (293 women and 39 men) diagnosed in 1993-1999 and 412 population controls (354 women and 58 men) frequency matched by gender and 5-year age group. Thyroid cancer was negatively associated with tobacco smoking and alcohol drinking, but no inverse dose-response relation was observed. Height was positively associated with thyroid cancer, particularly in men. Strong positive associations with weight and body mass index were observed in Melanesian women aged 50 years or more, with an odds ratio of 5.5 (95% confidence interval: 1.5, 20.3) for a body mass index of 35 kg/m2 or greater compared with normal-weight women, and there was a clear dose-response trend. This study clarifies the role of overweight for thyroid cancer in postmenopausal women. Because of the high prevalence of obesity among Melanesian women of New Caledonia, this finding may explain in part the exceptionally elevated incidence of thyroid cancer in this group.     

Stressful events, smoking exposure and other maternal risk factors associated with gestational diabetes mellitus

The incidence of gestational diabetes mellitus (GDM) has increased significantly in the last few decades in the US. Understanding its risk factors is imperative for the prevention of GDM and its sequelae, but the roles of behavioural risk factors such as stressful events and smoking on GDM are generally not well understood. Using data obtained from the New York State (NYS) Pregnancy Risk Assessment Monitoring System survey for 2004-06 and the NYS birth certificates, we examined relationships between GDM, stressful events and smoking among 2690 women who had live singleton births and did not have pre-pregnancy diabetes. After adjustment for risk factors such as maternal age, race/ethnicity, pre-pregnancy body mass index, hypertension, as well as smoking exposure, education, parity, and gestation at first visit for prenatal care, we found that having five or more stressful events 12 months before the baby was born was significantly associated with GDM (OR = 2.49, [95% CI 1.49, 4.16]). In another model, having any stressful event(s) other than 'moved to a new address' 12 months before the baby was born was also moderately associated with GDM (OR = 1.38, [95% CI 1.04, 1.85]). Smoking exposure, assessed by combining maternal smoking and second-hand smoke exposure into six levels, had no significant association with GDM, and did not show a dose-response pattern. The present study suggests that stressful events during pregnancy may be an independent risk factor for GDM. Future studies of GDM should include this common, but potentially modifiable risk factor in analyses.     

Risk factors for pre-eclampsia among Zimbabwean women: maternal arm circumference and other anthropometric measures of obesity

Maternal pre-pregnancy obesity is a risk factor for pre-eclampsia (proteinuric hypertension in pregnancy) among North American and European women. We studied the relationship between maternal obesity and risk of pre-eclampsia among Zimbabwean women. A case-control study was conducted at Harare Maternity Hospital, Harare, Zimbabwe, between June 1995 and April 1996. Study participants were 144 women with pre-eclampsia and 194 normotensive women serving as controls. Maternal weight, height and mid-arm circumference were measured and recorded during study participants' postpartum hospital admission. Maternal mid-arm circumference, considered to be relatively stable during pregnancy among women of developing countries, was used as the primary indicator of maternal pre-pregnancy obesity. Logistic regression procedures were used to estimate odds ratios and 95% confidence intervals. There were linear trends in risk of pre-eclampsia with increasing mid-arm circumference, increasing weight and increasing body mass index. After adjusting for potential confounding factors, women in the highest quintile for mid-arm circumference (28–39 cm) were 4.4 times more likely to have had their pregnancy complicated by pre-eclampsia than women in the lowest quintile (21–23 cm). Odds ratios of similar magnitude were observed for the other anthropometric measures. To our knowledge, this is the first study to demonstrate a positive association between maternal obesity and pre-eclampsia risk in a black African population. Biological mechanisms thought to explain this relatively consistent epidemiological finding include endothelial cell injury, possibly resulting from hyperlipidaemia.     

A survey of risk factors for cryptosporidiosis in New York City: drinking water and other exposures.

We conducted a survey to determine the prevalence of known and theoretical exposure risks for cryptosporidiosis among selected New York City residents. Subjects were recruited from outpatients attending either a practice for persons with HIV infection (n=160), or other medical practices (n=153), at The New York Hospital-Cornell Medical Center. Despite a greater concern for waterborne infection, 82% of HIV-infected subjects reported consuming municipal tap water compared to 69% of subjects from other medical clinics (OR 2.1, 95% Cl 1.2-3.6, P=0.006). Although 18% and 31% of subjects, respectively, denied any tap water consumption at home or work, all but one from each cohort responded positively to having at least one possible alternate source of tap water ingestion such as using tap water to brush teeth or drinking tap water offered in a restaurant. 78% and 76% of subjects, respectively, had at least one potential risk for exposure other than municipal water consumption, such as swimming in pools or contact with animals. Our findings indicate that it is possible to stratify the population into subsets by the amount of tap water consumed. This suggests that an observational epidemiologic study of the risk of contracting cryptosporidiosis from everyday tap water consumption is feasible.     

Learning the relationship between smoking,drinking alcohol and the risk of esophageal cancer

This study examined the effect of outcome feedback on learning the multiplicative relationship between daily intakes of tobacco and alcohol, and the risk of esophageal cancer. In the first of two experiments, 65 French adults judged the risk of esophageal cancer associated with combinations of five levels of intake of tobacco and five of wine. They made these judgments both before and after learning sessions in which they were shown the actual risk for each vignette. In the second experiment, 35 French adults underwent the same testing and learning, and were re-tested twice 1 month later. The study hypotheses were supported. First, prior to the learning sessions, the participants used a subadditive rule to combine the perceived risk of esophageal cancer from smoking and drinking. Second, they learned after only one training session to change to the multiplicative rule that is consistent with epidemiological data. Third, this learning persisted for 1 month. This methodology may prove useful in correcting people's underestimation of their health risks.     

Prospective study of hepatitis B and C viral infections, cigarette smoking, alcohol consumption, and other factors associated with hepatocellular carcinoma risk in Japan

This community-based prospective study examined the effects of viral infections and lifestyle habits on hepatocellular carcinoma (HCC) risk in Japan. A baseline survey was conducted for 981 males and 2,078 females in June 1992 and evaluated hepatitis B surface antigen, second-generation hepatitis C virus antibody, and history of cigarette smoking and habitual alcohol consumption. By March 1997, 14 males and 8 females had been newly diagnosed with HCC. After controlling for gender and age by using the Cox model, the authors found that positivity for hepatitis B surface antigen (hazard ratio = 7.28, 95% confidence interval: 1.62, 32.61; p < 0.01) and positivity for high-titer hepatitis C virus antibody (hazard ratio = 40.38, 95% confidence interval: 11.71, 139.21; p < 0.001) were significantly associated with HCC risk, although a history of smoking or alcohol consumption was not significantly related to risk. There was a significant interaction on an additive scale for the risk of HCC development between high-titer hepatitis C virus antibody status and a history of smoking (p < 0.05) in spite of no significant interaction on a multiplicative scale. Although preventing the transmission of hepatitis viruses is most important for reducing the risk of HCC, intervention regarding lifestyle habits such as cigarette smoking should not go unheeded.     

上海市青少年危险行为现状研究(三)--吸烟、饮酒与易成瘾药物使用情况

目的：了解上海市青少年吸烟、饮酒和易成瘾类药物的使用情况。方法：2002年4—6月，抽取上海市19个区县个27所初级个学、26所高级个学、13所完个和39所个等职业学校一年级学生的调查。调查采用分层整群抽样，各区县在辖区内按学校类别分为初中、高中和中等职业学校三层，采用《2002上海市青少年危险行为监测调查表》进行问卷调查，共调查学生9308人，有效调查表为9246份(99.3％)。结果：本次调查有15．2％的学生曾经吸过香烟，4.7％的学生在13周岁就吸过一整支香烟，5．0％的学生目前吸烟，1．3％的学生经常吸，0,5％的学生在吸烟的日子里，吸烟量至少为10支，2．0％的学生曾经在30天内每天至少吸1支烟。45．7％的学生曾经喝过酒，17．8％的学生近期饮酒，5．2％的学生在1个月内曾经喝醉过。4．4％的学生承认曾经服用可引起依赖的药物，0.9％的学生承认对服用药物有依赖。用近期吸烟和近期饮酒这两个变量做相关分析得到这两个变量为正相关。结论：中学阶段是形成良好生活方式的最好时期，中等职业学校学生是控制危险行为的重点人群，学生的心理社会能力应进一步提高。