中国儿童孤独症谱系障碍患病率的系统综述

Background

There are no reliable estimates of the prevalences of autism and autism spectrum disorders (ASD) in China.

Objective

Combine results across studies to estimate the prevalences of autism and ASD among Chinese children under the age of 18, and assess variations in the prevalences with respect to gender, ethnicity, and urban versus rural residence.

Methods

Based on pre-defined inclusion and exclusion criteria, studies were identified by searching the following databases: Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, Pubmed, and Web of Science. Statistical analysis was conducted using R-2.15.2 software.

Results

The 24 studies meeting inclusion criteria included 5 registry studies from Taiwan and Hong Kong (covering a total of 14570 369 children) and 19 community-based screening and diagnostic studies from mainland China (with a combined sample of 771 413 children). The annually reported prevalence of autism in the registry studies ranged from 1.8 to 424.6 per 10 000. A meta-analysis of 18 of the studies from mainland China (excluding a large nationwide study with the lowest prevalence of autism) with a range in rates from 2.8 to 30.4 per 10 000 generated an estimated pooled prevalence of autism of 12.8 per 10 000 (95%CI, 9.4 to 17.5). The pooled prevalence of ASD estimated from 5 of these studies (which had a range in rates from 7.3 to 75.3 per 10 000) was 24.5 per 10000 (95%CI, 10.4 to 57.4). The reported prevalence of autism varied substantially by gender, location of residence, date of publication, and source of the sample.

Conclusion

The huge difference between the rates for autism reported from registry systems in Hong Kong and Taiwan (a 200-fold difference) and the large differences in rates reported from community-based screening studies in mainland China (a 10- to 15-fold difference) highlight the urgent need for establishing standardized methods for estimating the prevalences of autism and ASD. Until these methodological improvements have been made, it will not be possible to develop evidence-based prevention and treatment strategies for the management of these uncommon but seriously disabling conditions.     

SSRIs类药物与自杀的关系:系统综述的方法学质量评价和研究结果归纳(英文)

背景:关于使用选择性5-羟色胺再摄取抑制剂(SSRIs)与自杀意念或行为的关系,一些系统综述已发表,但是对这些报告的质量并没有做过正式的评估。目的:评估有关使用SSRI与自杀意念和行为之间关系的系统综述的方法学质量;并提供在此评估的基础上得出的总体结论。方法 :通过检索Pubmed,Embase,Cochrane图书馆,EBSCO,PsycINFO,中国国家知网,中国科技期刊重庆维普数据库,万方数据库,和中国生物医学文献数据库来确定相关的系统综述,这些系统综述纳入了比较SSRI类药物与安慰剂、以自杀意念或行为作为关键变量的随机对照试验。两个专家评估者独自采用多系统综述11项评估量表(AMSTAR)对纳入评估的文献进行方法学质量的评估。结果 :共检出12篇系统综述和meta分析。AMSTAR总体质量评分的评分者信度非常好(ICC=0.86),但11个AMSTAR项目中有5项的评分者信度较差(Kappa值0.60)。根据AMSTAR总分,仅1篇为高质量等级,8篇为中等质量等级,3篇为低质量等级。这篇高质量综述和3篇中等质量的综述均报告SSRI组中自杀意念或行为的风险显著高于安慰剂组。4篇仅限于儿童和青少年的综述中有3篇报道服用帕罗西汀和患有抑郁症的青少年有显著增加自杀意念或行为的风险。结论 :现有证据表明,青少年使用SSRI类药物可能会增加自杀意念和行为的风险,尤其是抑郁症患者和服用帕罗西汀的患者。但是,相关高质量的综述很少,所以对这一结论还存有疑问。AMSTAR量表对于提高系统综述质量也许是有用的,但对量表中的某些项目需要严格操作标准。     

双相障碍临床指南的评价研究

目的运用指南研究与评价Ⅱ（AGREEⅡ）工具评价国内外双相临床指南的方法学质量。方法以“双相障碍（bipolardisorder）”“临床指南（clinicalguideline）”等为检索词,通过计算机检索中国知识资源总库、中国科技期刊数据库、万方数据检索系统、中国生物医学文摘数据库、PubMed、OVID、BMJBestPractice、Dynamed、ISIWebofKnowledge、美国国家指南交换库（NGC）以及国际指南网络（G-I-N）等网站,并辅以手动检索,收集国内外符合该研究标准的临床指南。依据AGREEⅡ工具,对其方法学质量进行评价。结果共纳入17个双相障碍临床指南。AGREEⅡ标准化总体得分显示：陈述清晰性（83％）、范围和目的（69％）领域较高,开发严谨性（40％）和参与人员（31％）领域次之,编辑独立性（25％）和应用性（15％）领域最低。循证指南在开发严谨性、陈述清晰性、应用性、参与人员以及范围和目的5个领域的得分均高于专家共识指南。中国双相障碍防治指南在编辑独立性领域得分为0,低于其他14个循证指南的总体得分。结论纳入的双相障碍临床指南总体质量与AGREEⅡ标准差距较大。建议今后指南开发制定或更新过程中更多采用AGREEII工具作为参考。     

内感受觉察度的心理学测量方法

内感受(Interoception)是一个较为广泛的概念,从广义上讲,包括本体感受和内脏感受两种不同形式[1].本体感受(proprioception)主要接受来自躯体皮肤、关节、肌肉等结构的信号;而内脏感受(visceroception)多用以描述来自躯体内部器官的信息,如心脏等.人与动物一样,均有饥、渴、痛等基本感受能力,这种感受易被觉察.然而,对于躯体内部器官而言,当它们处于静息状态时,不会引起特殊注意.只有这些平时"隐藏"的感受以疼痛或其他形式表达时,才会对内部器官有直接的感受[1],故对内感受的关注与研究常常被忽视.