中学生行为问题与伤害关系的流行病学研究

发布时间：2018-04-06 22:13

本文选题：中学生　切入点：伤害　出处：《南方医科大学》2009年硕士论文

【摘要】： 研究目的 1、青少年是伤害发生的高危人群,且青少年期伤害已纳入我国疾病控制工作的范畴。探讨青少年行为与伤害这两项与青少年健康密切相关的公共卫生问题之间的关系,开展青少年行为问题以及青少年期伤害的分布特征及其影响因素研究,为青少年行为问题及伤害的防治实践提供一定的理论依据。 2、由于对“伤害”的认识和国情不同,尚未形成一种世界各国都可参用的伤害界定标准。同样在国内伤害界定标准使用方面,也存在较大争议。由此也造成了在对伤害发生率进行统计时,无法进行横向和纵向的比较、分析。这是限制伤害流行病学发展的“瓶颈”,也是一个新分支在形成和拓展过程中必须优先解决的重要问题。为探讨目前国内已公布的两种伤害界定标准的适用性,为伤害界定标准的统一提供参考,所以本研究在探讨行为问题与伤害之间的关系后,还比较了两者在伤害发生率统计中的一致性。对造成差异的原因进行了分析。研究方法以华侨中学(初一,初二,高一,高二)全体学生2166名为研究对象,采用YRS青少年自评行为量表进行行为评定,并用自行设计的影响因素调查表,了解学生在校表现及同伴相关行为的情况。同时从现况调查的研究对象中以研究开始时经YRS行为问卷评定的有、无行为问题的学生作为两个队列,开展为期1年(2008年3月至2009年3月)伤害发生情况的随访观察和伤害信息的收集。用非参数检验法分析两队列学生伤害发生次数的差异,并用有序多分类反应变量的Logistic回归模型分析伤害的影响因素。用kappa一致性检验来分析两种伤害界定标准对伤害发生率统计的一致性。结果 1、学生行为问题检出率为10.619%。不同类型的行为问题检出率分别为:攻击行为(3.047%)、退缩(2.770%)、违纪行为(2.734%)抑郁焦虑(2.493%)、思维问题(2.262%)、社交问题(1.800%)、注意缺陷(1.985%)、躯体主诉(1.985%),多因素分析结果提示学习成绩差,与同学关系不好,有上网行为,和感知好友吸烟及常出入娱乐场所是行为问题发生的危险因素。 2、随访学生1958名的伤害年发生率为64.147%。有行为问题队列学生210名,伤害年发生率为99.523%。伤害类型前5位为跌伤(25.2%)、交通伤(16.2%)、锐器伤和咬伤(11.4%)、碰撞伤(11.0%)。无行为问题队列学生1748名,伤害年发生率为59.897%。伤害类型前5位为跌伤(17.9%)、咬伤(8.87%)、锐器伤(7.9%)、交通伤(6.9%)、碰撞伤和烧烫伤(6.2%)。两队列之间的伤害年发生次数分布差异有统计学意义(z=-4.895,P＜0.001)。有行为问题组发生伤害次数高于无行为问题组。有行为问题组发生伤害次数3次及以上者占10.476%(22/210),无行为问题组发生伤害次数3次及以上者占4.291%(75/1748)。有行为问题组伤害发生的相对危险度是1.66,归因危险度是39.63%。多因素分析表明学生伤害的发生与学生有行为问题、感知同伴行为(吸烟、常出入娱乐场所)呈正相关,其相对应的RR值分别为3.508、1.204、1.121。 3、两种伤害界定标准对伤害次数发生的统计结果存在一致性,kappa值为0.323,P＜0.001。三项标准的伤害发生率高于两项标准的发生率(分别是71.7%,42.8%),受伤后到医疗单位诊治的比例和受伤休息时间1天以上的比例分析中,两项标准高于三项标准。结论 1、学生的行为问题与学习成绩,与同学关系、与老师关系、上网及感知好友行为(常出入娱乐场所、吸烟)等多种因素有关。在有行为问题和无行为问题两队列的学生中发生的伤害种类不同。有行为问题者是发生伤害的高危人群。在制定伤害干预措施时,应尤其重视学生行为问题的预防和控制,以达到理想的干预效果。 2、在伤害界定标准的比较中,两项标准更适于伤害流行病学的研究。
[Abstract]:research objective
1, adolescents are at high risk of injury, and adolescent damage has been included in China's disease control category. To investigate the relationship between adolescent behavior and damage of the two and adolescent health is closely related to public health problems, study on the distribution characteristics and influencing factors of adolescent behavior problems and adolescent stage injuries, theory on the basis of some practice for the prevention and treatment of adolescent behavioral problems and damage.
2, due to the awareness and situation of "harm", has not yet formed a reference for all countries in the world can hurt. The same definition standard definition standard in domestic injuries, there is considerable controversy. This also resulted in the injury rate statistics, unable to carry out horizontal and longitudinal comparison analysis this is the limit of injury epidemiology. Development of the "bottleneck", is a new branch of important problems in the formation and should give priority to the development process.
To discuss the applicability of two kinds of damage at home has been announced to define the standard, provide uniform reference to define standards for the damage, so this study in exploring the relationship between behavior problems and injuries, also compare the difference in the incidence rate of injury of consistency in statistics. The causes for the differences were analyzed.
research method
The overseas Chinese middle school (junior, junior high school, and all 2166 students) as the research object, using the YRS self rating scale for adolescent behavior behavior assessment, and influence factors of self-designed questionnaire, understand student performance and peer related behavior. At the same time from the object of study in order to study the status of the investigation started when the YRS behavior questionnaire has no behavioral problems of students as the two cohort, for a period of 1 years (March 2008 to March 2009) were observed and the incidence of injuries hurt the information collection. The number of students injury column difference with non parametric test analysis, influencing factors and Logistic ordinal response the variable regression model to analyze the damage. To analysis of two kinds of damage definition standard consistency rate of statistical damage with kappa consistency test.
Result
1 students, the rate of behavioral problems for behavior problems of different types of 10.619%. respectively: aggressive behavior (3.047%), back (2.770%), discipline (2.734%) depression and anxiety (2.493%), thinking (2.262%), social problems, attention deficit (1.800%) (1.985%), somatic complaints (1.985%) multivariate analysis showed that, poor academic performance, and the relationship between students is not good, there are online behavior, and perceived smoking friends and frequented places of entertainment are risk factors of behavior problems.
2, follow up 1958 students injury incidence rate of annual 64.147%. cohort 210 students with behavior problems, injury incidence rate for 99.523%. type of damage before 5 falls (25.2%), traffic injury (16.2%), sharp injuries and bites (11.4%), (11%). No collision injury behavior problems cohort 1748 students name, injury incidence rate of 59.897%. damage type top 5 for injuries (17.9%), (8.87%), bite injuries (7.9%), traffic injury (6.9%), crash and burn injury (6.2%). The two queue between the injury happening frequency distribution difference was statistically significant (z=-4.895, P < 0.001). Behavioral problems group injury times higher than that without behavioral problems group. Behavioral problems group injury 3 times and above accounted for 10.476% (22/210), without behavior problems was 3 times the number of injuries and above accounted for 4.291% (75/1748). The behavior problems of injury group relative risk 1.66, the attributable risk 39.63%. is a multiple factor analysis. It shows that the incidence of student injury is positively correlated with students' behavioral problems, perceived peer behavior (smoking, entertainment places), and the corresponding RR values are 3.508,1.204,1.121..
3, two kinds of statistical damage definition standard of the injury number results are consistent, the kappa value is 0.323, the incidence rate is higher than the two standard P < 0.001. three standard damage (71.7%, 42.8%), injured after treatment in hospital and the proportion of injuries and rest for 1 days the proportion of the analysis, the two standard is higher than the standard three.
conclusion
1, student behavior and academic achievement, and students, and teacher relationship, and perceived behavior (Internet friends frequented places of entertainment, smoking) related factors. In behavior problems and behavior problems of students in the two queue. For different types of injury problems are high-risk groups hurt. In the intervention measures damage, should pay particular attention to prevent and control the students' behavior problems, to achieve the desired effect of intervention.
2, in the comparison of the criteria for the definition of injury, the two criteria are more suitable for the study of injury epidemiology.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R181.3

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