【作者】 商晓红；

【导师】 孙若鹏；

【作者基本信息】 山东大学 ， 儿科学， 2009， 博士

【摘要】 研究背景无论学龄前儿童还是学龄儿童,都处于快速生长发育的阶段,其健康状况一直是儿科医师们所关注的问题。近年来,儿童躯体疾病发病率逐年降低,国内外从环境、教育,经济和心理等角度对儿童健康影响的研究有很多,但其根本仍然是围绕着儿童的生长发育做文章。生长发育是儿童的基本特征和基本生命现象,监测儿童生长发育对于健康儿童可以反映其目前所达到的水平和发育潜力,对于患病儿童有助于早期发现疾病、随访疾病过程和评价治疗恢复的效果。对群体生长发育监测不仅可以反映出儿童生长发育的趋势和可能影响儿童生长发育的危险因素,还间接地反映一个国家的政治、经济、文化的发展状况。随着我国社会经济的快速发展,人们健康水平和生活方式发生了较大的改变,观察和掌握当前儿童的健康状况和体格发育的趋势,了解和分析儿童生长发育状况的差异,找出问题和影响因素,对完善儿童的体格发育管理、监控体系,以及儿童临床、儿童保健和科研等工作意义重大。根据WHO在1983年日内瓦会议上所建议的指标,身高参照美国国家卫生统计中心(national center for health statistics NCHS)参考值计算出的年龄别身高Z值HAZ(Height for age Z score)＜2者为生长迟缓。按照这一参考标准,我国各省、市、自治区有相当比例的学龄前儿童生长发育状况仍然不能令人满意,尤其是在农村地区,由于受到文化、经济和医疗卫生水平等因素的影响,其生长发育水平明显落后于城市儿童。我国卫生部十年一次(1995年)的全国营养状况调查资料显示,农村儿童的身高,不论男女,在同一年龄均低于相应年龄的城市儿童,而且,对农村儿童的调查也大多集中在西部地区或不发达的贫困地区。随着城市化的进程,许多城市郊区的农村也出现了翻天覆地的变化,有了经济基础,医疗卫生工作也逐渐出现改观和转机。因此,本课题通过一系列的调查分析,旨在了解城市边缘——郊区农村儿童的生长发育和常见病状况,从中找出与健康相关的影响和问题,以最大限度的减少农村生活的不利影响,并为进一步采取适当的干预措施提供理论依据。第一部分学龄前儿童健康状况研究研究一商河县学龄前儿童生长发育状况研究目的:评价济南市郊区幼儿园儿童生长发育状况,了解当前学龄前儿童的健康状况和存在的主要问题,为制定改善儿童保健政策和提高发育水平提供科学依据。方法:按照整群分层抽样调查方法,随机抽取了商河县56所幼儿园3～6周岁学龄前儿童1612人,分为县城、乡镇和村级三组,对其一般情况和生长发育状况进行调查,采用WHO推荐的NCHS标准和中国九市标准评价该儿童群体的健康状况。结果:根据Z值85%以上的个体发育等级均在中等以上,商河县学龄前儿童整体上无重度营养不良,低体重、生长迟缓和消瘦的发生率分别为2.36%、2.11%和0.37%,县城、和村级幼儿园间的低体重率和生长迟缓率有显著性差异(P＜0.01)结论:商河县学龄前儿童总体发育状况处于良好水平,营养不良发生率均显著低于全国的平均水平,县城幼儿园的学龄前儿童的生长发育状况要好于乡镇、村级幼儿园,而营养不良的发生率却相对低于它们,县、乡、村幼儿园之间的儿童保健水平有差距,有待于进一步加强和改善提高。研究二商河县学龄前儿童的常见病研究目的:了解济南市郊区幼儿园儿童的常见病患病状况,对当前学龄前儿童的健康状况做全面分析,为制定儿童保健政策提供科学依据。方法:按照整群分层抽样调查方法,随机抽取了商河县56所幼儿园3～6周岁学龄前儿童1612人,对其一般情况和常见病情况进行调查。结果:本次调查的贫血、佝偻病、视力低下的患病率分别为0.81%、3.66%、2.61%,不同性别学龄前儿童的常见病患病率无显著性差异,县城与村间佝偻病与视力低下的患病率比较差异有显著性,乡与村间佝偻病患病率的比较差异也有显著性。结论:商河县学龄前儿童的贫血患病率低于全国水平,佝偻病和视力低下患病率在县城和村级幼儿园间存在显著性差异,仍需加强农村健康教育的普及,发展儿童临床保健工作。研究三商河县学龄前儿童患龋状况调查及防治对策目的:了解并分析商河县学龄前儿童患龋状况,为防治干预决策提供依据。方法:采用随机抽样调查的方法,对商河县幼儿园2～6岁的学龄前儿童,进行牙齿检查,计算各年龄组龋齿的患龋率、龋均和龋失补构成比,并用SPSS软件进行分析。结果:调查56所幼儿园的2～6岁儿童2052名,患龋1088人,龋齿总数4487,乳牙患龋率53.02%,龋均是2.187,充填率是0.29%;男女患龋率差异无统计学意义;各年龄组间患龋率差异均存在显著性(P＜0.01),乳牙患龋率、龋均随年龄增长而增加;县城比乡、村幼儿园的患龋率稍高,有统计学意义(P＜0.05)。结论:商河县幼儿园儿童的乳牙健康状况不容乐观,加强农村学龄前儿童的口腔保健教育,预防为主,适当提高乳龋充填率是今后的工作重点。研究四商河县学龄前儿童健康状况分析目的:探讨近4年幼儿园儿童健康状况变化趋势。方法:采用纵向时间序列比较方法对商河县幼儿园2005-2008年儿童健康查体资料进行分析比较。结果:4年间儿童营养不良患病率逐年下降,2008年低体重、发育迟缓及消瘦率分别为1.78%、1.27%、0.12%,体格趋于肥胖儿童逐年增高,2008年4.5%。近4年营养不良、肥胖在县乡村儿童之间差异仍有显著性。2008年儿童贫血患病率0.85%,县乡村儿童之间差异无显著性。结论:全区儿童营养状况良好,在儿童营养不良患病率下降的同时.应重点对肥胖儿开展干预,儿童营养性贫血的防治也不容忽视。第二部分学龄儿童的健康状况研究研究五济南郊区学龄儿童单纯性肥胖调查分析目的:了解济南郊区某县、乡镇及偏远农村儿童单纯性肥胖的发生情况,探讨其主要影响因素,预防儿童肥胖的发生。方法:采用整群抽样方法,随机抽取济南市区内2所小学,郊区县城内4所小学,乡镇所在地小学4所,农村小学5所,选择其一年级至五年级,6～10岁的儿童2601名为观察对象,专业人员测量体重、身高并进行问卷调查和膳食调查。根据WHO推荐的身高别体重标准进行判断。结果:济南市区儿童肥胖发生率7.6%,郊区县城7.23%、乡镇1.23%、村级0.61%,各组之间有明显不同,统计学比较差异有非常显著性(P＜0.001)。结论:儿童单纯性肥胖发生的主要原因为高蛋白、高脂肪摄入过多,体力活动减少。提示儿童合理饮食及增加儿童活动量和活动时间对预防儿童肥胖的发生具有重要意义。研究六济南市小学生高血压及相关因素的流行病学研究目的:了解济南市小学生城乡血压水平及高血压患病情况,探讨儿童原发性高血压的易患因素。方法:采用整群随机抽样的方法,对济南市、郊区6-13岁小学生进行血压测量及问卷调查,通过逐步Logistic回归分析,观察与小学生高血压可能相关的危险因素。结果:在调查的6278名小学生中,男4396人,女1882人,收缩压平均水平为(97.77±11.25)mmHg,舒张压平均水平为(61.22±9.26)mmHg;其中高血压191例,患病率3.04%;城市儿童高血压患病率3.17%高于郊区农村2.76%。血压水平与年龄、体重、身高都具有显著相关,与儿童高血压患病率呈正相关的因素有:皮脂厚度、儿童肥胖、母亲体重指数。结论:小学生血压无论男女都表现随年龄增长而升高的趋势,高血压患病率与儿童肥胖成正相关,儿童高血压与遗传因素有关。郊区儿童的血压水平高但高血压的患病率低。重视对小学生高血压的健康教育,控制和降低体重可减少高血压的发生。更多还原

【Abstract】 BackgroundRegardless of pre-school children or school-age children, they are at the stage of rapid growth and development. Their status of health has always been concerned by pediatricians. In recent years, the morbidity of physical diseases on children has lowered gradually. Although a lot of researches on the impact on children’s health from the view of environment, education, economy and psychology both at home and abroad have been reported, the subject still concentrates on the children’s growth and development.Growth and development are basic features and biological of children. For healthy children, monitoring children’s growth and development may reflect their current status and their developmental potentials;for sick children it contributes to the early detection of diseases, the follow-up process and the evaluation of treatments. For a group, monitoring their growth and development can not only reflect the trend of children’s growth and development and the risk factors that may affect them, but also reflect political, economic and cultural development of the country indirectly. With the rapid development of China’s social economy, the health level and lifestyles have changed a lot. Observing and grasping the children’s health status and the trend of physical development, understanding and analyzing the differences in children’s growth and development, finding out problems and impact factors ,are of great significance to perfect the management and monitoring systems of children’s physical development, children’s clinical work, children’s health service and scientific researches.According to the indicators recommended by WHO on Geneva Conference in 1983 and height that refers to the reference values of the U.S. National Center for Health Statistics (NCHS) , calculated HAZ (Height for age Z score) <2 is defined as stunting. According to this criteria, the growth and development status of a significant proportion of preschool children remains unsatisfactory in China’s provinces, municipalities and autonomous regions, especially in rural areas. Due to cultural, economic ,medical care conditions and other factors ,the growth and development level of rural areas fall behind the urban’s significantly. The decennial (1995)national nutrition survey data collected by Ministry of Health of China shows that rural children’s heights, both male and female,are lower than that of the urban children’s in the corresponding age.And the survey on rural children was mostly concentrated in the western areas or undeveloped depressed areas. With the urbanization process, earth-shaking changes have taken place in the urban outskirts,where economic basis, medical and health work has also gradually changed.Therefore, this issue intends to investigate the status of children’s growth and development and the status of common diseases in the outskirts of cities - suburbs, and to find out the health-related impacts and problems to minimize the adverse impact on the rural life as possible as we can, and to provide theoretical basis for taking further appropriate interventions.PART 1: The study of pre-school children’s health status一、The study of pre-school children’s growth and development status in Shanghe countyObjective To evaluate the status of growth and development of preschool children with 3-6 years old in Shanghe County. To understand the main problems of pre-school children and to provide the scientific evidence for enhancing the standard of health care. Methods Random cluster sampling was used and 1612 preschool children were checked for weight and height. The related information were investigated with the uniform questionnaire . To conduct assessments by the criteria of National Center for Health Statistics (NCHS)and the criteria of Chinese jiushi. Results According the Z score , 85 percent of pre-school children were higher than the middle level.There was no serious anemia in all children.The prevalence of underweight stunting and wasting were 2.36%,2.11% and 0.37%respectively. There was significant difference between county and village with underweight and stunting(p<0.01). Conclusions The status of pre-school children in Shanghe County was better than that of the average of all over the country.There are gap among the pre-school children of county ,town and village. Some comprehensive intervention should be carried out to improve health statua.二、The reserch of common diseases of pre-school children in Shanghe countyObjective To study the status of common diseases of preschool children in Shanghe County. To analysis the cause of these diseases and provide the evidence for health policy. Methods Random cluster sampling was used and 1612 preschool children were checked for physical examine and chemical examine . The uniform questionnaire were always abtained. Results The prevalence of anemia ,rickets of vitamin D and undersight were 0.81%, 3.66% and 2.61%.There was no difference of the prevalence between the two sexes .The prevalence of rickets and undersight in group of county was slightly higher than that of town and village. Conclusions The status of anemia in Shanghe County was lower than the average of the country. The health education and health care should be to enhance in our countryside further. 三、Investigation on the status of caries of pre-school children in Shanghe countyObjective To study the status of dental caries of preschool children with 2-6 years old in Shanghe County of Shandong Province. Methods Random cluster sampling was used and 2052 preschool children were checked for dental caries. Results The incidence of caries of deciduous teeth in Shanghe County was 52.97%,2.18 of mean caries and 0.18% of the fill rate .There was no difference between the two sexes .The incidence of caries of deciduous teeth of preschool children increased with their age (P<0.01) .The prevalence rate of caries in group of county town was slightly higher than that of village town and village. Conclusions The status of caries of deciduous teeth in Shanghe County was not better. The oral health care would be to enhance in our countryside.四、The analysis of pre-school children health status in Shanghe countyfor 4 yearsObjective To study the trend of preschool children’s health stastus in Shanghe County for 4 years . Methods The data was used by grow monitoring and 1500 preschool children who checked for growth and development in 4 years were comparised. Results The incidence of malnutrition in Shanghe County was downed gradually.The prevalence of underweight ,stunting and wasting were 1.78%,1.27% and 0.12% respectively.More and more obesity were appeared. The prevalence of it was 4.5% in 2008. In the past 4 years ,there are also differences with malnutrition and obesity among the different areas, but there was no difference with anemia among different areas. Conclusions The nutrition status of entirely area is fine.While children malnutrition morbidity comes down we should pay attention to obesity,and to prevent and cure anemia. Part2 The study of school age children’s health status五、The investigation of school age children with obesity in Jinan ruralareaObjective To investigate the situation of school age children’s obesity in jinan rural area and to provide scientific evidence for prevention of obesity . Methods Random cluster sampling was used and 2601 6-10 years old students of primary school were checked for height and weight . These students were came from county ,town and village.Random one day’s diet was investigated by 24-hour dietary recall and weight method. The related risk factors were investigated with the uniform questionnaire . Results The prevalence of obesity in Jinan children was 7.6%. Urban children had a higher prevalence than rural children.The prevalence of county, town and village were 7.23%, 1.23% and 0.61% respectively. There was a obvious difference amomg them. Conclusions It was demonstrated that the main reason of obesity was adverse intake,the intake of high protein and high fat were more than reference intake.There is an urgent need to carry out prevention and control for obesity of children .To diet rational and to train proberbly can release the incidence of obesity.六、Epidemiological study on Children Hypertension and risk factorsin school age children of Jinan areaObjective To understand the epidemiological features of children’s blood pressure and the risk factors of children’s hypertension . Methods Random cluster sampling was used and 6278 6-13 years old students of primary school were checked for blood pressure .The related risk factors were investigated with the uniform questionnaire . Results The prevalence of hypertension in Jinan children was 3.04%. Urban children had a higher prevalence (3.17%)than rural children(2.76%).No matter of systolic blood pressure (SBP) or diastolic blood pressure (DBP) were both increased with aging .There was a difference between girls and boys. Blood pressure of children were highly correlated with weight. The risk factors of hypertension in children were sebaceous thickness and abesity ,and materal baric index. The children’hypertension was correlated with genetic information . Conclusions It was demonstrated that there is an urgent need to carry out prevention and control for hypertension of children . Blood pressure can be descended by lowing body weight.更多还原