OBJECTIVE:To analyze the association between maternal dietary zinc levels at different stages and preterm birth. METHODS:The subjects were from the 2010-2012 birth cohort of Maternal and Child Health Hospital of Gansu Province, and a total of 10 179 pregnant women were included in the final study. Dietary information before and during pregnancy was collected through semi-quantitative food frequency questionnaire, and daily zinc intake in each period was estimated according to the frequency of consumption and portion size of food items using the Chinese Standard Tables of Food Consumption. Logistic regression was used to analyze the OR value of preterm birth under different maternal dietary zinc levels. RESULTS:The detection rate of preterm birth was 10.0%, of which 81.8% were moderate preterm, 18.3% were very preterm, 33.2% were medically indicated preterm and 66.8% were spontaneous preterm birth. After adjusting for general conditions such as maternal age, education level, and history of preterm birth, compared with the group with the highest zinc intake before and during pregnancy, those with low zinc intake before or during pregnancy had a significantly higher risk of moderate, very, and spontaneous preterm birth. After further controlled of folic acid and fiber intake during pregnancy, compared with the group with the highest zinc intake before and during pregnancy, the risk of very preterm birth(OR=2.04, 95%CI 1.07-3.90) and spontaneous preterm birth(OR=1.38, 95%CI 1.01-1.88) was significantly increased in those with the lowest zinc intake during the third trimester. For pregnant women aged≥30 years(OR=1.55, 95%CI 1.12-2.13) and normal or less normal weight gain during pregnancy(OR=1.51, 95%CI 1.15-1.97), insufficient zinc intake was significantly associated with preterm birth. CONCLUSION:Maternal low dietary zinc intake during the third trimester was associated with very premature and spontaneous preterm birth.

孤独症谱系障碍(autism spectrum disorder,ASD)是一种终身损害性的神经发育障碍.在儿童开始表现出ASD症状前评估其早期社会经历,将有助于更好地确定社会经历和儿童早期ASD之间的联系.近年来屏幕媒体的使用越来越低龄化,研究对学龄前儿童屏幕暴露与ASD的关联进行综述,结合当前的研究现状提出未来研究方向,为优化电子视屏产品的使用提供依据.

工作过程导向和学习成果导向是目前国内公认的两大课程改革的指导理论.对工作过程导向和学习成果导向课程观分别进行阐述,并分析两者的辩证关系.以中职药剂专业课程体系改革为例,研究如何利用学习成果导向教育理念对原工作过程导向型课程体系进行优化,并传递"五育并举""以学生为中心"等教育理念,探索具有中国特色的职业教育课程改革模式.

立德树人始终是学校教育教学工作的中心环节,探究课程思政在护理专业课程的融合,系统设计两者的融合途径,突出世界观、人生观、价值观引领,将工匠精神融入护理专业教育,才能逐步构建大思政的护理专业课程教育新格局.

随着"普通教育有高考,职业教育有技能大赛"创新体制的出台,目前我国职业院校技能大赛日益趋向制度化、常态化.护理技能竞赛不仅强化了卫生职业院校师生的实际操作技能,更极大地促进了卫生职业教育教学改革和发展.从2009年开始,广东省确立了定期举办技能大赛的长效机制,随着精准育人人才培养模式的建立,其中护理技能竞赛呈现"三个不断"的特点,即内容不断丰富、比赛形式不断更新、竞赛水平不断提高.竞赛的要求也越来越高,既要保证护理技能操作规范、手法正确、轻巧娴熟,还要在其操作规程中体现出对患者的人文关怀、职业礼仪与人际沟通技巧、应激能力和理论知识等综合能力的灵活应用.传统的训练模式已无法适应新常态,为提升选手的操作技能成绩,笔者提出将"互联网+"时代信息技术与微格教学模式运用于选手的集训工作中.

《国家职业教育改革实施方案》中明确指出要坚持职普比例大体相当.但目前普高招生人数兴旺,中职学校却面临"招生难"现象,职普比列已失衡.笔者针对中等职业学校"招生难"问题进行分析并提出相应对策.

目的 通过分析2010-2016年甘肃省围生儿死亡数据资料,了解甘肃省围生儿死亡现状,为卫生行政部门制定降低围生儿死亡的干预措施提供理论依据.方法 回顾性分析2010-2016年甘肃省各地区上报的围生儿死亡报告卡与围生儿死亡监测报表.采用年估计变化百分比法(EAPC)来评价围生儿死亡率的时间变化趋势;应用x2检验比较各地区的围生儿死亡率.结果 2010-2016年甘肃省围生儿死亡率总体呈下降趋势,平均死亡率为8.08‰;2016年甘肃省围生儿死亡率为6.63‰;围生儿死亡主要发生在孕28周～、以死胎为主,低出生体质量儿居多;围生儿死亡中,尸检率低,死亡地点多在医院,占比达78.88％;家长认为病情不重是未治疗或未就医的主要原因;围生儿死亡前7位死因顺位依次是早产儿或低出生体质量、先天畸形、出生窒息、胎儿窘迫、新生儿疾病、肺透膜病、脐带异常.结论 甘肃省围生儿死亡率呈下降趋势;为进一步降低甘肃省围生儿死亡率,应加强孕期保健,完善围生保健系统,预防早产及出生缺陷三级预防依旧是降低围生儿死亡率的重要措施.

目的 了解甘肃省贫困地区6～24月龄婴幼儿贫血患病状况及其影响因素,为改善当地儿童贫血患病状况提供参考依据.方法 采用多阶段抽样的方法 ,在甘肃省12个儿童营养改善项目县对6～24月龄婴幼儿及看护人进行调查,用t检验、方差分析进行血红蛋白含量的比较、用 χ2检验进行患病率之间的比较、用Logistic回归分析模型进行影响因素的分析.结果 3188例有效数据中,贫血检出率为25.69％(819人),男童、女童中贫血检出率分别为24.54％ 、26.90％,不同性别间贫血检出率的差异无统计学意义(χ2=2.326,P=0.127),不同年龄组间贫血检出率的差异具有统计学意义(χ2=42.339,P<0.001);多因素分析结果 表明:儿童月龄、儿童民族、家长对喂养知识的知晓率、儿童出生6个月后喂养方式、营养包的服用方式与贫血均存在相关性(均有P<0.05).结论 甘肃省贫困地区6～24月龄婴幼儿贫血患病率较高,加强对看护人喂养知识及科学育儿的宣教,进一步落实营养包的有效服用,有助于改善儿童贫血患病状况.

Objective To know about the developmental characteristics and influencing factors of self -concept in primary and secondary school students .Methods Totally 5 435 primary and secondary school students were selected from 6 cities and counties of Gansu Province with random cluster sampling method through city /county maternal and child units organized by Gansu Provincial Maternity and Child -care Hospital during the period of January 2011 to January 2012.Piers-harris children self-concept scale ( PHCSS) and self-made general questionaires were used for survey .Results The whole level of self-concept of primary school students was significantly higher than that of secondary school students (t=8.089, P<0.01), mainly in the factors of intelligence and school , physical appearance and attributes , anxiety, gregariousness, happiness and satisfaction (t value ranged 3.452-7.236, all P<0.01).In the primary and secondary stages , the whole level of self-concept of girls was higher than boys (t value was -5.349 and -2.502, respectively, both P<0.05).Mother’s cultural degree and father ’ s cultural degree were the family influencing factor of self-concept in primary school stage and secondary school stage, respectively.School record, teacher-student relationship and classmate relationship were common factors of self -concept in primary and secondary school students .Conclusion The developmental level of self-concept in primary and secondary school stage decreases with the increase of grade , and it is especially influenced by school environment and parents ’ culture degree .

Objective To know about the incidence of school-age children behavior problem and its influencing factors in Gansu province,and provide reference for children's psychological health. Method A total of 5 435 school students aged from 8to 16 years were investigated in 6cities and counties of Gansu province with Achenbach Child Behavior Checklist(CBCL)Chinese Version and self-made questionaire of influencing factors. Results The detecting rate of school students identified with behavior problem was 19.8%.The prevalence of behavioral problems in male was 20.4% and that in females was 19.2%.The prevalence of behavioral problems in primary school was 14.9% and that in high school was 22.4%.Low birth weight(≤2 500g)and the poor relations among student-teacher or classmates were important factors affecting the behavior problems of school-age children. Conclusions Perinatal high-risk factors have a certain effects on the behavioral development of school-age children.A variety of factors in the family and school environment are associated with children's behavioral problems.

目的 了解甘肃农村留守儿童的生活质量并探讨其影响因素.方法 采用儿童少年生活质量量表和自编的一般情况调查表对随机抽取的1 484名农村留守儿童与非留守儿童进行调查与分析.结果 农村留守儿童的生活质量总体水平处于中下水平,占到总体留守儿童的84.9％;留守儿童的生活质量显著低于非留守儿童(P＜0.05);留守儿童在性别、是否住宿、学习成绩、家庭收入等变量上差异均有统计学意义(P＜0.05).结论 农村留守儿童的生活质量普遍较低,加强留守儿童的心理健康教育,是一项长期坚持的工作.

The problem of aggregation has been always one of the hot and focuses of the region research,and the positioning of aggregation is a prerequisite for continuing in-depth study in aggregation analysis.Aggregation appears a high degree of sensitivity on the scale.When the aggregation was analyzed by using the spatial autocorrelation method,scale choices are often susceptible to subjective judgments of the researchers,and exist the possibility of selection bias.So the spatial weight problem has been controversial.In addition,the aggregation is obviously space-dependent as well as time-dependent since different aggregation takes place within different time and space,which is neglected by the spatial autocorrelation method.Therefore,some scholars have been trying to explore better ways for aggregation analysis.In comparison,the spatial-temporal scan statistic method raised by scholars as Kulldorff shows its superiority.This paper targets at 51 districts and counties within the central and southern regions of Gansu Province,which are densely populated minority areas.Using software Geoda0.9.5 and Clusterseer0.2.3,spatial autocorrelation analysis and space time scan statistical analysis were adopted about 30463 perinatal deaths during 2001 to 2010 according to the report delivered by monitoring points of Ministry of Health.It also gives a detailed comparison between spatial autocorrelation and scanning statistic from the different perspectives of scale choices,scale transforming and space integration,and then tests the analysis results by appealing Sam 4.0.Through theoretical and empirical analysis,it further confirms that spatial-temporal scan statistic method has the significant advantage from the three aspects of scale selection,scale conversion,and spatial-temporal integration,which shows that it is not only effective measure to solve the problem of artificial selection,but also to achieve the scale extrapolation and automatic conversion,and more favorable mix of three-dimensional,dynamic,multi-scale analysis.Therefore,a conclusion is drawn that the space-time scan statistic method is superior than other methods.Specifically,there are three main aspects: 1) Compared to spatial autocorrelation methods and space-time scan statistic method,the adjacency and distance matrix is artificial selection in spatial autocorrelation.The space-time scan statistic method achieves the purpose of scale automatically conversion and avoids the instability.2) The scale of spatial autocorrelation methods is static,single,and the scale of space-time scan statistic is dynamic,three-dimensional and multi-scale.3) In analyzing the issue of spatial autocorrelation method does not take into account the time factor,while the space-time scan statistic method is not only the full integration of space technology,and achieves good analytical results.By combining the time factor,the range of aggregation can be reduced to a more accurate range.Moreover,space-time scan statistic method can even make a prediction,which can provide a basis for decision-making.

Objective To explore the correlations between self-concepts and behavior problems among children and adolescents.Methods Totally 5 435 students aged 8-16 years were selected from Gansu province.Child Behaviour Checklist(CBCL) and Children's Self-Concept Scale were used to evaluate behavior problems and self-concepts among the students.Results Among the students with behavior problems,46.3%-63.4% reported negative self-concepts.There were significant negative correlations between self-concepts and behavior problems,with the correlation coefficients of-0.060——0.317 for the studtens of 8-11 years old and-0.050——0.372 for the studnets of 12-16 years old(P0.05 for all).The correlation coefficients between self-concept anxiety,gregariousness,behavior factors and behavior problems were all lower than-0.3 for the students of 12-16 years old(P0.01 for all).Conclusion After entering pubertal period,the self-concepts of students are more objective and could be used to measure mental and behavior problems.

【Objective】 To know about the current situation of the self-concept and its influential factors of school-age children in Gansu province.【Method】 5 435 school students were randomly selected from 6 cities and counties of Gansu province.Then Piers-Harris Children's Self-concept Scale(PHCSS) was used and assessed.【Results】 The whole level of self-concept of the children in Gansu was significantly lower than the level of Chinese norms(P0.01).Girls got more scores than boys about behavior,intelligence and school,anxiety,happiness and satisfaction as well as total score(P0.01).The level of children's self-concept in town was markedly higher than the level of the rural children(P0.01).Multiple stepwise regression analysis showed that the risk factors of self-concept were as follows,the different degree of parents' education,mother's occupation,school record,the teacher-student relation,classmate relation.【Conclusions】 The level of pupil's self-concept relates with economy and social development,and is influenced by the environment of family and school.It is an important developmental task to promote the level of self-concept in the growing of children.

【Objective】 To know about the developmental level and risk factors of the self-concept of Hui nationality school-age children.【Method】 The Piers-Harris Children's Self-concept Scale(PHCSS) and Self-designed Questionnaire were used to investigate 495 Hui nationality school-age children.【Results】 The whole lever of self-concept of the Hui nationality school-age children was significantly lower than the level of Chinese norms(P0.01).Girls got higher scores than boys about behavior,anxiety,gregariousness as well as total score(P0.01).And the score was becoming lower with the grade growing.Parents' education,occupation,family income,family type had effects on self-concept.And so did the school environment factors,such as study score,teacher-student relationship,classmate relationship.The level of pupil's self-concept was markedly higher than the level of the middle school students.【Conclusions】 School age is the critical period of the development of self-concept.To create a better environment of family and school is an effective protection to improve the children mental health.

Objective:To investigate and analyze human resources of personnel in maternal and child health(MCH) institutions from 2006 to 2009 in Gansu province so as to provide a basis for formulating human resourse development planning in MCH institutions in Gansu province in future.Methods:Data of 100 MCH institutions in Gansu province were collected through 'National Management Information Web-based Reporting System of Woman and Children Health Facilities'to realize the network report.Results:The situation of staffing deficiency was raising progressively;The majority of all staff were medical and health personnel,with proportion about 80%.12 MCH institutions of municipality(85.7%) were qualified in 2009 and all of the prefectural institutions were unqualified.Medical and health personnel who were post-secondary education and below accounted for 50%.Title of a senior professional post medical health personnel of province accounted for 40%.The majority of professional in municipality and prefecture under the title of a technical post.Along with the organization rised,the health personnel proportion reduced.Conclusion:The problem of staffing deficiency,unreasonable structure,low professional quality,insufficient full-time care personnel were serious.It must be inevitably affect maternity and child care centers function to perform and sustainable development.

Objective:To analyze the obstetrical causes of maternal death in Gansu province from 2005 to 2010,provide a scientific basis for reducing the maternal mortality in Gansu. Methods:The assessment results of maternal death in Gansu province from 2005 to 2010 were analyzed,then the causes of maternal death and the change trend were obtained. Results:From 2005 to 2010,the maternal mortality in Gansu province showed a decreasing trend,but it was still higher than the national average level.The proportions of direct obstetrical causes and indirect obstetrical causes were 74.48% and 25.52%,respectively.Among the direct obstetrical causes,the top three causes included placental retention,postpartum uterine inertia and amniotic fluid embolism.The proportion of placental retention showed a decreasing trend,while the proportions of postpartum uterine inertia and amniotic fluid embolism showed a increasing trend.Among the indirect obstetrical causes,the top three causes included pregnancy combined with cardiovascular diseases,iron-deficiency anemia pregnancy,pregnancy combined with liver diseases;in recent years,the proportions of pregnancy combined with diseases of other systems increased. Conclusion:From 2005 to 2010,the maternal mortality decreased in Gansu province,but it is still higher than the national average level.The training of obstetrical professionals and the medical quality of obstetrical department should be enhanced.

目的:通过对2006～2009年度甘肃省妇幼保健机构人力资源现状的调查,掌握各级妇幼保健机构人力资源配置现状,为今后全省各级妇幼机构规范化建设提供依据.方法:依托国家妇幼保健中心妇幼保健机构监测信息网络直报系统,对2006～2009年度甘肃省100所妇幼保健机构进行调查,对数据进行描述性研究.结果:2006～2009年度各级妇幼保健机构人员编制缺乏情况呈逐年增长趋势;在职职工构成以卫生技术人员为主,占职工总数80%以上,并呈逐年增长趋势;2009年市州级机构有12所合格(85.7%),县区级机构卫生技术人员比例均不合格;学历方面大专及以下人员占50%以上;省级机构中级职称以上人员占卫生技术人员40%以上,市州级和县区级机构以中级和助理及以下职称人员为主;随着机构级别的升高,保健科室人员所占比例降低.结论:甘肃省各级妇幼保健机构人员编制不足、卫生技术人员构成不合理、专业素质较低、专职保健人员配备不足等问题严重,势必会影响到妇幼保健机构职能的履行及妇幼保健事业的可持续发展.

目的 了解甘肃省1997~2007年围产儿的出生缺陷发生状况及趋势,为降低我省出生缺陷发生率及提高出生人口素质提供依据.方法 通过收集甘肃省1997~2007年31个监测点围产儿的监测数据,获得围产儿出生缺陷发生率,分析其变化趋势及主要病种顺位.结果 1997~2007年甘肃省出生缺陷平均发生率为108.42/万,不同性别围产儿和城乡分布的出生缺陷发生率差异有统计学意义.11年间出生缺陷主要病种前5位依次为神经管畸形,先天性脑水肿,总唇裂,多指(趾),马蹄内翻.结论 1997~2007年甘肃省围产儿出生缺陷发生率变化趋势不稳定,且城乡差距较大,应提高围产儿出生缺陷干预措施的质量,加强产前检查及围产期保健工作,以减少出生缺陷的发生.

【Objective】To understand the death status and changing trend of the child under age 5 in 1996—2007 of Gansu province and provide basis for improving the health care situation of the child under age 5 as well as decision-making of the health administration department. 【Methods】Collecting the monitoring data between 1996 and 2007 which from several maternal and child monitoring points in Gansu province.To obtaine the child under age 5 mortality rate,as well as analyzed the changing trends. 【Results】1)It showed that the mortality rate of infant and child under age 5 decreased year by year from 1996 to 2007.The estimating average annual percent change(EAPC) of the mortality in whole province,urban and rural areas respectively were-6.46%,-6.89%(P0.05).2)The death of newborn account for the biggest proportion in child under age 5;the main disease categories which caused child under age 5 deaths were birth asphyxia and premature delivery or low birth weight and pneumonia. 【Conclusions】The health condition of child under age 5 have improved in Gansu province over 12 years,but the mortality of rural children obvious higher than that of urban children,and the health care services should be enhanced in rural areas and the technique level should be improved.