【作者】 王晓；

【导师】 汪玲；

【作者基本信息】 复旦大学 ， 儿少卫生与妇幼保健学， 2013， 硕士

【摘要】 第一部分上海市学龄前儿童气质特征及其影响因素分析研究目的了解上海市学龄前儿童气质特征,探讨学龄前儿童气质特征的影响因素,为儿童气质特征的干预提供可行的措施,为学龄前儿童的科学教育提供依据。研究方法本研究为现况研究,采用整群抽样法,抽取上海市四个城区共10所幼儿园,每所幼儿园抽取小班、中班、大班各2个班级,将符合纳入标准的全部儿童共1200名作为施测对象。由熟悉儿童的家长(主要是母亲)填写“学龄前儿童儿童及相关情况问卷”,包括儿童气质量表、家庭环境量表、父母教养行为量表、家庭一般情况等内容。用SPSS16.0软件进行统计分析。研究结果研究对象的年龄范围为3岁到6岁,平均年龄为(4.89±0.90)岁。男女比例为1：1.24。调查对象中易养型104例(占9.6%),中间型758例(占70.1%),启动缓慢型109例(占10.1%),难养型111例(占10.3%)；以中间型最多,其他三种类型比例相近。不同性别、年龄儿童气质类型无统计学差异。在活动水平和反应阈2个维度,男童得分高于女童；而在心境和注意分散度2个维度,女童得分高于男童。随着年龄的增长,男童反应强度和反应阈2维度得分逐步下降；而趋避性和适应度2维度得分逐步上升。无序多分类Logistic回归分析表明,以易养型为参考水平,控制可能的混杂因素后,教养行为、家庭环境、父母对孩子态度一致性、老人与父母对孩子态度一致性、出生胎龄等因素对儿童中间型气质和启动缓慢型气质无影响；控制可能的混杂因素后,家长敌意/强制教养行为较多、支持/参与行为较少、家庭环境独立性较强的儿童难养型气质比例较高。多重线性回归分析显示,学龄前儿童气质维度的影响因素包括以下方面。家长教养行为：敌意／强制维度、支持／参与维度；家庭环境：矛盾性、知识性、娱乐性、道德观、组织性、控制性；家庭一般情况：父亲职业、母亲年龄、老人与父母对孩子态度一致性、家事决定人；母亲孕期及儿童出生情况：妊娠反应、孕期重大生活事件、出生胎龄；看电视时间；入睡困难。研究结论学龄前儿童的气质类型分布以中间型最多,不同性别、年龄儿童气质类型无统计学差异,气质类型影响因素主要是家长教养行为和家庭环境中的独立性,表明气质类型具有相对稳定性。部分气质维度存在年龄差异和性别差异。学龄前儿童气质维度受家长教养行为、家庭环境、家庭一般情况、母亲孕期情况、儿童出生情况、生活作息等因素的影响。建议提高家长对儿童气质的重视,了解自家儿童的气质特征和生活环境,以适宜的方式养育儿童,使儿童气质和环境“适应良好”。第二部分学龄前儿童气质特征和健康相关状况的关系研究目的了解学龄前儿童健康相关状况,分析气质特征、家庭环境和健康相关状况的关系,探讨可干预的因素,为健康问题早期干预提供依据。研究方法采用整群抽样法,抽取上海市四个城区共10所幼儿园,每所幼儿园抽取小班、中班、大班各2个班级,将符合纳入标准的全部儿童共1200名作为施测对象。由熟悉儿童的家长(主要是母亲)填写“学龄前儿童气质及相关情况问卷”,包括儿童气质量表、家庭环境量表、父母教养行为量表、家庭一般情况、儿童健康相关状况等内容。用SPSS16.0软件进行统计分析。研究结果学龄前儿童总体健康状况良好、一般和较差的比例分别为54.6%、40.7%和4.7%。龋患率为27.6%。卫生服务利用的情况两周就诊率为17.3%。不同性别儿童总体健康状况、龋齿、两周就诊率没有统计学差异。不同年龄儿童龋患率、两周就诊率差异均具有统计学意义,6岁儿童龋患率高达37.2%,高于4岁和5岁的儿童。4岁和5岁的儿童两周就诊率高于6岁的儿童,不同年龄儿童总体健康状况没有统计学差异。无序多分类Logistic回归分析发现,控制混杂因素后,以健康状况良好为参考水平,气质类型依然影响儿童的总体健康状况,气质类型为D型、趋避性和适应度得分较低的儿童健康状况一般的比例较高。采用二分类Logistic回归分析探讨龋齿和气质特征的关系。单因素和多因素分析均显示,气质类型为D型、节律性得分较低、反应强度得分高、反应阈得分较高是患龋齿的危险因素。采用二分类Logistic回归分析探讨两周就诊情况和气质特征的关系。气质类型为D型的儿童两周就诊率高于E型的儿童,是两周就诊率的危险因素。研究结论儿童气质特征影响学龄前儿童总体健康状况、龋患率和两周就诊率。气质特征不仅对儿童生理健康问题产生影响,亦影响儿童卫生服务利用的情况。建议家长针对不同的气质特点采取不同的抚养方式,使儿童与环境“调适良好”,发挥出最佳的状态,以预防身心健康问题的发生。更多还原

【Abstract】 PartⅠ Temperamental characteristics and its impacted factors among preschooler in Shanghai CityObjectivesTo understand the characteristics of preschooler temperament and explore the impacted factors, then to provide the feasible intervention measures and the basis for the scientific education of preschool children.MethodsCross sectional survey method and cluster sampling techniques were used in the study. The1200students were selected from10kindergartens in four districts in Shanghai City. Two classes were extracted in each grade. Parents of the preschoolers were surveyed by NYLS Preschool-children Temperament Scale and other questionnaire involved the family basic information, the family environment scale and the parent behavior inventory. SPSS16.0was used in the study.ResultsThe age of preschoolers was among3to6years and the average age was4.89±0.90years old. The gender ratio was1:1.24. The temperament type distribution of preschoolers showed that9.6%children were easy nurturing type,10.1%slow-to-warm up type,10.3%difficult nurturing type and70.1%medium nurturing type. The major was the medium type in the preschool children’s temperament style distribution. The proportion of the other three types was similar. There were no gender and age differences in the temperament style distribution. In the nine temperament dimensions, the scores of boys’activity level and the response threshold were higher than girls, but, the scores of the mood and the attention dispersion lower than girls(p <0.05). There were statistically significant differences in the dimension scores of approach/withdrawal, adaptability, response intensity and response threshold among boys in different age groups (p<0.05). For girls, there were statistically significant differences in the dimension scores of activity level, approach/withdrawal and response intensity in different age groups (p<0.05).Multinomial logistic regression analysis showed that the medium type and the slow-to-warm up type were not affected by parenting behavior, home environment, the parent attitude toward children, the attitude of the elderly and parents to children, and the gestational age compared with the easy type. Controlling for possible confounding factors, in comparison with the easy type, the parenting hostility/coercion behavior, the supportive/engaged behavior, the Independence of family environment were the risk factors of the difficult type.Multiple linear regression analysis indicated that the influencing factors of preschooler temperament dimensions involved the parenting hostility/coercion behavior, the supportive/engaged behavior, home environment (conflict, intellectual-cultural orientation, recreation, orientation, moral emphasis, organization, control), the family basic information (the father career, mother’s age, the attitude of the elderly and parents to children, the family decided people), the pregnancy of mother and the child birth condition (pregnancy reaction, pregnancy major life events, gestational age), watching TV time, difficulty in falling asleep.ConclusionsThe major was the medium type in the preschool children’s temperament style distribution. There were no gender and age differences in the temperament style distribution. The main influencing factors of the temperament type were the parenting behavior and the independence of the home environment. There were age and gender differences in the partial temperament dimensions. The impacted factors of the temperament dimensions involved the parenting behavior, the home environment, the family basic condition, the pregnancy of mother and the child birth condition, watching TV time, difficulty in falling asleep. So the parent should pay more attention to the temperament of their children and raise children in an appropriate manner. The concept of "goodness of fit" is essential in the interaction between home environment and the child temperament. PartⅡ The relationship between preschool temperament characteristics and health statusObjectivesTo understand the preschooler health related conditions and explore the relationship between preschool temperament characteristics and health status, then to provide some practical measurements and the basis for the early intervention.MethodsCross sectional survey method and cluster sampling techniques were used in the study. The1200students were selected from10kindergartens in four districts in Shanghai city. Two classes were extracted in each grade. Parents of the preschoolers were surveyed by NYLS Preschool-children Temperament Scale and self-made questionnaire involved the family basic information, the family environment scale, the parent behavior inventory and the health status. SPSS16.0was used in the study.ResultsThe overall health status of preschoolers showed that54.6%children were good status,40.7%general health condition,4.7%bad condition. Caries rate was27.6%. The two-week outpatient rate of health servies utilization was17.3%. The gender differences of overall health status were not statistically significant, as well as the dental caries and the two-week outpatient rate. There were age differences in the dental caries rate and the two-week outpatient rate. The6-year-old children’s caries rate was37.2%, higher than that of the4-year-old and5-year-old children. Instead, the6-year-old children’s two-week outpatient rate was lower than that of the4-year-old and5-year-old children. There were no age differences in the overall health status.Multinomial logistic regression analysis showed that, compared with the good health status, the temperament type still affected the overall health status. The risk factors of the general health status involved D-type temperament, the low scores of approach/withdrawl dimension and adaptability dimension.Binary logistic regression analysis was used to explore the relationship between caries and temperament charactetistics. Univariate and multivariate analysis all showed that the risk factors of caries included the D-type temperament, the low scores of rhythmicity and the high scores of threshold of responsiveness and intensity. Binary logistic regression analysis was used to investigate the relationship between the two-week outpatient rate and the temperament characteristics. The two-week outpatient rate of the D-type preschoolers was higher than that of the E-type children.ConclusionsChildren’s temperament characteristics affect the overall health status, the caries and the two-week outpatient rate. Temperament characteristics not only have an impact on children’s physical health problems, but also affect the utilization of child health servies. Parents should take a different raising way according to the special temperament of their child."Good of fit" results when the properties of environment and its expections and demand are in accord with the preschooler’s temperament. Emphasis is placed on helping parents to understand their toddler’s temperament-based behavior and to devise strategies that maximize compatibility between the toddler’s temperament and parental expectations.更多还原