中山市儿科医务人员对孤独症认识度的调查
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摘要
目的调查中山市医护人员对孤独症的认识,为更好地发现和管理此类患儿提供参考数据。方法自编调查问卷,包括参与人员的一般情况(医院等级、职业方向医生/护士、工作年限、职称、年龄)、儿童孤独症相关知识(症状学、起病年龄、病因学、治疗学)和首选转诊医生对象。采用整群分层随机抽样,将中山市医院分为基层、一甲、二甲、三甲4个层次抽取,医院指定负责人联系专科医生解答问卷过程中的任何问题并监视儿科和儿童保健的全体医护工作者闭卷完成。结果调查共抽取10家医院,共273名医护人员参与。常见症状通过率:症状2为25.6%、症状3为31.9%、症状5为55.2%、症状11为54.1%、症状16为58.5%(相对偏低),症状14为69.6%,其余条目通过率均>70%。起病年龄认为在0~3岁的医护人员占45.2%,4~6岁的占42.9%,7~12岁的占9.7%,12岁以上的占2.3%;病因学24.2%的医护人员认为与经常看电视有关,61.3%认为与家人没时间管有关,46.5%认为与遗传有关,80.7%认为不明确,60.2%认为是脑功能发育异常。治疗方法中94.5%的医护人员认为无特效药,98.5%认为需要早发现早诊断早干预,对各项治疗方法的选择均在85%以上;首选转诊医生对象:61.8%的医护人员认为选儿童心理专科医生,20.1%选普通儿科医生,7.6%选精神科医生,4.5%选特殊教育人员,4.2%选神经科医生,1.8%选康复科医生。结论医护人员对孤独症的病因学、症状学、治疗方法有基本认识,对起病年龄认识不足,大多数人员能及时将患儿转诊到儿童心理专科诊治,但仍需要加强对起病年龄、语言发育异常、刻板行为表现的认识,加强和相关兄弟科室的合作交流。
Objective To assess the knowledge about childhood autism in paediatric doctors and nurses in Zhongshan and to provide referenes for better detection and managment of autism patients.Methods A self-made questionnaire was developed,including general information of participants(rank of hospital,career direction doctor/nurse,working years,titles,age),knowledge of childhood autism(semiology,onset age,etiology,therapeutics)and preferred referral doctor.Stratified cluster random sampling method was used to draw hospitals in Zhongshan which were graded as basic,A class,AA class and AAA class.An appointed person answered questions of specialists and supervised closed reply of questionnaire by all doctors and nurses.Results Altogether 10 hospitals and 273 medical staff were included in survey.Pass rate of semiology was 25.6%for symptom 2,31.9%for symptom 3,55.2%for symptom 5,54.1%for symptom 11,58.5%for symptom 16(comparatively low)and 69.6%for symptom 14.Pass rate of the rest items was over 70%.Proportion of medical staff thinking onset age as 0-3 was 45.2%,4-6 was 42.9%,7-12 was 9.7% and above 12 was 2.3%.For etiology knowledge,24.2% of medical staff considered constantly watching TV relative to this disease,61.3% considered care-time limitation,46.5% considered inheritance,60.2% considered dysfunction of brain development,and 80.7%thought that causes were unclear.For therapeutics,94.5% of medical staff considered that there was no specific medicine,and 98.5% thought that early recognition,diagnosis and intervention was important.Choice rate of each therapeutic method was above 85%.For preferred referral doctor,61.8% of medical staff chose specialist of child psychology,20.1% chose general pediatrician,7.6% chose psychiatrist,4.5% chose special education worker,4.2% chose neurologist and 1.8% chose rehabilitation doctor.Conclusion Medical staff have basic knowledge of etiology,semiology,and therapeutics of autism,but knowledge of onset age is deficient.Most staff will transfer patients to child psychological specialist.Education on knowledge of onset age,language development abnormality and stereotyped behavior should be strengthened.Cooperation and communication between related departments should be reinforced.
Objective To assess the knowledge about childhood autism in paediatric doctors and nurses in Zhongshan and to provide referenes for better detection and managment of autism patients.Methods A self-made questionnaire was developed,including general information of participants(rank of hospital,career direction doctor/nurse,working years,titles,age),knowledge of childhood autism(semiology,onset age,etiology,therapeutics)and preferred referral doctor.Stratified cluster random sampling method was used to draw hospitals in Zhongshan which were graded as basic,A class,AA class and AAA class.An appointed person answered questions of specialists and supervised closed reply of questionnaire by all doctors and nurses.Results Altogether 10 hospitals and 273 medical staff were included in survey.Pass rate of semiology was 25.6%for symptom 2,31.9%for symptom 3,55.2%for symptom 5,54.1%for symptom 11,58.5%for symptom 16(comparatively low)and 69.6%for symptom 14.Pass rate of the rest items was over 70%.Proportion of medical staff thinking onset age as 0-3 was 45.2%,4-6 was 42.9%,7-12 was 9.7% and above 12 was 2.3%.For etiology knowledge,24.2% of medical staff considered constantly watching TV relative to this disease,61.3% considered care-time limitation,46.5% considered inheritance,60.2% considered dysfunction of brain development,and 80.7%thought that causes were unclear.For therapeutics,94.5% of medical staff considered that there was no specific medicine,and 98.5% thought that early recognition,diagnosis and intervention was important.Choice rate of each therapeutic method was above 85%.For preferred referral doctor,61.8% of medical staff chose specialist of child psychology,20.1% chose general pediatrician,7.6% chose psychiatrist,4.5% chose special education worker,4.2% chose neurologist and 1.8% chose rehabilitation doctor.Conclusion Medical staff have basic knowledge of etiology,semiology,and therapeutics of autism,but knowledge of onset age is deficient.Most staff will transfer patients to child psychological specialist.Education on knowledge of onset age,language development abnormality and stereotyped behavior should be strengthened.Cooperation and communication between related departments should be reinforced.
引文
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[3]邹小兵.孤独症谱系障碍的研究进展[J].临床儿科杂志,2010,28(8):715-717,724.
[4]Constantino J N,Marrus N.The early origins of autism[J].Child Adolesc Psychiatr Clin N Am,2017,26(3):555-570.
[5]Raja M,Azzoni A.Autistic spectrum disorders and schizophrenia in the adult psychiatric setting:diagnosis and comorbidity[J].Psychiatr Danub,2010,22(4):514-521.
[6]金宇.孤独症谱系障碍与注意缺陷多动障碍成年期的转归[J].中国实用儿科杂志,2012,27(6):412-415.
[7]静进.孤独症谱系障碍诊疗现状与展望[J].中山大学学报(医学科学版),2015,36(4):481-488.
[8]李佩琼,章钧,章远志.临床医生对儿童孤独症的了解状况抽样调查[J].重庆医学,2013,42(17):1983-1984,1987.
[9]徐翠青,张静.孤独症儿童早期识别的1∶2病例-对照研究[J].特别健康,2017,(19):212.
[10]Igwe M N,Ahanotu A C,Bakare M O,et al.Assessment of knowledge about childhood autism among paediatric and psychiatric nurses in Ebonyi state,Nigeria[J].Child Adolesc Psychiatry Ment Health,2011,5(1):1.
[11]刘雅静,贾美香.144例儿童孤独症门诊病例回顾性分析[J].中国当代医药,2010,17(24):193-194.
[12]Miller M,Young G S,Hutman T,et al.Early pragmatic language difficulties in siblings of children with autism:implications for DSM-5 social communication disorder?[J].J Child Psychol Psychiatry,2015,56(7):774-781.
[13]杜亚松.孤独症的诊断和治疗[J].实用儿科临床杂志,2010,25(23):1771-1774.
[2]林素英,陈小志,高镇松,等.汕头市精神病患者第二代精神残疾评定结果分析[J].社区医学杂志,2012,10(13):11-12.
[3]邹小兵.孤独症谱系障碍的研究进展[J].临床儿科杂志,2010,28(8):715-717,724.
[4]Constantino J N,Marrus N.The early origins of autism[J].Child Adolesc Psychiatr Clin N Am,2017,26(3):555-570.
[5]Raja M,Azzoni A.Autistic spectrum disorders and schizophrenia in the adult psychiatric setting:diagnosis and comorbidity[J].Psychiatr Danub,2010,22(4):514-521.
[6]金宇.孤独症谱系障碍与注意缺陷多动障碍成年期的转归[J].中国实用儿科杂志,2012,27(6):412-415.
[7]静进.孤独症谱系障碍诊疗现状与展望[J].中山大学学报(医学科学版),2015,36(4):481-488.
[8]李佩琼,章钧,章远志.临床医生对儿童孤独症的了解状况抽样调查[J].重庆医学,2013,42(17):1983-1984,1987.
[9]徐翠青,张静.孤独症儿童早期识别的1∶2病例-对照研究[J].特别健康,2017,(19):212.
[10]Igwe M N,Ahanotu A C,Bakare M O,et al.Assessment of knowledge about childhood autism among paediatric and psychiatric nurses in Ebonyi state,Nigeria[J].Child Adolesc Psychiatry Ment Health,2011,5(1):1.
[11]刘雅静,贾美香.144例儿童孤独症门诊病例回顾性分析[J].中国当代医药,2010,17(24):193-194.
[12]Miller M,Young G S,Hutman T,et al.Early pragmatic language difficulties in siblings of children with autism:implications for DSM-5 social communication disorder?[J].J Child Psychol Psychiatry,2015,56(7):774-781.
[13]杜亚松.孤独症的诊断和治疗[J].实用儿科临床杂志,2010,25(23):1771-1774.