| Background: Child injury is one of the most important public health issues around the world,and the number of children killed by injury every year is about 950,000.In developed countries,child injuries account for about 40% of all child deaths,while this proportion is more than 95% in developing and low-income countries.Among the all types of injuries,road traffic injuries and falls are the primary causes of injury or disability to children.China has a large population base of about 1.34 billion,of which children account for 16.6%.The incidence of child injuries in China remains high,with child injury cases accounting for about 25% of total injury cases;the rate of reported injuries has risen to about 20%,with an incidence rate of 2624.62 per 100,000.There are high medical expenses resulting from injury-induced disability.The economic loss caused by injuries in children(0-14)is approximately 50 billion US dollars per year,including medical expenses and productivity impairment.Child injury,particularly in one-child family,has more negative effects.After the proposition of the Convention on the Rights of the Child and the Millennium Development Goals,various countries have gradually considered child injury as the main focus of health prevention and control.China,as the largest developing country,has more typical characteristics of child injury: a large number of children,a high prevalence of child injury,weak awareness of injury prevention,and an ignorance of health education in schools.Injuries can be preventable and controllable.Therefore,domestic and foreign scholars have paid more attention in investigating the influencing factors of child injuries.However,there is a lack of highquality epidemiological research in China.Most of the identified influencing factors are general demographic characteristics and behavioral problems have been less addressed.The purpose of this study is to explore the causal relationship between children’s behavioral problems and injuries by using cross-sectional study,casecontrol study,and cohort study,to identify the influencing factors associated with children’s injuries,and to propose strategies and measures for preventing child injuries.Objectives: 1.To analyze the current situation of child injury in China and current situation of child behavioral problems,and to describe statistically the basic characteristics such as the prevalence of child injury and the types of injury.2.To explore the influencing factors that cause children’s injuries by case-control and cohort studies,and explore whether children’s behavior problems are one of the risk factors for children’s injuries.3.To put forward targeted strategies and measures for child injury prevention.Methods: 1.Cross-sectional study: Using cluster sampling,students from 3 primary schools in a southern city of Jiangsu Province were selected as the survey objects.The current situation of children’s behavioral problems was assessed according to the Rutter Children’s Behavior Scale.General demographic characteristics,family environment,caregiver characteristics,injury situation and other characteristics were surveyed according to Injury Surveillance Card 2014.2.Case-control study: A 1: 1 matched case-control study was used to take the children who suffered injuries in the cross-sectional study as the case group,and the matched control group was matched according to the same grade,same gender,and the age does not exceed two years.Chi-square analysis and conditional logistic regression analysis analyze the factors that affect children’s injuries,and explore which behavioral problems children have that are related to injuries.3.Cohort study: We used the Rutter scale to evaluate children with behavioral problems,treated children with behavioral problems as exposed groups,and treated the remaining children without behavioral problems as non-exposed groups.We used ordered multi-class logistic regression to explore the influencing factors and confirmed the connection between children’s behavioral problems and the occurrence of injury,and provide research foundation and scientific basis for future in-depth research.Results: 1.The incidence of child injuries in a southern city of China was 17.41%.The top three causes of injuries were fall injuries,animal injuries and burns,which accounted for 37.59%,12.29% and 11.57%,respectively;the main injuries occurred were unintentional injuries,accounting for 69.85%.2.Among the basic demographic characteristics of children,the incidence of injury among boys(19.5%)was higher than that of girls(15.1%);among children in grades 1 to 5,the incidence of injuries was highest in children in grade 4(21.7%),followed by children in grade 5(19.8%);the injury rate of children from nonlocal places(19.9%)was higher than that of local children(15.5%).3.The detection rate of children with behavioral problems in a southern city of China was 10.04%.The median of children ’s behavior scores was 4,the upper quartile was 8,and the lower quartile was 1.The differences of the distribution of children ’s behavior scores among children of different grades,genders,and regions were statistically significant(P <0.05).Children with behavioral problems were regarded as the exposed group,and children without behavioral problems were regarded as the control group.The association between the occurrence of each specific injury type(fall,blunt injury,firearm injury,knife injury,burn injury,drowning,animal injury,sexual assault,injury from other causes)and risk exposure factors was statistically significant(P<0.05).4.The case-control study included 420 cases in the case group.A 1: 1 matching control group was used for the same grade,same gender,and same household registration.The results showed the risk factors for children’s injuries are as follows: neurotic behavioral problems(OR = 1.460,95% CI: 1.047 ~ 2.037),family’s annual income of more than 100,000 yuan(OR = 2.651,95% CI: 1.199 ~ 5.862),mother as the main caregiver(OR = 1.769,95% CI: 1.203 ~ 2.599),punishment as the main education method of(OR = 2.645,95% CI: 1.303 ~ 5.368),and the combination of education and punishment and preaching(OR = 1.439,95% CI: 1.049 ~ 1.974).5.In the cohort study,a total of 245 children were exposed to the behavioral problems.The incidence of injury was 33.47% in children with behavioral problems and 18.12% in children without behavioral problems.Compared with children with mixed behavioral problems,children with antisocial behavioral problems had a RR of 1.617(95%CI: 1.321~1.952)and children with neurotic behavioral problems had a RR of 1.333(95%CI: 1.104~1.594);Compared with girls,boys had a RR of 1.224(95%CI: 1.037~1.434);Compared with other people,the children whose caregiver is mother had a RR of 1.314(95%CI: 1.064~1.604);Compared with teaching children and caring about children before children’s exam,other attitudes had a RR of 1.732(95%CI: 1.150~2.437).Conclusions: 1.The incidence of child injuries is high in a city in southern Jiangsu.Unintentional injuries are the main areas of prevention and control of child injuries.Fall injuries,animal injuries and burns are the main types of injury prevention and control.2.The incidence of injuries of children with behavioral problems is significantly higher than that of children without behavioral problems.Children’s behavioral problems have become an important aspect that affects the occurrence of child injuries;3.Risk factors of injuries for children are as follows: children’s anti-social behavioral problems and neurotic behavioral problems,male gender,mother as the main caregiver,and irrelevant caregivers’ education attitude rather than caring.The results lay the foundation for interventions for injury on children. |
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