Kuwonetsedwa pazowonera zolaula mukamakula kumakhudzana ndi machitidwe owopsa azakugonana akamakula (2020)

Kudalirika

Background

Kuwonetsedwa pazinthu zolaula paubwana kumapezeka kuti kumalumikizidwa ndi chiopsezo chogonana. Komabe, kafukufuku wakale adakumana ndi zovuta za njira, monga kusankha kusankhana. Kuphatikiza apo, ndizodziwika zomwe zimadziwika pokhudzana ndi kuwonekera kwazomwe zimachitika paziwonetsero zokhudzana ndi kugonana zokhudzana ndi chiwerewere, komanso momwe unansiwu ungagwiritsidwire ntchito pazinthu zomwe sizili zakumadzulo.

Zolinga

Kafukufukuyu cholinga chake chinali kuwongolera maphunziro aposachedwa pogwiritsa ntchito kuyerekezera kwamphamvu. Kuphatikiza apo, kafukufukuyu adaphatikizanso mitundu ingapo yamankhwala oonetsa zachiwerewere komanso njira zitatu zoopsa zogonana kuchokera pa achinyamata a ku Taiwan.

Njira

Ophatikizidwa adaphunzitsidwa kuchokera ku kafukufuku yemwe angayembekezeredwe kuti adzafufuze kotenga nthawi yayitali (Taiwan Project Project) Onse anali mu 7th kalasi (kumatanthauza zaka = 13.3) pomwe phunziroli lidayambitsidwa mchaka cha 2000. Kuwonetsedwa pazinthu zokhudzana ndi kugonana, kuphatikiza kuwonetsedwa konse ndi kuchuluka kwazinthu zodziwonekera, zimayezedwa mu wave 2 (8th kalasi). Khalidwe la chiwerewere losavuta linayezedwa mafunde 8 (amatanthauza zaka = 20.3) ndi 10 (kutanthauza zaka = 24.3). Gulu laling'ono la magawo awiri lidagwiritsidwa ntchito, nthawi yovomerezeka ngati chosinthika.

Results

Pafupifupi 50% ya omwe atenga nawo mbali adazindikiratu zolaula ndi 8th kalasi, kuchokera pamachitidwe amodzi. Kuwonetsedwa pofalitsa nkhani zakanema kunaneneratu zoyambirira zogonana, kugonana kosatetezeka, komanso ogonana nawo angapo (onse: p <.05). Kuphatikiza apo, kuwonetsedwa pazowulutsa zambiri kumawonjezera mwayi wakugonana. Komabe, zokhazokha pazoyambira zogonana koyambirira zimangokhala zosasinthika pakati pa amuna ndi akazi.

Mawuwo

Kuwonetsedwa pazowonera zolaula mukamakula anali ndi ubale wopambana ndi machitidwe oyipa azakugonana akamakula. Kudziwa momwe zimayendera ngati izi kumapereka maziko omanga mapulogalamu oyenera kupewa kwambiri muubwana. Njira imodzi yotchuka ndiyo maphunziro aposachedwa pamaphunziro azama TV, ndipo madokotala nawonso angafunike kudziwa zomwezo kuti ayambitse.

Ndemanga: Lin WH, Liu CH, Yi CC (2020) Kuwonetsedwa pazakugonana poyambirira paunyamata kumayenderana ndi kuchita chiwerewere pachiwopsezo pakukula. MALO A 15 (4): e0230242. https://doi.org/10.1371/journal.pone.0230242

Editor: Luis M. Miller, Spain National Research Council, SPAIN

Zilandiridwa: June 24, 2019; Zavomerezedwa: February 26, 2020; Lofalitsidwa: April 10, 2020

Copyright: © 2020 Lin et al. Ichi ndi nkhani yopata yotseguka yomwe idagawidwa pansi pa Chilolezo cha Creative Commons Licribution, zomwe zimaloleza ntchito, kugawidwa, ndi kubwezeretsa mwachinthu chilichonse, kupatsa wolemba woyambirira ndi chitsimikizo.

Kupezeka kwa Data: Zosintha zomwe zidapangidwa ndikuwunika pa kafukufuku wapezekazi zimapezeka ku Survey Research Data Archive (https://srda.sinica.edu.tw/). Zolemba za TYP zilipo kuti zitha kugwiritsidwa ntchito ndi anthu ndipo zitha kugwiritsidwa ntchito pazofufuza mwakuvomerezeka ndi Academia Sinica ku Taiwan (http://www.typ.sinica.edu.tw).

Ngongole: Kafukufukuyu adathandizidwa ndi thandizo lochokera ku Unduna wa Sayansi ndi Ukadaulo, ku Taiwan (MOST 107-2410-H-010-001 kupita ku Wen-Hsu Lin). Othandizira ndalamawo analibe nawo gawo pakuphunzira, kusonkhanitsa deta ndi kusanthula, kusankha kufalitsa, kapena kukonza malembawo.

Zofuna zokakamiza: Olemba amanena kuti alibe kutsutsana kwa chidwi.

Machaputala: ATE, Avereji Yothandiza Chithandizo; HIV / AIDS, kachilombo ka chitetezo cha anthu / matenda a immunodeficiency syndrome; IV, Chida Chosasintha; OLS, Mabwalo Amtundu Wakale; PDS, Publeal Development Scale; RCT, Kuyesa Kuyesa Kwambiri; SLS, Magawo Awiri Ogwira Nawo; Matenda opatsirana pogonana; TYP, Project ya Achinyamata ku Taiwan

Mafotokozedwe Amkhalidwe azakugonana, kuphatikiza ziwonetsero zoyambirira zogonana, kugonana kosatetezeka (mwachitsanzo, kugwiritsa ntchito kondomu mosagwirizana), ndi zibwenzi zingapo zogonana (mwachitsanzo, kuchuluka kwakukulu kwa asungwana) [1], alandila chidwi padziko lonse lapansi chifukwa cha zovuta zawo zazitali [2], makamaka zokhudzana ndi thanzi, monga kupeza matenda opatsirana pogonana (STI) [3], matenda ena [4], mimba yosakonzekera / yachinyamata [3-5], ndi kugwiritsa ntchito zinthu [6]. Achinyamata alandila chidwi chifukwa ali m'gulu la omwe ali pachiwopsezo cha matenda opatsirana pogonana (mwachitsanzo, chinzonono) m'maiko ambiri, monga US [7] ndi Taiwan [8] ndipo kumadera ambiri padziko lapansi (mwachitsanzo, Asia ndi Africa) pakali pano ali ndi mliri wa HIV / AIDS [9]. Chifukwa chake, pakufunika kumvetsetsa zomwe zimayambira kukhala pachiwerewere zomwe zingatilepheretse kupewa, ngati njira imodzi yothanirana ndi zotsatira zoyipa pambuyo pake.

Khalidwe lochita chiwerewere pakukula paubwana limatengedwa ndi magawo angapo ofunikira, monga banja / makolo, abwenzi, komanso zochitika za munthu payekha. Mwachitsanzo, zinthu zingapo zokhudzana ndi mabanja, monga kulera mwankhanza [10-11], ulamuliro wochepera wa makolo [12], komanso mgwirizano wabanja [13] adadziwika kuti ndi zinthu zomwe zingayike pachiwopsezo cha kutenga chiwerewere komanso momwe zimayambira zimafotokozedwanso (mwachitsanzo, kuwongolera pang'ono kwa makolo → Kuletsa kochepetsa → kuchita chiopsezo kapena kuvutitsidwa koyambilira. Momwemonso, kafukufuku wina adatsutsana pamalingaliro osiyanasiyana opezedwa ndipo adapeza omwe angatengere zikhalidwe zomwe zimakhala zoopsa. Mwachitsanzo, zovuta pamaganizidwe [14] amafotokoza kuti zovuta zimakhala ndi mikangano; Chifukwa chake, kugwiritsa ntchito mankhwala oyamba kumayenderana kwambiri ndi mikhalidwe yoopsa yomwe ingachitike pambuyo pake, kuphatikizapo machitidwe omwe ali pachiwerewere [15-16]. Momwemonso, malingaliro olamulira pamachitidwe [17] adatinso kusowa kwa mgwirizano wamtundu (mwachitsanzo, kudzipereka kusukulu yocheperako) "kumasula" munthu panjira yopatuka, kuphatikizapo kuchita chiwerewere zoopsa18]. Zina zimangopereka mwayi wochita zogonana ndipo zimakhudzana ndi chiwerewere zomwe zimayipa, monga zokhala pachibwenzi [15, 19]. Ngakhale zina izi zikukhudzana ndi machitidwe oopsa ogonana, kafukufuku wawonetsa ngakhale kuwongolera izi zotsogola, chinthu chimodzi chimakhalabe ndiubwenzi wolimba ndi zomwe zimakhala zoopsa zokhudzana ndi kugonana - zomwe ndi zolaula kapena zolaula (SEM) [20-22]. Strasburger ndi al. [23] adamaliza zakugonana mawailesi ndizofalitsa zomwe zimakhudza ana ndi achinyamata machitidwe ogonana, malingaliro, ndikukhulupirira. Wright [24] kutchula za SEM kumapangitsa kuti anthu azisintha ndikuyamba kuchita zachiwerewere, zomwe zimagwirizana kwambiri ndi machitidwe oopsa ogonana mtsogolo. Kafukufuku wina akuwonetsa kukhudzidwa ndi SEM kumakhala kofanana ndi zomwe zimakhala zoopsa chifukwa zimasintha maonedwe a owonerera pakugonana ndi amayi [25-26]. Mwakutero, Kafukufuku wina adatsutsa, pomwe zotsatira za zakugonana pazama TV zitha kukhala zobisika, ndikofunikira kwambiri kuwongolera ndi kuyeza [27]. Zotsatira zake, SEM ikhoza kukhala yofunikira pomvetsetsa chikhalidwe chowopsa cha kugonana.

Ngakhale kukhudzana ndi SEM kumatha kupangitsa munthu kukhala pachiwopsezo chogonana mtsogolo, zili choncho kwambiri kwa achinyamata pazifukwa zitatu. Choyamba, SEM sikuti imangokhala yotchuka, komanso yamphamvu paubwana [28-30]. Mwachitsanzo, Owens et al. [29] ati kuchuluka kwa zolaula "kwasokoneza chikhalidwe cha achinyamata komanso chitukuko cha achinyamata m'njira zosawerengeka komanso zosiyana." Chachiwiri, achinyamata ali m'gulu la ogula kwambiri la SEM [31-32] ndikuwona zowonetsera monga zenizeni [32]. Kuphatikiza apo, achinyamata amakhudzidwa ndi momwe amalumikizirana (mwachitsanzo, kugwiritsa ntchito ndikumvetsetsa) media ndipo nthawi zambiri amalola atolankhani kuwongolera ndikulongosola kugonana kwawo, chikondi, ndi ubale [33]. Pomaliza, m'maiko ambiri otukuka, mwayi wopezeka ku SEM ndiwokhazikika komanso movomerezeka, zomwe zimapangitsa chidwi kwa achinyamata chifukwa cha "zipatso zoletsedwa" [34].

Mfundo zomwe zili pamwambazi zikusonyeza kuti achinyamata komanso achinyamata ndi ogula a SEM ndipo ali pachiwopsezo cha SEM. Komabe, ngati zomwe zili mu SEM sizili "zovulaza," kukhudzana ndi SEM sikungadzetse zotsatira zoyipa. Mwachitsanzo, ena anena kuti SEM imapereka maphunziro azakugonana [35-36] ndikukulitsa malingaliro okhudzana ndi jenda [37]. Tsoka ilo, kafukufuku wasonyeza kuti zomwe zili mu SEM zimawonetsa kukhutira kwamakhalidwe ogonana ndipo sizilipira pang'ono kapena siziganizira zotsatira zoyipa [38], amanyoza akazi ndi "skew [s] kude ndi chikondi” (p.984) [39], ndikuwonetsa zolemba zogonana zovomerezeka kwambiri [24]. Chifukwa chake, kafukufuku wam'mbuyomu adawonetsa kuti kuwonekera pa SEM nthawi yaunyamata kumayenderana ndi kugonana koyambirira [40-41], kugwiritsa ntchito kondomu mosagwirizana / kugonana kosatetezeka [20, 25], ndi ogonana angapo [42-43]. Komabe, zoyipa za "zoyesedwa" zowonekera za SEM komanso chikhalidwe chowopsa cha kugonana sizinapezeke mosiyanasiyana mu maphunziro ena [44-48]. Mwachitsanzo, kafukufuku waposachedwa wapeza kuti kuwonetsa kwa SEM sikunakhudzane ndi ziwonetsero zakugonana koyambirira [48] kapena ogonana angapo (kutanthauza, kuposa amuna kapena akazi awiri)44].

Ngakhale kusiyanasiyana kwa zitsanzo ndi kusiyana kwa miyezo, zotsatira zosakanikirana zitha kukhalanso chifukwa chosiyana mwanjira ndi / kapena kudzisankhira (mwachitsanzo, achinyamata ochita zogonana amatha kuwona zinthu zolaula) zomwe zimatilepheretsa kudziwa ubale wamphamvu pakati Kuwonetsedwa kwa SEM komanso mtsogolo pachiwerewere [49-51]. Monga Tolman ndi McClelland amakangana [51], "Zotsatira zakuwona zachiwerewere zimavutidwa ndi vuto la 'nkhuku kapena dzira'; ndiye kuti, ngakhale achinyamata omwe ali ogonana omwe ali ndi mwayi wogwiritsa ntchito SEM kapena achinyamata azigonana chifukwa chakuwonekera kwa SEM. Kugwiritsa ntchito mayeso olamulidwa mwachisawawa (RCTs), "muyezo wagolide," mwina ungakhale wopanda tanthauzo chifukwa chalamulo (mwachitsanzo, kupereka zokhudzana ndi kugonana kwa ana) komanso zofunikira (mwachitsanzo, kupatsa anthu magawo omwe angakhumudwitse zaumoyo). Njira ina yodziwikiratu yozisankhira kudzera mwa njira yofananira. Kafukufuku wam'mbuyomu adagwiritsa ntchito kufanana kwa mayeso ndipo onse adavumbulutsa kuti kuwonekera kwa SEM sikunali kokhudzana ndi kuyambitsidwa kwa kugonana [46-47, 49]. Komabe, kuchuluka kwa kuchuluka kumatha “kuthetsa” kusiyana kowoneka (mwachitsanzo, kufananirana ndi mawonekedwe omwe akuwoneka) koma kumakhala kochepa pakuwerengera ma heterogeneity osawerengeka (mwachitsanzo, kusiyana kosawoneka). Njira imodzi yothanirana ndi malireyi ndikugwiritsa ntchito deta kuti mulingalire ubalewo, kuphatikiza zida (IV), ngati njira yofananira ndi RCT. Zotsatira zake, zikagwiritsidwa ntchito moyenera [52], njira ya IV imapereka njira yodziwitsira zotsatira zamankhwala kuchokera kuzowonera (mwachitsanzo, ubale wogwirizira).

Kupatula njira zolerera, ngakhale kuwonetsedwa kosiyanasiyana kwa SEM kungapangitse mwayi waukulu wogonana womwe sunakhale wolandira chidwi chambiri. Maphunziro ambiri am'mbuyomu adangoyang'ana za mitundu ina ya zinthu zolaula (mwachitsanzo, makanema ovota a X kapena mawebusayiti a SEM) [44-48] ndi zovuta zina (mwachitsanzo, zoyambirira zogonana kapena angapo ogonana nawo). Pazidziwitso zathu, kafukufuku m'mbuyomu m'mbuyomu adawunika momwe zimawonekera pazama zinthu zingapo zolaula ndikupeza kuti kudziwitsidwa ndi mitundu yambiri ya SEM kumalumikizidwa ndikuyenera kugona ndi anyamata komanso kugonana koyambirira [31]. Popeza zotsatira zosakanikirana za kuyanjana kwa SEM komanso pambuyo pake koopsa pakugonana komanso kafukufuku m'modzi yekha yemwe adawunikiranso zotsatira za kuyesedwa kwa ma SEM ambiri pazakuopsa, pitilizani kuphunzira komwe kumapangitsa kuti pakhale zovuta zina komanso chimodzimodzi. Nthawi imawona kukhudzidwa kwamitundu yambiri SEM ndikuwonera machitidwe osiyana siyana oopsa.

Pomaliza, maphunziro ambiri am'mbuyomu adatengera zitsanzo zaku Western (mwachitsanzo, United States, United Kingdom, ndi mayiko aku Europe). Kuwonetsedwa kwa SEM komanso ubale wake ndi machitidwe oopsa azakugonana m'malo ena osatetezeka (mwachitsanzo, maiko aku Asia) sakukhudzidwa. Kuchokera pamabuku omwe alipo, zitha kuwoneka kuti kuwonetsedwa kwa SEM komanso njira zowopsa zogonana ndizosiyana kwambiri pazikhalidwe zaku Asia kuposa mayiko akumadzulo. Mwachitsanzo, kafukufuku wochokera kumaiko angapo a East Asia adawonetsa kuti chiwonetsero cha SEM pakati pa achinyamata ndi achinyamata chinali pafupifupi 50%: 4.5-57% ku China [53], 40-43% ku Taiwan [54] ndi Korea [55], ndi 9-53% ku Hong Kong [56]; Mosiyana ndi izi, maphunziro ochokera kumayiko a Azungu, kuphatikiza United States [57], England [58], Sweden [59], Germany [60], ndi Australia [61] nthawi zambiri amapereka malipoti owonetsa 80% kapena kuposa. Momwemonso, kugwiritsa ntchito koyambirira kwa kugonana ngati mwachitsanzo, kuchuluka kwa achinyamata omwe amagonana ndi achinyamata akadali achichepere (mwachitsanzo, ≦ 16 kapena ≦ 14) nthawi zambiri amakhala okwera kumayiko a azungu kuposa ku Asia [62-64]. Popeza kuti pali kusiyana kwakukulu kotere, kusindikizanso zotsatira kuchokera kumayiko aku Western kupita kumalo akummawa ndi kofunika. Velezmoro ndi anzawo [65] anenetsa kuti kuwerenga mawu azikhalidwe zosiyanasiyana kumawunikira zofanana komanso kusiyanasiyana kwa zikhalidwe zomwezi. Kuphatikiza apo, mayiko ena aku Asia akuvutika ndi kuchuluka kwa matenda opatsirana pogonana, monga kuchuluka kwa kachilombo ka HIV pakati pa achinyamata ku China [53, 66] ndi South Korea [67] onse omwe ali ndi kachilombo ka HIV komanso matenda ena opatsirana pogonana (mwachitsanzo, gonorrhea) ali pamlingo waukulu kwambiri pakati pa achinyamata ndi achinyamata (11-29) ku Taiwan [8]. Ngakhale maphunziro ochepa adachitidwa ndikupeza zotsatira zofananira, maphunziro awa nawonso adakumana ndi zovuta zomwe tatchulazi [68, 53-54].

Phunziroli

Kafukufukuyu adagwiritsa ntchito kuwerengera kwa IV komanso kapangidwe kake kaubwenzi kuti athe kuwona ubale womwe ulipo pakati pa kuwonekera kwa SEM paubwana komanso njira zogonana zowopsa pakukula. Tidawunikiranso zotsatira za ma modality angapo a SEM (mwachitsanzo, intaneti ndi kanema) pamachitidwe oopsa ogonana. Zofufuzira zonse zidachitika pogwiritsa ntchito zitsanzo zochokera ku Taiwan, dziko losasamala; chifukwa chake, zikhalidwe zosiyanasiyananso zachikhalidwe zitha kupezeka [65]. Tidawerengera kuti kuwonekera kwa SEM kumakhudzana ndi kugonana komwe kumadzetsa ngozi, ndikuti unansiwo ungalimbike pamene achinyamata amagwiritsa ntchito njira zambiri za SEM. Pomaliza, poti anyamata ndi atsikana amakula mosiyanasiyana [69] ndipo amacheza mosiyana ndi kugonana [70], kuwonjezera pa zotsatira zazikulu, tidasinthananso ndi jenda kuti tionenso kusiyana kulikonse pakati pa ubale wa SEM ndi kugonana pakati pa amuna ndi akazi.

Zida ndi njira

Ophunzira ndi kapangidwe ka kafukufuku

Zambiri zidachokera ku Taiwan Youth Project (TYP), kafukufuku wa ophunzira apamwamba a kusekondale ochokera m'mizinda iwiri (New Taipei City ndi Taipei) ndi County imodzi (Yi-Lan County) kumpoto kwa Taiwan komwe adayambitsa mchaka cha 2000. Sukulu iliyonse yosankhidwa, makalasi awiri amasankhidwa mosasankha kalasi iliyonse (7th kalasi (J1) ndi 9th kalasi (J3)), ndipo ophunzira onse mgulu lililonse lomwe adasankhidwa adalembedwa. Iwo omwe adatenga nawo gawo pachiwonetsero adatsatiridwa chaka chilichonse mpaka 2009 (wave 9), ngakhale mafunde ena sanasiyanane chaka chimodzi. Mu 2011, gulu lofufuzira linayendetsa ma wave 10, ndipo atha kutsatira zotsatirazi zaka zitatu kupatula (wave 11 mu 2014 ndi wave 12 mu 2017). Kafukufukuyu adasanthula gulu la J1 cohort (7th giredi) data kuchokera pamafunde 1 (basement; mean age = 13.3 (SD = .49)) kugwedeza 10 (kumatanthauza zaka = 24.3 (SD = .47).

Kafukufukuyu adasanthula J1 cohort (7th giredi) data kuchokera ku wave 1 (basement; mean age = 13.3 (SD = .49)) to wave 10 (tanthauza zaka = 24.3 (SD = .47)). Pafupifupi theka la zitsanzo anali amuna (51%). Kukula kwa zitsanzo zoyambirira zakugonana ndikugonana kosatetezeka kunali 2,054, pomwe kwa ogonana ambiri anali 1,477. Kusiyana kwa zitsanzo zachitsanzo kumakhala chifukwa cha mitundu yosiyanasiyana yankho. Kuchepa kwa zitsanzo zamtunduwu kunachitika chifukwa nthawi yocheza pakati inali yolimba (mwachitsanzo, zaka ziwiri ndi theka pakati pa mafunde 9 ndi 10) poyerekeza ndi mafunde am'mbuyomu. Zomwe zimachitika poyambira (wave 1) ndi mafunde a 2 (mwachitsanzo, kuwonetsa kwa SEM) zinali zochokera pazodzidziwitsa okha za achinyamata; Mosiyana ndi izi, kafukufuku wofananira wa makolo adagwiritsidwa ntchito pamaphunziro a makolo ndi ndalama za mabanja, zomwe zimachitika poyankhulana kunyumba. Kwa mafunde amtsogolo a maphunziro athu (wavesa 8, 9, ndi 10), zokambirana zapakhomo zidachitika kuti zisonkhanitse zonse. Poyambira (wave 1), achinyamata onse omwe adagwirizana nawo adapereka nawo pakamwa. Kwa achinyamatawa omwe atenga nawo mbali, m'modzi mwa makolo awo owalera kapena owasamalira mwalamulo amapereka chilolezo. Kuphatikiza apo, adapemphidwanso kuti achite nawo kafukufukuyu, ndipo pafupifupi 97% yaiwo adachita nawo. Kafukufuku wapano adavomerezedwa ndi gulu lowunikira mkati ku National Yang Ming University (YM108005E) pomwe wolemba woyamba adagwira ngati membala wa zamasukulu.

Njira

Kuwonetsedwa pazowonetsa zolaula (wave 2)

Kusintha kumeneku kunayeza ngati wave 2 (kumatanthauza zaka = 14.3) pogwiritsa ntchito funso limodzi: "Kodi mudawaonapo atolankhani otsala okha kapena okhazikika (Ovotera]?" Anapatsidwa mndandanda wazosinthidwa zisanu ndi chimodzi: mawebusayiti, magazini, mabuku azithunzi, zolemba, makanema, ndi zina. Ngakhale "akulu okha" ndi "Ovotera ovota" sikuti ndi zachiwerewere m'magulu ambiri, mawu a funsoli ku Mandarin (Xian Zni Ji) ikhoza kumvedwa ku Taiwanese ngati ikunena za zolaula (mwachitsanzo, zogonana ndi zamanyazi). Chifukwa chake, chinthuchi chatulutsa zofunikira za SEM. Zinthu zomwe zimakhudzana ndi kuwonetsedwa kwa SEM ndi machitidwe ogonana zinali zofunikira; chifukwa chake, ophunzira atha kukhala osafuna kunena. Kuti tipewe izi, kafukufuku wonse wa TYP anali wodzilemba yekha ndipo adamalizidwa mkalasi momwe ophunzira omwe amatenga nawo mbali ndi othandizira magulu othandizira adakhalapo. Othandizira kafukufukuyu adalongosolera ophunzirawa kuti palibe wina kupatula ofufuzawo omwe angawone zomwe adafufuza komanso kuti kafukufuku onse sanadziwika. Mitundu iwiri idapangidwa kuti iwonetse mawonekedwe a SEM: chiwonetsero cha mitundu yambiri ndi kuwonetsedwa nthawi zonse. Mwa yakale, tidawerenga kuchuluka kwa momwe ophunzira adawonetsera, kotero zotsatira zake zidachokera ku 0 (osatulutsa) mpaka 6 (amagwiritsa ntchito mitundu yonse isanu ndi umodzi). Kwa otsirizawa, ophunzira nawo adagawika pakuwonetseredwa kwa SEM (1) komanso kusawonetsedwa (0).

Khalidwe la chiwerewere (wave 8-wave 10)

Kusintha kumeneku kunaphatikizanso machitidwe atatu: woyamba kugonana, kugonana kosadzitetezandipo ambiri ogonana nawo. Koyamba kugonana anayeza pa wave 8 (amatanthauza zaka = 20.3). Wophunzira aliyense adapemphedwa kuti anene za msinkhu wake wakugonana koyamba. Kuvomerezana pazaka zomwe zimawoneka kuti zikuyimira ndalama zoyambirira sizinafikebe m'mabuku, ndi maphunziro osiyanasiyana ogwiritsira ntchito mibadwo yosiyanasiyana monga odulidwa, monga a zaka 14 kapena kuchepera [71], Wazaka 16 kapena kuchepera [72-73], kapena ngakhale wazaka 17/18 kapena ochepera [74]. Kutengera zaka zomwe agwiritsidwa ntchito, kuchuluka kwa oyambitsa oyambirira amachokera 17% [72] kwa 44% [73]. Pa kafukufuku wapano, azaka 17 zochepera adagwiritsidwa ntchito ngati odulidwa, zomwe zimapangitsa kuti pafupifupi 11.9% (n = 245) mwa omwe amasankhidwa kuti akhale oyambitsa. Kudula kumeneku kumatanthauza tanthauzo laku Taiwan pazifukwa ziwiri. Choyamba, zaka 18 zimavomerezedwa mwalamulo ngati munthu wamkulu. Kuphatikiza apo, chilimwe cha zaka 18 ndi nthawi yayitali pomwe achinyamata adataya unamwali wawo chifukwa adamaliza sukulu yasekondale ndipo adatsala pang'ono kulowa koleji, yomwe imapezekanso ku South Korea komwe maphunziro ndi chikhalidwe chawo ndi chofanana [75]. Chachiwiri, kuchuluka kwa odula kumeneku kuli pafupi ndi oyimira zitsanzo kuchokera ophunzira aku sekondale (10th-12th kalasi), zomwe zidawonetsa kuti pafupifupi 13% ya ana asukulu yasekondale adagonapo kale [76].

Kugonana kosadziteteza idawunikidwa patsamba 8 ndi funso wogwiritsa ntchito kondomu pakugonana (mwachitsanzo, "Kodi mumagwiritsa ntchito makondomu mukagonana?"). Magawo omwe adayankha anali "osadziwa chilichonse," "amagwiritsa ntchito kondomu nthawi zonse," "nthawi zina amagwiritsa ntchito kondomu" komanso "osagwiritsa ntchito kondomu nthawi yayitali." Ophunzira omwe adasankha mayankho awiri omaliza adawonedwa kuti agonana mosadziteteza. Ngakhale muyezo uwu ukhoza kukhala wosiyana ndi njira zomwe amagwiritsidwa ntchito kawirikawiri (mwachitsanzo, kugwiritsa ntchito makondomu pakugonana), zidakhudza machitidwe aomwe akuchitidwa. Chifukwa chake, idapereka zambiri zokhudzana ndi kugwiritsa ntchito kondomu wamba m'malo mongogwiritsa ntchito kapena momwe mwangogwirira ntchito pazochitika zina. Chifukwa chake, lidatanthauzira tanthauzo lenileni la kugonana kosadziteteza. Kutengera ndi izi, kuchuluka kwa machitidwe ogonana osatetezedwa ndi 18%.

Pomaliza, zaka 10 (zikutanthauza zaka = 24.3), omwe anafunsidwa adafunsidwa kuchuluka kwa nthawi yogonana. Izi zimagwiritsidwa ntchito kuti ziwone ambiri ogonana nawo. Ziwerengerozi zimachokera ku 0 (palibe chochitika chogonana) mpaka 25 (zikutanthauza = 1.76; SD = 2.46). Ngakhale kuchuluka kwa mchitidwe wogonana wowopsa ungaphatikizepo machitidwe osiyanasiyana ogonana, njira zonse zomwe zimayesedwa zimachulukitsa chiopsezo cha munthu kutenga matenda opatsirana pogonana. Mwakutero, kafukufukuyu adagwiritsa ntchito zoyambilira zogonana, kugonana osadziteteza, ndi zibwenzi zingapo zogonana monga mitundu itatu yamakhalidwe oopsa. Kafukufuku wam'mbuyomu adagwiritsa ntchito zinthu zitatu izi [1] ndipo ena adagwiritsa ntchito ziwiri mwa izi ngati muyeso wamavuto oopsa [48]. Kuphatikiza apo, zovuta zoyambirira zogonana komanso zibwenzi zingapo zogonana zakhala zikugwirizana chifukwa chogonana kosatetezeka komanso kupatsirana matenda opatsirana pogonana.77-78]. Ngakhale gawo lathu silingakhale lotopetsa, lilinso ndi machitidwe oyenera azakugonana omwe adawunikira maphunziro apitawa.

Nthawi yofalitsa (wave 1)

Nthawi yofukufuku idawunikidwa pa wave 1 (amatanthauza zaka = 13.3) kudzera pa kudzidziwitsa. Kwa atsikana, zinthu zinayi zodzinena kuchokera ku Pubertal Development Scale (PDS) zidalemba ntchito [79]: Kukula kwa tsitsi la pubic, kusintha kwa khungu, msambo wa msambo, ndi kutalika kwa msana (α = .40). Magulu oyankha amayambira pa 1 (sanayambebe mpaka) mpaka 4 (opangidwa kwathunthu). Atsikana adagawika m'magulu atatu a nthawi yoyambira pokhapokha potsatira njira imodzi yopatuka (SD) kuchokera ku tanthauzo la PDS: (1) koyambirira (1 SD Pamwamba pa tanthauzo), (2) mochedwa (1 SD m'munsimu tanthauzo), ndi (3) nthawi. Kwa anyamata, tidagwiritsanso ntchito zinthu kuchokera ku PDS: kusintha kwa mawu, kukulitsa tsitsi, tsitsi la bere, kusintha kwa khungu, ndi kutalika kwa kukula (α = .68). Mayankho ndi magulu amachitidwe anali ofanana kwa atsikana. Njira yamagulu awa yagwiritsidwa ntchito m'maphunziro am'mbuyomu [80-81] ndi kudalirika komanso kuvomerezeka kwa PDS kwatsimikizidwa [82]. PDS yawonetsedwa kuti ikupereka gawo loyenera kutha msinkhu ndikugwira zofunikira za chikhalidwe cha chitukuko cha pubertal [83]. Komabe, gawo ili lakhala likuvomerezeka m'maphunziro am'mbuyomu, mwina silingatengere lingaliro lofanizira mukamagwiritsa ntchito pamwambo. Zotsatira ziwiri zosadziwika zitha kuthana ndi izi. Choyamba, zolemba zawonetsa kuti nthawi yoyambirira ya pubertal imakhudzana ndi kunyentchera ndi kukhumudwa [84-85], ndi kafukufuku awiri omwe adagwiritsa ntchito zomwe zidafanana ndi kafukufukuyu awonetsa ubale uwu [80, 86]. Chachiwiri, kufalitsa zaka zoyambira msambo kuchokera kwa nthumwi zoimira achinyamata ku Taiwan zinali zofanana kwambiri ndi zomwe zilipo masiku ano (chitsanzo cha mayiko woimira: 82.8% isanachitike kapena 7th kalasi; kuphunzira kwaposachedwa: 88% kale kapena 7th kalasi) [87]. Pazonse, PDS imapereka chithunzithunzi chokwanira cha chitukuko cha pubertal ku Taiwan. Pakufufuza kwotsatira, kusintha kwa mitundu ya PDS kunagwiritsidwa ntchito kupanga IV.

Kuwongolera mosintha (wave 1 ndi wave 2)

Kafukufuku wapano yemwe adayendetsa ambiri omwe angadabwe nawo: jenda [88], kuchuluka kwa maphunziro a abambo, kuchuluka kwa maphunziro a amayi [89], ndalama zapabanja mwezi uliwonse [90], kusakhazikika kwa banja [91], kuchuluka kwa abale, kukhalapo kwa abale akulu [92], ulamuliro wa makolo [93], mgwirizano wabanja [94], magwiridwe antchito [95], thanzi labwino [96], zizindikiro zachisoni [97], chibwenzi [98], komanso zoyeserera kusukulu [99]. Kusintha kulikonse kwapezeka kuti kukugwirizana ndi kugonana kwa achinyamata kapena SEM komanso machitidwe achiwerewere omwe ali pachiwopsezo. Mwachitsanzo, zosinthana zokhudzana ndi mabanja (mwachitsanzo, kulera ndi kuwongolera kwa makolo) zidayika kuthekera kwakuti banja ndi makolo nthawi zambiri zimatenga gawo lalikulu pakuthandizira machitidwe achinyengo a achinyamata (mwachitsanzo, kuwonetsedwa kwa SEM ndi machitidwe oopsa ogonana). Momwemonso, monga tafotokozera pamwambapa, kuwongolera mabvuto kumatha kufooketsa machitidwe osayenera a achinyamata, monga kugwiritsa ntchito SEM komanso chikhalidwe chogonana. Kuphatikiza apo, momwe ophunzira angaphunzirire zitha kunena kuti zomwe abale ndi anzawo amachita zimasiyana pang'onopang'ono paubwana komanso akamakula.100]; chifukwa chake, timayang'anira kuchuluka kwa abale athu. Zinthu zina (mwachitsanzo, sukulu) zitha kupanga malo pomwe achinyamata amalandila zinthu zosiyanasiyana zomwe zimawalimbikitsa machitidwe awo (mwachitsanzo, maphunziro azakugonana). Zosintha zonse zimayesedwa pamafunde 1 kapena 2. Adolescent chikhalidwe anali wolemba ngati wamwamuna (1) kapena wamkazi (0). Onse abambo ndi maphunziro a amayi magawo adachokera ku kuyesa kwa makolo pa wave 1 ndipo adawerengedwa m'magulu atatu: otsika kuposa sekondale, sekondale, ndi koleji yaying'ono kapena kupitilira apo. Pakufufuza konse komwe kunachitika, zinthu ziwiri zosinthika zinagwiritsidwa ntchito ndi "otsika kuposa sekondale" monga gulu lotchulira. Chuma cha pamwezi, yoyesedwa ndi wave 1 kuchokera pa kafukufuku wa makolo, idagawika m'magulu asanu (kutengera madola atsopano aku Taiwan): zosakwana 30,000, 30,000-50,000, 50,001-100,000, 100,001-150,000, ndi oposa 150,000. Chimodzimodzinso, mitundu inayi yama dummy idagwiritsidwa ntchito ndi "osakwana 30,000" monga gawo la gawo. Kusakhazikika kwa banja anali dichotomized mosasintha ndi osagwirizana monga gulu lotchulira, lomwe lidakhazikitsidwa ndi wave 2 yodzilemba. Zoyenera zonse za abale ndizochokera pa zomwe achinyamata amakwanitsa kunena okha ndipo anaphatikiza kuchuluka kwa abale omwe aliyense ali nawo ndi dongosolo la kubadwa kwa m'bale wake. Kuchokera pazidziwitso izi, tidapanga kuchuluka kwa abale ndi kupezeka kwa abale anu okalamba. Omaliza anali ndi magulu atatu: mwana yekha, inde, ndipo ayi (gulu lolozera). Kulamulira kwa makolo zinali zochokera chimangirizo za 5-dichotomized zinthu anafunsa achinyamata ngati makolo awo kulamulira zinthu zisanu tsiku (mwachitsanzo, ntchito foni nthawi ndi nthawi TV). Zambiri zapamwamba zinawonetsa kuwongolera kwakukulu kwa makolo. Mgwirizano wabanja zidakhazikitsidwa motengera zinthu zisanu ndi imodzi zomwe zimagwira kulumikizana komanso kulumikizana (mwachitsanzo, "ndikakhala pansi, nditha kulimbikitsidwa ndi abale anga"). Chilichonse chidakhazikitsidwa pamakwerero 4 a Likert (mwachitsanzo, "ndikutsutsana kwambiri" kuti "ndikuvomereza mwamphamvu"). Zambiri zapamwamba zinkawonetsa mgwirizano wapabanja. Kuchita masukulu adayesedwa ndi funso, "Kodi gulu lanu mumakalasi angati?" Magulu oyankha anali 1 (pamwamba 5), ​​2 (6-10), 3 (11-20), ndi 4 (oposa 21). Mkhalidwe waumoyo zinali zozikika pa thanzi lanu pogwiritsa ntchito magawo asanu oyankha. Tidagawa anthu m'magulu atatu: oyipa / oyipa kwambiri (otsogolera gulu), achilungamo, komanso abwino / abwino kwambiri. Zizindikiro zovuta anali mtundu wopitilira muyeso wazinthu zazisanu ndi ziwiri (mwachitsanzo, "ndikumva kupsinjika"), yomwe idatengedwa kuchokera ku Syndromeom Checklist-7-Revised (SCL-90-R) [101]. Chilichonse chimakhazikitsidwa pamiyeso ya 5-point (ie, ayi (0) mpaka inde komanso zowopsa (4). Malingaliro pazinthu zisanu ndi ziwirizi adagwiritsidwa ntchito kuwerengera zonse. Zochitika paubwenzi zimadalira chinthu chimodzi, chomwe chidafunsa achinyamata ngati ali ndi mwana wamwamuna / wamkazi. Pomaliza, zinthu zopanda pake kusukulu zidayendetsedwa ndikuphatikizapo sukulu yokhazikika pakuwunika kotsatira (ziwerengero zofotokozera zamitundu yonse zimapezeka mu Gulu 1).

thumbnail Utsogoleri

Gome 1. Ndondomeko zofotokozera zamitundu yonse.

https://doi.org/10.1371/journal.pone.0230242.t001

Kusanthula kusanthula

Njira yotsogola yotheka (LPM) kutengera njira yaying'ono wamba (OLS) idagwiritsidwa ntchito kuyerekezera kutulutsa kwakutali kwa chiwonetsero cha SEM (kuwonetsedwa nthawi zonse komanso kuwonetsedwa kosiyanasiyana) panthawi yaunyamata pamachitidwe atatu oopsa omwe amagonana. Pomwe msonkhano wazotsatira zathu ukutha kukhala wogwiritsa ntchito njira zotsogola / zofananira (zomwe zikutanthauza kuti, kugonana koyambirira komanso kugonana kosatetezeka) ndi Poisson pakuyerekeza (mwachitsanzo, zibwenzi zingapo), tidagwiritsa ntchito OLS pazifukwa zingapo. Choyamba, Hellevik [102] adawonetsa kuti LPM ili pafupi ndi mtundu wamalonda mu mapulogalamu ambiri koma ili ndi mwayi womwe maofesi ake ndiosavuta kufotokoza. Chachiwiri, mtundu wopambana wamapepala ndiwosanja masiteji awiri (2SLS) ogwiritsira ntchito modabwitsa, womwe ndi mtundu wofananira. Chifukwa chake, kusanthula kwa zinthu kumagwiritsa ntchito mitundu ya mitundu yosavuta kapena mitundu yocheperako kuthekera kwa kuyerekezera ndi malingaliro kuti mufotokozere tanthauzo la coefficients. Pomwe ma covariate ambiri adawongolera, zotsatira zake mwina zitha kukhala zosakondera chifukwa chosinthidwa mosasokoneza. Chifukwa chake, kuti mupeze kuyerekezera kosasinthika, kosasinthika kwa zotsatira za kuwonekera kwa SEM paziwopsezo zogonana pakati pa achinyamata, njira ya 2SLS yokhala ndi nthawi ya pubertal monga IV idagwiritsidwira ntchito.

Kusintha kwa nyengo yofananira ya gulu limodzi (pub1i ndi pub2ali) imagwiritsidwa ntchito kupangira mawonekedwe a SEM (ysem,i) pagawo loyamba, lokhazikitsidwa ndi mawonekedwe amunthu (Xi) Ndi junior zotsatira sekondale atathana (ai0): (1) kumene ysem,i ndiwodalira mawonekedwe ambiri a SEM komanso kuwonetsedwa kwa SEM, motere; teremuyo vi ndiye kuti cholakwika. Chiyanjano pakati pa nthawi ya pubertal ndi nthawi yodziwikirana ndi SEM iyenera kukhala yabwino. A F kuphatikiza koyeserera kumayesedwa poyesa kuyerekezera kophatikizika komwe ma coefficients amapanga pazida (mwachitsanzo, nthawi ya pubertal) onse ndi zero. Ngati lolingana F-osintha kupitilira 10, ndiye kuti zida zimapangidwa mwamphamvu ndi mawonekedwe a SEM.

Chiyeso chachiwiri chikuyerekeza kuchuluka kwa kuwonekera kwa SEM muubwana wathanzi pamachitidwe owopsa a kugonana (ymachitidwe oopsa ogonana) pakukula: (2) kumene ymachitidwe oopsa ogonana ndi chiopsezo chogonana choyambirira chogonana, kugonana kosatetezeka, ndi kuchuluka kwa ogonana, motsatana; machitidweXi) Ndi junior zotsatira sekondale atathana (ai0) ali ofanana ndi omwe alowa Eq (1) ndi mtundu wamkati mwa (2) ndi mawonekedwe a SEM (ysem,i). Tidzawerengera mosiyana zotsatira za SEM-wowonera komanso kuwonetsa kwa SEM zambiri pazakugonana koopsa (kusanthula konse koyambira kungapezeke mu S1 Zowonjezera).

Nthawi yofalitsa inakhazikitsidwa ngati IV, popeza imakwaniritsa zofunika ziwiri zazikulu za IV zovomerezeka: kufunika ndi exogeneity [103]. Zakalezo zimafuna kuti IV ikhale yogwirizana kwambiri ndi mankhwalawa (mwachitsanzo, kuwonekera kwa SEM). Kutha msambo kumadziwika ndi kukwera kwa mahomoni, ndipo kafukufuku wasonyeza kuti kuwonekera kwa SEM kumakhala kofala kwambiri paunyamata. Chifukwa chake, anthu omwe akula msinkhu amakhala othekera kwambiri kuwonekera pa SEM kuposa anzawo, ndipo izi zathandizidwa ndi maphunziro ambiri [104-105]. Chofunikira ichi chitha kutsimikizidwanso kudzera pa F-osinthaF > 10) mu gawo loyamba la 2SLS [106]. Exogeneity, kumbali ina, imafunikira kuti IV ikhale yosagwirizana ndi mawu akuti cholakwika mu equation equation. Choyamba, kakulidwe ka chakudya cham'madzi ndi njira yachilengedwe yomwe pafupifupi anthu onse amakumana nayo. Kukula kumeneku kumayendetsedwa ndi majini komanso chilengedwe, komwe anthu sangathe kuwongolera [107]. Mwachitsanzo, kafukufuku amapasa awonetsa kuti pafupifupi 50-80% ya kusintha kwakanthawi kocheperako kumachitika chifukwa cha majini ndipo zotsalazo zimatha kukhala chifukwa chosagawana kapena cholakwika poyesa [108-109]. Zomaliza, monga zikuwonekera pa mzere womaliza ndi pansi pa Gulu 1, pepalali likuwunikira kuyanjana komwe kungachitike pakati pa nthawi ya pubertal ndi zachuma ndipo sanapeze kulumikizana kwakukulu pakati pa nthawi yofalitsira komanso zinthu zina zomwe zimawonongeka. Kuphatikiza apo, zinthu zingapo zachilengedwe (mwachitsanzo, sukulu ndi banja) zidayendetsedwa pazowunikirazo, zomwe zingachepetse nkhawa za kusiyanitsa kosiyana. Chifukwa chake, ma IV ayenera kukhala osakhudzana ndi zinthu zilizonse zosadziwika zomwe zimatsimikiza kuchita chiwerewere. Kuphatikiza apo, chiyerekezocho chinali ndi ma IV awiri (mitundu iwiri yoyenda). Yeseso ​​lozindikiritsa kwambiri (J-test) kapena mayeso a Sargan-Hansen [110] ikhoza kupereka mawunikidwe a mawunikidwe ngati zotsatira zowerengeka zamankhwala zikugwirizana mu lingaliro la 2SLS.

Ngakhale mamangidwe ovomerezeka a IV angakupatseni kuyerekezera kwaposaka, kukopa kapena kusowa kwa data kumatha kukondera kuwerengera kumeneku. Kafukufukuyu adagwiritsa ntchito njira zingapo kuti awone ngati kusankhana kungachitike. Choyamba, zitsanzo zathu za analytic zidakhazikitsidwa kwa iwo omwe anali ndi chidziwitso pakugwiritsa ntchito SEM mu wave 2; kuchuluka kwakusowa kwa zina zonse zomwe zimafotokozeredwa kuphatikiza zida zomwe zimasinthidwa (nthawi yofalitsa) zinali zochepa kwambiri (Onani. Gulu 1). Zotsatira zake, kusowa kwa mbali yakumanja kumanzere potsatira mitundu ya mawunikidwe a tsambalo sikungakhale vuto lalikulu. Chachiwiri, kuchuluka kwa zosowa pa zogonana zowopsa sikunali kotsika: 20% (514 / 2,568) pazogonana zoyambirira komanso zogonana osatetezeka ndi 42% (1,091 / 2,568) kwa ogonana angapo. Zambiri zomwe zikusowa ndi chifukwa chokopa. Kwa iwo omwe sanayankhe mafunso awiri oyamba ochita zachiwerewere (mwachitsanzo, kuwonekera kogonana koyambirira komanso kugwiritsa ntchito kondomu mosagwirizana), tinawalimbikitsa chilichonse powunika lipoti lawo pazinthu zomwezo pa wave 9 kapena wave 10. Komabe, kwa anthu angapo ogonana nawo , tinaponya omwe sanayankhe. Chachitatu, tinayerekeza kugawa kwa zosemedwa zachitsanzo choyambirira pa nthawi yofalitsa, kuwonekera kwa SEM, ndi zina zonse zosintha (onani Gulu 1). Monga tikuwonera, kusiyana kwa tanthauzo ndi SD pakati pa zitsanzo zathu zosimbidwa zingapo komanso zitsanzo zoyambirira pazomwe zimagwiritsidwa ntchito zinali zochepa chabe. Pomaliza, mawonekedwe osankhidwa a Heckman adagwiritsidwa ntchito kuti awone ngati kukopeka kumagwirizana ndi chiopsezo cha kugonana. Mu chithunzichi, tidagwiritsa ntchito zinthu zinayi monga zoletsa zina: mtundu wanyumba (mwachitsanzo, khalani mnyumba yokhayokha kapena nyumba), kukonda malo omwe muli, chitetezo cha oyandikana nawo (mwachitsanzo, "Kodi mukuganiza kuti mdera lanu ndi lotetezeka?" ), ndi kuchuluka kwa zaka zokhala ku adilesi yaposachedwa. Zotsatira zitha kupezeka Gulu 2. Kuchokera pansi Gulu 2, wina atha kuwona kuti mayeso a Wald adawonetsa kuti kulumikizana pakati pa kukopa kwachitsanzo ndi machitidwe oopsa ogonana sikofunikira pamitundu yonse (mwachitsanzo, magulu awiriwo ndi odziimira pawokha). Mwanjira ina, kukopa sikogwirizana ndi zisankho zokhudzana ndi kugonana koopsa. Mayeso ena owonjezerawa adapereka chidaliro kuti kusowa kwa chidziwitso pazomwe zingakhalepo mosasintha. Zotsatira zake, kuwerengera komwe sikunachitike sikunasungidwe koma potayika kwa kutayika kwa chidziwitso ndi mphamvu chifukwa zolakwika zofananira nthawi zonse zinali zokulirapo kuposa zonena zozikidwa pa data yonse. Mayeso onse owerengera adakhazikitsidwa pa mayeso a 2-lehlakoreng-hypothesis okhala ndi heteroskedasticity-robust standard zolakwika zosinthika kusukulu yapamwamba ya junior ndipo adachitidwa pogwiritsa ntchito pulogalamu ya Stata (Stata 13.1; Stata Corp, College Station, TX).

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Tebulo 2. Mitundu yosankha maubwenzi pakati pazotsatira zomwe zasowa komanso zowopsa zogonana1.

https://doi.org/10.1371/journal.pone.0230242.t002

Results

Ziwerengero zofotokozera

Monga tafotokozera Gulu 1, pafupifupi theka la achinyamata (50%) adadziwika ndi SEM adakali achichepere, pamawonekedwe amodzi (M = 1.02; SD = 1.37). Mitundu yodziwika kwambiri inali mabuku azithunzithunzi (32.7%) ndipo ochepera anali magazini (9.4%). Ponseponse, komabe, kuchuluka kwa machitidwe oopsa ogonana kunali kotsika: zovuta zoyambirira zakugonana, 11.9%; kugonana kosatetezeka, 18.1%; Nthawi yayitali anthu ogonana anali pafupifupi 2. Kusiyana pakati pa amuna ndi akazi kunapezeka mwa njira ziwiri zoopsa zogonana (kugonana mosadziteteza komanso kuchuluka kwa akazi ogonana), amuna amatenga nawo gawo pazikhalidwe izi. Kuphatikiza apo, yofunika tZotsatira zake (t = -3.87; p <.01) idawonetsa kuti amuna, pafupifupi, anali ndi zibwenzi zambiri (M = 1.99) kuposa akazi (M = 1.51). Monga tikuonera, njira yodziwika kwambiri ya SEM inali mabuku azithunzithunzi (32.7%), otsatiridwa ndi makanema (22.7%). Chodabwitsa ndichakuti, ndi 18.5% yokha ya achinyamata omwe amagwiritsa ntchito intaneti kuti awone SEM. Kafukufuku wowonjezera adawonetsa kuti anyamata ambiri amagwiritsa ntchito mtundu uliwonse wa SEM kuposa momwe atsikana adagwirira, kupatula chimodzi: atsikana (22.5%) anali owonekera pamanema kuposa anyamata (13.7%). Kuphatikiza apo, tZotsatira zake (t = -7.2; p <.01) idawonetsa kuti anyamata achichepere, pafupifupi, amagwiritsa ntchito mitundu yambiri ya SEM kuposa achichepere achikazi.

Kuwonetsedwa pazinthu zolaula komanso chiwerewere choopsa

Kupeza kosasintha (onani Chizindikiro 1A ndi 1B) chinali chakuti kuwonetsa kwa SEM muubwana woyambirira kunali kokhudzana kwambiri ndi machitidwe oopsa ogonana kumapeto kwa unyamata (tsatanetsatane mu S2 Zowonjezera). Makamaka, mu Chizindikiro 1A ndi 1B, zotsatira za kuyerekezera kwa 2SLS zidawonetsa kuti pachibale ndi anzawo, achinyamata omwe adawonekera pa SEM adakali achichepere anali 31.7% ndi 27.4% makamaka ochita zachiwerewere asanakwanitse zaka 17 ndikugonana mosadziteteza. Kuphatikiza apo, achinyamatawa anali ndi zibwenzi zitatu kapena kupitilira apo pofika zaka 24. Zotsatira za mitundu ya 2SLS zinali 2.8 mpaka 5.7 zochulukirapo kuposa zomwe a OLS anaziyerekeza.

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Chithunzi 1. Zotsatira zazikulu kuchokera ku OLS ndi 2SLS zotsatira.

(a) Kuchepa kwa mwayi wakugonana koyambirira komanso kugonana mosadziteteza, komanso kuchuluka kwa abwenzi ogonana kuchokera ku SEM pazotsatira zonse za OLS ndi 2SLS (b) Kuchulukitsa kwa mwayi wakugonana koyambirira komanso kugonana kosatetezeka, komanso kuchuluka kwakugonana. mnzanu kuti muwone zowonjezera pa SEM pazotsatira zonse za OLS ndi 2SLS.

https://doi.org/10.1371/journal.pone.0230242.g001

Monga momwe taonera Gulu 3, zotsatira za ma module angapo mods SEM pa zoopsa zogonana zidalinso zamphamvu. Achinyamatawa anali 12.3% ndi 10.8% mochuluka kuti atha kukhala pachibwenzi choyambirira ndikuchita zachiwerewere mosatetezeka, pomwe adawona njira zingapo kapena zingapo za SEM panthawi yaunyamata poyerekeza ndi omwe samawona SEM iliyonse. Chodetsa nkhawa kwambiri ndikuti nthawi zonse unyamata umayamba, nthawi zambiri, munthu wina wogonana naye mochedwa. Zotsatira zamitundu ingapo ya SEM zitha kumvekanso Chithunzi cha 2 momwe timawonetsera kuthekera kosiyanasiyana kokhala mchitidwe wogonana woyambilira komanso zogonana osadziteteza komanso anthu angapo ogonana nawo (kwa nambala yayandikira) pa 1 (tanthauzo), 2 (1 SD), 4 (2 SD), ndi 6 (zapamwamba kwambiri) modalities. Kuchokera pazithunzi, zomwe zikuwonetsedwa zikuwonetseratu kuti kuwonetsedwa kwambiri kudali kokhudzana ndi chiopsezo chachikulu chamakhalidwe oyenera ogonana komanso anthu ambiri ogonana nawo. Kusiyanaku kunanenedwa pakati pa tanthauzo (1 modality) ndi owonjezera (6 modalities). Zowerengera za 2SLS zinali nthawi 2.3 mpaka 3.4 zochulukirapo kuposa zomwe zinali za OLS. Zotsatira kuchokera pamwambazi zinali zogwirizana ndi zomwe kafukufuku wakale adapeza kuti kuwonekera kwa SEM kumakhudzana ndi machitidwe ena azikhalidwe zoopsa [20, 41-43, 56-57].

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Mkuyu 2. Zotsatira za Mipikisano modality kukhudzana pa Mwina khalidwe yowopsa kugonana ndi ogonana.

https://doi.org/10.1371/journal.pone.0230242.g002

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Tebulo 3. Zotsatira zakuwoneka bwino kwa SEM pazowopsa zakugonana.

https://doi.org/10.1371/journal.pone.0230242.t003

Ngakhale kuwonetsedwa kwa SEM kudali kokhudzana kwambiri ndi machitidwe oopsa omwe amabwera pambuyo pake, zotsatira zoyesedwa zitha kuperewera pazotsatira zapakati pazachithandizo chakanthawi (LATE) m'malo mwazotsatira zamankhwala (ATE) [111], poganiza kuti zotsatirapo za chithandizo zingagwire ntchito kwa okhawo (mwachitsanzo, okhwima omwe adadyanso SEM), osati kwa onse omwe akugwiritsa ntchito njira yamakono. Kuti athane ndi vutoli, mitunduyi idali yongoyerekeza pakukakamiza mawonekedwe othandiza kuti athane ndi matenda onse. Monga tawonera Gulu 4, zotsatirazi zidawonetsa kuti zotsatira zonse za kuwonekera kwa SEM paziwopsezo zakugonana zimakhalabe zazikulu, ngakhale kuchuluka kwake kudachepetsedwa.

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Tebulo 4. Malingaliro a mawonekedwe osagwirizana ndi zotsatira za SEM pazotsatira zowopsa zogonana1.

https://doi.org/10.1371/journal.pone.0230242.t004

Nditatsimikizira tanthauzo lalikulu, kafukufukuyu anapitiliza kusanthula zomwe zingachitike potsatira jenda. Zotsatira zonse zidali chimodzimodzi, ukuluwo unali wotsika kwa onse amuna ndi akazi. Kwa anyamata, zotsatira zake zidatsalira; Ndiye kuti, kudziwitsidwa koyambirira kwa SEM komanso zikhalidwe zambiri zomwe anyamata akuwonekera, nthawi zambiri amakhala ndi mwayi wogonana wogonana ndi anyamata ambiri. Mosiyana ndi izi, zoyipa zazimuna zonse zimachepa mpaka kukhala zopanda tanthauzo kupatula zoyambirira zakugonana. Mwanjira ina, kudziwonetsa msanga ku SEM ndikuwonetsa zochitika zambiri za SEM kumawonjezera mwayi wogonana wogonana ndi achinyamata achichepere kumpoto kwa Taiwan. Komabe, wina ayenera kukumbukira nthawi zonse kuti zotsatirapo zake zinali zolondola (monga, zabwino). Popeza kukula kwa mtundu wochepetsedwa, kuchepa kwa kukula kumayembekezeredwa (Onani S3 Zowonjezera).

Kukambirana

Kafukufuku ambiri adawonetsa kuti kuwonetseredwa koyambirira kwa SEM kumatha kukhala ndi zotsatirapo zosiyanasiyana zoyipa pakukula kwa chiwerewere choopsa. Khalidwe la chiwerewere loopsa limalumikizidwa ndi mavuto onse akuthupi (mwachitsanzo, kubereka kosafunikira ndi matenda opatsirana pogonana) komanso mavuto amisala (mwachitsanzo, kukhumudwa). Kuphatikiza apo, zovuta zokhudzana ndi kugonana kuphatikizapo kugonana ndi kuwonetsedwa kwa SEM zimatha kusiyanasiyana zikhalidwe zonse; chifukwa chake, kumvetsetsa maubwenzi oterewa m'mitundu yodziwika bwino kumatha kubweretsa chidwi muubwenziwu. Kuphatikiza apo, chifukwa cha kuchuluka kwa matenda opatsirana pogonana komanso kutenga pakati kwa achinyamata m'maiko ambiri aku Asia [53, 66-67] Ndi kuitana kwa WHO zokhudza achinyamata uchembere wabwino padziko lonse [112], kumvetsetsa chibwenzicho kumatha kuwunikira njira zodzitetezera. Zowunikira izi limodzi ndi zolephera zina za maphunziro am'mbuyomu (mwachitsanzo, miyezo yochepera ya SEM komanso chikhalidwe chowopsa pakugonana komanso njira zochepetsera), zinaonetsa kuti kufufuza kopitilira kufunikira kwa SEM ndikugonana koopsa kuyenera. Cholinga cha phunziroli chinali kupangitsa kuti pakhale mgwirizano wamphamvu pakati pa kuwonekera kwa SEM ndi chikhalidwe chowopsa cha kugonana, komanso nthawi yomweyo kuwunika momwe kuwonekera kwa ma SEM pamavuto atatu akulu pachiwerewere. Kuphatikiza apo, kafukufukuyu adawunikanso ubalewu m'mayiko omwe siamadzulo.

Zotsatira za phunziroli zidakhazikitsidwa pa mtundu wa kulingalira kwa IV womwe udawonetsa kukhudzana ndi zotsatira za SEM paziopsezo zakugonana (osachepera othandizira). Ndiye kuti, okhwima oyamba omwe adakumana ndi SEM adachitanso zachiwerewere zomwe zingawopseze. Kupenda kwathu kunawonetsa mosawonekera kuti kuwonekera koyambirira kwa SEM (8th kalasi) chikugwirizana ndi mchitidwe wamavuto oopsa omwe ungachitike pakukalamba kuphatikizira ngongole zoyambirira zogonana, kugonana kosatetezeka, ndi anthu angapo ogonana nawo kwa nthawi yayitali. Ngakhale mtundu wosasinthika (mwachitsanzo, mawonekedwe osinthika pafupipafupi) ndi mawonekedwe a 2SLS onse adawonetsa zotsatira zazikulu zakuwonekera koyambirira kwa SEM pazolakwika zomwe zimadza pambuyo pake pakugonana, kuchuluka kwa maumboni onse oyerekezedwa anali amphamvu pamitundu ya 2SLS. Chifukwa chake, zopezeka pa kafukufukuyu sizimangofanana ndi zomwe zidachitika m'mbuyomu komanso kuti ubalewu ndiwofunika. Zotsatira izi zitha kumveka kuchokera pamaganizidwe awiri. Choyamba, chiphunzitso cha chikhalidwe cha anthu [113] imanena kuti zizolowezi zimaphunziridwa kudzera muzochitika mwachindunji, zokumana nazo zowonera ena (mwachitsanzo, kusanja), ndi zochitika zazovuta (mwachitsanzo, kusunga ndi kukonza zidziwitso). Achinyamata “amayang'anira” mu SEM ndikuphunzira momwe angachitire. Atha kusunganso ndikusanthula chidziwitso chomwe aphunzira kuchokera ku SEM (mwachitsanzo, matanthauzidwe kapena zotengera), mwakutero akuwonjezera kapena kuchepetsa mwayi wawo wophunzirira ndikugwiritsa ntchito zofananira. Mofananamo, mawonekedwe a Wright, kugula, ndi kugwiritsa ntchito (AAA) [114] ikufotokoza kuti achinyamata amaphunzira zolemba zogonana kudzera munjira iyi-A: monga, amapenyerera ndikupeza zolemba kuchokera pazofalitsa, ndipo kuyambira pamenepo kuwonetsa zochitika zofananazo kudzalimbikitsa kwambiri zolemba zomwe zaphunziridwa ("activation"). Zotsatira zakulembedwako zikakhala kuti ndizabwino kuposa zoipa, anthu amatha kugwiritsa ntchito zolembedwazi.

Kupatula kuwonetseredwa kawirikawiri (mwachitsanzo, owonera vs.), tidaganiziranso zamayendedwe angapo a SEM chifukwa Morgan [31] adanena kuti kugwiritsidwa ntchito kwa SEM kumeneku ndikofunikira. Zotsatira zathu zinawonetsa kuti kugwiritsidwa ntchito kosiyanasiyana kwa SEM muubwana kumakhudzana kwambiri ndi machitidwe oopsa ogonana. Mwanjira ina, momwe machitidwe ambiri a SEM amadziwikiridwira, mwayi waukulu wogonana womwe ungakhale wowopsa pakukula. Zotsatira zake ndizogwirizana ndi malingaliro onse ophunzirira chikhalidwe [113] ndi AAA [114] chitsanzo chifukwa kuwonetsedwa kwambiri kungapangitse malembo ophunziridwa ndikuwoneka bwino ndi zomwezo mu SEM. Ngakhale mulingo wambiri Mlingo umagwiritsidwa ntchito pakufalikira kapena kuchuluka kwa mawonekedwe, zofalitsa zina zam'mbuyomu zimakulitsa ubalewu kuti pakhale kusakumana ndi zoyipa zamitundu yosiyanasiyana [115-116]. Makamaka, Felitti [115] et al adanena kuti zotsatira zawo zinali zotsata chifukwa anthu omwe amakumana ndi zovuta zambiri zaubwana amakhala ndi moyo wotsika (mwachitsanzo, wathanzi lam'mutu).

Pomaliza, malingana ndi momwe mawonekedwe omwe amagwiritsidwira ntchito powunikira kwambiri anali olondola, zotsatira zathu zinali pafupi kwambiri ndi ATE, zomwe pakali pano pali kusiyana mu njira yakugonana yomwe ili pachiwopsezo pakati pagwiriridwa (kuwonetsedwa kwa SEM) ndi kusawonetsedwa (kusawonetsedwa) ) anthu pagulu lonselo, osati chithandizo chamankhwala ambiri chokwanira (monga, opanga). Izi zimatipatsa chidaliro chakuti kuwonekera koyambirira ku SEM kumatha kukhala koopsa pakubala kwa munthu ndipo zotsatirapo zake zimayamba kukhala munthu wamkulu.

Ngakhale zotsatira zathu zinali zazikulu komanso zamphamvu, zotsatira zake sizinali zosasintha pomwe zimagwirizana ndi jenda. Ngakhale zovuta zambiri zinali zofanana pamayendedwe ake komanso kukula kwake, zovuta zoyambirira zakugonana ndi anthu angapo ogonana nawo ndizofunikira kwa anyamata komanso kuwonekera koyambirira kwa kugonana kwa atsikana. Zotsatira zopanda pake izi zitha kukhala chifukwa chosowa mphamvu. Kusiyana kwakukulu kwa atsikana kungathenso kukhudzana ndi zinthu zina zofunika. Mwachitsanzo, mdziko la makolo (mwachitsanzo, China, Taiwan, ndi US), malingaliro omwe ali pawiri ndi ozika mizu. Chifukwa chake, ngakhale kukhudzana ndi SEM kumatha kuyambitsa kugonana koyambirira zaka zitatu kapena zinayi pambuyo pake, kusala kwa chiwerewere (mwachitsanzo, ambiri ogonana nawo) komanso kusowa kwa mphamvu yogwiritsira ntchito chitetezo kungachepetse zotsatira za SEM.

Pazonse, mphamvu zingapo zikuwonetsa zomwe tapeza. Choyamba, zoyeserera zathu za SEM komanso machitidwe oopsa ogonana ndiwofalikira kuposa omwe adagwiritsidwa ntchito m'maphunziro ambiri am'mbuyomu, zomwe zidapangitsa kuti kafukufukuyu kuti athe kuyang'ana ubale womwe umachitika pakubwera kwa ziwonetsero za SEM ndi machitidwe ena oopsa ogonana. Mphamvuyi idawulula ubale wokondweretsa-monga kuyankha. Chachiwiri, nkhokwe yachidziwitso ndiyomwe imatenga nthawi yayitali. Izi zidatipangitsa kuti tigwiritse ntchito kuyerekezera kothandizika chifukwa cha zinthu zopanda umboni komanso kupereka nthawi yoyenera. Ndi izi, kafukufukuyu adawulula ubale wamphamvu pakati pa kuwonekera kwa SEM ndi chikhalidwe chowopsa cha kugonana. Kuphatikiza apo, tayang'ana zotsatira pogwiritsa ntchito mitundu yomwe ili ndi malingaliro ofanirana kwambiri ogawa (mwachitsanzo, mtundu wa bivariate probit) ndipo tidafikanso pazomwezi. Chifukwa chake, tili ndi chidaliro kuti LATE yolingaliridwa ili pafupi kwambiri ndi ATE. Kuphatikiza apo, kusanthula komwe kumayendetsedwa kosiyanasiyana kosasangalatsa monga mkhalidwe waumoyo, zododometsa, zokumana nazo komanso zoyeserera kusukulu kuti muchepetse kusinthaku. Izi zimatipatsa mwayi wowunika zotsatira zofananira ndi thanzi la kubereka kwa achinyamata azikhalidwe zosiyanasiyana.

Zotsatira zomwe zilipo pano zimapereka chidziwitso chakuwonekeranso momwe kuwonekera kwa zithunzi zolaula kumakhudzira chiwerewere zomwe zili pachiwopsezo, mapanga ena akuyenera kuthetsedwa. Choyamba, muyezo wowonetsera zachiwerewere sunaphatikizepo kuwonekera kawirikawiri. Kuphatikiza apo, muyesowo unali wofanana; Chifukwa chake, kusintha kwamphamvu pakati pa kuwonetsa zachiwawa pazakugonana komanso njira zakugonana zowopsa sikunathe kuwunikira [117]. Chachiwiri, gawo lathu la SEM limaphatikizira ambiri omwe sanali Internet. Izi zimatha kudzutsa nkhawa mukamagwiritsa ntchito zotsatira zamakono. Pafupifupi izi, izi zitha kukhala zolepheretsa kuphunzira; Komabe, phunziroli lidachitidwa koyambirira kwa kugwiritsa ntchito intaneti, kuchuluka kwa SEM kumveka. Ngakhale intaneti imakhala chofalitsa chachikulu pazosangalatsa komanso chida chachikulu cha zinthu za SEM, zoyeserera za SEM kuchokera pazofalitsa zakale zokhudzana ndi zoopsa zakugonana zimapezeka mosalekeza [20]. Chifukwa chake, malire awa sangakhale owopsa phunziroli. Komabe, kukambirana pazinthu zitatu ndizothandiza. Choyamba, powonetsedwa bwino pa SEM pa intaneti ndikukhala "kwakusakanikirana", zotsatira zathu za SEM kuchokera pazofalitsa zakale zokhudzana ndi chiwerewere zitha kukhala zosasangalatsa pazowonera. Chachiwiri, kugwiritsa ntchito makanema pa intaneti kungapangitse kuti kuchepetsedwa kulumikizana, zomwe zimachepetsa machitidwe ogonana. Mwachitsanzo, kugwiritsa ntchito intaneti / zovuta pa intaneti zingakhale zokhudzana ndi zovuta zoopsa (mwachitsanzo, kusungulumwa komanso kukhumudwa) [118], zomwe zingapangitse kuti achepetse zochitika zogonana. Pankhaniyi, kuwonekera pa SEM pa intaneti kungachepetse machitidwe ogonana, ambiri, komanso ngozi zowopsa zogonana, makamaka; chifukwa chake, kuwerengetsa kwathu kungakhale kopitilira muyeso. Chachitatu, kafukufuku wina wasonyeza kuti kugwiritsa ntchito zibwenzi (App) kwenikweni sikunawonjezere mwayi wopanga zibwenzi zazitali, zomwe zingapereke mwayi wogonana. Komabe, Mapulogalamuwa adakulitsa mtundu umodzi wa machitidwe ogonana oopsa (mwachitsanzo, kulumikizana) [119]. Muzochitika zomalizazi, zoyambitsa za pa intaneti pazakugonana zomwe zili zoopsa zimakhala zabwino koma zitha kukhala zopanda pake pakugonana. Ngakhale awa ndi mafotokozedwe ndi malingaliro ena, kafukufuku wamtsogolo akuyenera kuganizira izi.

Chachiwiri, zofunika kuti IV ikhale yosagwirizanitsidwa ndi gawo lachiwiri la zolakwika sizingakhale zofunikira konse m'maphunziro olimbitsa. Kafukufukuyu adawonetsa kuti IV inali yanzeru, koma izi sizingatheke. Mwachitsanzo, ngakhale kafukufuku wina wasonyeza kuti nthawi yovomerezeka sichikugwirizana ndi mikhalidwe yoopsa yomwe ingachitike pambuyo pake [120-121], ena awonetsa mgwirizano wapakati [122-123]. Chifukwa chake, wina anganene kuti pakhoza kukhala kulumikizana mwachindunji pakati pa nthawi yovomerezeka pambuyo pake komanso mikhalidwe yangozi ya kugonana. Komabe, maphunziro ambiri am'mbuyomu sanaganizire za momwe zingagwiritsire ntchito nthawi yolumikizana komanso njira zoopsa zogonana (mwachitsanzo, kukhudzana ndi SEM) ndipo awonetsa kuti zovuta zomwe zimachitika munthu akatha msanga mtsogolo zimatha kukhala zosakhalitsa chifukwa anthu onse pamapeto pake amakumana ndi kusintha kumeneku mukalamba [122,124]. Poganizira kuti tilingalira zovuta zakantha nkhawa yayitali ya SEM pamavuto akugonana, tili ndi chidaliro mu ma IV athu. Kuphatikiza apo, zotsatira zomwe zapezekazi zikuwonetsanso kuti kutha kwa nthawi yayitali nthawi yovomerezeka yokhudzana ndi chiopsezo cha kugonana kumagwiritsa ntchito SEM (Onani. Gulu 2 chifukwa chazovuta zomwe zimachitika panthawi yovomerezeka pazoyipa zogonana mukamayang'anira kuwonekera kwa SEM). Izi zidatsitsanso nkhawa kuti nthawi yokhala ndi nthawi yovomerezeka imakhala yokhazikika komanso yayitali pakubwera kwachidziwikire. Chachitatu, zosintha zathu zidangokhala zikhalidwe zitatu zomwe zimakhala zoopsa; chifukwa chake, zotsatira zathu sizingakhale zokhudzana ndi chiwerewere zomwe sizingachitike mwanjira zitatu izi. Komabe, kafukufuku wakale adawonetsa kuti kuwonetseredwa kwa SEM kudali kokhudzana kwambiri ndi zovuta zina zakugonana kapena zotsatira zake, monga kugonana wamba [31] ndikugonana zogonana kapena gulu lagulu [125]. Chachinayi, zotsatira zonse zinali zochokera pazodzidziwitsa; chifukwa chake, kunena za kukondera kungakhale komwe kwakhudza zotsatira zapano.

Ofufuza zamankhwala ndi azaumoyo nthawi zambiri amatsutsa kuti kupewa koyambirira ndi njira yabwino komanso yabwinobwino yolimbana ndi matenda amtsogolo. Popeza kulumikizana kwakukulu pakati pa kuwonekera kwa SEM ndi machitidwe omwe ali pachiopsezo chakufukufukuyu, njira zodzitetezera zokhudzana ndi kuwonekera kwa SEM ziyenera kukhazikitsidwa mudakali mwana, mwina musanayambe kapena kutha. Malangizowa akutsimikiziridwa ndi American Academy of Pediatrics yomwe idawonetsa kuti unyamata ndi nthawi yoyambira kukambirana njira zogonana [126]. Njira imodzi yoteteza ndi kuphunzitsa achinyamata kuti azitha kuwerenga monga achinyamata, monga kudziwa zinthu (monga, kudziwa za malingaliro ndi zomwe zalembedwako) komanso kuwerenga kalembedwe ka mawu. monga ma ngodya ndi malo osungirako zozungulira) [127]. Kuti akhazikitse kutsegula zam'malemba, akuluakulu (mwachitsanzo, ana ndi aphunzitsi amasukulu) ndi makolo atha kutenga gawo kuti apatse achinyamata chidziwitso choyenera pokhudza kugonana (mwachitsanzo, njira zochepetsera chiopsezo chogonana). Kupititsa patsogolo kuwerenga ku galamala, makolo ndi oyang'anira masukulu amatha kuthandiza ana kudziwa zolemba mu SEM ndiku "kufalitsa" malembedwe olondola (mwachitsanzo, zotsatira zoyipa zogonana mosadziteteza kapena kugona nawo). Ndemanga yaposachedwa idawonetsa kuti kulowerera kuwerenga kwa atolankhani kunali kothandiza poletsa zovuta zomwe zimawonedwa ndi utolankhani pamavuto azakuopsa kwa achinyamata [127]. Kuphatikiza apo, maphunziro azakugonana omwe amathandizira zidziwitso zabwino, monga kupewa (mwachitsanzo, kupewa ziwopsezo) ndi chikhalidwe choteteza (mwachitsanzo, chitetezo cha matenda opatsirana pogonana), chimatha kukhala ndi gawo lalikulu pa thanzi la achinyamata ogonana. M'malo mwake, kafukufuku wina adawonetsa kuti kulandira chidziwitso cholondola kumathandizira chitetezo cha anthu pawokha mikhalidwe yoopsa [128]. Komabe, poganizira za mitu iyi, pamaso pa oyang'anira masukulu ndi makolo asanakonzekere kulera kuwerenga kwa achinyamata kapena kupereka zokhudzana ndi kugonana, chinsinsi pakati pa magulu awiriwa iyenera kukhazikitsidwa [129]. Pomaliza, pambali pazomwe tidapeza, zotsatira zathu zoyambirira za 2SLS zidawonetsa kuti mgwirizano wapabanja umakhudzana ndikuwonekera kochepa kwa SEM; Chifukwa chake, kulimbikitsa makolo kukhazikitsa nthawi yabwino yothandizana ndi banja kumathandizira kuchepetsa kukhudzana kwa SEM, komwe kumathandizanso kuchepetsa chiopsezo chakugonana.

Kutsiliza

Zotsatira ziwiri zofunika kwambiri zidatuluka mu phunziroli. Choyamba, kuwonetsa pachithunzithunzi chaukadaulo pa unyamata kumakhudzana kwambiri ndi zikhalidwe zitatu zomwe zimakhala zoopsa monga kugonana koyambirira, kugonana kosatetezeka, ndi zibwenzi zogonana - kumapeto kwa unyamata, ndipo ubalewu udatsala pang'ono kutha. Chachiwiri, kuyanjana kunali kuyankha, kotero kuti kugwiritsa ntchito njira zambiri zofalitsa nkhani zolaula zimapangitsa kuti akhale ndi chiopsezo chogonana pambuyo pake. Popeza zotsatirapo zoyipa za kugonana zomwe zitha kukhala zoopsa (mwachitsanzo, matenda opatsirana pogonana komanso pakati posakonzekera) zili ndi ndalama zowonongera zambiri kumayiko azizungu ndi ku Asia, ndikofunikira kukhazikitsa njira zodzitetezera koyambirira.

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