不同方法、标准评价上海市浦东新区学龄儿童超重肥胖率

目的 分析上海市浦东新区学龄儿童超重肥胖现状,为进一步筛查学龄儿童超重、预防学龄儿童肥胖提供方向。方法 采用分层随机整群抽样的方法于2017年10月抽取上海市浦东新区1 738名学龄儿童进行体格测量与问卷调查,分别采用国内外不同BMI、腰围和腰高比标准对学龄儿童超重肥胖状况进行评价。 结果 仅使用BMI标准进行超重肥胖评价会遗漏有中心性肥胖风险的儿童,漏查率为7.6%~16.2%;而仅使用中心性肥胖判定标准,也会漏查2.8%~10.9%的全身性肥胖学龄儿童。上海市浦东新区郊区中心镇的学龄儿童超重肥胖率最高(28.6%~39.4%)。男童全身性超重肥胖率为26.2%~35.5%,明显高于女童的18.1%~26.4%,但女童腰围高于正常值的人数(254/766)与男童(316/946)相当,差异无统计学意义(χ²=0.011,P>0.05),应引起关注。此外,一、二年级学龄儿童超重肥胖率明显低于三年级(P＜0.05)。 结论 应同时使用全身性肥胖和中心性肥胖标准对学龄儿童进行筛查,尽早预防学龄儿童超重肥胖,并制定相应干预策略。     

居家培训在学龄期儿童屈光相关性弱视防治中的应用

目的探讨居家培训在学龄期儿童屈光相关性弱视防治中的临床疗效。方法将符合诊断标准的114例学龄期屈光相关性弱视儿童按完全随机对照顺序编号,分成A、B、C 3组,3组儿童均进行规范的验光配镜及个体化弱视训练等。A组在上述基础上加用"居家培训",B组加用"针刺治疗",C组为对照组。通过问卷和现场考核等方法进行了为期1~7年的临床随访,观察学龄期弱视儿童视功能恢复情况。结果A、B、C 3组弱视儿童最佳矫正视力均有不同程度提高,注视性质均转为中心注视;弱视程度、三级视功能A、B两组之间差异无统计学意义(P>0.05),A、B两组与C组比较差异有统计学意义(P<0.05),且均优于C组。结论"居家培训"模式在学龄期儿童屈光相关性弱视方面的防治中更加规范了弱视治疗,提高了治疗的依从性,且与中医针刺治疗疗效相近,故"居家培训"模式值得在临床上进一步推广使用。     

Individual Case Analysis of Processing Speed Difficulties in Children With and Without Traumatic Brain Injury

Two studies were conducted to determine the frequency of processing speed difficulties relative to estimates of other problem-solving abilities in children with and without traumatic brain injury (TBI). The two samples consisted of 213 normally functioning school-age children and 65 TBI children and 19 trauma controls. All children were administered the WISC-III/IV Vocabulary, Block Design, and Coding subtests. The frequency of children in each sample having a Coding subtest score of 3 or 4 scale points below the Vocabulary or Block Design score (whichever one was lower) was calculated. Using a 3-point scale difference, the presence of processing speed deficits relative to other cognitive abilities in the school sample was low (5.2%), and was equivalent to that demonstrated by trauma controls (5.3%). However, in the TBI sample, 18 out of 65 TBI patients (27.7%) showed this same pattern. Using a 4-point discrepancy scale, 3.3% of normal children and 16.9% of TBI children showed this pattern. The frequency of this pattern increased with severity of TBI, using two different but related classification systems. These preliminary findings require cross validation in a larger sample before definite conclusions can be reached.     

Children of mentally ill or addicted parents participating in preventive support groups

The large number of children with mentally ill or addicted parents calls for efficient provision of preventive support: interventions should be offered to children most at risk and attune to their risk levels and needs. This study provided insight in the (heterogeneous) needs of children participating in preventive support groups. Questionnaires were filled out by 170 children (8–12 years) and their ill parent on children's psychosocial problems, parental illness-related cognitions and various risk factors. Outcomes show that 55.7% of the children had clinical psychosocial problems, 13.3% had subclinical problems and 31% functioned relatively well. Eighty-three percent experienced multiple risk factors. A linear cumulative relation was found between the number of risk factors and intensity of child problems. Children were classified into four risk profiles according to their own functioning and family risk level. The heterogeneity in the support group participants might call for interventions of different intensity and content.     

学龄期儿童不同类型屈光参差眼球生物学参数的研究

目的：比较学龄期儿童,不同类型屈光参差,双眼间视力及生物学参数的差异及其相关性。

方法：回顾性研究。纳入轻中度屈光参差的学龄期儿童(6-12岁)128例。根据屈光参差的类型分为5组。所有患儿均行睫状肌麻痹验光、眼部A超、角膜地形图检查。记录以下数据：屈光状态、最佳矫正视力(BCVA)、前房深度(ACD)、晶体厚度(LT)、玻璃体腔深度(VCD)、眼轴长度(AL)、角膜曲率半径(CR)、轴率比(AL/CR)。统计学分析采用Kruskal-Wallis检验和Spearman秩和检验。

结果：远视性屈光参差双眼间视力差异最大(0.14±0.20),近视性屈光参差双眼间眼球生物学参数AL和VCD差异最大(0.56±0.41,0.56±0.39 mm)。双眼间屈光参差和BCVA、VCD、AL、AL/CR呈正相关(P<0.05),相关系数r分别为0.266、0.379、0.350、0.263与LT、CR无显著相关(r=-0.019,-0.069,P>0.05)。然而在每个类型的组别中,屈光参差与双眼间的眼球生物学参数并无显著相关性。

结论：学龄期儿童远视性屈光参差在四种屈光参差类型中双眼视力差异最大。单纯远视或近视型屈光参差两眼间生物学参数的差异主要是由于VCD和AL的不对称,而散光型屈光参差双眼间的眼球生物学参数无显著差异。     

Pupil's opportunities to influence activities: a study of everyday practice at a Swedish leisure-time centre

The focal point of this article is a discussion of pupils' opportunities to make their voices heard and influence the activity in a Swedish leisure-time centre. The study comprises six weeks of ethnographically inspired field work including data from participating observations and walk-and-talk conversations. Two voluntary activities, referred to here as ‘free play' and ‘thematic activity', are discussed. The study shows that free play can be described as an activity where the staff take their point of departure based on the children's perspectives and the enhancement of democratic values and decision-making. The thematic activity can, as with free play, be described as a stimulating activity which is also in line with relevant steering documents. However, staff members’ points of departure are grounded in an adult perspective, a perspective that focuses on affording ‘good' activities. This results in an activity where the pupils’ opportunities to take part in democratic decision-making differ compared to that in free play.     

空气污染对学龄儿童呼吸系统影响的研究

目的 了解室内外空气污染对学龄儿童呼吸系统健康的影响。方法 通过对污染区和对照区2079名学龄儿童呼吸系统症状、疾病住院率比较，并运用非条件Logistic回归方法进行分析研究。结果 污染区室内外空气污染较严重，大气总悬浮微粒、二氧化硫和氮氧化物的浓度均超过国家Ⅱ级标准，儿童呼吸系统症状、疾病患病率明显高于对照区。影响儿童呼吸系统健康的环境因素为大气污染、被动吸咽、燃煤、冬季取暖和室内油烟污染。其中咳嗽与以上5个因素有显著相关关系(P＜0．05)，支气管炎与除被动吸烟外的其它4个因素有显著相关关系(P＜0．05)，咳痰与大气污染、被动吸烟、冬季取暖和室内油烟污染，气喘和呼吸系统疾病住院率与大气污染、室内油烟污染有显著相关关系(P＜0.05)。哮喘与室内外空气污染无显著性关系。结论 对儿童呼吸系统发病有显著影响的环境因素是大气污染、被动吸烟、燃煤、冬季取暖和室内油烟污染。     

学龄期多动症患儿视频脑电图异常改变与智力水平的关系

目的 探讨学龄期多动症患儿视频脑电图的检查结果及其与智力水平的关系。方法 选取2015年3月—2019年7月佛山复星禅诚医院收治的80例学龄期多动症患儿作为甲组,另选取同期体检健康的72例学龄期儿童作为乙组。两组均进行视频脑电图检查,对比脑电图异常情况,采用中国韦氏学龄儿童智力量表（C-WISC）评估其智力水平,比较甲组脑电图正常者与异常者的智力水平,采用Spearman法分析学龄期多动症患儿的视频脑电图异常情况与智力水平的关系。结果 甲组脑电图异常率为23.75%（19/80）,其中9例表现为α波形欠整齐及调节调幅欠佳,θ波增多且呈弥散或阵发性出现,θ/α、θ/β比值升高,6例表现为θ波弥漫性活动、δ波增多、左右不对称及有少量癫痫样放电,有4例表现为明显δ波活动、弥漫性慢波异常且多伴癫痫样放电;乙组脑电图异常率为6.94%（5/72）,其中4例表现为θ波弥漫增多及基线不稳、调幅不佳,1例表现为δ波增多且形态不规则;甲组视频脑电图异常率高于乙组（P <0.05）;两组言语智商（VIQ）、操作智商（PIQ）及总智商（FIQ）等级比较,差异有统计学意义（P <0.05）,甲组VIQ、PIQ及FIQ等级（优秀+中上+中等）占比低于乙组（P <0.05）;甲组脑电图异常者的VIQ、PIQ及FIQ的等级与正常者比较,差异有统计学意义（P <0.05）,异常者VIQ、PIQ、FIQ等级（优秀+中上+中等）占比低于正常者（P <0.05）;经Spearman相关性分析显示,学龄期多动症患儿脑电图异常与其VIQ、PIQ和FIQ水平呈正相关（r_s =0.579、0.583和0.562,P =0.002、0.006和0.005）。结论 部分学龄期多动症患儿有脑电图异常改变及智力水平下降的表现,且脑电图异常者的智力水平降低更为明显,脑电图异常与智力水平存在一定相关性。     

Parenting stress, marital quality, and child behavior problems at age 7 years

The study examined the relationship of early family environment and infant characteristics with childhood behavior problems at age 7 years. Sixty-two mothers and 56 fathers of preterm (30-36 weeks gestation and greater than 1500 g) and full-term boys and girls completed the Parenting Stress Index, Dyadic Adjustment Scale, and a measure of socioeconomic status during the child's first year. When their child was age 7 years, parents completed the Eyberg Child Behavior Inventory Intensity (frequency of behavior) and Problem (impact of behavior) scales. Hierarchical regression analyses showed that parenting stress because of their child's distractibility during infancy predicted the frequency of childhood behavior problems at age 7 years for mothers and of the impact of behaviors on the mother and the father. The quality of the marital relationship during infancy predicted the frequency of behavior problems reported by fathers. Public health nurses are well positioned to assess parenting stress and marital quality and to provide support to families during the early stages of parenthood.     

地特胰岛素注射液联合短效胰岛素治疗学龄期1型糖尿病的疗效分析

[摘要]目的：观察地特胰岛素注射液联合短效胰岛素治疗学龄期1型糖尿病（T1DM）的临床疗效,为临床提供参考。方法：选取2012年1月至2017年1月在郑州儿童医院内分泌遗传代谢科初诊住院、血糖控制稳定后出院门诊长期随访的学龄期T1DM患儿64例,按治疗方案分为观察组和对照组各32例。观察组应用睡前地特胰岛素注射液联合三餐前短效胰岛素,对照组采用传统治疗方案三餐前短效胰岛素联合睡前中效胰岛素治疗。观察两组患儿糖化血红蛋白、晨起空腹血糖、C肽、胰岛素用量及低血糖、糖尿病酮症酸中毒发生情况。结果：出院治疗3个月、6个月时,观察组糖化血红蛋白均低于对照组（P均<0.05）;两组C肽、晨起空腹血糖、胰岛素用量比较差异均无统计学意义（P均>0.05）。出院6个月内,观察组发生非严重低血糖12例次,对照组发生62例次（χ2=7.14,P<0.05）。两组均无严重低血糖、糖尿病酮症酸中毒发生。结论：地特胰岛素注射液能够较好地控制学龄期T1DM患儿的血糖,减少非严重低血糖发生率,且不增加胰岛素用量,值得临床推广应用。