近距离工作和户外活动对学龄期儿童近视进展的影响

目的：探讨近距离工作以及户外活动等对学龄期儿童近视进展的影响。方法：将80名 7~11岁的在校学生随机分入观察组（41人）和对照组（39人）,指导观察组控制近、中距离工作时间30 h/周以内,增加户外活动至14~15 h/周以上,2年内定期医学验光得到屈光度,2年后由眼科医生进行问卷调查,内容包括阅读、书写、使用电脑等近距离工作时间;看电视、课外辅导等中距离工作时间;户外活动时间;使用自然光线以及每日戴镜时间等。结果：观察组儿童的年平均屈光度进展度数为0.38±0.15 D,明显低于对照组（0.52±0.19 D）（P<0.01）。观察组近距离工作时间与对照组差异无统计学意义,但看电视、课外学习等中等距离用眼时间明显短于对照组（P<0.01）。观察组户外活动时间（13.7±2.4 h/周）明显长于对照组（6.2±1.6 h/周）（P<0.01）。多元回归分析显示4个变量是减慢近视屈光度进展的主要因素：增加户外活动,增加戴镜时间,较多使用自然光,减少使用电脑时间。在观察组内,增加户外活动减慢近视进展（t=-2.510,P<0.05）;在对照组内,增加戴镜时间是减慢近视进展的主要因素（t=-3.115,P<0.05）。结论：增加户外活动,尽量使用自然光线和坚持戴镜可以减慢学龄期儿童的近视进展。     

成都市9~15岁儿童出生情况与体格指标流行病学调查

目的：宫内环境可能对儿童生长发育产生影响,通过流行病学调查研究四川省成都市9~15岁儿童出生胎龄、体重与体格发育指标的关系。方法：调查9~15岁的中小学学生共7194名,根据出生胎龄及体重对儿童进行分类（包括小于胎龄儿、适于胎龄儿、大于胎龄儿）,测量身高、体重,并对其家长进行问卷调查。结果：被调查人群小于胎龄儿发生率为6.23%（448例）,其中身高未出现“追赶生长”（低于均值两个标准差）为5.13%,且多个年龄段儿童平均身高低于适于胎龄儿（P<0.05）。大于胎龄儿发生率为18.06% (1299例),大于胎龄儿中超重发生率为13.78% (179 例),肥胖发生率为4.39%（57例）,且多个年龄段儿童平均体重大于适于胎龄儿（P<0.05）。结论：出生时为小于胎龄儿、大于胎龄儿的儿童在远期生长发育中,可以出现身高和体重异于正常儿童,应关注这类孩子在学龄期的身高体重发育情况。     

小儿慢性咳嗽的病因分析

目的：研究儿童慢性咳嗽的病因。方法：对2010年8月至2011年9月132例慢性咳嗽患儿的临床资料进行回顾性分析,调查慢性咳嗽的病因构成。结果：咳嗽变异性哮喘是慢性咳嗽最常见的病因（56例次）,其次为上气道咳嗽综合征（44例次）、感染/感染后咳嗽（22例次）、变应性咳嗽（8例次）、胃食管反流性咳嗽（5例次）,3例次为其他病因。感染/感染后咳嗽在婴儿组（<1岁）、幼儿组（1岁~）、学龄前儿童组（3岁~）、学龄期儿童组（6~14岁）间的病因分布差异有统计学意义（χ2=11.638,P=0.001）,其中<1岁的婴儿组感染/感染后咳嗽的比例高于其他3个年龄组（P<0.05）。感染/感染后咳嗽是婴儿组（<1岁）慢性咳嗽的主要病因,咳嗽变异性哮喘和上气道咳嗽综合征是幼儿组（1岁~）、学龄前儿童组（3岁~）、学龄期儿童组（6~14岁）慢性咳嗽的主要病因。变应性咳嗽、咳嗽变异性哮喘以及上气道咳嗽综合征患儿有较高比例的个人过敏史、不良外界环境接触史以及家族过敏/哮喘史。结论：咳嗽变异性哮喘、上气道咳嗽综合征、感染/感染后咳嗽是儿童慢性咳嗽的主要病因。不同年龄组患儿慢性咳嗽的主要病因不同。具有个人过敏史、不良外界环境接触史以及家族过敏/哮喘史的慢性咳嗽患儿更易患变应性咳嗽、咳嗽变异性哮喘以及上气道咳嗽综合征。     

乌鲁木齐市近视小学生社交焦虑现状及其危险因素分析

目的 了解乌鲁木齐市四至六年级近视学生社交焦虑的发生情况,分析近视小学生社交焦虑发生的危险因素。方法 采用分层整群随机的抽样方法抽取乌鲁木齐市4所小学中552名四至六年级近视学生为研究对象,采用自行设计的调查表、儿童社交焦虑量表和自尊量表调查学生一般人口学资料和社交焦虑、自尊现状,并采用多因素logistic回归分析调查近视学生社交焦虑的危险因素。结果 552名儿童中,社交焦虑检出为31.3%（173例）。多因素logistic回归分析结果显示,较高年级学生、女生以及专制型家庭环境、高度近视、低自尊或戴镜时间 > 2年的近视学生更易发生社交焦虑（P < 0.05）。结论 乌鲁木齐市四至六年级近视学生社交焦虑问题较为突出,其社交焦虑的发生与年龄、性别、近视程度、戴镜时间、父母教育方式及自尊水平等因素有关。     

3022例儿童乙型肝炎表面抗体检测结果分析

目的：观察儿童乙型肝炎表面抗体（HBsAb）阳性率情况。方法对2009~2011年3022例在门诊行健康体检的儿童采用酶联免疫法进行乙肝血清学检测,分析HBsAb阳性率。结果HBsAb阳性率随年龄增高而降低（P0.05),但1岁~组男孩HBsAb阳性率低于女孩(P<0.01),而3~＜4岁组男孩HBsAb阳性率高于女孩(P<0.01)。男孩组中HBsAb阳性率随年龄增高而降低,2岁~组男孩HBsAb阳性率低于1岁~组（P<0.01）;女孩组中HBsAb阳性率亦随年龄增高而降低,且各年龄组之间两两比较差异均有统计学意义（均P<0.01）。结论HBsAb阳性率随儿童年龄增高而降低,且低龄儿童是感染乙型肝炎的高危人群,需要加强乙肝血清学监测。     

龙岗区1～12岁儿童血清25-羟维生素D检测结果分析

<正>为了解目前本地区1~12儿童维生素D缺乏状况,本研究检测幼儿(1~3岁)、学龄前期儿童(~6岁)及学龄期儿童(~12岁)血清总25-羟维生素D(即血清25-羟维生素D2+25-羟维生素D3)水平,为儿童合理补充维生素D,预防维生素D缺乏提供依据。1临床资料2011年11月至2014年4月,在广东省深圳市龙岗区妇幼保健院儿童保健科门诊进行健康检查的1~12岁儿童1 699例。根据年     

学龄期儿童神经性尿频与心理状况关系的临床研究

目的：探讨焦虑、抑郁心理与学龄期儿童神经性尿频发生的关系。方法：选取136例9~12岁神经性尿频患儿为病例组,136例9~12岁健康儿童为对照组。以儿童焦虑性情绪障碍筛查表（SCARED）评价患儿焦虑心理,以儿童抑郁障碍自评量表（DSRSC）评价患儿抑郁心理,比较两组焦虑和抑郁的发生率以及两组SCARED和DSRSC评分,并运用logistic 多元回归分析探讨焦虑和抑郁心理与神经性尿频发生的关系。结果：病例组焦虑和抑郁的发生率均高于对照组,差异有统计学意义（P23分者(即存在焦虑)神经性尿频发病风险为SCARED≤23者的1.224倍;DSRSC筛查≥15分者(即存在抑郁)神经性尿频发病风险为DSRSC<15者的1.148倍。结论：焦虑和抑郁心理参与了学龄期儿童神经性尿频的发病。     

儿童肺炎支原体肺炎流行病学特征

目的：了解儿童肺炎支原体肺炎流行病学特点,为临床诊治提供参考。方法：对2011年2月至2012年1月确诊为社区获得性肺炎的3156例住院患儿应用酶联免疫吸附法检测血清肺炎支原体抗体IgM,同时对肺炎支原体肺炎患儿的鼻咽分泌物进行7种呼吸道病毒抗原检测。结果：（1）3156例患儿中,肺炎支原体抗体IgM阳性检出427例,阳性率为13.53%,其中女性患儿感染率高于男性（16.30% vs 11.70%, P<0.01）。（2）＜1岁、1岁～、3岁～、6～14岁肺炎支原体抗体IgM检出率分别为3.6%、12.5%、19.2%、24.4%（P<0.01）,其中≥3岁者总检出率高于<3岁者（P<0.01）。（3）不同季节肺炎支原体抗体IgM检出率不同,夏秋季节明显高于冬春季节（19.18% vs 9.61%,P<0.01）。（4）427例肺炎支原体抗体IgM阳性患儿中,合并呼吸道病毒感染 60例（14.1%）,合并比例最高的呼吸道病毒为呼吸道合胞病毒。结论：儿童肺炎支原体肺炎呈全年散发,以夏秋季节多见,学龄前及学龄期儿童高发,同时还存在混合感染现象。     

兰州市城区3~6岁儿童2001~2010年体格发育变化趋势分析

目的：调查分析兰州市城区3~6岁儿童2001~2010年的体格发育变化趋势。方法：依据该地地理、社会功能区特征、参考幼儿园公私立等性质,采用分层随机整群抽样的方法,选取35所幼儿园儿童在2001、2006及2010年的体检资料。以身高、体重及体重指数（BMI）为主要指标分析其变化趋势。以Z评分,即年龄别身高（HAZ）、年龄别体重（WAZ）和身高别体重（WHZ）3项指标筛查其生长迟缓、低体重、超重、消瘦和肥胖情况并分析变化趋势。结果：该人群在同年龄段身高、体重、BMI等数值有逐年增长趋势（P<0.05）;且在同一检测年份中该人群身高和体重随年龄增长而增长,BMI随年龄增长呈逐渐减小趋势;Z评分分析发现3项指标平均值逐年增加（P<0.05）,低体重、生长迟缓和消瘦的平均患病率逐年下降,而超重和肥胖平均患病率则逐年上升。结论：兰州市城区3~6岁儿童2001~2010年间体格发育变化明显,身高、体重呈增长趋势,生长迟缓、低体重、消瘦等体格发育问题在逐渐改善,但也出现如超重、肥胖等新的体格发育障碍问题。提示应在注重营养不良问题改善的同时高度关注营养过剩的体格发育障碍问题。     

儿童不明原因晕厥诱因分析

目的：分析儿童不明原因晕厥的常见诱因。方法：详细询问2006年1月至2011年10月就诊的434例不明原因晕厥儿童（3.0～17.9岁,男192例,女242例）的晕厥病史及诱因,分析诱因在不同年龄、性别、晕厥频次、直立倾斜试验（HUTT）结果之间的差异。结果：（1）偶发晕厥常见诱因依次为持久站立（30%）、运动（13%）、体位改变（9%）、坐位（7%）、玩耍（6%）等。①性别比较：持久站立引起的偶发晕厥女性较男性多见(P<0.01）;排尿晕厥主要见于男性;闷热环境主要诱发女性晕厥。②年龄比较：体位改变诱发偶发晕厥在≥12岁组较<12岁组常见（P<0.05）,其余诱因在不同年龄间差异未见统计学意义。③不同HUTT结果比较：体位改变诱发偶发晕厥多见于HUTT阴性组（P<0.05）。（2）所有偶发晕厥诱因均可诱发反复晕厥,56.2%的反复晕厥为同一诱因所致。结论：儿童不明原因晕厥常见诱因为持久站立、运动、体位改变等,临床上避免诱因有助于预防晕厥发作。     

Hypothesis: Myopia of prematurity is caused by postnatal bone mineral deficiency

Myopia is a frequent finding in preterm children. The close association between myopia and retinopathy of prematurity (ROP) suggested a causal relationship, but myopia of prematurity without ROP has yet to be explained. An alternative explanation is presented: myopia is caused by postnatal ellipsoid deformation of the spheric eyeball, i.e. excessive elongation of the optical, as a result of a dolichocephalic deformation of the skull with a short frontal axis. This deformation of the skull is the direct result of bone mineral deficiency frequently observed in very low birth weight infants with increasing postnatal age. This hypothesis is supported by the results of a historical comparison of very low birth weight infants without and with supplementation with calcium and phosphorus that was given in order to prevent postnatal bone mineral deficiency. In the unsupplemented group 4 of 23 children (61%) needed spectacles but only 6 out of 55 (11%) children who were supplemented as babies (questionnaire). Refraction measurements showed myopia stronger than –1 o.d. in group 1 in 5 of 14 infants, whereas in group 2 only 2 out of 22 infants were myopic (P<0.05).     

Myopia in preterm children at 12 to 24 months of age

PURPOSE: To examine biometric factors that may influence the high incidence of myopia in pre-term children at 12 to 24 months of age. PATIENTS AND METHODS: Fifty eyes of 25 patients with myopia and 70 eyes of 35 patients with emmetropia at 12 to 24 months of age were selected from a group of preterm children who had been screened for retinopathy of prematurity and returned for follow-up examinations. Forty eyes of 20 full-term children of the same age were also included in the study as a control group. A-scan ultrasonography was performed to measure axial length, lens thickness, and anterior chamber depth in the three groups. RESULTS: The myopic group had a significantly greater axial length than did the other groups. However, the three groups did not differ in lens thickness or anterior chamber depth. The degree of myopia increased with the increase in axial length and the decrease in anterior chamber depth. CONCLUSIONS: The development of myopia in preterm children 12 to 24 months of age appears to be influenced mainly by axial length, whereas the degree of myopia seems to be related to axial length and anterior chamber depth. Among refractive components, axial length plays a major role in myopia occurring at this age in preterm patients.     

Accommodation in hyperopic and myopic school children

Binocular accommodation of 150 consecutive hyperopic and 150 myopic school children was measured during the eye examination. There were 99 girls and 51 boys in the hyperopic group and 100 girls and 50 boys in the myopic group. The ages varied from seven to 16 years. Accommodation of the hyperopic children varied from 4 to 20 D (mean 10.6 +/- 3.4), and in the myopic children also from 4 to 20 D (mean 10.9 +/- 2.5). The difference between these means was not statistically significant. However, hyperopic girls aged 12 to 16 years showed low values of accommodation (mean 9.0 +/- 2.7) compared to the other corresponding age groups. In the second part of the study the refraction of 80 children, aged seven to 15 years, with decreased accommodation was studied retrospectively to see if they had a tendency to become myopic. The follow-up time was from one to eight years, and the accommodation at the beginning of the observation time varied from 2 to 7 D. The mean annual change of the refraction of these children was from -0.03 to -0.17 D. In 34 children there was no change at all, and in 12 children the change of refraction was slightly toward more hyperopia. Only three of these 80 children became myopic during the observation time. This incidence is lower than the incidence of myopia at these ages. Thus, accommodative power of hyperopic and myopic school children appears to be on the same level, and low accommodation does not predict the development of myopic refraction in the school years.     

Predicting of myopia progression in school children

Myopia in 214 school children has been followed from one to nine years. The children have been divided in groups according to the age of onset of myopia and the amount of final myopia at the age of 15 or 16 has been recorded. If myopia started before puberty (at the age of 10 or younger) 70% of the children ended up with myopia of -3.0 to -5.75 D, only 12.5% remained under -3.0 D, and 17.5% had myopia -6.0 D or more. If myopia began at the ages of 11-15, 66.7% remained under -3.0 D, 32.2% reached -3.0 to -5.75 D, and only 1.1% of the children had myopia of -6.0 D or more. Of all the 214 children, 95.8% had myopia less than -6.0 D at the age of 15-16 years. However, the individual variation is very wide, and it is difficult to predict the final amount of myopia in school years in an individual case.     

Age of Onset and Progress by Ageing in High Myopia

Abstract The amount of refractive errors, visual acuity, fundus findings, age of onset and other relevant data were examined in 614 cases of myopia, at the Department of Ophthalmology in Juntendo University.
Twenty-seven per cent (27/100 cases) among high myopia (-15.0D ± 7.5D) with typical chorio-retinal atrophy and 20% (55/275 cases) of myopia (-12.7D ± 6.4D) without typical myopic atrophy had onset at 4 yrs old or younger. However, there was no case whose age of onset was 4 yrs old or younger among 239 cases of myopia with 5D or weaker. All of them had onset in 7 yrs old or older.
The average corrected visual acuity became worse as the patient became older, especially in 'high myopia with chorio-retinal atrophy, it was (0.4-0.5 already in childhood and about 0.2 in 40 yrs old or older). However, the corrected visual acuity in high myopia without typical myopic atrophy was kept comparatively good (about 0.7 in 40s or younger and 0.4 in 60s or older). Degree of myopia increased significantly by age, but stopped at around the 40s. These facts show that early age of onset of high myopia is very important.     

Safe restraint of the child passenger

AIM: The aim of this study was to understand the need for, and use of, booster seats in the 4-12 years age group and to identify risk factors for booster seat-non-use. METHOD: A cross-sectional sample of 1101 children aged 4-12 years travelling in 663 privately owned vehicles was taken from the Auckland region. Auckland is New Zealand's largest population centre, with a population of over 1.5 million. Information was gathered using a short questionnaire followed by direct inspection to identify those children using booster seats. The SafetyBeltSafe USA '5-step rule' was used to look at those children not using a booster seat to determine whether one was still required. RESULTS: While booster seat use has improved significantly in younger children since a similar study in 1992, only 40% of sampled children requiring a booster seat were using one. Booster seat use by children requiring them declined sharply as age increased. While 93% of 5- to 8-year-olds required a booster, only 30% were using one. The requirement for booster seats fell dramatically to 34% of 9- to 12-year-olds, but only 3% were using one. CONCLUSION: The high rate of need for booster seats and the lack of use of booster seats in children aged 5-8 years is a strong argument for legislation and education programmes targeting this age group. While the proportion of 9- to 12-year-olds needing a booster drops sharply, there would likely be benefits from educating parents on the '5-step rule' or similar method to help identify the 30% of these older children that would continue to benefit from a booster seat. Rear seating should be promoted alongside booster seat use in the age group 4-12 years.     

Hepatitis B vaccination rate of homeless children in Baltimore

OBJECTIVE: To investigate the hepatitis B vaccination rate in homeless children 2 to 18 years old living in Baltimore City. METHODS: During a 21-month period, 250 children from homeless shelters were enrolled. RESULTS: The percent of children who had received 3 or more doses of hepatitis B vaccine was inversely related to age; 90% in 2- to 5-year-olds and 29% in 13- to 18-year-olds (P<0.0001). Seventy percent of 2- to 5-year-olds had at least some of their vaccine history recorded in the Baltimore Immunization Registry Program but the history was complete in only half. Forty-two percent of 13- to 18-year-olds had no hepatitis B vaccine doses recorded in any source; 49 per cent of 10- to 18-year-olds were either not immunized or had received only one hepatitis B vaccine dose. CONCLUSIONS: Hepatitis B vaccine coverage is high in homeless children up to 9 years of age, whereas the majority of homeless children 10 years of age and older are unprotected against hepatitis B virus infection. Tracking the vaccine records in homeless children is labor intensive. Better public health strategies to deliver hepatitis B vaccine to older homeless children are urgently needed.     

儿童直立性低血压的年龄和性别差异

目的探讨儿童直立性低血压(OH)的性别和年龄差异。方法选取2000年1月-2010年5月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥、头痛、头晕的患儿1 158例。年龄3.1～17.0(10.72±2.80)岁;男597例,女561例。经直立倾斜试验(HUTT)诊断为OH的患儿45例。将45例OH患儿分为≥12岁组与<12岁组,分析2组HUTT的阳性率、OH病程、平卧后站立位3 min内舒张压及收缩压下降量的年龄和性别差异。结果 1.HUTT阳性率为3.88%(45/1 158例),男女间HUTT阳性率比较差异无统计学意义(χ2=0.584,P>0.05),≥12岁组与<12岁组比较差异无统计学意义(χ2=0.631,P>0.05)。2.病程:<12岁组病程为0.03～60.00(8.13±14.06)个月,男女比较差异无统计学意义[(4.77±7.86)个月vs(10.59±17.10)个月;t=0.634,P>0.05];≥12岁组OH病程为0.30～72.00(20.10±22.20)个月,男女比较差异无统计学意义[(16.55±1.80)个月vs(26.03±2.87)个月;t=0.273,P>0.05]。<12岁组与≥12岁组病程比较差异无统计学意义[(8.73±16.07)个月vs(20.11±22.20)个月,t=1.932,P>0.05]。3.血压下降量:HUTT 3 min内收缩压和舒张压的下降量在<12岁组与≥12岁组间差异无统计学意义(t=1.495、0.079,Pa>0.05),<12岁组男女间差异无统计学意义(t=0.019、1.730,Pa>0.05),≥12岁组男女间比较差异无统计学意义(t=0.364、0.843,Pa>0.05)。结论 OH的诊断率、病程、3 min血压下降量在儿童不存在年龄和性别差异。