Table of Content

10 January 2021, Volume 29 Issue 1

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Prosessional Forum

Principles of monitoring and intervention for micronutrient deficiency in children with autism spectrum disorder

LI Ting-yu, TAN Mei

2021, 29(1):  1-4.  DOI: 10.11852/zgetbjzz2020-1787

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Autism spectrum disorder (ASD) is a common and complex neurodevelopmental disorder for which there is no specific treatment and the clinical practice is mainly based on behavioral interventions,causing a huge economic burden to the families and society.The etiology of ASD is unclear and is recognized as the result of interaction of a complex genetic background with environmental risk factors,resulting in different clinical manifestations of children with ASD.Current evidence suggests that malnutrition,especially micronutrient deficiencies in utero and in early postnatal period,may be associated with the onset and clinical manifestations of ASD.These measures,including ensuring sufficient micronutrients during pregnancy,strengthening micronutrient monitoring for ASD children,and timely and reasonable intervention,may reduce the incidence of ASD and improve the behaviors of children with ASD to some extent.

Management of family intervention for young children with autism spectrum disorder

XU Xiu

2021, 29(1):  5-8.  DOI: 10.11852/zgetbjzz2020-2106

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder onset in the early stage of development.There is a consensus that early identification,early detection and early intervention of ASD can greatly improve the prognosis of children with ASD.In the early intervention of ASD,the role of family intervention has attracted more and more attention,and has gradually become the research hotspot of early intervention of ASD in the world.This paper discusses the aspects that may be involved in the management and evaluation of family intervention for young children with ASD.

Original Articles

Study on the correlation between electronic screen exposure time and hyperactivity index in infants

WU Jian-bo, YIN Xiao-na, WU Chuan-an, ZHANG Jing-yu, ZHANG Li-jun, JING Jin

2021, 29(1):  9-12.  DOI: 10.11852/zgetbjzz2020-0807

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Objective To investigate the correlation between screen time and hyperactivity index in infants,so as to provide clues for the impact of screen time on hyperactivity behavior in young children.Methods Totally 22 586 children in Longhua district of Shenzhen were enrolled in this study,and their parents were surveyed in September 2018.The general demographic variables and screen time were collected by a self-designed questionnaire.The hyperactivity index was investigated by Conners Parental Symptom Questionnaire(PSQ) to analyze the correlation between screen time and hyperactivity index in infants.Results The abnormal rate of hyperkinetic index was 1.7%.Screen time for TV sets and new electronic products in infants increased with age,which was significantly related to abnormal results of hyperactivity index in children under 1 year old,1-to 2-year-old children,and 2-to 3-year-old children,and the risk was higher in younger children.The longer the daily screen time in children under 3 years old,the higher the risk of abnormal hyperactivity index would be.Compared with the non-screen group,TV screen time≥1 h/d (OR=5.36,95%CI:3.27-8.78) and ＜1 h/d (OR=2.06,95%CI:1.24-3.42) were risk factors for abnormal hyperactivity index,and the corresponding OR value in new electronic products was 5.94(95%CI:3.79-9.30) and 2.25(95%CI:1.48-3.41),respectively.The longer the single screen time,the higher the risk of abnormal hyperactivity index would be.Compared with screen time＜15 min,the OR value (95%CI) for abnormal hyperactivity index in single screen time ≥120,60-120,30-60,15-30 min was 3.13 (1.33-7.37),2.81 (1.83-4.31),1.46 (1.05-2.04),and 1.23 (0.92-1.64),respectively.Conclusions Early exposure to screen and excessive screen time in infant stage may be correlated with abnormal hyperactivity index.It is recommended that children under 2 years old should not screen every day,and the total screen time should be controlled less than 0.5 hour in 2-to 3-year-old children.

Mediating role of parental reflection function between parental abuse experience and parent-child relationship in childhood

LIU Jing, HUANG Zheng, LI Xin-ting

2021, 29(1):  13-17.  DOI: 10.11852/zgetbjzz2020-1726

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Objective To explore the relationship between parental childhood abuse experiences,parental reflective functioning and parent-child relationship,so as to provide a theoretical basis for improving parent-child relationship.Methods A cluster stratified random sampling method was used to select 582 parents in Tongzhou District from April to July 2019.And the participants were assessed by the Childhood Trauma Questionnaire (CTQ-SF),the Parental Reflective Functioning Questionnaire(PRFQ) and Parent-Child Relationship Scale(CPRS).Results No mediating effect of reflective functioning between fathers' experiences of childhood abuse and parent-child relationships were found,with the model fit indexes of χ²/df=1.222,GFI=0.981,CFI=0.986,RMSEA=0.028,TLI=0.975,AGFI=0.957.Mothers' reflective functioning partially mediated the relationship between mothers' childhood abuse and parent-child relationship,with the model fit indexes of χ²/df=1.726,GFI=0.976,CFI=0.968,RMSEA=0.049,TLI=0.942,AGFI=0.945,and the mediating effect was 19%.Conclusions Reflective functioning mediates the effects of mothers' experiences of childhood abuse on parent-child relationships.Thus,improving mothers' reflective functioning can make parent-child relationship better and facilitating the healthy development of children.

Case control study on behavioral characteristics and parents' emotional state of children with developmental dyslexia

HU Jun, FENG Xue-ying, YI Ming-ji, WANG Yan-xia, LIU Xiao-mei, MA Liang

2021, 29(1):  18-22.  DOI: 10.11852/zgetbjzz2020-1064

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Objective To study the behavioral characteristics and parents' emotional state of children with developmental dyslexia (DD),and to analyze the correlation between them,so as to provide scientific basis for multidirectional intervention.Methods A total of 45 children diagnosed with DD were recruited as case group in Department of Child Health,the Affiliated Hospital of Qingdao University,from August and November 2019.Meanwhile,50 normal children matched by gender,age and grade were selected as control group.The caregivers were asked to fill in the self-designed social demographic scale,Dyslexia Checklist for Chinese Children (DCCC),Pupil Rating Scale (PRS),Child Behavior Checklist (CBCL) and Symptom Self-evaluation Scale (SCL-90).SPSS 22.0 statistical software was used to describe and analyze the data.Results The total score of CBCL scale in case group was significantly higher than that in control group (47.58±33.66 vs.20.98±16.94,t=4.784,P<0.001).Except for bad communication (male)/sexual problem (female),the scores of other factors of CBCL in case group were significantly higher than those in control group (t=3.239,3.409,2.706,3.053,6.168,4.850,4.560,4.728,P<0.01).The positive rate of each factor in case group was higher than that in the control group,and the differences were statistically significant in factors of depression,social withdrawal,hyperactivity,aggressivity,and compulsivity(male)/ brutality(female)(χ²=7.034,7.385,7.034,9.460,17.463,P<0.01).The total score of SCL-90 scale in case group was significantly higher than that in the control group (139.28±37.80 vs.111.92±27.18,t=4.012,P<0.001),so was it in other factors of SCL-90 scale (t=3.335,4.167,3.913,3.724,3.188,4.328,3.818,3.363,3.454,P<0.01).And the positive rate of each factor in case group was higher than that in control group (χ²=10.791,17.625,12.868,9.490,18.727,9.886,13.282,15.097,15.097,P<0.01).The total score of the DCCC scale and the score of each subscale were positively correlated with each factor in CBCL and SCL-90.The significantly close correlations included the correlation between the total score of DCCC and aggressivity,the total score of DCCC and discipline violation,meaning understanding disorder and aggression,meaning understanding disorder and discipline violation, written expression disorder and aggressiveness,written expression disorder and discipline violation(r=0.522,0.500,0.515,0.506,0.558,0.528,P＜0.01).Conclusions Children with DD are more likely to develop behavioral problems and their parents' emotional problems are more common.Therefore,children with developmental dyslexia should be given behavioral intervention while learning skills training.At the same time,it is suggested to provide parents with psychological support to enhance the physical and mental health of children.

Study on the norm and the reliability of the second edition of the Ages & Stages Questionnaires:Social-Emotional with a Chinese national sample

BIAN Xiao-yan, SQUIRES Jane, LU Hong-mei, YI Yan, WANG Guo-wen, XU Ru-chai, SONG Wei, ZHANG Jing

2021, 29(1):  23-27.  DOI: 10.11852/zgetbjzz2020-1795

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Objective To introduce the Ages &Stages Questionnaires:Social-Emotional,Second Edition (ASQ:SE-2),a parent-completed screening questionnaires for psychological behaviors of children aged 1 to 71 months to China,and to create a Chinese version,thus to explore its cut-off scores for the norm and its reliabilities.Methods According to internationally accepted standard steps,the Chinese version of ASQ:SE-2 was established by cooperating with the original English authors.A stratified cluster random sampling method was utilized to recruit 2 830 children aged 1 to 71 months in 2017-2019 from respectively urban and rural areas in one moderately developed city in each of the six administrative regions of China as the sample,and 176 of them were retested for test-retest reliability.Primary caregivers of children were guided by national unified trained investigators to complete questionnaires online or in paper form.Through qualitative and quantitative analysis of the data,and comparison with the cut-off scores of the English version,the cut-off scores of Chinese children were established in combination with the national conditions.The internal reliability and test-retest reliability of the questionnaires were developed.Results The Chinese version of ASQ:SE-2 was established.The demographic characteristics of this Chinese sample matched the recent China census data on gender,urban or rural location and family income.The percentile norms of ASQ:SE-2 was established,and the 75th percentile (the recognition rate was 15.19%) and the 90th percentile (the recognition rate was 11.80%) were taken as the cut-off scores in the monitoring zone and above the cutoff,respectively.The Cronbach's alpha coefficient for the whole measure was 0.77,and test-retest reliability was 0.87(P<0.001).Conclusions ASQ:SE-2 is a reliable and valid measure with a representative national sample norm and appropriate cut-off scores.It can be used to screen and monitor the social-emotional behavior development of children in the mainland of China.

Study on mental health status and its influencing factors in kindergarten children in Shanghai

GAO Yue, ZHANG Yun-ting, ZHAO Jin, SHAN Wen-jie, WANG Xue-lai, ZHANG Zi-chen, ZHU Qi, DONG Yuan-yuan, JIANG Fan

2021, 29(1):  28-32.  DOI: 10.11852/zgetbjzz2020-1540

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Objective To study the mental health status and its influencing factors of new children in kindergartens,so as to provide theoretical basis for the follow-up strategy planning of children's health intervention.Methods Using multi-stage stratified cluster random sampling method,a total of 22 509 children from 187 kindergartens were selected from 16 districts and counties in Shanghai in 2017.Children's demographic characteristics,rearing environment and mental health were assessed by Index of Child Rearing Environment (ICCE) and Strengths and Difficulties Questionnaire (SDQ) via an online survey.Results Totally 22 067 children completed the survey,with an average age of 43.5 months old.And 18.29% of the children were detected with abnormal SDQ results.Chidren who were girls,with better socio-economic condition,not-only child, a completed family,adequate sleep,less screen time,and had no early adverse experience breastfed early had a significantly higher score of SDQ.The total score of SDQ and the high risk of each dimension were negatively related to ICCE score,and the odds ratio of avoiding restriction was the lowest(OR=0.713,0.754,0.493,0.553,0.506,0.726,P<0.001).Conclusions Parenting environment is not only related to family socioeconomic factors and family structure,but also related to the early breastfeeding experience.The nurturing environment plays an important role in promoting children's early development.

Internet indulgence and its relation with depression in the middle and high school students

BAO Cheng-zhen, GAO Li-li, HAN Li-li

2021, 29(1):  33-36.  DOI: 10.11852/zgetbjzz2020-1774

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Objective To explore the status of internet indulgence and the relations between internet indulgence and depression among middle and high school students,so as to provide reference for three-grade prevention.Methods A total of 4 500 students in Beijing participated in this survey from January,2018 to June,2018 by multistage cluster sampling.Based on field survey,students' internet indulgence,depression and other relevant data were collected.Results In 4 234 valid questionnaires,the percentages of students with features of poor fungibility of internet,high priority order for internet,high demand of internet game,and surfing the internet not less than 4 hours per day were 22.19%,19.62%,18.60% and 21.37%,respectively.The group with relatively heavy internet addiction also had a higher proportion of playing games online.And 43.33% perceived themselves to be addicted to the Internet,with parents being their main recourse.High priority order for internet (OR=1.63,95%CI:1.36-1.95),high demand for online game (OR=1.33,95%CI:1.10-1.60),and surfing the internet for a long time (2-3 hours per day:OR=1.40,95%CI:1.09-1.80;3-4 hours per day:OR=1.32,95%CI:1.01-1.75;≥4 hours per day:OR=1.80,95%CI:1.38-2.36) were independent risk factors of depression among the middle and high school students.Conclusions Internet indulgence become a severe situation in the middle and high school students,which might become the risk factor of depression,so parents should pay more attention to the prevention of internet addiction.

Effect of situational exercise training on motor function of children with motor retardation

XIAO Feng, ZHOU Li, PI Xiang

2021, 29(1):  37-41.  DOI: 10.11852/zgetbjzz2020-1515

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Objective To explore the effect of situational exercise training on motor function of children with motor retardation,so as to analyze its influence on motor function development,in order to provide scientific basis for clinicl application.Methods Totally 95 children with motor retardation were enrolled in this study from February 2018 to January 2019 and were divided into experimental group (n=48) and control group (n=47).The control group received early comprehensive intervention such as low frequency pulse electric stimulation,exercise therapy and somatosensory therapy,while the experimental group was given situational exercise training additionally.The physique,intelligence,motor ability and balance ability of the two groups were compared before treatment,2 months after treatment and 4 months after treatment,thus the clinical therapeutic effect was evaluated.Results The total effective rate of the experimental group was significantly higher than that of the control group (54.17% vs.31.91%,Z=2.212,P<0.05).After 2 or 4 months of treatment,the scores of gross motor quotient (GMQ),fine motor quotients (FMQ),mental development index (MDI),psychomotor developmental index (PDI),Berg Balance Scale (BBS) and development quotient (DQ) in experimental group were significantly higher than those in control group(P<0.05).Repeated measurement analysis of variance showed that the main effect of intervention and time on GMQ,FMQ,MDI,PDI,BBS and DQ was statistically significant (P<0.05),and there was interaction between the effect of intervention and time on these indicators (P<0.05).There was significant difference on the therapeutic efficacy among children with different degrees of motor retardation (H=7.433,P<0.05).The lighter the degree,the better the therapeutic efficacy.Conclusion Situational sports training can promote the gross and fine motor function,balance ability and intelligence level of children with motor retardation,which is worthy of clinical promotion.

Review

Review in neurobiological mechanisms of somatosensory disorders in autism spectrum disorder

HU Mei-xin, LI Hui-ping, XU Xiu

2021, 29(1):  42-46.  DOI: 10.11852/zgetbjzz2020-17501

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Somatosensory disorder refers to abnormalities in the somatosensory system's perception and processing of stimuli from the skin and deep tissues.It is one of the core symptoms of autism spectrum disorder (ASD),which seriously affects children's social,communication and adaptation skills development and prognosis.There are many studies on somatosensory disorders,but the mechanism between ASD and somatosensory disorders is still unclear.Therefore,this article will review the neurobiological mechanisms of somatosensory disorders and further analyze the known neurobiological mechanisms of ASD combined with somatosensory disorders,thereby providing an idea for understanding the role of somatosensory disorders in the pathogenesis of ASD and for exploring ASD intervention methods.

Research progresson voltage-gated calcium channel-encoding genes in autism spectrum disorders

JIAO Cui, LIU Tao

2021, 29(1):  47-51.  DOI: 10.11852/zgetbjzz2020-0945

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Autism spectrum disorder (ASD) is a generalized neurodevelopmental disorder with social disorders and narrow interest as common symptoms.Genetic contributions are its main pathogenesis.Research on ASD susceptibility genes is a hot topic in the medical field at home and abroad.Voltage-gated calcium channels (VGCC) are essential for the regulation of neuronal action potential and neurotransmitter release.Currently,all 10 subtypes of the VGCC encoding genes have been found to be associated with ASD.So this review aims to summarize the research progress of the 10 genes encoding VGCC and ASD.

Influence of the parental migration modes on problem behaviors of rural left-behind children

SHAO Mei-Ling, ZHANG Quan

2021, 29(1):  52-55.  DOI: 10.11852/zgetbjzz2019-1933

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The left-behind children in rural areas are a group with high incidence of problem behaviors.Under different modes of parental migration,the performances in problem behaviors of the group are different.By reviewing relevant studies recently,it is found that compared with non-left-behind children,left-behind children whose parents both migrated have higher prevalence rate of problem behaviors.When father or mother migrates,problem behaviors caused by mother's migration are more prevalent than that of father's migration.This review aims to provide an insight for future study on problem behaviors of rural left-behind children,provide suggestions for the government to adopt appropriate policies for left-behind children,such as improving the policy of migrant children and encouraging parents to return to hometown to start businesses by themselves.

Role of vitamin A in the treatment of iron deficiency and iron deficiency anemia

ZHU Dan, YU Wen

2021, 29(1):  56-59.  DOI: 10.11852/zgetbjzz2019-1755

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In recent years,it has been found that there is a significant correlation between vitamin A deficiency and iron deficiency.Vitamin A used to treat iron deficiency anemia and iron deficiency has achieved good clinical effect.This article reviews the correlation and mechanism between vitamin A deficiency and iron deficiency,as well as the clinical effect and research progress on vitamin A in the treatment of iron deficiency anemia,thus to provide basis for vitamin A in the treatment of iron deficiency anemia in children,and to give more effective reference for reducing the rate of iron deficiency anemia and iron deficiency.

Progress on the treatment and prevention of micronutrient deficiency in children with biliary atresia

XIAN Ruo-ling, HU Yan, LI Ying-cun

2021, 29(1):  60-62.  DOI: 10.11852/zgetbjzz2019-1784

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Biliary atresia (BA) is a common cause for cholestasis in neonates and is also the main disease for liver transplantation in children.Poor prognosis may occur for delayed treatment.Patients may accompany with malnutrition due to negative effect on digestion,absorption,metabolism caused by biliary obstruction.The lack of micronutrients,especially fat-soluble vitamins,may not only lead to the aggravation of the disease,but also cause other clinical symptoms.Therefore,this paper reviews the status,mechanisms,treatment and prevention of micronutrient deficiency in children with BA,thus to provide support for improvement of nutritional status and prognosis of these children.

Research progress on breast milk stem cells

HUANG Xing, YANG Fan

2021, 29(1):  63-66.  DOI: 10.11852/zgetbjzz2019-1752

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In recent years,the introduction of human breast milk stem cells (hBSCs) has made the understanding of the components and advantages of breast milk cells more diversified than before.Its non-invasive cell source,multiple differentiation potential,self-renewal ability and other characteristics make it of great significance in cell replacement therapy and regenerative medicine.This will provide a new way to describe the importance of breast milk in early life and explain how breast milk has a positive influence on the long-term health of infants and adults.In this review,the source,acquisition,distribution and functional characteristics of hBSCs are described,and the future application direction is discussed.

Clinical Research

Investigation on the sleep problems in children with attention deficit hyperactivity disorder

CHEN Feng-feng, WEI Nian-jin, MA Chen-huan, PAN Li-zhu, WANG Yu

2021, 29(1):  67-70.  DOI: 10.11852/zgetbjzz2020-0153

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Objective To investigate the sleep problems of children with attention deficit hyperactivity disorder (ADHD),in order to provide reference for the comprehensive assessment and intervention of ADHD.Methods A total of 186 children diagnosed with ADHD and 215 healthy children aged 5 to 12 years were enrolled in this study from July 2019 to November 2019 in Shanghai Children's Hospital.Sleep onset latency,sleep time,sleep efficiency,sleep disorders and common sleep problems were assessed by using a questionnaire in aspects of sleep quality and problems,and the results were compared with those of healthy children.Results Totally 8.60% (16/186) of the children in the ADHD group had sleep quality problems,and it was 2.79% (6/215) in healthy controls,the difference was significant(χ²=6.495,P<0.05).Sleep problems mainly manifested in prolonged sleep time and decreased sleep efficiency,which were scored as 1(1,2) and 0(0,0) in ADHD group,0(0,1) and 0(0,0) in control group,and the differences were significant (Z=-7.090,-3.504,P<0.05).As for common sleep problems,the incidence of bed-wetting was 17.7% (33/186) in ADHD group,4.7% (10/215) in the control group (χ²=17.852).The rate of sleep disordered breathing was 7.0% (13/186) in ADHD group,2.3% (5/215) in control group (χ²=5.059).The rate of involuntary twitching during sleep was 23.7% (44/186) in ADHD group,12.1% (26/215) in control group (χ²=9.253),and the differences on the above indicators were significant (P<0.05).Conclusions Sleep problems are common in ADHD children,and the prevalence of involuntary twitching during sleep is high.Thus the comorbidity of sleep problems in ADHD children need to be evaluated and intervened in clinical diagnosis and treatment.

Effects of recombinant human growth hormone therapy on psychological behavior of children with idiopathic short stature

ZENG Pei-pei, HUANG Li-ping, DENG Liang-qiong, FENG Yu-shan, XIONG Li, ZENG Ting, LI Hong-hui

2021, 29(1):  71-74.  DOI: 10.11852/zgetbjzz2020-1695

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Objective To investigate the effect of recombinant human growth hormone therapy on the psychological behavior of children with idiopathic short stature (ISS),in order to provide reference for clinical treatment.Methods From January 2018 to December 2019,a total of 70 children with ISS treated in Liuzhou Maternity and Child Healthcare Hospital were randomly divided into treatment group and control group,with 35 cases in each group.The treatment group was given recombinant human growth hormone 0.15 IU/(kg·d) and injected subcutaneously before bedtime.Both groups received enhanced nutrient supplement,proper exercise,adequate sleep and good mood,and the treatment lasted for 6 months.After the treatment,the score of psychological behavior were compared between two groups.Results After treatment,the scores of split-like,hyperactivity,aggression,violation of discipline factors for boys,(t=4.465,5.053,7.064,5.804,6.815,5.112) body complaint and division forcing factor for girls (t=6.815,5.112) in the treatment group were lower than those before treatment(P<0.05).The scores of split-like,hyperactivity,aggression,violation of discipline factors for boys (t=-3.576,-2.551,-6.100,-2.859),body complaint,social retreat and division forcing factor for girls (t=-7.357,-5.036) in the treatment group were significantly lower than those in the control group after treatment (P<0.05).Conclusions Recombinant human growth hormone therapy can effectively improve some psychological and behavioral problems in ISS children.Recombinant human growth hormone therapy can make the physical and mental development of ISS children more stable and healthy,thus reducing the incidence of psychological and behavioral problems in ISS children.

Study on the association between sleep time and physical activity of high school students in Urumqi

JI Xiao-peng

2021, 29(1):  75-78.  DOI: 10.11852/zgetbjzz2019-1631

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Objective To understand the sleep status and physical activity of high school students in Urumqi,and to analyze the relationship between them,so as to provide effective support for improving the physical activity level of high school students in Urumqi.Method From October to December 2018,a self-designed questionnaire was used to investigate the sleep and physical activity of 5 424 high school students in Urumqi,and the association was analyzed.Results The proportion of high school students with insufficient sleep in Urumqi was higher in girls(56.53%),higher grade students(84.96%),students who exercise less(63.03%),have less physical education classes(62.17%) and have no extracurricular activities(58.14%) (P<0.01).Multivariate Logistic analysis showed that walking or cycling for 30 min/d less than 1 d/week (OR=1.134,95%CI:1.014-1.268,P<0.001),and no extracurricular activities each week (OR=1.416,95%CI:1.248-1.492,P<0.001) were risk factors for sleep insufficiency.Conclusions Sleep insufficiency in high school students in Urumqi is serious.Cycling,extracurricular sports activities and step walking play a positive role in promoting sleep.So it is suggested for high school students to participate in physical exercise as much as possible in order to improve physical activity and to promote sleep.

Study on changes for behavior problems of 4- to 6-year-old children in Xi'an in 2007 and 2018

HE Hong-ling, LIU Yu-chen, ZHANG Da-wei, LI Na, MA Ming-fang, LIU Hui, YANG Lu, GAO Cheng-ge, HUANG Yan-ping

2021, 29(1):  79-83.  DOI: 10.11852/zgetbjzz2020-0402

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Objective To observe the changes of behavior problems in 4- to 6-year-old children in 2007 and 2018,so as to provide the evidence for promoting healthy development of their behavior.Methods A cluster random sampling method was used to select 4- to 6-year-old children in five kindergartens from East,West,South and North of Xi'an in October 2007 and October 2018.Achenbach Child Behavior Checklist Questionnaire for Children Aged 4-16 (for parents) (CBCL) was used to investigate the behavioral problems with anonymous way.Data were analyzed by SPSS 21.0 software.Results 1) The abnormal rates of immature behavior (2.36% vs. 0.23%) and sexual problem (7.26% vs. 18.85%) of children were significantly higher in 2018 than those in 2007 (P<0.05).The total abnormal rate of behavioral problems of children in 2018 (24.1%) was significantly higher than that in 2007 (18.8%)(P<0.05).2) The abnormal rate of depression factor of girls aged 4—5 years in 2018 was higher than that in 2007,and the abnormal rate of three factors including schizoidia,social withdrawal and sexual problems in 2018 were lower than those in 2007.And the total abnormal rate in 2018 was 30.3%,significantly lower than that in 2007(37.5%) (P=0.029).3) The abnormal rate of bad communication in 6-year-old boys in 2018 (1.96%) was significantly lower than that in 2007 (14.29%) (P>0.05).But it was not found significant difference on the abnormal rate of all factors of behavioral problems in girls,and the total abnormal rate of behavioral problems in 6-year-old children between the year 2018 and 2007(P>0.05).Conclusions The abnormal rate of behavioral problems in 4- to 6-year-old children at different age groups changes differently during 11 years.In terms of behavioral problems,the abnormal rate in boys significantly increased,while it decreased in girls.It is suggested that parents and preschool workers should give active intervention individually according to the characteristics of children's age and gender,so as to promote the healthy development of children's behavior.

Analysis of clinical features of children comorbid epilepsy and attention deficit hyperactivity disorder

GUO Ying-ying, LIU Yu, WANG Xue-ying, YANG Lin, HUANG Shao-ping, LEI Xiao-mei

2021, 29(1):  84-87.  DOI: 10.11852/zgetbjzz2020-0338

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Objective To describe the clinical characteristics of attention deficit hyperactivity disorder (ADHD) in children,and to evaluate the prevalence and risk factors for comorbidity of epilepsy and ADHD,in order to provide scientific reference for clinical intervention and treatment.Methods A total of 120 children aged 6 to 15 years,who were admitted to the Department of Pediatric Neurology of the Second Affiliated Hospital of Xi'an Jiaotong University from January 2018 to December 2018 and were diagnosed with epilepsy according to National Anti-epilepsy Alliance Criteria,were enrolled in this study.ADHD was detected in children with epilepsy using Diagnostic and Statistical Manual of Mental Disorders-5(DSM-5),and the clinical characteristics of ADHD with epilepsy were analyzed.Results Totally 23(19.2%) of 120 children with epilepsy were diagnosed with ADHD,most of which were inattentive type (65.2%).Gender,the initial onset age,course of disease and multiple antiepileptic drugs were closely related to the comorbidity of ADHD(χ²=4.90,7.42,7.75,5.23,P＜0.05),while the type of seizures and the origin of the electroencephalogram discharge had no effect on the prevalence of ADHD with epilepsy.Conclusion ADHD occurs frequently in children with epilepsy,and gender,the onset age of epilepsy,the course of disease as well as the combined application of antiepileptic drugs were closely associated with the prevalence of ADHD in children with epilepsy,which should be paid more attention in clinical practice.

Analysis of the prevalecnce and risk factors of flatfoot in primary and secondary school students in Shenzhen

CHENG Xiang-yu, LIU Jian-quan, ZHAO Zhe, CHEN Xiao-qiang, LI Wen-cui

2021, 29(1):  88-91.  DOI: 10.11852/zgetbjzz2020-0851

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Objective To investigate the prevalence of flatfoot and its related factors in primary and secondary school students in Shenzhen,in order to provide scientific reference for foot &ankle healthcare.Methods From June to December in 2019,11 884 primary and secondary school students aged 6-14 in 10 primary and secondary schools in Shenzhen of Guangdong Province were screened for flatfoot disease,and the data of gender,age,body mass index (BMI),family history of flatfoot,distance from residence to school and activity time were collected.The specialist examination and footprints analysis were performed in primary and secondary school students,and those with positive screening and symptoms were will be further examined by X-ray of foot weight-bearing position in the hospital,then were divided into mild,moderate and severe flatfoot.Results Totally 1 397 (11.76%) primary and secondary school students were screened with positive results,of which 932 (66.71%) were diagnosed with mild flatfoot,289 (20.69%) with moderate flatfoot,176 (12.60%) with severe flatfoot.Students who were younger,obese,male and with family history for flatfoot had a higher risk for flatfoot(P＜0.05).Conclusion The prevalence rate of flatfoot in primary and secondary school students in Shenzhen is slightly higher than the international average level,so attention should be paid to foot and ankle healthcare of high risk children.

Experience Exchange

Survey on behavior problems of pupils and family related factors in Zhengzhou

FANG Shuan-feng, ZHANG Yi-xia, YE Bei, JIAO Min, ZHU Xiao-hua, REN Ling-min

2021, 29(1):  92-96.  DOI: 10.11852/zgetbjzz2020-1697

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Objective To explore behavior problems of pupils in Zhengzhou and analysis of its family related influencing factors,and to provide reference and basis for targeted intervention of behavioral problems of primary school students.Methods A total of 3 180 pupils were randomly sampled from 5 districts in Zhengzhou in June of 2019.Using the Conners Parent Symptom Questionnaires (PSQ) and self-designed children common condition Scale to evaluate behavior problems and make statistical analysis.Results A total of 3 180 questionnaires were issued,and 3 063 valid questionnaires,with an effective rate of 96.3%.588 pupils' behavior problems were positive (19.2%).Among them,1 669 were male,349 (20.9%) were found to have behavioral problems,and 1394 were female,and 248 (17.8%) were found to have behavioral problems,the difference was statistically significant (χ²=4.646,P=0.031).Compared with the sixth grade children,there was no significant difference in the detection rate of behavioral problems in the third grade [Odds Ratio (OR)=0.910,95% CI:0.648-1.210],but there was significant difference in the detection rate of behavioral problems in fifth grade,fourth grade,second grade,first grade [OR (95% CI) were 0.617(0.449-0.846),0.633(0.474-0.845),0.377(0.263-0.540),0.281(0.204-0.388) respectively,P<0.01].Compared with the father addicted to the Internet,the detection rate of behavioral problems in the children whose father did not indulge in the Internet was lower,and the difference was statistically significant(OR=0.647,95% CI:0.498-0.840,P=0.001).Compared with the children whose mother's occupation was a cadre,there was a statistically significant difference between the mother's occupation was teacher and farmer[OR (95% CI) were 0.578(0.342-0.977),0.349(0.219-0.555) respectively,P<0.05 or <0.01].Conclusions The detection rate of behavior problem of pupils in zhengzhou is high and it need further attention.Gender,grades,whether the father was is indulged in the internet and mother's occupation are the influencing factors of behavior problems of pupils in Zhengzhou.

Clinical investigation analysis of tic disorders in children with and without attention deficit hyperactivity disorder

SUN Yun-yun, HAN Fei, YANG Qing-qing, LI Ji

2021, 29(1):  97-100.  DOI: 10.11852/zgetbjzz2021-0830

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Objective To analyze the clinical characteristics of tic disorders (TD) in children with and without attention deficit hyperactivity disorder (ADHD),in order to provide ideas for clinical treatment.Methods A total of 408 children aged 6 to 12 years old with TD-only and TD+ADHD were randomly selected from Pediatric Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences from June 2018 to November 2019,including 296 children with TD-only and 112 children with TD+ADHD.The differences on the incidence,such as disease course,clinical subtypes,onset age of TD,severity of TD between the two groups were compared,and the distribution of ADHD in TD+ADHD group were analyzed.Results In terms of Yale Global Tic Severity Scale(YGTSS) score and damage ratio,the TD+ADHD group was significantly higher than the TD alone group(t=-23.24,-19.17,P<0.001),which were not affected by the ADHD subtype.In TD+ADHD group,the score of attention-deficit subscale was significantly higher than that of hyperactivity/impulsivity (t=2.96,P＜0.05).The age of TD comorbid with hyperactivity/impulsiveness of ADHD (TD+ADHD-HI) and TD comorbid with the mixed of ADHD (TD+ADHD-C) was lower than that of TD comorbid attention-deficit of ADHD (TD+ ADHD-I) (F=7.93,P=0.019).Conclusions The condition is more serious in children with TD+ADHD,but the severity is not affected by the ADHD subtype.Moreover,compared with TD+ADHD-I,the early behavioral problems of TD+ADHD-HI and TD+ADHD-C are more prominent and easy to be early identified.However,the attention deficit of children with TD+ADHD-I is usually very serious when seeing doctors.

Investigation of early social-emotional development and the family environment related factors of children under 3 years old in Kunshan

LU Ping, YU Qian, BIAN Xiao-yan, CHEN Lei

2021, 29(1):  101-105.  DOI: 10.11852/zgetbjzz2020-1256

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Objective To understand the social-emotional development of children under 3 years old in Kunshan,and to analyze the influence of family environment on social emotional development.Methods Infants and toddlers who took physical examination in 6 community health service centers from September 2018 to August 2019 were enrolled in this study.The age and Development Progress Questionnaire-social Emotion Scale was used for screening.The family environment information of infants and toddlers was collected,and the influence of family environment on the emotional and social development of them was analyzed by multivariate logistic regression.Results The total detection rate of social emotional problems was 24.56%. The detection rate of high-risk children was 33.0%,significantly higher than that of normal children(χ²=16.608,P＜0.01).The detection rate of social emotional problems was 24.71% for boys and 24.39% for girls,and the difference was not significant(χ²=0.014,P>0.05).With the increase of age,the detection rate of social and emotional problems increased(χ²=28.89,P＜0.01).Logistic regression analysis showed that higher maternal education (OR=0.547,95%CI:0.338-0.886) and the higher-income family (OR=0.714,95%CI:0.593-0.921) were protective factors for social emotional problems of infants and toddlers.Conclusions The rate of social emotional problems of infants in Kunshan region is high.Maternal education and family income have important effects on early social and emotional development in infants.

Appropriate Technology

Construction and practice of two-way referral platform for children's mental health care in Beijing

ZHANG Wan-xia, WEI Zhuang, ZHAO Ming, LI Shi-jie, DU Juan, LIANG Ai-min

2021, 29(1):  106-109.  DOI: 10.11852/zgetbjzz2020-1218

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Objective To make full use of the resources of grassroots and top professional pediatric hospitals,establish a two-way referral platform for children's mental health care in Beijing,in order to provide convenient diagnosis and comprehensive intervention management services for children with psychological development deviation and suspicious behavior problems,so as to achieve the ideal result.Methods Through the platform,558 referral samples with psychological development deviation and suspicious behavior problems,who transferred from 16 district-level early childhood development centers from November 9th,2018 to December 31st,2019 were enrolled in this study.And their related data on comprehensive intervention,regular monitoring and follow-up management provided by children's health center were analyzed to carry out practical research and support preliminary assessment of the platform.Results Totally 524 cases (93.91%) with psychological behavior problems were diagnosed in the children's health center,through the way of inner collaboration to complete the diagnostic development assessment,medical behavior observation and necessary examination of causes in 558 referral samples.The top four types of the confirmed cases included overall retardation (301,53.94%),language retardation (119,21.33%),autism spectrum disorders (61,10.93%) and motor development delay (29,5.20%).Regular follow-up indicated that 408 (77.86%) children received various forms of rehabilitation interventions in the health center and the district child development center,and the efficacy rate was 29.77%.Conclusion As a successful practice to optimize the model of children's mental health care,this platform fully integrates multi-level and multi-discipline medical resources,carries out efficient two-way referral,implements comprehensive intervention management,facilitates and benefits the people.

Consensus

Expert consensus on clinical application of vitamin A and vitamin D in Chinese children

Child Health Care Professional Committee, Chinese Preventive Medicine Association

2021, 29(1):  110-116.  DOI: 10.11852/zgetbjzz2020-2118

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