Table of Content

10 April 2022, Volume 30 Issue 4

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Professional Forum

Advances and reflections on nutrient signalling pathways as biomarkers of autism spectrum disorders

LI Ting-yu

2022, 30(4):  349-351.  DOI: 10.11852/zgetbjzz2022-0335

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Autism spectrum disorder (ASD) is a common and complex neurodevelopmental disorder. Nutrition plays an important role in the growth and development of children, and there is a certain relationship with the occurrence, development and prognosis of ASD subtypes. With the deepening of research, correlating ASD symptoms with serum nutrient levels has been extremely challenging. This manuscript takes folic acid and vitamin A (VA) as examples to review the new ideas of using nutrient signaling pathway as a potential biomarker of ASD, hoping to provide reference for further exploring the occurrence, diagnosis and treatment of ASD.

Electronic health programs for behavioral intervention and management of autism spectrum disorder

WU Li-jie

2022, 30(4):  352-354.  DOI: 10.11852/zgetbjzz2022-0336

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Autism spectrum disorder (ASD) is a complex of neurodevelopmental disorder. There are no targeted drugs to ASD, and the main treatment is behavioral intervention. Electronic health (e-health) programs for intervention and management of ASD have attracted considerable attention. This paper focuses on the research progress in e-health for ASD, so as to provide evidence for professionals.

Original Articles

Association between picky eating and core symptoms in children with autism spectrum disorder

AI Nü-tian, ZHANG Qian, YANG Ting, CHEN Jie, CHEN Li, DAI Ying, JIA Fei-yong, WU Li-jie, HAO Yan, LI Ling, ZHANG Jie, KE Xiao-yan, YI Ming-ji, HONG Qi, CHEN Jin-jin, FANG Shuan-feng, WANG Yi-chao, WANG Qi, JIN Chun-hua, LI Ting-yu

2022, 30(4):  355-360.  DOI: 10.11852/zgetbjzz2021-0398

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Objective To investigate the relationship between severely picky eating and the core symptoms among children with autism spectrum disorder(ASD),so as to provide reference for early identification and targeted intervention. Methods From May 2018 to December 2019,1 349 children aged 2 to 7 years were enrolled in this study from 13 hospitals in 13 cities across the country,meanwhile 1 170 typically developed children were recruited. A self-made questionnaire was used to investigate the picky eating status of ASD children. Autism Behavior Scale(ABC),Social Response Scale(SRS) and Childhood Autism Rating Scale(CARS) were used to assess the core symptoms of ASD children. Linear regression was used to analyze the impact of severely picky eating on physical growth and core symptoms of ASD. Results The rate of severely picky eating in ASD children was 56.5%(763/1 349),which was 29.7%(348/1 170) in TD children. It was found that ASD and the age of children in two groups were risk factors for occurrence of severe picky eating after adjusting for confounding factors(OR=3.075,1.183,1.156,P＜0.05). Severely picky eating significantly affected ASD children's weight,body mass index(BMI),scores of ABC scale and subscales,scores of SRAS scale and subscales(β=-0.220,-0.319,6.305,1.139,2.111,1.043,1.427,0.946,5.908,0.597,1.029,1.517,1.328,1.503,P<0.05). Conclusions There is a high incidence and persistence of severely picky eaters in autistic children. Severely picky eating has significant impact on children's weight growth and BMI,and is associated with core symptoms of ASD. Therefore,clinical medical staff should pay more attention to the assessment of picky eating behaviors in ASD children,so as to carry out early identification and precise intervention of children.

Associations of maternal anxiety with emotional and behavioral problems in children with autism spectrum disorder

LIU Si-yu, LIN Li-zi, WANG Xin, DAI Mei-xia, CHEN Qian, CHEN Jia-jie, CAO Mu-qing, JING Jin

2022, 30(4):  361-365.  DOI: 10.11852/zgetbjzz2021-0756

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Objective To compare maternal anxiety between children with autism spectrum disorder (ASD) and children with typical development (TD), and to explore the associations of maternal anxiety with emotional and behavioral problems in children with ASD. Methods A total of 55 ASD children and 74 TD children aged 6 to 12 years were recruited in this study. Station-Trait Anxiety Inventory (STAI) was used to evaluate maternal anxiety, and Strengths and Difficulties Questionnaire (SDQ) was used to assess children's emotional and behavioral problems. Results Mothers of ASD children had a higher level of maternal anxiety including state anxiety score and trait anxiety score (t=5.272, 4.484, P<0.05). In terms of SDQ, ASD children had higher scores of emotional and behavioral problems, hyperactivity/attention deficit, emotional symptoms, peer relationship problems and conduct problems(t=10.791, 7.482, 4.295, 12.925, 3.544, P＜0.05), and lower score of prosocial behaviors than TD children (t=5.084, P<0.01). In children with ASD, both maternal state anxiety and trait anxiety score were positively associated with total difficulties score [S-AI: β=0.83 (95%CI: 0.19 - 1.46), T-AI: β=0.60 (95%CI: 0.05 - 1.14), P<0.01] and emotional symptoms score [S-AI: β=2.28 (95%CI: 0.72 - 3.84), T-AI: β=2.04 (95%CI:0.74 - 3.33), P<0.01]. In TD children, maternal state anxiety score was positively associated with total SDQ score [β=0.50 (95%CI: 0.03 - 0.96), P<0.05] and conduct problem score [β=1.74 (95%CI:0.19 - 3.30), P<0.05], maternal trait anxiety score was positively related to conduct problem score [β=1.54 (95%CI: 0.09~3.00), P<0.05]. Conclusions Mothers of ASD children have higher levels of anxiety than those of TD children. Maternal anxiety is associated with emotional problems in ASD children, while it is associated with conduct behaviors in TD children.

Correlation between repetitive and stereotyped behaviors and sensory gating in autism spectrum disorder

HAO Hui-rui, DONG Xian-wen, LI En-yao, FAN Ya-lei, CHENG hui, JIANG Miao-miao, ZHAO Peng-ju

2022, 30(4):  366-370.  DOI: 10.11852/zgetbjzz2021-0669

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Objective To explore the developmental trajectory of restricted and repetitive behavior (RRB) in children with autism spectrum disorder (ASD), and to determine whether there is a correlation between RRB and sensory gating, so as to provide reference for clinical diagnosis and treatment. Methods From August 2018 to May 2021, 89 children with ASD and 76 children with global developmental delay (GDD) in Children's Rehabilitation Department of the Fifth Affiliated Hospital of Zhengzhou University were selected into this study. RRB was assessment by the Repetitive Behavior Scale-Revised (RBS-R), and cerebral sensory gating was evaluated by the sensory gating P50 ratio, and the correlation was analyzed. Results There was no significant correlation of the total scores, low-level and high-level of RRB with sensory gating in ASD children and GDD children (P>0.05). There was no significant decrease with age in the total scores, low-level and high-level of RRB in ASD children (P>0.05). However, RRB score was negatively related to the age of children with GDD (r=-0.43 to -0.23, P<0.01). Conclusions The developmental trajectory of RRB in ASD children is not a simple negative linear curve with age. There is no significant correlation between RRB and sensory gating. P50 may not be an effective index to predict repetitive and stereotyped behaviors.

Association between maternal passive smoking exposure before/during pregnancy and the risk of autism spectrum disorders in offspring

LIU Xian, GUO Cheng, YI Peng, CHEN Yi-ru, CHEN Wen-xiong

2022, 30(4):  371-375.  DOI: 10.11852/zgetbjzz2021-0628

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Objective To explore the association between maternal passive smoking exposure before/during pregnancy and the risk of autism spectrum disorders (ASD) in offspring, so as to provide theoretical reference for the prevention of ASD. Methods A total of 141 children diagnosed with ASD (ASD group) in Guangzhou Women and Children's Medical Center and a rehabilitation organization and 247 healthy children (control group) were enrolled in this case-control study. The questionnaire survey was performed to collect the general characteristics and parental passive smoking exposure information. Univariate and multivariate Logistic regression analysis were used to examine the association between perinatal maternal passive smoking exposure and the risk of ASD in their offspring. Results Maternal passive smoking exposure either before pregnancy (crude OR=6.69,95%CI:2.33 - 19.25) or during pregnancy(crude OR=5.78,95%CI:2.15 - 15.49) had significantly increased the risk of ASD in their offspring. After adjusting the confounders such as children's sex, parity, maternal education, maternal vitamin intake and paternal passive smoking before pregnancy, the trends above remained. After sex matching, the sensitivity analysis showed that maternal tobacco exposure before and during pregnancy still served as a risk factor for offspring's ASD. Conclusion Perinatal maternal passive smoking exposure might be associated with the increasing risk of offspring's ASD.

Preliminary development, reliability and validity of Screening Questionnaire of Autism in Toddlers

ZHENG Rui-xuan, ZHANG Li-li, ZHOU Zi-yun, CAO Jia-yan, ZHOU Xing, QIAN Yu-qian, DU Fei-yu, CHENG Zao-huo

2022, 30(4):  376-380.  DOI: 10.11852/zgetbjzz2021-0250

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Objective To develop a screening questionnaire of autism suitable for children with Chinese cultural background, and to test its reliability and validity. Methods Screening Questionnaire of Autism in Toddlers (SQAT) was compiled based on the relevant research results and DSM-5 diagnostic criteria for autism spectrum disorder (ASD).Totally 238 children in outpatients or physical examination and 392 children in rehabilitation training institutions were selected for the SQAT assessment, 28 of them were retested 2 to 4 weeks later, and some children were tested by criteria scale.The item selection, reliability and validity of the questionnaire were made by expert evaluation, item analysis, correlation analysis, factor analysis and ROC analysis. Results Thirteen items with good responsiveness (0.394 - 0.626), discrimination (0.465 - 0.697) and common factor loading (0.317 - 0.605) were selected to form the SQAT, which included social and behavioral components.The S-CVI/UA and S-CVI/Ave of expert evaluation was 0.99 and 0.89, respectively.The Cronbach'α coefficients, split-half reliability and retest reliability of the total scale and two components were 0.770 - 0.851, 0.838 - 0.890 and 0.601 - 0.734, respectively.Exploratory factor analysis extracted two factors with eigenvalue >1 and accounted for 50.2% of variance, and confirmatory factor analysis showed that the two factor model of SQAT had a good fit (RMSEA=0.055, NFI=0.872, IFI=0.926, CFI=0.924).The correlation coefficients of total and component scores with ABC and M-CHAT-R/F were 0.518 - 0.656 and 0.305 - 0.833, respectively (P<0.01), and total score of ASD group (23.26 ± 4.73) was higher than that of GDD group (17.32 ± 3.39) and TD group (15.85 ± 2.01) (P<0.01).The sensitivity, specificity and positive predictive value of the SQAT in screening ASD were 82.00%, 80.60% and 96.46%, respectively. Conclusion SQAT has good reliability and validity, which can be used as a preliminary screening tool for children with ASD.

Reliability and validity of the Chinese version of the Quantitative Checklist for Autism in Toddlers

XIAO Ting, XIAO Xiang, CHU Kang-kang, KE Xiao-yan

2022, 30(4):  381-385.  DOI: 10.11852/zgetbjzz2021-0484

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Objective To assess the reliability and validity of the Chinese version of the Quantitative Checklist for autism in toddlers (Q-CHAT), so as to provide an appropriate tool for early screening of autism spectrum disorder(ASD). Methods From July 2019 to January 2020, a total of 91 18- to 48-month-old ASD children diagnosed by DSM-5, alongside 45 age-matched individuals with other developmental disabilities (DD) and 60 typically developed (TD) children were screened by the Q-CHAT and Childhood Autism Rating Scale (CARS). Results The test-retest reliability was satisfactory (r=0.89).In addition, the Cronbach's α coefficient for internal reliability was 0.67(P<0.05).The Q-CHAT score was significantly correlated with the total CARS score (r=0.44, P<0.001).And correlation coefficients of 0.22—0.60 were obtained between the Q-CHAT score and total CARS score for various items.ROC analysis of ASD versus unaffected control subjects showed an area under the curve of 0.87, yielding maximum sensitivity (0.71) and specificity (0.92) with a cutoff of 45 points.Q-CHAT scores were significantly higher in ASD children compared with control children(t=9.42, P＜0.01), revealing sufficient discriminant validity. Conclusion Chinese version of Q-CHAT can be used for early screening of ASD children in urban Mandarin Chinese speaking populations with acceptable reliability and validity.

Preliminary development and evaluation of the Responsive Caregiving Rating Scale for children aged 0 to 4 years

HUANG Ying, ZHANG Hai-feng, TONG Lian

2022, 30(4):  386-391.  DOI: 10.11852/zgetbjzz2021-0474

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Objective To develop the Responsive Caregiving Rating Scale for children aged 0 to 4 years (RCRS), and to testify its reliability and validity. Methods Based on attachment theory and the existing responsive caregiving scales, the original items of the scale were formed. A total of 2 759 parents whose children aged 0 to 4 years in Shanghai were recruited from March to May 2020, and each parent was asked to fill in an online questionnaire. Exploratory factor analysis and confirmatory factor analysis were performed to test the structural validity. The Strengths and Difficulties Questionnaire (SDQ) was used to test the concurrent validity. Results The exploratory factor analysis indicated that RCRS had 16 items grouped into three dimensions, which explained 78.04% of the total variance. The confirmatory factor analysis showed that the three-dimension model fit well (CFI=0.971, TLI=0.965, RMSEA=0.069, SRMR=0.024). The Cronbach's α coefficient for the overall scale was 0.97, which in the dimensions of promotion of cognitive and emotional development, responsive, respect for autonomy was 0.95, 0.93 and 0.91, respectively. The scores of RCRS were significantly different between the normal and the abnormal children evaluated by SDQ(Z=7.071,P<0.05). Conclusion The RCRC is demonstrated to be an ideal tool with good reliability and validity to assess the quality of responsive caregiving.

Review

Research progress in the regulation of endocannabinoid system on abnormal neuroinflammation in autism spectrum disorder

XIE Shu, LIU Yu, LI De-xin, LI Ling, ZOU Ming-yang, SUN Cai-hong

2022, 30(4):  392-395.  DOI: 10.11852/zgetbjzz2020-1839

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Autism spectrum disorder (ASD) is a serious neurodevelopmental disorders with an increasing prevalence all over the world.Emerging evidence has implicated that neuroinflammation is one of the causes of ASD, including abnormal expression of inflammatory cytokines and abnormal activation of microglia.The endocannabinoid (eCB) system plays a key role in the regulation of the central nervous system, regulating the neuroinflammation and maintaining the immune balance.It has been confirmed that there is decreasing eCB signaling in ASD, and increasing eCB signaling can reduce the abnormal neuroinflammation of ASD and improve ASD symptoms.Therefore, inhibiting neuroinflammation by regulating the eCB system could be a new therapeutic target for ASD.This review combs the relationship and effect among the eCB system, neuroinflammation and ASD.

Research progress in the motor difficulties in children with autism spectrum disorder

LONG Dan, LI Ting-yu

2022, 30(4):  396-400.  DOI: 10.11852/zgetbjzz2020-2163

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Children with autism spectrum disorders(ASD) are often accompanied with motor difficulties,and perform as early motor delay,motor learning difficulties,slow movement,fitness decline and so on,which is affected by heredity,age,core symptoms,comorbidity,intervention and other factors. The motor difficulties of ASD children are often ignored,which disturb their learning and social activities. Pediatricians should monitor the early motor difficulties of ASD children,and carry out individualized training according to their characteristics in order to promote motor development and improve core symptoms,thus improving their quality of life.

Research progress in the mechanism of attention deficit hyperactivity disorder combined with obesity

CHEN Shu-jin, WU Dan-dan, LI Xiao-nan

2022, 30(4):  401-404.  DOI: 10.11852/zgetbjzz2021-0002

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Epidemiological survey shows that the incidence of attention deficit and hyperactivity disorder with comorbid obesity is relatively high. Obesity not only increases the risk of hypertension and hyperglycemia, but also impairs the social function of ADHD patients, which brings challenge to the management of ADHD. Recent etiology studies about the comorbidity of ADHD and obesity reveal that brain volume and functional connectivity abnormalities, abnormal neurotransmitters metabolism and high genetic correlations may explain part of the causes.

Application of quantitative electroencephalogram in the study of neonatal brain function

PENG Zhen, TU Wen-juan

2022, 30(4):  405-408.  DOI: 10.11852/zgetbjzz2020-1644

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In the study of brain function, the original interpretation of the routine electroencephalogram(EEG) results is strongly professional, and is easily influenced by subjective factors, so there is certain limitation in clinical and research applications.As an extension of the original EEG, the emergence of quantitative EEG (qEEG) has a qualitative leap to the study of brain function.In addition to the advantages of objectivity, timeliness, non-invasiveness and dynamic follow-up, a greater advantage is that qEEG can reflect the energy of the size and function of the brain in a quantitative way.So it can be used as an important method for the study on clinical brain function and brain injury.In recent years, many scholars have made some progress on brain diseases by using qEEG.This paper reviews the progress of this technique in the study of neonatal brain function.

Research advances in immunopathological mechanism of Tourette syndrome

ZHANG Xiao-ling, LIU Xiu-mei

2022, 30(4):  409-412.  DOI: 10.11852/zgetbjzz2020-2044

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Increasing studies focus on the association between immune reactions and the onset of Tourette syndrome (TS).This article reviews the immunological mechanism involved in the development of TS.Immune dysfunction plays an important role in the pathophysiology of TS and may be the characteristic of a specific subgroup in TS heterogeneity spectrum disorder.Different distribution and expression of immune cell subpopulations, immune cytokines or genes affect the immune response in patients with TS.Hyperdopamine function, increased microglia activation and autoantibodies are involved in the immunopathological mechanisms of TS development.Therefore, large-scale prospective studies are warranted to further explore the causal relationship between the neuropsychiatric symptoms and immune dysfunction of TS.

Current status of eye health management in children and adolescents

LI Ling, ZHANG Hong

2022, 30(4):  413-416.  DOI: 10.11852/zgetbjzz2020-1710

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Eye health is an indispensable foundation in the process of human growth, and it is related to the academic achievement, mental health and social development of children and adolescents. However, the eye health of children and adolescents is not optimistic. The visual impairment of young people, especially myopia, poses a major public health challenge. During the "13th Five-Year Plan" period, the demand for eye health is increasing. The government, schools and families attach great importance to eye health and actively explore eye health management models. Therefore, protecting the eye health of children and adolescents requires the whole society to take action. This article reviews the eye health management of children and adolescents at home and abroad in recent years from the four levels of policy, school, family and individual, thereby providing references for further improving the level of eye health of children and adolescents.

Meta Analysis

Three-level Meta-analysis of the relationship between parental
control and depression in children and adolescents

WEI Xing, GAO Shuang, XU Jiang, WANG Wen-juan, ZHAO Yuan

2022, 30(4):  417-421.  DOI: 10.11852/zgetbjzz2021-0875

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Objective To systematically review the published articles on parental control and depression in children and adolescents using a three-level Meta-analysis method, so as to provide ideas for the treatment of depression. Methods English and Chinese database were searched to retrieve articles related to parental control and depression in children and adolescents.R language was used for data analysis, and the correlation coefficient Fisher's Z value was selected as the effect size to assess the overall model.I² distribution was used to evaluate heterogeneity, and Funnel plot calculation method was used to evaluate publication bias, then Meta-regression was used to perform subgroup and moderation analysis. Results A total of 18 articles were included.The results showed that parental control was positively correlated with students' depression (Fisher's Z= 0.278, P<0.001, I²=87.36%).Meta regression showed that the moderating effect of different control types was significant.Parental behavior control has no significant impact on students' depression (Fisher's Z=-0.067,P>0.1), while other control types were not only related to children and adolescents' depression symptoms (Fisher's Z=0.279,P<0.001), but even induced depressive personality in children and adolescents(Fisher's Z=0.272,P<0.05).This correlation was detected in many countries. Conclusions Parental control is related to children's depression.Therefore, family factors should be considered in the intervention of children and adolescents' depression.

Meta-analysis of serum zinc, iron, lead, copper, magnesium and calcium in children with tic disorder

LI Wei-feng, WANG Zi-yang, XU Meng-jun, HAN Xin-min

2022, 30(4):  422-426.  DOI: 10.11852/zgetbjzz2020-1969

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Objective To explore the difference of serum trace elements between children with tic disorder (TD) and healthy children, in order to provide reference for the prevention and treatment of TD. Methods CNKI,VIP, Wanfang, Clinical Trial Registration Center, Pubmed, Embase, Web of Science and Cochrane Library were searched to retrieve case-control studies where serum levels of zinc, iron, lead, copper, magnesium, calcium and other elements in TD children were tested.Keywords included tic disorder/TD, trace elements, blood lead, blood zinc, blood iron, etc.RevMan 5.3 and Stata 15 were used to conduct Meta-analysis. Results A total of 19 articles in Chinese and English were finally included, with a time span of 15 years.Totally 3 762 TD children and 4 800 healthy children in the control group were included.Meta-analysis results showed that compared with healthy children, TD children had higher serum level of lead (MD=23.75, 95%CI:13.57 - 33.92, P＜0.001), lower serum levels of iron (MD=-62.64, 95%CI:-84.35 - -40.93, P＜0.001) and zinc (MD=-0.87, 95%CI:-1.19 - -0.55, P＜0.001),but no significant difference was found in serum magnesium, calcium and copper(P＞0.05).Logistic regression analysis showed that the abnormality of serum lead, zinc and iron was related to tic disorder. Conclusions Children with TD have higher level of serum lead and lower level of serum zinc and iron.And the abnormality of serum lead, zinc and iron may be related to the pathogenesis of tic disorder.

Clinical Research

Analysis of clinical and electroencephalogram features in children with autism spectrum disorder combined with epilepsy

DU Ya-kun, WANG Xia, CHEN Fang, LI Bao-guang, SUN Chen-bo, SUN Su-zhen

2022, 30(4):  427-430.  DOI: 10.11852/zgetbjzz2021-0141

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Objective To analyze the clinical and electroencephalogram(EEG)features in children with autism spectrum disorder(ASD)combined with epilepsy,in order to provide clues for optimizing the clinical treatment of these children. Methods A total of 120 children with ASD combined with seizures in Children's Hospital of Hebei Province from January 2017 to December 2019 were enrolled in this study. Their clinical features and EEG features were retrospectively analyzed. Results The features of seizures in ASD children combined with epilepsy were mainly focal seizures(83.3%),which peaked at 5 to 7 years old,and the proportion of children with low intelligence level was high.EEG discharges were most common in the frontal region(40%) and temporal area(30%).The intelligence level of the patients was negatively correlated with the interictal epileptiform activity(IEA)(r=-0.736,P<0.001). Conclusions ASD combined with epilepsy has its own clinical features.As a method to evaluate brain function,EEG has a high application value in the diagnosis and treatment of diseases.

Investigation on allergic diseases in children with attention deficit hyperactivity disorder

FANG Yuan, KONG Wei-yan, MA Chen-huan, PAN Li-zhu, ZHU Pei-ying, WANG Yu

2022, 30(4):  431-435.  DOI: 10.11852/zgetbjzz2021-0165

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Objective To investigate the prevalence of allergic diseases in children with attention deficit hyperactivity disorder(ADHD) aged 4 to 12 years,in order to provide theoretical basis for the prevention and treatment of ADHD. Methods A case-control study was adopted. From October 2019 to April 2020,800 children with ADHD in the Department of Child Healthcare of Shanghai Children's Hospital were enrolled in the ADHD group,meanwhile 800 healthy children were selected as the control group. Demographic data and clinical disease data of the two groups were collected by questionnaire. Univariate analysis was used to compare the prevalence of allergic diseases between ADHD group and control group. Logistic regression analysis was used to analyze the risk of ADHD in children with co-morbidities of allergic diseases and the effect of anti-allergic treatment on the symptoms of ADHD. Results There was significant difference in the prevalence of allergic diseases between ADHD group and control group(χ²=23.220,P<0.001). The risk of ADHD in single allergic disease group was 1.681(95%CI: 1.163 - 2.375),which was 2.494(95% CI:1.912 - 3.254) in the mixed allergic disease group. When children with ADHD developed allergic symptoms,58.2% of them had worse ADHD symptoms than before. The proportion of ADHD in children with mixed allergic diseases was higher than that in children with single allergic diseases(60.6% vs. 53.7%,χ²=434.161,P<0.001). Conclusion Allergic diseases may increase the risk of ADHD in children,and the more co-morbidities of allergic diseases,the higher the risk of ADHD.

Behavioral problems and its influencing factors of 4- to 6-year-old children in Shenyang

YUAN Ling-hao, WEI Bing, YUE Xiao-zhe, QI Shuang-hui, WANG Huan, JIA Jing-jing, LIAO Shi-e

2022, 30(4):  436-440.  DOI: 10.11852/zgetbjzz2021-0124

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Objective To understand the current situation of behavioral problems of preschool children aged 4 to 6 years in Shenyang, and to analyze its influencing factors, so as to provide reference for preventing behavioral problems. Methods Preschool children aged 4 to 6 years in 36 classes of 18 kindergartens from 9 districts of Shenyang City were selected as the study subjects, and the basic situation questionnaire and Questionnaire-Children with Difficulties (QCD) were distributed. According to the score of QCD questionnaire, children were divided into functional impairment group (QCD＜30) and non-functional impairment group (QCD≥30). Univariate and multivariate Logistic regression analysis was conducted for analyzing the factors associated with behavior problems. Results A total of 900 questionnaires were distributed, of which 877 were returned and 834 were qualified. The overall rate of functional impairment was 13.3%. The rate of functional impairment in boys and girls was 15.1% (67/443) and 11.3% (44/391), with the ratio of 1.34∶1. Multivariate Logistic regression analysis indicated that begging communication(OR=5.878, 95%CI:1.626 - 21.253) and homework time of 30 to 60 minutes(OR=2.372, 95%CI:1.146 - 4.908) were risk factors for children's behavioral problems, while age of 5 to 6 years old(5 years old OR=0.261, 95%CI: 0.137 - 0.497; 6 years old OR=0.522, 95%CI:0.295 - 0.923) and doting education(OR=0.231, 95%CI:0.068 - 0.783) were protective factors (P<0.05). Conclusions The behavioral problems of 4- to 6-year-old children in Shenyang are prevalent, and the influencing factors are complex. It is supposed to avoid the corresponding risk factors in advance and prevent the occurrence of children's psychological and behavioral diseases in early stage.

Investigation on current situation and influencing factors of pupil's behavioral problems in Zhengzhou

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

2022, 30(4):  441-445.  DOI: 10.11852/zgetbjzz2021-1491

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Objective To investigate current situation and influencing factors of pupil's behavioral problems in Zhengzhou, so as to provide reference for targeted intervention of behavioral problems of primary school students. Methods A total of 3 180 pupils were randomly selected in Zhengzhou. Achenbach Child Behavior Checklist (CBCL) and a self-designed questionnaire were used to assess behavioral problems and collect demographic data. Results A total of 3 180 questionnaires were distributed, and 2 832 (89.1%) valid questionnaires were collected. The detection rate of behavioral problems was 7.8% (222/2 832) in pupils, which was significantly higher in 12- to 14-year-old pupils than 6- to 11-year-old pupils (12.2% vs. 7.3%, χ²=83.168, P＜0.001).The detection rate of behavioral problems in boys was significantly higher than that in girls (8.9% vs. 6.6%,χ²=4.788,P = 0.029).Compared with other grades, first-grade pupils had lower detection rate of behavioral problems (χ²=13.592, P=0.018). Pupils whose fathers were teachers, mothers were workers, boys, premature, mothers or fathers with less than high school education, fathers addicted to the internet or alcohol, and pupils with intracranial haemorrhage at birth all had higher overall scores of behavioral problems, and the differences were statistically significant(P＜0.05). Conclusions The prevalence of behavioral problems among primary school students in Zhengzhou varies by gender, age and grade, and is also related to parental occupation, parental education, health status at birth and father's behavioral problems. It is suggested to improve the behavioral problems among primary school students in Zhengzhou by the cooperation of family, school and medical staffs.

Research on family factors related to adolescent depressive symptoms

XIE Xiao-min, FENG Bei, LI Ya-li, LIANG Ya-hong, WANG Yue, LIN Yan, JIANG Xun

2022, 30(4):  446-449.  DOI: 10.11852/zgetbjzz2021-0278

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Objective To investigate the occurrence of depressive symptoms in adolescents,and to analyze their related family factors. Methods A stratified cluster sampling method was used to select 650 middle school students from two junior high schools and two high schools in Xi'an as the survey objects in November 2019. Surveys were conducted by using the general situation questionnaire,the Center for Epidemiological Studies Depression Scale,the Childhood Trauma Questionnaire-Short Form and the Short-Egna Minnen Barndoms Uppfostran. Multiple linear regression analysis was used to explore related family factors influencing the level of adolescent depression symptoms. Results The score of depressive symptoms in adolescents in this survey was 16.00(9.00,20.00),and the positive screening rate for depressive symptoms was 19.7%. Multiple linear regression analysis showed that gender,marital status of parents,emotional abuse,physical neglect,paternal overprotection,maternal overprotection,paternal emotional warmth,maternal emotional warmth were the main influencing factors for depressive symptoms of adolescents(β=-0.028,0.030,0.103,0.267,0.467,0.047,-0.279,-0.272,P＜0.001,R²=0.923). Conclusions The positive screening rate for depressive symptoms in adolescents is relatively low. Gender,marital status of parents,emotional abuse,physical neglect,overprotection of parents,and emotional warmth of parents mainly affect the depressive symptoms in adolescents.

Impact of type 2 diabetes mellitus and gestational diabetes mellitus on neonatal respiratory distress syndrome

NI Song-pin, HUA Xiao-zhen, ZHANG Su-chun

2022, 30(4):  450-453.  DOI: 10.11852/zgetbjzz2021-0354

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Objective To analyze the effects of previous history of maternal type 2 diabetes mellitus (T2D) in pregnant women and gestational diabetes mellitus (GDM) on the incidence of neonatal respiratory distress syndrome (NRDS), in order to provide evidence for preventing NRDS. Methods A retrospective cohort study was conducted among pregnant women hospitalized in Cangnan County People's Hospital from January 2015 to September 2020.Electronic medical records were retrospectively collected.Cox regression risk ratio of potential confounding factors was adjusted, then the relative risk of NRDS associated with maternal intrauterine diabetes in preterm infants was estimated. Results A total of 618 pairs of mothers and infants were included in this study, of whom 67 (10.8%) were exposed to T2D, 106 (17.2%) were exposed to GDM, and 80(12.9%) premature infants were diagnosed with NRDS.The prevalence of NRDS in infants exposed to T2D, GDM or no diabetes was 25.4% (17/67), 21.7% (23/106) and 9.0% (40/445), respectively.Risk analysis showed that newborns with gestational age of 32 to 34 weeks at delivery had a higher risk of NRDS than those at 35 to 37 weeks (HR=2.11, 95%CI: 1.21 - 3.96, P＜0.001).Compared with no diabetes during pregnancy, gestational diabetes with previous T2D (HR=1.96, 95%CI:1.28 - 3.42, P=0.006) and requiring antidiabetic drugs during pregnancy(HR=1.83, 95%CI: 1.22 - 3.10, P=0.017) were significantly associated with increased risk of NRDS.For gestational diabetes not requiring antidiabetic medication during pregnancy, there was no correlation between GDM and NRDS (P=0.375). Conclusions NRDS is predominantly attributed to exposure to the established T2D environment compared with non-diabetes during pregnancy.And the risk for NRDS is lower in children with maternal GDM requiring medication treatment, while the risk would not be significantly increased in children with maternal GDM not requiring medication.

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Expression and its significance of peripheral blood mononuclear cells myeloid differentiation factor 88 and Toll-like receptor 4 in multiple organ dysfunction syndrome after asphyxia in premature infants

TIAN Bo, ZHAO Kai-hong, ZHAO Yi-ran, FU Hong-tao

2022, 30(4):  454-457.  DOI: 10.11852/zgetbjzz2021-0518

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Objective To discuss the expression of peripheral blood mononuclear cells myeloid differentiation factor 88(My D88) and Toll-like receptor 4(TLR4) in multiple organ dysfunction syndrome(MODS) after asphyxia in premature infants, in order to provide a new idea for the early diagnosis and prognosis evaluation of MODS after asphyxia in premature infants. Methods A prospective study was conducted on 115 cases of asphyxiated premature infants in Neonatology Department of Tangshan Maternal & Child Health Care Hospital from January 2019 to December 2020.According to 1 min Apgar scores, the asphyxiated premature infants were divided into mild asphyxia group (n=70) and severe asphyxia group (n=45).Meanwhile, 50 cases of healthy preterm infants were selected as the control group.The prevalence of MODS, the mortality of MODS and the incidence of single organ damage were compared among the three groups.The expression levels of My D88 mRNA and protein, TLR4 mRNA and protein were compared among three groups. Results The incidence rates of MODS in severe asphyxia group, mild asphyxia group and control group were 73.33%, 31.43% and 6.00%, respectively, and the mortality rates of MODS were 24.44%, 5.71% and 0, respectively.There were statistically significant differences in the incidence rate of MODS and the mortality rate of MODS among the three groups (χ²=47.845, 16.978, P<0.001).The incidence of single organ damage in severe asphyxia group and mild asphyxia group were significantly higher than that in control group (P<0.05), and the incidence of single organ damage in severe asphyxia group was significantly higher than that in mild asphyxia group (P<0.05).The expression levels of My D88 mRNA and protein, TLR4 mRNA and protein in severe asphyxia group and mild asphyxia group were significantly higher than those in control group, which were also significantly higher in severe asphyxia group than in mild asphyxia group (F=4.251, 4.804, 4.772, 4.690, P<0.001). Conclusions The incidence of MODS and the expression levels of peripheral blood mononuclear cells My D88 and TLR4 are significantly increased in asphyxiated premature infants.My D88 and TLR4 are expected to be indicators for early diagnosis and prognosis evaluation of MODS after asphyxia in premature infants.

Correlation of ureaplasma urealyticum and chlamydia trachomatis infections in the second trimester of pregnancy with small for gestational age infants

QIAO Liang, LIU Hong-jing, FENG Xue

2022, 30(4):  458-460.  DOI: 10.11852/zgetbjzz2021-0427

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Objective To investigate the correlation of ureaplasma urealyticum(UU) and chlamydia trachomatis(CT) infections in the second trimester of pregnancy with small for gestational age (SGA)infants, in order to provide reference for early prevention of adverse pregnancy outcomes. Methods From May 2018 to May 2020, 112 parturients with SGA infants born in the Beijing Huairou Maternal and Child Health Care Hospital were selected as the observation group, and 112 parturients with normal newborns born at the same period were selected into the control group. Real-time fluorescent quantitative PCR (qPCR) method was used for CT and UU detection. Logistic regression was used to analyze the factors affecting the occurrence of SGA. Results The maternal UU infection rate(40.18%), CT infection rate(24.11%) and UU+CT infection rate(15.18%) of the observation group were higher than those of the control group (7.14%, 4.46%, 2.68%) with significant differences (χ²= 33.836, 17.646, 9.278, P<0.05). The proportions of fetal distress, neonatal asphyxia, admission to neonatal ward, premature delivery, premature rupture of membranes and early-onset sepsis in the observation group were significantly higher than those in the control group (χ²= 4.074, 4.573, 8.518, 9.475, 7.146, 4.167, P<0.05). Multivariate Logistic regression analysis showed that UU infection and CT infection were independent risk factors affecting the occurrence of SGA (OR=2.674, 95%CI:1.149 - 6.223; OR=2.762, 1.139 - 6.698, P<0.05). Conclusions UU and CT infections in the second trimester are related to SGA. Early screening of UU and CT for women of childbearing age and pregnant women has important clinical significance.