Table of Content

10 December 2023, Volume 31 Issue 12

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Professional Forum

Early identification and treatment on childhood anxiety disorders

ZHANG Jinsong

2023, 31(12):  1277-1279.  DOI: 10.11852/zgetbjzz2023-1196

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Anxiety disorders are prevalent in children, and early identification and treatment are crucial to minimize their impact on children's development. There are several subtypes of anxiety disorders, and the symptoms in children are diverse and atypical, often manifesting as behavioral and physical responses. Raising awareness of early identification can be achieved by reinforcing correct understanding, enhancing foresight, focusing on high-risk children, and maintaining sensitivity. This article provides a brief overview of common manifestations for identifying anxiety symptoms, the process of early identification and diagnosis of anxiety disorders, and a treatment plan for childhood anxiety disorders that integrates preventive intervention and comprehensive treatment.

Early identification and treatment of emotion-related mental disorders in children and adolescents

JIN Yu

2023, 31(12):  1280-1285.  DOI: 10.11852/zgetbjzz2023-1195

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It has been found that children and adolescents are highly susceptible to emotion-related mental disorders such as anxiety disorder, major depressive disorder, bipolar and related disorder. If left untreated, it may severely impact the normal functioning of individuals, family and society, indicating the importance of early detection and interventionin preventing and treatingchildren and adolescents who are at high risk for emotion-related mental disorders. This article reviews different types and risk factors of emotion-related mental disorders in biological, family and school contexts, and identifies effective early detection methods and intervention strategies for children and adolescents with emotion-related mental disorders.Further implications and recommendations for early detection and intervention are also discussed.

Original Articles

Characteristics of resting-state functional magnetic resonance imaging in adolescents with major depressive disorder comorbid anxious distress

LI Gaizhi, QIAO Dan, NIU Ying, WEN Yujiao, LIU Zhifen, ZHANG Kerang

2023, 31(12):  1286-1291.  DOI: 10.11852/zgetbjzz2023-0745

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Objective To assess the neuroimaging characteristics of adolescents with major depressive disorder (MDD) comorbid anxious distress, in order to understand the underlying neuro-mechanism. Methods A convenient sample of 27 adolescents with MDD with anxious distress who visited the outpatient clinic of the Department of Psychiatry of the First Hospital of Shanxi Medical University from January to December 2022, and 36 healthy controls were included in this study. All participants completed a case report form and underwent fMRI data collection.Difference in general demographic data and fMRI data between the two groups were compared,and the correlation between the differentiated brain areas and clinial symptoms was analyzed. Results No significant difference was observed in age and gender between the two groups(P>0.05). However, after adjusting for age, gender and educational level, the Bc value in the left middle occipital gyri (MOG) was significantly higher in MDD with anxious distress group (P<0.05, FDR correction). Additionally, the NCp/NLe value of the bilateral inferior occipital gyri (IOG) and NLe of the left cuneus were significantly lower compared to the healthy control group (P<0.05, FDR correction).However, the Bc/NCp/NLe value of the differentiated brain areas did not show any correlation with the scores on the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) (P＞0.05, FDR correction). Conclusions The topology properties of adolescents with MDD and anxious distress differ from those of healthy controls, particularly in the bilateral IOG, left cuneus, and MOG. These findings further the understanding of MDD with anxious distress.

Relationship between adverse life events and mental disorders among rural adolescents in Henan province

CHANG Xuening, LI Ruizhen

2023, 31(12):  1292-1296.  DOI: 10.11852/zgetbjzz2023-0072

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Objective To investigate the prevalence of adverse life events and the mental health status of rural children in Henan province, and to analyze the correlation between adverse childhood life events and mental disorders, specifically anxiety and depression. Methods A cross-sectional study was conducted among school students in a selected county in Henan province. Two middle schools and twelve senior high school classes were randomly selected from a total of ten rural middle schools and 54 classes. The questionnaire consisted of demographic information, adolescent life events, social support, depression and anxiety measures. χ²test, spearman correlation analysis, and a multivariate Logistic regression model were used for analysis. Results The detection rate of anxiety disorder among adolescents was found to be 23.22%. Abnormal interpersonal factors (OR=2.01, 95%CI:1.16 - 3.48) and academic pressure factors (OR=2.61, 95%CI:1.81 - 3.75) were identified as risk factors for anxiety(P<0.05). The detection rate of depressive symptoms among adolescents was 12.31%, with abnomal interpersonal factors (OR=1.90, 95%CI:1.01 - 3.55), academic pressure factors (OR=1.97, 95%CI:1.27 - 3.06), and health adaptation factors (OR=1.93, 95%CI:1.05 - 3.55) identified as risk factors for depression(P<0.05). Poor interpersonal relationship and academic pressure were found to be common risk factors for both anxiety and depression. Conclusions Adverse life events are common among rural children in Henan province and are correlated with mental disorders. Strengthening mental health education of secondary school students and implementing relevant countermeasures at all levels are of great social and practical significance.

Characteristics of sensory processing and self-regulation and their influence on hyperactivity in children with autism spectrum disorder

REN Jiaojiao, ZHANG Xi, QI Jing, GAO Hong, BAI Ruibei, WANG Zhaohui

2023, 31(12):  1297-1301.  DOI: 10.11852/zgetbjzz2023-0920

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Objective To analyze the characteristics of sensory processing and self-regulation in children with autism spectrum disorder (ASD) and their influence on hyperactivity. Methods From October 2022 to June 2023,ASD children in the Department of Child Healthcare of Xi'an People's Hospital were enrolled in this study. Meanwhile, healthy children matched by age were selected as controls. Then ASD children were divided into ASD group and ASD comorbid with hyperactivity according to the hyperactivity index of Conners Parent Symptom Questionnaire. The Sensory Processing and Self Regulation Checklist (SPSRC) was completed by parents. Using Z-score of the SPSRC scale, six sections of sensory processing (auditory, visual, tactile, olfactory, vestibular balance, and proprioception) and three sections of self-regulation (physiological condition, emotional regulation, and adaptability) were divided into abnormal (Z<-1) and normal groups. The data were statistically analyzed using χ² test, one-way ANOVA, and binary Logistic regression. Results Totally 35 children were included in the ASD group, 33 children were included in the ASD comorbid with hyperactivity group, and 35 children were included in the healthy group. The proportion of abnormal sensory and self-regulation in all sections was highest in the ASD comorbid with hyperactivity group, followed by ASD group, and the differences among the three groups were statistically significant (P<0.05). The results of binary Logistic regression analysis showed that abnormal proprioception and emotional regulation were risk factors for hyperactivity in ASD children (OR=5.31, 7.31, P<0.05). Conclusions ASD children have abnormal sensory processing and self-regulation, and the abnormalities are more significant in ASD children comorbid with hyperactivity. Moreover, abnormal proprioception and emotional regulation are risk factors for hyperactivity in ASD children.

Relationship between grandparental involvement in parenting and screen exposure of preschoolers

HU Mengzhu, HAO Yinjun, CUI Naixue

2023, 31(12):  1302-1307.  DOI: 10.11852/zgetbjzz2023-0316

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Objective To explore the relationship between grandparental involvement in parenting and preschoolers' screen exposure, in order to provide scientific evidence for reducing screen exposure in preschoolers. Methods Three kindergartens in Ji'nan City were selected using convenience samplingfrom March to April 2022.Parents of all preschoolers were invited tocomplete the questionnaireto collect general information of children and parents (including gender, age, home location, parental education level), grandparental involvement in parenting, and children's screen exposure on schooldays and weekends. Independent sample t-test and one-way ANOVA were used to compare preschoolers' screen time against different sociodemographic information. Multiple linear regression analysis was used to analyze the relationship between grandparental involvement in parenting and screen exposure. Binary Logistic regression was used to analyze the correlation of grandparental involvement in parenting with the time and activities of daily screen exposure. Results A total of 753 parents returned valid questionnaires. Among all participating families, grandparents were involved in half (55.0%) of the 753 preschoolers' daily care. Multiple linear regression analysis showed that compared with chidlren whose main caregivers were not grandparents, screen time on weekdays, weekends and average screen time weekly of preschoolers whose grandparents were involved in parenting was 7.9, 12.9 and 9.4 min longer, respectively (P＜0.05). Preschoolers whose grandparents were involved in parenting had a significantly higher risk of watching electronic screen devices after 20:00 on weekends than preschoolers whose primarycaregivers were not grandparents(OR=1.43, 95% CI:1.01 - 2.04, P=0.047). However, types of screen activities did not significantly differ between preschoolers with and without grandparental involvement in parenting (P＞0.05). Conclusions Grandparental involvement in parenting is associated with increased screen time among preschoolers. It is recommended that grandparents who are frequently involved in child care should be told about the adverse effects of excessive electronic screen use to improve grandparents' management skills of children's screen use behavior.

Correlation between the characteristics of intelligence structure and the severity of autism spectrum disorder in preschool boys and girls

WEI Wenqing, HUANG Zhifang, YU Jing, CHEN Wenxiong

2023, 31(12):  1308-1313.  DOI: 10.11852/zgetbjzz2023-0339

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Objective To explore the characteristics of intelligence structure in preschool boys and girls with autism spectrum disorder (ASD) and its correlation with the severity of autism, in order to provide reference for clinical diagnosis and intervention. Methods Preschool children who met the DSM-5 ASD diagnostic criteria and visited Neurology Department,Guangzhou Women and Children's Medical Center between 2020 and 2022, were included in the study. Children with Full Scale Intelligence Quotient (FSIQ) ≥70 were divided into high function group, while those with FSIQ<70 were divided into low function group. The severity of autism was assessed using the Child Autism Rating Scale (CARS).The structural characteristics of intelligence of preschool children with ASD were compared by gender and ability level, and the correlation between total IQ and symptom severity was analyzed. Results A total of 170 ASD children were recruited, with the medium age of 3.96 (3.50, 4.33) years old, including 140 boys and 30 girls. FSIQ and visual-spatial intelligence (VSI) scores of boys were significantly higher than those of girls (Z=2 612.0, 2 600.0, P<0.05); when comparing verbal comprehension intelligence (VCI), VSI, and working memory intelligence (WMI) across the overall ASD sample, boys group and girls group, there was a significant advantage in the VSI domain in all three groups; VCI scores of the overall sample and boys showed significant advantages over WMI; there was a negative correlation between FSIQ and CARS scores in the overall ASD sample, boys group and girls group (r =-0.556, -0.561,-0.563, P<0.001). Among the overall sample, 137 children were in the low-functioning group, including 114 boys and 23 girls; FSIQ and VSI scores of boys were significantly higher than those of girls (Z=1 949, 1 872, P<0.001); the overall sample and both boys and girls showed significant advantages in VSI, while boys also displayed disadvantages in WMI; there was a negative correlation between FSIQ and CARS scores in both the overall sample and boys (r=-0.292, -0.291, P<0.05). Among the overall sample, there were 26 boys and 7 girls in the high-functioning group; both boys and girls showed a significant advantage in VSI, while there were no significant differences in VSI, VCI, and WMI among the girls; there was a negative correlation between FSIQ and CARS scores in the overall sample and girls group (r＝－0.368,-0.769, P<0.05). Conclusions Boys with ASD may exhibit higher FSIQ and VSI compared to girls, and boys in the low-functioning group also display similar advantages. Both preschool boys and girls with ASD show VSI advantages. Boys with ASD have an advantage in VCI over WMI, while girls do not show a similar advantage. There is no sex difference in the relationship between the severity of autism and FSIQ. Higher FSIQ scores are associated with lower severity of autism.

Cohort study of the correlation between screen time and emotional problems in primary school students across the COVID-19 pandemic

HAN Yaohui, DONG Fang, SUN Xiaoya, LI Lihong, YANG Weiting, LIN Yin

2023, 31(12):  1314-1319.  DOI: 10.11852/zgetbjzz2023-0567

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Objective To investigate the screen time of primary school students in Shenzhen during the COVID-19 outbreak, and to analyze the association between the screen time and emotional problems of primary school students. Methods A cohort study design was designed. Students from two primary schools in Shenzhen completed questionnaire survey in 2019 and 2021, including screen time, Morning and Evening Questionnaire-5(MEQ-5), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD-7). The paired t-test was used to analyze the differences in screen use of primary school students before and during the middle period of COVID-19, and Logistic regression was used to analyze the impact of screen time on emotion. Results The differences in computer time on weekdays, TV time on weekdays, cell phone time on weekdays, computer time on holidays, and TV time on holidays were not statistically significant compared with the pre- and mid-epidemic periods among primary school students in Shenzhen (P>0.05), but the proportion of cell phone use ≥2h/d on holidays in mid-epidemic period was significantly higher than that of pre-epidemic period(χ²=4.785, P<0.05). Protective factors for depression among elementary school students in the pre-epidemic period included cell phone time ≥2h/d on weekdays(OR=0.258, 95% CI: 0.133 - 0.500), and protective factors for anxiety included cell phone time≥2h/d on weekdays(OR=0.436, 95% CI: 0.206 - 0.923) and weekday TV time ≥2h/d (OR= 0.377, 95%CI: 0.180 - 0.790); protective factors for depression among elementary school students in mid-epidemic period were TV time ≥2h/d on weekdays(OR=0.424, 95% CI: 0.202 - 0.890) and cell phone time ≥2h/d on holidays(OR=0.308, 95% CI: 0.162 - 0.585), and sleep rhythms for early morning type was a risk factor for depression among elementary school students in mid-epidemic period (OR=5.817, 95%CI:1.790 - 18.898), and a protective factor for anxiety among elementary school students inmid-epidemic period was cell phone use ≥2h/d on weekdays(OR=0.388, 95% CI:0.179 - 0.842). Conclusion Primary school students in Shenzhen spend more time using mobile phones during holidays in mid-epidemic period than pre-epidemic period, and appropriate screen time could alleviate anxiety and depression in primary school students.

Review

Theoretical models and empirical studies progress in the influence of adverse childhood experiences on lifelong health

WEI Ruihong, WAN Yuhui

2023, 31(12):  1320-1324.  DOI: 10.11852/zgetbjzz2022-1563

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Adverse childhood experiences (ACEs) are associated with lifelong health, but the underlying mechanisms of the association are not well understood. By searching previous literature, this review combs the theoretical models of the health effects of ACEs and related confirmatory studies, in order to help researches better understand and recognize the potential mechanism of ACEs affecting physical and mental health.

Effect of parental emotional management and intervention on the development of children with autism spectrum disorder

CHEN Huiying, LI Jing

2023, 31(12):  1325-1330.  DOI: 10.11852/zgetbjzz2022-1564

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Through systematic literature review, this paper analyzes the domestic and overseas researches on theinfluence of the emotional state of parents and emotional intervention measures development of children with autism spectrum disorder (ASD), explores the correlation of parents' emotional management with emotional and behavioral problems of ASD children, and reviews the influence of parents' emotional management intervention on the emotional and behavioral symptoms of ASD children. It is found that:1) The emotional state of parents is negatively correlated with the emotional and behavioral problems of children with ASD; 2) The way parents respond to their children's emotional expressions and their use of emotion regulation strategies positively predict the emotional and behavioral problems of children with ASD; 3) Implementing emotional management interventions for parents is of great significance and has shown positive effects in adjusting parents' emotional state and improving the emotional and behavioral symptoms of children with ASD.

Research progress on the effect of screen exposure on cognitive function in children

LI Yang, JIA Xiangrui, CAO Jianqin, WU Hongmei, SU Hong, YU Hong

2023, 31(12):  1331-1334.  DOI: 10.11852/zgetbjzz2023-0134

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In recent years, advancements in science and technology have led to the widespread use of electronic devices such as mobile phones, iPads, TVs, and computers, making them an integral part of daily life. Consequently, children's exposure to electronic screens has significantly increased over time. This growing trend has raised concerns regarding the impact of screen exposure on children's cognitive function. To address this issue, this study conducts a comprehensive analysis of the current state of children's screen exposure, incorporating relevant literature from both domestic and international sources. Furthermore, this study discusses the effects of screen exposure on children's cognitive function and assesses the research progress, aiming to provide a theoretical foundation for promoting the physical and mental health development of children.

Research advance in family intervention for children with autism

MAI Yiping, DU Yasong

2023, 31(12):  1335-1339.  DOI: 10.11852/zgetbjzz2023-0112

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Autism spectrum disorders (ASD) is a neurodevelopmental condition with social interaction and social interaction as well as repetitive, stereotypic behaviors and narrow interests as core symptoms. This article focuses on the significance of family interventions for children with ASD, methods of family interventions, and challenge in implementing family interventions.

Review of the family-mediated intervention through telemedicine in children with autism spectrum disorder

ZHAN Yangmei, LI Tingyu

2023, 31(12):  1340-1344.  DOI: 10.11852/zgetbjzz2023-0375

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The incidence of autism spectrum disorder (ASD) is increasing annually. Early, intensive, and continuous intervention is crucial for the prognosis of children with ASD. However, the lack of accessible medical resources and the challenges posed by the global COVID-19 pandemic have exacerbated the difficulties in implementing interventions. Consequently, there has been a growing recognition of the telemedicine model and family intervention in recent years. Studies have shown that parent-mediated intervention through telemedicine is extremely cost-effective which can not only effectively improve the symptoms of ASD children, but also overcome geographical limitations and enable children with ASD in remote areas to obtain a large number of effective medical resources. However, there are few researches on telemedicine model and family intervention in China at present. Therefore, this paper systematically reviews the family intervention through telemedicine, in order to provide reference for the intervention model in China in the future and bring hope for the intervention of children with ASD in remote areas.

Meta Analysis

Meta-analysis of the effect of exercise on motor skills in children with attention deficit hyperactivity disorder

BI Xiaoyu, ZHU Xiaotong, ZHU Feilong, KUANG Dongqing, SHENG Siying, REN Yuanchun

2023, 31(12):  1345-1352.  DOI: 10.11852/zgetbjzz2023-0275

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Objective To explore the effect of exercise intervention on motor skills in children with attention deficit hyperactivity disorder (ADHD), in order to provide theoretical reference for exercise intervention of ADHD. Methods Literature on the effects of exercise interventions on motor skills in ADHD children was searched in five databases from January 2002 to September 2022, including PubMed, Web of Science, Cochrane Library, China Knowledge Base and Wanfang Database. Reviewer Manager 5.4.1 software was used for analysis, and standardized mean differences (SMD) and 95% confidence intervals (CI) were used to assess the effectiveness of exercise interventions in improving motor skills in ADHD children. A Meta-analysis was conducted using fixed or random effects models according to the heterogeneity of the studies, and subgroup analysis was performed. Results Eleven articles were eventually included in the literature. The cumulative study population was 1 190, including 602 cases in the ADHD exercise intervention group and 588 cases in the ADHD control group. Overall effect analysis showed that exercise intervention had a positive effect on the improvement of gross motor skills (SMD=1.04, 95%CI: 0.53 - 1.54, P<0.05) and fine motor skills (SMD=0.48, 95% CI: 0.24 - 0.71, P<0.05) in children with ADHD. Subgroup analysis showed that open motor skill-based and closed motor skill-based motor interventions had positive effects on children's gross motor skills (SMD=0.55, 1.68, 95% CI: 0.08 - 1.02, 0.76 - 2.60, both P<0.05) and fine motor skills (SMD=0.46, 0.54, 95% CI: 0.21 - 0.71, 0.15 - 0.93, both P<0.05). The gross motor skills and fine motor skills in children with total motor interventions ≥720 min improved better than those of the control group (SMD=0.88, 0.67, 95%CI: 0.59 - 1.17, 0.38 - 0.95, both P<0.05), while those with total motor interventions ＜720 min only improved gross motor skills better than the control group (SMD=1.24, 95%CI: 0.40 - 2.08, P<0.05). Conclusions Exercise can improve the development of motor skills in ADHD children. Different total intervention amount of exercise, frequency and duration have a varied influence on the improvement of both gross motor skills and fine motor skills in ADHD children.

Clinical Research

Characteristics of adverbs developmentat in children aged 1 to 6 in Jiangsu urban areas

XU Yaqin, GUO Xiaojie, SU Nan, ZHU Yuanyuan, ZHANG Lei, TONG Meiling

2023, 31(12):  1353-1358.  DOI: 10.11852/zgetbjzz2023-0568

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Objective To discuss the developmental sequence and characteristics of children's understanding and expression of common adverbs by analyzing the developmental characteristics of adverbs used by children aged 1 to 6. Methods A total of 1 093 children were sampled from four cities in Jiangsu Province. The adverb test, adopted from the Language Development Scale for Children Aged 1 - 6, was used to assess their understanding and expression of various adverbs. The correct rate of understanding and expression of adverbs in different age groups was analyzed, with the 50th percentile as the standard for language acquisition. Results 1) The understanding and expression of adverbs generally increased with age, with a rapid increase observed between two years old and four years old, followed by a leveling-off after four years old. 2) Negative adverbs developed earlier, while scope adverbs appear late, and time adverbs and adverbs of degree fell in between. However, the age at which children understand the same type of adverb varies greatly. 3) Gender differences in adverb understanding were statistically significant in certain young age groups (χ²=7.290, 5.552, 7.836, 4.124, 15.490, P＜0.05), while gender difference in adverb expression in all age groups had no statistical significance (P＞0.05). Conclusions The understanding and expression of adverbs in children aged 1 to 6 follow specific acquisition sequences and rules. This provides a reference for promoting the language development of typically developed children and intervening in children with language delays.

Influencing factors of quality of life in asthma children

ZHANG Boyuan, HOU Wei, DUAN Yina

2023, 31(12):  1359-1364.  DOI: 10.11852/zgetbjzz2023-0777

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Objective To investigate the current status of quality of life in children with asthma and explore the impact of variables such as self-efficacy, psychological resilience, and asthma control level on the quality of life of these children, so as to provide insights for improving the quality of life of children with asthma and expanding asthma prevention and treatment strategies. Methods A total of 244 children aged 7 to 14 years with bronchial asthma who visited the Children's Asthma Clinic at the Second Affiliated Hospital of Xi'an Jiaotong University from February to December 2022 were selected as the study subjects. General information questionnaires, the General Self-Efficacy Scale (GSES), the Asthma Control Test (ACT), and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) were used for data collection, and statistical analysis was performed using SPSS 27.0. Results The total score of quality of life in children with asthma was 5.92±0.99, the score of self-efficacy was 2.69±0.55, and the scores for the interpersonal assistance dimension and positive cognition dimension of psychological resilience were 3.50±0.87 and 3.81± 0.89, the score on the asthma control level test was 21.87±3.67. The results of multiple stepwise linear regression analysis showed that whether combined withomalizumab(OMA) treatment, multiple comorbidities, and positive cognition were important influencing factors for the overall average score of PAQLQ (β = 0.18, 0.18, 0.17, P<0.05). Positive cognition and interpersonal assistance dimensions in psychological resilience, multiple comorbidities, and combined OMA treatment were influencing factors for the symptom score of quality of life in children with asthma (β=0.14, 0.13, 0.18, 0.15, P<0.05). Positive cognition, multiple comorbidities, and combined OMA treatment were important influencing factors for the activity limitation dimension of PAQLQ (β=0.20, 0.18, 0.17, P<0.05). Whether combined with OMA treatment, multiple comorbidities, and positive cognition were important influencing factors for the emotional function score of PAQLQ (β= 0.21, 0.18, 0.14, P<0.05). Conclusions The quality of life in asthmatic children in this study is at a moderate to high level. Having positive cognition, good interpersonal assistance, different types of diagnosis, and receiving OMA treatment all contribute to the quality of life of asthmatic children. Immunotherapy with biologic agents represented by OMA should be actively carried out in the clinic, and attention should also be paid to health education and psychological resilience development to enhance the quality of life of asthmatic children.

Experience Exchange

Clinical phenotype and gene variation profile in children with Noonan syndrome

TAO Dongying, CHENG Shengquan, ZHANG Jingjing, ZHANG Huiqin, NIU Huanhong

2023, 31(12):  1365-1369.  DOI: 10.11852/zgetbjzz2023-0889

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Objective To analyze the clinical phenotype and genetic characteristics of children with Noonan syndrome (NS), in order to provide theoretical evidence for early diagnosis and treatment of the disease. Methods A retrospective analysis of the clinical data and genetic testing results of 21 NS children diagnosed from January 2016 to January 2023 were performed. Therapeutic follow-up results of some of the shorter children were also included. Therapeutic follow-up results of some of the shorter children were also included. Results Among the 21 NS patients, there were 13 males and 8 females, with a diagnosis age ranging from 5 days to 14 years old and a mean age of 4.6 years old. Most common clinical features included special facial features (n=12), congenital heart disease (n=11), short stature (n=9), feeding difficulties (n=6), abnormal skeletal development (n=3), hearing disorder (n=3), and sparse hair (n=3). In addition to classic phenotypes, rare phenotypes such as sparse teeth, scoliosis, photophobia, hair follicle keratosis, epilepsy, and arrhythmias were also observed. Seven mutant genes were identified by genetic testing, including PTPN11(n=7), BRAF(n=4), LZTR1(n=3), SOS1(n=3), KRAS(n=2), RAF1(n=1), and SHOC2(n=1). Nine short stature children were treated with rhGH for an average of 16.6 months, with a mean height change from -3.62s to -3.21s. Conclusions Complete exome sequencing is helpful for early diagnosis of NS patients. In addition to the classic phenotype of NS, the RAF1 gene may be associated with frequent atrial arrhythmias, suggesting a new phenotype spectrum. Heterozygous variants in the LZTR1 gene may result in a mild phenotype with sparse hair, which is a rare phenotype of RAF1 and SHOC2 variants of NS. The short-term efficacy of rhGH treatment in NS patients is acceptable, but the correlation between rhGH efficacy and genotype was not clear.

Effect of milk drinking behavior on malnutrition in 3 286 school-age children in Hainan Province

ZHANG Tao, GUO Jingyue, ZHONG Chengwang, ZHAO Chanjuan, ZHANG Fan

2023, 31(12):  1370-1374.  DOI: 10.11852/zgetbjzz2022-1406

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Objective To analyze the influence of milk drinking behavior of school-age children on malnutrition in Hainan Province, so as to provide theoretical basis for improving the malnutrition status of students. Methods Stratified random whole-group sampling was used to randomly select 1 city and 1 county from 4 cities and 15 counties in Hainan Province as urban and rural survey sites, respectively. Then a total of 10 schools were randomly selected from 2 survey sites, each stratified by grade level, and 3 - 5 classes were randomly selected from each grade level from 3 to 5 in each school. Questionnaires and physical tests were used to collect relevant information from students. The effect of milk drinking behavior on malnutrition status of children in this age group was analyzed. Results Among the 3 286 school-age children aged 8 - 12 years, the prevalence of malnutrition was 23.5% (771/3 286), of which the prevalence rates of growth retardation, mild weight loss, moderate and severe weight loss were 4.0% (132/3 286), 9.0% (296/3 286) and 11.7% (385/3 286), respectively. And 92.3% (3 033/3 286) of children drank milk every week, 46.2% drank milk more than 5 days every week, and 11.1% (364/3 286) drank milk ≥ 300mL per day on average. There were significant differences in age, nationality, residence, choice of milk or dairy products as snacks, frequency of milk consumption, average daily milk consumption between students with or without malnutrtion (P<0.05). Multivariate Logistic regression showed that the malnutrition risk of children living in rural areas was 2.066 times higher than that of children living in urban areas (95%CI: 1.742~2.451). Age (OR=0.768, 95%CI: 0.698 - 0.845), higher milk drinking frequency [1 - 2 days/week (OR=0.413, 95%CI: 0.305 - 0.559), 3 - 4 days/week (OR=0.338, 95%CI: 0.247 - 0.461), and 5 - 7 days/week (OR=0.286, 95%CI: 0.214 - 0.383)], choosing milk or dairy products as snacks (OR=0.676, 95%CI:0.570 - 0.801), the average daily milk intake ≥ 300mL (OR=0.648, 95%CI:0.475 - 0.883) were protective factors of malnutrition (P<0.05). Conclusions The malnutrition rate of school age children in Hainan Province is high, and milk drinking behavior is closely related to malnutrition. It is recommended to strengthen the education on milk drinking for children, increase the amount and frequency of milk drinking for students and improve milk drinking behavior.

Influence of diabetes camp on blood glucose levels and emotion in children and adolescents with type 1 diabetes mellitus

WANG Lina, TIAN Fei, FENG Xueying, CHEN Zhihong

2023, 31(12):  1375-1379.  DOI: 10.11852/zgetbjzz2023-0041

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Objective To analyze the influence of diabetes camp on blood glucose levels and emotion in children and adolescents with type 1 diabetes mellitus (T1DM). Methods A total of 72 children and adolescents with T1DM were selected into this study from Endocrine Metabolism Digestive Department,Affiliated Hospital of Qingdao University, and were divide into two groups according to whether they have participated in diabetes camp or not. The latest glycated hemoglobin A 1c(HbA1c) level was tested. The emotional status of children and adolescents with T1DM was evaluated by Depression Self-rating Scale for Children (DSRS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED). The blood glucose levels, depression and anxiety rates of the two groups were compared. The correlations of the number of diabetes camps with depression and anxiety were analyzed. Results The average HbA1c level of T1DM group was at an optimal level [(7.481±1.331)%]. The average HbA1c level in children who have participated in diabetes camp was significantly lower than that in children who have not participated in diabetes camp before [(7.146±1.265)% vs. (7.797±1.331)%, t=2.127, P=0.037]. The detection rate of depression in children who have participated in diabetes camp was significantly lower than that in children who have not participated in diabetes camp before (20.0% vs. 43.2%, χ²=4.470, P=0.035). Concerning the detection rate of anxiety in children and adolescents, there was no significant difference between the two groups(14.3% vs. 24.3%, χ²=1.157, P=0.282). The number of diabetes camps was negatively correlated with the depression in children and adolescents with T1DM (OR=0.417,P=0.004),but no correlation with anxiety (P=0.231). Conclusions Diabetes camp can improve blood glucose levels and reduce the depression in the children and adolescents with T1DM.The more chidren participate in the diabetes camp, the less likely children are to experience depression.

Health Education

Current situation and influencing factors of adolescent students' sexual behavior and cognition from the perspective of social norm cognition

LUO Ying, LIU Ting, SUN Yaru, WANG Xin, LU Mingqin, KOU Zhiru, XU Xiaohan, YANG Xiuling

2023, 31(12):  1380-1385.  DOI: 10.11852/zgetbjzz2023-0335

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Objective To understand the current situation of sexual behavior and cognition among adolescent students, and to analyze the influencing factors of sexual intercourse, so as to provide a basis for formulating targeted interventions to reduce the adverse consequences of adolescent sexual behavior. Methods Using a stratified cluster sampling method, 1 228 adolescents from six vocational schools in Shandong Province were selected from August to October 2022. Questionnaires were used to collect information related to general characteristics, sexual knowledge, sexual concepts and behavior, and social norm cognition. An electronic version of the questionnaire was developed and distributed through the commonly used platform, Wenjuanxing. Results Among the 1 228 students, 242 (19.7%) were male and 986 (80.3%) were female. Out of the total sample, 77 (6.3%) reported having engaged in sexual intercourse, with 75 (97.4%) of them engaging in risky sexual behaviors. The overall score of sexual knowledge among students in the six schools was 21.41 ± 5.93. Logistic regression analysis revealed that being male (OR=3.342, 95%CI:1.919 - 5.818), being older than 16 years (OR=2.095, 95%CI=1.049 - 4.181), having migration experience (OR=1.764, 95%CI:1.016 - 3.064), being in a romantic relationship (OR=6.812, 95%CI=3.806 - 12.192), approving of sexual behavior outside marriage (OR=2.486, 95%CI:1.174 - 5.262), approving of one night stand (OR=3.263, 95%CI:1.197 - 8.899), and agreeing that condoms cannot be used for one-time sexual intercourse (OR=6.804, 95%CI:2.797 - 16.548) were risk factors for engaging in sexual behavior. Conclusions The prevalence of sexual behavior among adolescents is low, but the prevalence of risky sexual behavior is high. It is recommended to adopt a multi-party collaborative approach to intervene high-risk groups, aiming to promote the physical and mental health of adolescents.

Appropriate Technology

Application of mental health screening pathway and three-level management platform for 0- to 6-year-old children in Fujian Province

HUANG Xinxin, MIAO Chong, XU Libo, OU Ping

2023, 31(12):  1386-1392.  DOI: 10.11852/zgetbjzz2023-0645

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Objective To develop and validate a screening pathway for children's mental development suitable for primary care, in order to establish a monitoring platform for children's mental health care at the county, city, and province levels. Methods From January 2019 to March 2020, a stratified cluster sampling study was conducted in nine cities of Fujian province. Relevant items were selected to construct the screening model of children's mental development, and the validity and reliability were verified. Since April 2020, a monitoring platform has been built for routine management of the screening pathway. Results A total of 3 526, 3 568 and 3 553 samples of 0- to 6-year-old children were collected to construct the screening model of intelligence, motor cooperation, social interaction and life ability. The screening models for intelligence, motor coordination, social interaction, and life ability showed AUCs of 0.872 - 0.993, 0.902, and 0.914-0.990, respectively (P<0.05). The Cronbach's α coefficient of three dimensions was 0.731 - 0.938, 0.767 and 0.784 - 0.837, respectively (P<0.05). The construct validity was 0.692 - 0.829, 0.672 - 0.793 and 0.736 - 0.864, respectively (P<0.05). The statistical test showed that the model had good reliability and validity. The sensitivity and specificity were 84.73% and 89.26% for intelligence, 82.77% and 92.16% for motor coordination, and 91.84% and 96.93% for social interaction, respectively. A regional information platform was created to digitize the screening reports. A total of 29 355 children were screened, and 8 513 children tested positive for the initial screening. Among them, 8 183 children were referred to specialists for further treatment, resulting in a high-risk management rate of 96.12%. Conclusion The effective integration of monitoring platform and children's psychological screening technology can improve work efficiency, increase the coverage of children's mental health care, enhance the management rate of high-risk children, promote case closed-loop management and hierarchical diagnosis and treatment, and achieve secondary prevention.