ObjectivesTo systematically review the association between bullying and risk of non-suicidal self-injury among adolescents.MethodsPubMed, MEDLINE, EMbase, The Cochrane Library, CNKI and WanFang Data were searched from inception to September 1st 2017 to collect studies on the association between bullying and non-suicidal self-injuries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by Agency for Healthcare Research and Quality (AHRQ). Then, meta-analysis was performed using CMA 2.2 software.ResultsA total of 23 studies involving 18 819 participates were finally included. The results of meta-analysis showed that bullying victims reported more NSSI than uninvolved adolescents (OR=2.41, 95%CI 1.96 to 2.96, P<0.001). The bullying perpetrators reported more NSSI than uninvolved adolescents (OR=2.26, 95%CI 1.39 to 3.68,P=0.001). Individuals acting as both victims and perpetrators could also increase risks of NSSI (OR=2.76, 95%CI 1.17 to 6.51, P=0.02). Using meta-regression, it was found that the relation between NSSI and bullying victimization was significantly moderated by age, with studies in which respondents were younger reporting larger effect sizes than studies in which respondents were older (B=–0.33, 95%CI –0.38 –0.28, P<0.001).ConclusionsThe current study demonstrates that involvement in bullying in any capacity is associated with non-suicidal self-injuries. Due to the limitation of research, more studies are required to verify above conclusions.
ObjectiveTo systematically review the methodological quality of guidelines concerning attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice.
MethodsGuidelines concerning ADHD were electronically retrieved in PubMed, EMbase, VIP, WanFang Data, CNKI, NGC (National Guideline Clearinghouse), GIN (Guidelines International Network), NICE (National Institute for Health and Clinical Excellence) from inception to December 2013. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared.
ResultsA total of 9 guidelines concerning ADHD in children and adolescents were included, with development time ranging from 2004 to 2012. Among 9 guidelines, 4 were made by the USA, 3 in Europe and 2 by UK. The levels of recommendations were Level A for 2 guidelines, and Level B for 7 guidelines. The scores of guidelines according to the domains of AGREE Ⅱ decreased from "clarity of presentations", "scope and purpose", "participants", "applicability", "rigour of development" and "editorial independence". Three evidence-based guidelines scored the top three in the domain of "rigour of development". There were slightly differences in the recommendations of different guidelines.
ConclusionThe overall methodological quality of ADHD guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE Ⅱ vary with scores, while the scores of evidence-base guidelines are higher than those of non-evidence-based guidelines. The guidelines on ADHD in children and adolescents should be improved in "rigour of development" and "applicability" in future. Conflicts of interest should be addressed. And the guidelines are recommended to be developed on the basis of methods of evidence-based medicine, and best evidence is recommended.
ObjectiveTo explore the effectiveness of knee extensor mechanism reconstruction in the treatment of recurrent patellar subluxation with bone anchor in adolescents.
MethodsBetween January 2010 and December 2013, 20 patients with patellar subluxation were treated by knee extensor mechanism reconstruction with bone anchor. There were 11 males and 9 females, aged from 12 to 17 years (mean, 15.3 years). The left knee was involved in 12 cases and the right knee in 8 cases. The disease duration was 5-10 years (mean, 7 years). All the patients had knee pain and lateral subluxation of the patella. Preoperative Lysholm knee score was 71.4±4.7. All the patients received the MRI examination to exclude menisci or ligaments lesion. CT examination showed the tibial tuberosity trochlear groove spacing ranged from 15 to 20 mm (mean, 17 mm). X-ray film examination indicated that no varus or valgus was observed, and bony structure was normal.
ResultsAll the incisions healed at first stage. The patients received follow-up of 12-24 months (mean, 13 months). Knee pain occurred in 2 cases and were cured after symptomatic treatment. The axial X-ray films showed good position of the patella and normal anatomic relationship of the patellofemoral joint. No anchor loosening and pulling out, internal fixation failure, pseudoarthrosis formation, and postoperative recurrent patellar subluxation occurred during follow-up. At 1 year, the Lysholm knee score was significantly improved to 94.2±3.4 (t=22.705, P=0.000). According to Insall criterion, the results were excellent in 9 cases, good in 9 cases, and fair in 2 cases, with an excellent and good rate of 90%.
ConclusionThe bone anchor for extensor mechanism reconstruction is a convenient and reliable way to treat the recurrent patellar subluxation, with a satisfactory early effectiveness and less complications; however, its long-term effectiveness is required a further follow-up.
Objective To explore the effect of arthroscopy in diagnosis and treatment of osteochondritis dissecans of elbow joint in adolescent. Methods From May 2003 to February 2006, 11 patients with osteochondritis dissecans of elbowjoint were diagnosed and treated with arthroscopy. There were 6 males and 5 females, aging from 13 to 19 years. The left joints were involved in 4 cases and right joints in 7 cases. Seven patients had obvious history of injury. The interval of injury and operation was from 7 months to 12 years. The score of VAS was 80±10, the range of flexion and extend of joint 80±10°, the range of rotation of joint 100±5° preoperatively. The brachial plexus anesthesia, the elbow hung to traction, soft spot, interna and extrapathway were given to explore and debride elbow joint and remove corpus liberum. Results All patients recovered daily life and work 7 to 12 dayspostoperatively. There were no complications of blood vessel and nerve injuries. Eleven cases were followed up for 6 to 18 months (mean 12-5 months). The results wereexcellent in 7 and good in 4 according to HSS scoring system. At the final followup, the score of VAS was 32±15, showing statistically significant difference when compared with preoperation (Plt;0.05). The range of flexion and extend of joint was 110±10°，the range of rotation of joint was 120±5° postoperatively, showing statistically significant differences when compared with preoperation (Plt;0.05). Conclusion The elbow arthroscopy might be a reliable methodto diagnose and treat osteochondritis dissecans of elbow joint in adolescent with minor trauma，quick recovery，significant improving function and less complications.
ObjectiveTo develop a smart orthosis personalized management system for the treatment of patients with adolescent idiopathic scoliosis (AIS) and to evaluate the feasibility and efficiency through clinical preliminary applications.MethodsThe smart orthosis personalized management system consists of a wireless force monitor, a WeChat Mini Program, a cloud-based storage system, and a website backstage management system. Twenty-two patients with AIS who underwent orthosis treatment and met the selection criteria between March 2020 and December 2020 were enrolled. The follow-up time was 4 months. The parameters used to evaluate patients’ compliance were as follows (back and lumbar): baseline force value, measured force value, force compliance (measured force value/baseline force value×100%), measured wearing time (wearing time of force value was more than 0 N), and time compliance (measured wearing time/prescribed wearing time×100%), in which the prescribed wearing time was 23 hours/day. The baseline force values were measured at initiation, while the measured force value, measured wearing time, force compliance, and time compliance were measured during follow-up. The differences of these parameters between back and lumbar, and the differences among these parameters at 1, 2, 3, and 4 months after orthosis wearing were analyzed.ResultsThe average measured force value of 22 patients (back and lumbar) was (0.83±0.34) N, the average force compliance was 68.5%±17.9%, the average measured wearing time was (15.4±1.7) hours, and the average time compliance was 66.9%±7.7%. The baseline force value and measured force value of back were significantly higher than those of lumbar (P<0.05); the measured wearing time, force compliance, and time compliance between back and lumbar showed no significant difference (P>0.05). The measured force value, measured wearing time, force compliance, and time compliance at 1 month after wearing were significantly lower than those at 2, 3, and 4 months after orthosis wearing (P<0.05), no significant difference was found among 2, 3, and 4 months after orthosis wearing (P>0.05). At different time points after wearing, the measured force value of back were significantly higher than that of lumbar (P<0.05), while there was no significant difference between back and lumbar on the other parameters (P>0.05).ConclusionThe smart orthosis personalized management system has high feasibility to treat AIS, and can improve the compliance of such patients with orthosis wearing.
ObjectiveTo investigate the changes and relationship of cervical spine sagittal alignment and other spinal-pelvic sagittal parameters in adolescent idiopathic scoliosis.
MethodsBetween July 2011 and July 2014, 35 patients with idiopathic scoliosis who met the inclusion criteria underwent posterior pedicle screw instrumentation and fusion. There were 12 males and 23 females with a mean age of 16.2 years (range, 13-20 years), including 16 cases of Lenke type 1, 7 cases of Lenke type 2, 4 cases of Lenke type 3, 3 cases of Lenke type 4, 4 cases of Lenke type 5, and 1 case of Lenke type 6. The average follow-up time was 10.9 months (range, 5-36 months). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), T1 slope, C2 slope, C7 sagittal vertical axis (C7 SVA), C2-7 plumbline (cSVA) were measured on pre-and post-operative standing lateral X-ray film. Based on preoperative CL, the patients were divided into kyphosis group (CL>0°) and lordosis group (CL < 0°); after operation, the patients were divided into restored lordosis (group A), decreased kyphosis (group B), and increased lordosis (group C) after operation. All data about sagittal profile changes were analyzed. The relations between CL and other spinal-pelvic parameters in the kyphosis and lordosis groups before operation were determined via Spearman correlation coefficient.
ResultsStatistically significant changes were observed in PT, PI, SS, and LL between at pre-and post-operation (P < 0.05), but no significant difference was found in the other parameters (P>0.05). There were 17 patients in lordosis group and 18 in kyphosis group before operation. Intra-group comparisons showed significant changes in PT, PI, SS, C2 slope, and C7 SVA in lordosis group, and in PT, PI, SS, LL, CL, TK, T1 slope, and C2 slope in kyphosis group (P < 0.05). Subgroup comparisons showed significant changes in CL, TK, C2 slope, C7 SVA, and T1 slope before operation (P < 0.05) and T1 slope at last follow-up between 2 groups (P < 0.05). In kyphosis group, 7 cases (group A) had restored lordosis, 7 cases (group B) had decreased kyphosis, and 4 cases had increased lordosis. In lordosis group, 9 cases (group C) had increased lordosis, 3 cases had decreased lordosis, and 5 cases had kyphotic cervical alignment after operation. Significant difference was found in LL, CL, T1 slope, C2 slope, and C7 SVA of group A, in TK and CL of group B, and in CL and cSVA of group C between pre-and post-operation (P < 0.05). There were significant differences in pre-and post-operative LL between groups A and B (P < 0.05). In lordosis group, there was a strong correlation between CL and C2 slope (P < 0.05) at pre-operation. CL had strong correlation with C2 slope and T1 slope (P < 0.05) at pre-operation in kyphosis group, and CL had moderate correlation with cSVA (P < 0.05).
ConclusionCervical sagittal alignment plays an important role in the balance of the spine and pelvis. The change of cervical sagittal alignment has a certain correlation with the change of thoracic kyphosis. Attention to properly maintaining or restoring cervical sagittal lordosis alignment should be considered in preoperative evaluation of adolescent indiopathic scoliosis.
Objective To systematically review the rate of sleep deprivation in children and adolescents in China from 2004 to 2019. Methods PubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI and WanFang Data databases were searched to collect cross-sectional studies on the sleep deprivation rate of children and adolescents in China from inception to July 15th, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using Stata 15.0 software. Results A total of 45 cross-sectional studies were included, with a total sample size of 769 918 participants, of whom 587 457 reported sleep deprivation. The results of meta-analysis showed that the sleep deprivation rate of Chinese children and adolescents was 61% (95%CI 55% to 68%). Subgroup analysis indicated that the sleep deprivation rates were 62% for female children and 59% for male children. The rate was 84% in junior high school, 80% in high school and 64% in primary school. The rates in south China, southwest China, northwest China, north China, east China and central China were 68%, 62%, 61%, 57%, 57% and 54%, respectively. The rate of sleep deficiency based on "health requirements for daily study time of primary and junior school students" was the highest at 74% (95% CI 70% to 79%). The cumulative meta-analysis by time showed that the sleep deprivation rate had gradually stabilized and approached 60% since 2011. Conclusion Current evidence shows that the sleep deprivation rate of Chinese children and adolescents is high. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review literature on the influencing factors related to adolescent sub-health problems. Methods We electronically searched the following four databases including CBM, VIP, CNKI and WanFang Data to collect Chinese literature on adolescent sub-health status and problems in China published before May 2012. Two reviewers independently screened literature, extracted data, and cross checked records. Then qualitative analysis was applied. Results According to the inclusion and exclusion criteria, 41 cross-sectional studies were included. The results of qualitative analysis showed that the influencing factors of adolescent sub-health could be classified into four categories including social factors, family factors, school factors, and interpersonal relationships. The main ones were social support, employment pressure, family economic conditions, learning burden, unhealthy habits, etc. Conclusions There are many influencing factors of adolescent sub-health with interaction. Due to the limitation of the included studies, more prospective cohort studies are needed to provide high quality evidence.
ObjectiveTo systematically review the relationship between polycyclic aromatic hydrocarbons (PAHs) and emotion and behaviors in children and adolescents. MethodsThe PubMed, EBSCO, Web of Science, CBM, VIP, WanFang Data, OVFT, Proquest Psychological database and CNKI databases were electronically searched to collect studies on the relationship between PAHs and emotion and behaviors in children and adolescents from inception to October 20, 2022. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. A qualitative systematic review was then performed. ResultsA total of six cohort studies were included, five studies involving maternal exposure during pregnancy, found that maternal exposure to PAHs during pregnancy was associated with an increase in childhood anxiety/depression syndrome, attention problems, social withdrawal, social competence, social problems, orientation/regulation, withdrawal behaviors, and autism-related behaviors. Another study of exposure in school-age children found that PAHs exposure was associated with poorer attention performance in school. Results of other emotional behaviors were inconsistent, or no association was found. ConclusionCurrent evidence shows that PAHs have certain effects on emotional behaviors of children and adolescents. Due to the limited quality and quantity of the included studies, more high-quality cohort studies are required to verify above conclusion.
Objective To explore the association between behavioral, emotional problems and life events among adolescents, and to determine which factors of life events correlate most highly with the behavioral, emotional problems. Method A total of 1 325 adolescents were investigated with Youth Self-Report (YSR) of Achenbach’s behavior checklist and Adolescent Self-Rating Life Events Checklist (ASLEC), and the data were analyzed with canonical correlation analysis. Results Canonical correlation was statistically significant. The correlation coefficients of the first pair of canonical variables in the male and female group were 0.631 3 and 0.621 1, respectively, and the cumulative proportion of the first two pairs of canonical variables was above 0.95. In the first pair of canonical variables, the loadings of anxious/depressed, interpersonal sensitivity and study pressure were higher, while in the second pair, withdrawal and punishment were the most important factors. Conclusions The effects of life events on emotional problems mainly contributed to interpersonal sensitivity and study pressure.
