Objective To investigate the organizational structure, routine management, emergency response, and material reserves related to the prevention and control of infectious diseases in maternal and child health institutions at all levels in Sichuan, and to understand the construction of emerging infectious diseases prevention and control system in maternal and child health institutions throughout the province. Methods We conducted a survey on the current situation of the epidemic prevention and control system in maternal and child health institutions using a self-developed questionnaire, which was conducted in October 2020 and July 2021, respectively. We conducted comparative analysis on the basic situation, the construction of emerging infectious disease prevention and control systems, and the setting and management of fever clinics/rooms of maternal and child health institutions at all levels in Sichuan in 2020 and 2021. Results In 2020, a total of 166 maternal and child health institutions participated in the survey, and 166 questionnaires were collected, including 17 at the provincial and municipal levels and 149 at the county level. In 2021, a total of 182 maternal and child health institutions participated in the survey, and 182 questionnaires were collected, including 17 at the provincial and municipal levels and 165 at the county level. In 2021, all levels of maternal and child health institutions in Sichuan had established epidemic prevention and control leadership groups. Compared with 2020, the construction of the emerging infectious disease prevention and control system in maternal and child health institutions at all levels in Sichuan in 2021 had improved to a certain extent in terms of establishing epidemic prevention and control leadership groups, hospital area three channel management, three-level pre-examination triage, inpatient area allocation, staff management, and patient management (P<0.05). Compared with 2020, fever clinics that met the requirements of three zones and two channels management, fever clinics that met the requirements of closed-loop management, and management of fever clinics/rooms in maternal and child health institutions at all levels in Sichuan in 2021 had improved to a certain extent (P<0.05). Conclusion Through strengthened construction during the epidemic prevention and control period, the construction of the emerging infectious disease prevention and control system in maternal and child health institutions in Sichuan has improved, but still faces continuous challenges in normalized prevention and control.
Objective To assess the global situation of off-label drug use in hospitalized children. Methods The databases such as PubMed, EMbase, CBM, CNKI and VIP were searched to collect studies on off-label drug use in hospitalized children at age of 0 to 18 years old. The publication language was limited to English and Chinese. The quality assessment was based on Crombie Criteria for cross-sectional studies. The incidence of off-label drug use was described in different wards and age groups, and the proportion of different off-label used drugs was analyzed. Results The total 29 cross-sectional studies were included, involving 8 560 children and 41 655 prescriptions. a) Median (IQR) of off-label use incidence: Neonatal ICU 52.5% (23.0% to 44.8%), Pediatric ICU 43.5% (34.5% to 60%), General pediatric ward 35.5% (23.8% to 43.3%), Pediatric surgical ward 27.5% (23.0% to 44.8%); b) The results of off-label incidence in different age groups were inconsistent among different studies; and c) The off-label drug use for “no pediatric information” had the largest proportion, followed by dose and age. Conclusion a) Off-label drug use exists widely around the world, but the incidence varies a lot in different countries and different types of wards; b) The incidence of off-label drug use may be higher in ICU than in non-ICU, and higher in the neonatal ward than the pediatric ward; c) The off-label drug use for no pediatric information is the commonest type, and further clinical studies should focus on areas in which high quality evidence is totally absent; and d) The multi-center studies with unified design on off-label drug use in hospitalized children in China are urgently needed to provide evidence for policy-making.
Objective To explore the effectiveness of free paraumbilical perforator flaps in repairing skin and soft tissue defects in children. Methods Between February 2018 and March 2024, 12 children with skin and soft tissue defects were treated with the free paraumbilical perforator flaps. There were 7 boys and 5 girls with an average age of 6.3 years (range, 2-12 years). The defects located on the upper limbs in 6 cases, lower limbs in 5 cases, and neck in 1 case. The causes of wounds included 7 cases of electrical burns, 1 case of thermal burn, 2 cases of scar release and excision due to scar contraction after burns, 1 case of scar ulcer at the amputation stump after severe burns, and 1 case of skin necrosis after a traffic accident injury. The size of defects after debridement ranged from 7.0 cm×4.0 cm to 18.0 cm×10.0 cm. According to the defect size, 11 cases were repaired with unilateral paraumbilical perforator flaps centered on the umbilicus, among which 3 cases with larger defects were designed as “L”-shaped flaps along the lateral and lower ends of the perforator; the donor sites were directly closed. One case with extensive defect after scar excision and release was repaired with bilateral expanded paraumbilical perforator flaps; the donor sites were repaired with autologous split-thickness skin grafts. The size of flaps ranged from 9.0 cm×4.0 cm to 20.0 cm×11.0 cm. Postoperatively, analgesia and sedation were provided, and the blood supply of the flaps was observed. Results All operations were successfully completed. The operation time was 4-7 hours, with an average of 5.0 hours. After postoperative analgesia and sedation, the visual analogue scale (VAS) score for pain in all children was less than or equal to 3, and there was no non-cooperation due to pain. All flaps and skin grafts survived completely, and the wounds healed by first intention. Ten children underwent 1-4 times of flap de-fatting, finger separation, and trimming. All children were followed up 6-48 months (mean, 26.6 months). No obvious swelling of the flaps occurred, and the texture was soft. At last follow-up, among the 6 children with upper limb defects, 2 had upper limb function grade Ⅳ and 4 had upper limb function grade Ⅴ according to the Carroll upper limb function assessment method. The 4 children with lower limb defects had no limitation of joint movement. The neck flexion and rotation in the 1 child with neck defect significantly improved when compared with that before operation. The 1 child with residual ulcer at the amputation stump could wear a prosthesis and move without limitation, and no new ulcer occurred. Linear scars were left at the donor sites, and no abdominal wall hernia was formed. ConclusionThe free paraumbilical perforator flap has abundant blood supply and can be harvested in large size. It can be used to repair skin and soft tissue defects in children and has the advantages of short operation time, minimal injury, high safety, and minimal impact on the growth and development of children.
Objective
To compare the short-term outcomes of small thoracotomy and thoracoscopic approach for pediatric lobectomy.
Methods
From June 2011 to June 2016, 42 patients with lung diseases undertook lobectomy in Xinhua Hospital. There were 24 males and 18 females with an average age of 7.13±5.00 years, ranging from 4 months to 16 years. According to different operation methods, they were divided into a thoracoscopy group (n=22) and a small incision group (n=20). Duration of operation, intraoperative blood loss, duration of postoperative drainage, and postoperative hospital stay and complications between the two groups were recorded and compared.
Results
There was no significant difference in the age, body weight between the two groups (8.44±4.99 yearsvs. 5.68±4.69 years,t=1.84,P=0.07; 34.18±16.52 kgvs. 25.03±18.06 kg,t=1.72,P=0.09). Two patients (9%) undergoing thoracoscopy required conversion to small thoracotomy. Perioperative outcomes, including operation time (151.64±74.59 minvs. 136.40±50.36 min,t=0.77,P=0.45), intraoperative blood loss (43.41±45.91 mlvs. 79.50±131.00 ml,t=–1.21,P=0.23), drainage duration (5.00±1.79 dvs. 4.90±2.36 d,t=0.23,P=0.82), length of hospital stay (8.41±3.11 dvs. 8.65±2.66 d,t=–0.27,P=0.79) showed no significant differences between the two groups. One patient suffered pneumonia in thoracoscopy group after operation and the rest patients recovered well without severe complications such as atelectasis, active bleeding and bronchopleural fistula.
Conclusion
Lobectomy via small thoracotomy and thoracoscopic approach is effective and safe for pediatric patients with equivalent short-term outcomes. While thoracoscopic surgery with relatively small incision achieves good cosmetic outcome.
ObjectiveTo evaluate the effect of rural alone-two-child policy (RAC policy) on zero population growth, high sex ratio at birth (SRB), and aging population in China.
MethodsRural areas of cities which implement the RAC policy were included. Data from the fifth and the sixth population censes were used to analyze the variation of the total fertility rate (TFR), SRB, and the number of teenagers of every household (NTH) in context of different social and economic levels.
ResultsThe implementation of RAC policy in rural areas with middle and upper social economic levels showed a long-term effect of increasing the TFR and decreasing the SRB. The implementation of rural girl policy mixed with RAC policy in areas with middle social economic level showed a long-term effect of decreasing the TFR and increasing the SRB; but the long-term effect in areas with low social economic level was uncertain. The NTHs were decreased in all included areas. According to the urban and rural birth preference, we made inferences that the implementation of alone-two-child policy in cities could result in the increase of TFR and the decrease of SRB.
ConclusionThe long-term effect of RAC policy implemented in rural areas with middle social economic level could solve the problems of zero population growth and the high SRB, but the long-term effect of mixed policy implemented in rural areas with middle social economic level may aggravate the two problems above. The RAC policy cannot solve the aging population problem in rural area.
ObjectiveTo identify the effects of transition to siblinghood (TTS) on the firstborn children’s emotions and behaviors, and to define the time of TTS.MethodsCBM, VIP, CNKI, WanFang Data, PubMed, Web of Science and EBSCO were electronically searched to collect studies on the emotional and behavioral characteristics of firstborn children in TTS from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, qualitative methods were used to analyze the studies.ResultsA total of 13 studies involving 980 children were included. 12 behavioral related studies explored self-behavior of the firstborn children during TTS, 3 studies focused on the interaction behavior between the firstborn children and their parents, the firstborn children and the second children. The systematic reviews found that TTS showed both positive and negative effects on the behavioral characteristics of firstborn children, primarily the negative effects. Firstborn children’s anxiety, confrontation and attachment showed 3 different patterns over time, respectively. Two studies showed the increase of negative emotions of firstborn children during TTS. The time range of TTS was mainly concentrated in the third trimester to 12 months after the birth of the second child.ConclusionsThe current evidence shows that TTS primarily increases the negative emotions and behaviors of firstborn children, and the behaviors of firstborn children changes over time. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveThe aim of this study was to understand the relationship between IQ and glucose metabolism in brain cells in a wide variety of epilepsy subjects.
MethodsThe study participants were 78 children with epilepsy and 15 healthy children for comparison. All participants were administered the Chinese Wechsler Intelligence Scale for Children (C-WISC). The verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ) and full scale intelligence quotient (FIQ) were compared between epileptic children and typically developing children. 78 patients underwent interictal positron emission computed tomography (PET) using 2-deoxy-2[18F]fluoro-D-glucose (FDG) as the tracer for evaluating brain glucose metabolism.
ResultsVIQ, PIQ and FIQ based on the C-WISC were significantly lower in epileptic children than those in the healthy comparison group (P < 0.001, P=0.001 and P < 0.001, respectively). The IQ of patients with normal metabolism, unifocal abnormal hypometabolism and multifocal abnormal hypometabolism determined by PET differed significantly. The extent of the abnormal hypometabolism was negatively correlated with the FIQ (rs=-0.549, P < 0.001). In patients with lateralized hypometabolism based on PET, the VIQ/PIQ discrepancy (︱VIQ-PIQ︱≥15 points)scores differed significantly between the left hemisphere abnormal hypometabolism and right hemisphere abnormal hypometabolism subgroups, being negative values in the left and positive values in the right subgroups(P=0.004).
ConclusionsBrain metabolic abnormalities are correlated with IQ, and perfoming interictal PET along with C-WISC can better assess the extent of severity of cognitive impairment and VIQ/PIQ discrepancy.
ObjectiveTo systematically review the efficacy of non-pharmacological interventions to reduce fear of childbirth. MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of non-pharmacological interventions to reduce fear of childbirth from inception to December 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies; then, a network meta-analysis was performed using Stata 15.0 software. ResultsA total of 19 RCTs involving 3 409 patients were included. Ten non-pharmacological interventions (prenatal education, scenario-based health education, psychological guidance, yoga training, hypnosis, mobile learning education, cognitive behavioral therapy, physical relaxation guidance, breathing guidance, and usual care) were included. The results of the reticulated meta-analysis of the Wijma Delivery Expectancy Questionnaire (W-DEQ-A) showed that the rankings of the interventions were as follows: prenatal education > yoga training > cognitive behavioral therapy > situational simulation health education > psychological guidance > physical relaxation guidance > conventional care. The results of the Wijma Experience of Childbirth Questionnaire (W-DEQ-B) mesh meta-analysis showed that the rankings of the interventions were as follows: mobile learning education > prenatal education > scenario-based health education > cognitive behavioral therapy > breathing instruction > hypnosis > psychological instruction > physical relaxation instruction > usual care. ConclusionThe current evidence suggests that prenatal education, mobile learning education, situational simulation health education, and yoga training may be effective interventions in improving maternal fear of childbirth. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Idiopathic thrombocytopenic purpura (ITP) is a common bloody disease with a high incidence in children, but its diagnostic method is exclusive diagnosis, and the existing detection techniques are mostly invasive, which may cause secondary injury to patients and also may increase the risk of disease. In order to make up for the lack of the detection method, this study made a preliminary exploration on the diagnosis of children's ITP from the perspective of infrared thermography. In this study, a total of 11 healthy children and 22 ITP children's frontal infrared thermal images were collected, and the pattern characteristic (PFD), average temperature (Troi) and maximum temperature (MAX) characteristics of 7 target areas were extracted. The weighted PFD parameters were correlated with the platelet count commonly used in clinical diagnosis, and the sensitivity and specificity of the weighted PFD parameters for children's ITP were calculated through the receiver operating characteristic curve (ROC). The final results showed that the difference of the weighted PFD parameters between healthy children and ITP children was statistically significant, and the parameters negatively correlated with platelet count. Under the ROC curve, the area under the curve (AUC) of this parameter is as high as 92.1%. Based on the research results of this paper, infrared thermography can clearly show the difference between ITP children and healthy children. It is hoped that the methods proposed in this paper can non-invasively and objectively describe the characteristics of ITP infrared thermal imaging of children, and provide a new ideas for ITP diagnosis.
ObjectivesTo investigate the occurrence and parents’ cognition of accidental injury among pre-school children in Nanchong city, and provide advice and countermeasures to reduce accidental child injuries.MethodsUsing the multi-stage cluster sampling method, a total of 945 students and parents from 3 classes in each of 4 kindergartens in three districts of Nanchong city were surveyed with questionnaire.ResultsA total of 945 questionnaires were issued and 858 valid questionnaires were returned and the effective response rate was 90.79%. The incidence of incidental injury of pre-school children in Nanchong city was 25.99%, with no difference between boys and girls, and no difference between age groups. The top three injuries were falling (35.64%), smashing/touching/squeezing (22.11%), cutting/stabbing (10.56%). The child smashing/touching/squeezing rate was higher in boys than in girls, the difference was statistically significant (χ2=5.549, P=0.018). The top three places of the occurred injury were outdoor (53.67%), home (43.58%), and playground and kindergarten (13.76%). Between parents who possess injury-related knowledge and those who didn’t, there was no difference in the incidence of accidental injuries among their children. Parents often learned from cell phone (23.88%), TV (21.76%) and computer (18.11%). Ways in which they most hoped to learn from were the school advertised education (22.67%), TV (18.80%) and cell phones (17.75%). Of all types of emergency management skills, the top three figures acquired by the largest population were post-burn emergency treatment (72.03%), emergency treatment for traumatic bleeding (52.56%) and emergency treatment of animal bites (37.53%).ConclusionsThe incidence of accident injuries is high in urban areas of Nanchong city. The safety management of home and kindergarten should be strengthened, including schools' safety education and skills training for children and parents.
