社会组织参与困境儿童社会支持网络构建的服务策略研究--以广州市S组织困境儿童服务项目为例

要妥善回应深化改革过程中困境儿童多元化的需求,须从困境儿童社会支持着手,通过发挥社会组织联动多元主体的作用来筑实困境儿童社会支持网络。研究聚焦S组织困境儿童服务实践策略,分析其回应需求的服务过程,旨在为社会组织参与构建困境儿童支持网络提供实务参考。研究发现,S组织在开展困境儿童服务时能够充分发挥枢纽平台优势,在一定程度上促进了儿童主体发展和多元主体参与,但组织存在建设局限性、服务内容与形式创新不足、服务不够规范、机制缺失等方面的问题。推动儿童福利事业发展的关键在于要坚持政府主导的公共服务供给格局,拓宽社会参与渠道和门槛,整合跨界创新力量,动员多元主体在困境儿童服务中积极投入服务和资源,强化其社会支持网络。

国内儿童游戏空间研究述评——基于硕博论文的分析

游戏空间是儿童成长的重要空间。随着人文地理研究的社会转向和社会科学研究的空间转向,教育研究需要对空间概念有新的解读:教育空间不仅是物质空间,更是社会文化空间。对2002-2016年88篇儿童游戏空间研究硕博论文的分析发现,目前,儿童游戏空间的教育学研究欠缺,已有研究主要关注了儿童游戏空间的"自然地理性",忽视了儿童游戏空间的主观性、社会性和文化性,忽视了空间的教育生产性。儿童游戏空间的研究应重视空间的教育生产性和文化性,教育研究的空间转向是教育研究的新取向。

应用德尔菲法筛选提高儿童ADHD服药依从性的核心信息的研究

目的通过分析和筛选最有助于提高儿童ADHD服药依从性的核心信息,为进一步提高服药依从性及今后此类疾病的健康教育干预提供相关理论依据。方法应用德尔菲法,通过详细考察及精心挑选,邀请来自北京、上海、广州、成都的29名儿科、儿童精神科、儿童心理科等科室的资深专家,开展2轮专家咨询,筛选核心信息。结果对2轮德尔菲咨询专家的积极程度、权威程度系数、变异系数、协调系数等数据进行统计分析。其中,专家的积极程度为:第一轮:100%,第二轮:96.56%。专家的权威程度系数分别为:第一轮:0.75,第二轮:0.75。变异系数均小于0.25。评价指标重要性的专家协调系数分别为:第一轮:0.11,第二轮:0.20。通过2轮专家咨询,确定4项一级指标,16项二级指标。结论所筛选的核心信息合理,能全面、客观地衡量影响服药依从性的相关因素,为今后开展此类疾病的健康教育奠定了坚实基础。

Ultrasonic manifestations and age distribution of internal abdominal hernia in children

Objective To observe the ultrasonic manifestations and age distribution of internal abdominal hernia in children.Methods Data of 53 children with internal abdominal hernia confirmed by operation were retrospectively analyzed.The ultrasonic findings were observed,and the age distribution of children was analyzed.Results Among 53 cases,"cross sign"was observed in 22 cases(22/53,41.51%),and"hernia ring beak sign"was detected in 26 cases(26/53,49.06%)by preoperative ultrasound,according to which 21 cases were diagnosed as internal abdominal hernia,with the accuracy of 39.62%(21/53).Meanwhile,manifestations of intestinal obstruction were noticed in 48 cases(48/53,90.57%),and intestinal necrosis was considered in 22 cases(22/53,41.51%).Four cases were misdiagnosed as intestinal perforation,appendicitis,intestinal atresia and volvulus,each in 1 case.The onset age of postoperative adhesive band internal hernia was larger than that of mesenteric hiatal hernia(P<0.05),while no significant difference of onset age was found among other types of internal abdominal hernias(all P>0.05).Intestinal ischemic necrosis was found in 25 cases,while the incidence of intestinal necrosis in children aged≤1 year,>1 and≤3 years,>3 and≤7 years and those>7 years was 66.67%(12/18),33.33%(4/12),36.36%(4/11)and 41.67%(5/12),respectively.Conclusion The characteristic ultrasonic findings of internal abdominal hernia in children included"cross sign"and"hernia ring beak sign".Internal abdominal hernia in children under 1 year had high risk of intestinal necrosis.

腺样体低温等离子消融术联合扁桃体摘除术治疗儿童OSAHS的疗效观察

目的探讨腺样体低温等离子消融术联合扁桃体摘除术治疗儿童OSAHS的疗效。方法回顾分析23例儿童OSAHS患者,经过PSG（多导睡眠图）和电子鼻咽喉镜检查确诊,主要病因为腺样体肥大和扁桃体肥大,治疗采用腺样体低温等离子消融联合扁桃体摘除术。术后随访1年以上,再次行PSG和电子鼻咽喉镜检查评估疗效。结果 23例患儿术后随访12~24月,平均（18±5）个月,客观检查患儿术前术后平均AHI,OAI及LSa O2变化（P〈0.01）。结论 OSAHS儿童患者尤其是患腺样体肥大、扁桃体肥大者,行腺样体低温等离子消融术联合扁桃体摘除疗效极好,有效率达90%。

儿童选择性信任研究:述评与展望

儿童的选择性信任是指个体面对不同的信息时,能依据各种策略区分其可信任性,而有选择的接受某些信息或信任某些信息提供者。现今的大多数研究将儿童的选择性信任与学习情景结合起来,探究信息提供者的先前准确性、特征,旁观者的非言语性线索等对它的影响。本文将回顾过去的研究,对其发展、影响因素等进行梳理。未来研究应从心理理论、冲突情境、情景等内容以及实验范式的补充完善两方面展开。

Inactivated Bone Replantation with Preservation of the Epiphysis in Children with Osteosarcoma:Clinical Report of Two Cases

Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.

Primary Malignant Renal Tumors in Infancy and Childhood: CT Appearances

Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.

Transcatheter to Close the Patent Duetus Arteriosus and Atrial Septal Defects in Children

Objective: To evaluate the therapeutic effect, safety and complications oftranscathetering Amplatzer device in the closure of patent ductus arteriosus (PDA) and atrial septaldefects (ASD) in children. Methods: Patients with PDA (n = 25) and ASD ( n = 16), confirmed byechocardiography, were treated by transcatheterization. Amplatzer occluder device was placed by thetranscatheterization with the image support of X-ray and transthoracic echocardiography ( TTE) . TheTTE, ECG and X-ray examination were engaged to evaluate the therapeutic results on the time pointsof 24 h , 1, 3 , 6, 12 months after the operation, and all these cases were engaged to the follow-upexamination. Results: The cardioangiographic diameter was 13.0-28.0 mm ([19.3+-4.9] mm) in ASD and2.0-7.7 mm ([3.9+-1.5] mm) in PDA . The diameter of the Amplatzer occluder selected were 13.0-30.0mm ( [20.6+-5.1] mm) in ASD and 4.0-12.0 mm ([6.6+-1.9] mm) in PDA , respectively. All the Amplatzeroccluders were placed successfully. There were no complications during and after the operation.Very small residual shunt was still found soon after the operation in 10 cases , and there were noresidual or recanalization after three months of the operation. The pulmonary artery pressure andheart size were significantly decreased in follow-up examination . Conclusion: Transcatheteringclosure with Amplatzer device is an effective, simple and safe technique in the treatment of ASD andPDA in children.

Long-term Follow-up Study on Perthes Disease

Objective: To analyze the efficacy of various therapies on Perthes diseaseand summarize a systematic treatment strategy. Methods: One hundred and sixty-five cases merelong-term followed. The advantages and disadvantages of various therapies were compared. Results:Each method had its advantage and disadvantage; the effects were correlated with the stages andtypes of the patients and the therapy they were given. Simple treatment is recommended for type Ⅰcases . For type Ⅱ , simple procedures can be used in stage Ⅰ of the patients and surgery wasusually contraindicated for stage Ⅲ cases . For type Ⅲ, vascularized fibula grafting may beconsidered for cases of stage Ⅰ , Ⅱ and Ⅲ. For type Ⅳ cases, combined therapies should beenconsidered. Conclusion: The therapy should be individualized to patient.

Effect of lifestyle intervention on non-alcoholic fatty liver disease in Chinese obese children

AIM: To investigate the effect of lifestyle intervention on non-alcoholic fatty liver disease (NAFLD) in Chinese obese children. METHODS: Seventy-six obese children aged from 10 to 17 years with NAFLD were enrolled for a one-month intervention and divided randomly into three groups. Group1, consisting of 38 obese children, was an untreated control group without any intervention. Group 2, consisting of 19 obese children in summer camp, was strictly controlled only by life style intervention. Group 3, consisting of 19 obese children, received oral vitamin E therapy at a dose of 100 mg/d. The height, weight, fasting blood glucose (FBG), fasting serum insulin (FINS), plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), total cholesterol (TCHO) and homeostasis model assent- insulin resistance (HOMA-IR) were measured at baseline and after one month. All patients were underwent to an ultrasonographic study of the liver performed by one operator who was blinded to the groups. RESULTS: The monitor indices of BMI, ALT, AST, TG, TCHO and HOMA-IR were successfully improved except in group 1. BMI and ALT in group 2 were reduced more significantly than in group 3 (2.44 ± 0.82 vs 1.45 ± 0.80, P = 0.001; 88.58 ± 39.99 vs 63.69 ± 27.05, P = 0.040, respectively).CONCLUSION: Both a short-term lifestyle intervention and vitamin E therapy have an effect on NAFLD in obese children. Compared with vitamin E, lifestyle intervention is more effective. Therefore, lifestyle intervention should represent the first step in the management of children with NAFLD.

Physical activity and academic achievement in children:A historical perspective

As the focus on academic achievement has increased,physical activity(PA) opportunities in schools have decreased in the United States.In an attempt to discover how the decline in PA may affect academic achievement,researchers have been studying the effects of PA on cognition and academic achievement in children for more than 50 years.This review takes a historical perspective on the science of PA and academic achievement prior to and during the past 5 years.A total of 125 published articles were included and reviewed.Fifty-three of these articles were published in the past 5 years.In recent years,the overall quality of the studies has increased,but the results continue to be inconsistent.Many use cross-sectional designs and the methods vary substantially.The majority of conclusions show a positive effect of PA on constructs related to academic achievement.Future studies should use strong study designs to examine the types and doses of PA needed to produce improvements in academic achievement.

Non-alcoholic fatty liver disease:An early mediator predicting metabolic syndrome in obese children?

AIM:To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome,and if liver B-ultrasound can be used for its diagnosis.METHODS:We classified 861 obese children (6-16 years old) into three subgroups:group 0 (normal liver in ultrasound and normal transaminases);group 1 (fatty liver in ultrasound and normal transaminases);and group 2 (fatty liver in ultrasound and elevated transaminases).We measured the body mass index,waist and hip circumference,blood pressure,fasting blood glucose,insulin,homeostasis model assessment of insulin resistance (HOMA-IR),whole-body insulin sensitivity index (WBISI),lipid profile and transaminases in all the participants.The risk of developing metabolic syndrome (MS) was assessed according to the degree of liver fatty infiltration based on the B-ultrasound examination.RESULTS:Among the 861 obese children,587 (68.18%) were classified as having NAFLD,and 221 (25.67%) as having MS.The prevalence of MS in NAFLD children (groups 1 and 2) was 37.64% (221/587),which was much higher than that in non-NAFLD group (group 0,12.04%) (P < 0.01).There were significantly higher incidences concerning every component of MS in group 2 compared with group 0 (P < 0.05).The incidence of NAFLD in MS patients was 84.61% (187/221),which was significantly higher than that of hypertension (57.46%,127/221) and glucose metabolic anomalies (22.62%,50/221),and almost equal to the prevalence of dyslipidemia (89.14%,197/221).Based on the B-ultrasound scales,the presence of moderate and severe liver fatty infiltration carried a high risk of hypertension [odds ratio (OR):2.18,95% confidence interval (95% CI):1.27-3.75],dyslipidemia (OR:7.99,95% CI:4.34-14.73),impaired fasting glucose (OR:3.65,95% CI:1.04-12.85),and whole MS (OR:3.77;95% CI:1.90-7.47,P < 0.01).The state of insulin resistance (calculated by HOMA-IR and WBISI) deteriorated as the degree of fatty infiltration increased.CONCLUSION:NAFLD is not only a liver disease,but also an early mediator that reflects metabolic disorder,and liver B-ultrasound can be a useful tool for MS screening.

IL-10 and TNF-α promoter haplotypes are associated with childhood Crohn’s disease location

AIM： To determine the distribution and frequencies of the genotypes and haplotypes of the genes encoding for the glucocorticoid receptor （GR）, the tumor necrosis factor （TNF）-α and the interleukin （IL）-10 in childhood Crohn＇s disease （CD） and to assess the impact of the corresponding DNA variants on clinical and disease phenotypes.METHODS： Ten variants in GR, TNF-a and IL-10 were genotyped in 113 childhood CD cases and 95 healthy subjects, both of French-Canadian origin.RESULTS： For the GR polymorphisms （R23K and N363S） and IL-10 variants in the 5＇flanking region （-1082 G 〉 A, -819 T 〉 C and -592 A 〉 C）, no difference was observed in allele and genotype frequencies between CD patients and controls. At the haplotype level, we found three IL-10 haplotypes previously described in Caucasians （GCC, ACC and ATA） and three novel haplotypes only present in IBD patients. When we analyzed the haplotype distribution with the anatomical location of the disease, the GCC haplotype was associated with the colonic and the ACC haplotype with the terminal ileum location, respectively. The genotyping of five polymorphisms in the promoter region of the TNF-α gene （-1031 T 〉 C, -863 A 〉 C, -857 T 〉 C, -308 A 〉 G and -238 A 〉 G） revealed a significant overrepresentation of homozygous -1031 CC among CD patients （OR = 9.9） and an association with the colonic location. For TNF-α, eleven haplotypes were inferred, including two frequent ones, TCCGG and CACGG, which were significantly observed more frequently in controls and cases, respectively.CONCLUSION： This is one of the first studies investigating the association between haplotype structure and disease location in a CD pediatric cohort. Our results will help to increase our understanding of the genetic determinants of childhood CD.

Exercise and children's cognition:The role of exercise characteristics and a place for metacognition

Definitive conclusions concerning the impact of exercise interventions on children＇s mental functioning are difficult to ascertain because of procedural differences among studies. A narrative review of studies was conducted to evaluate the role of two types of exercise interventions on children＇s cognition. Acute and chronic exercise interventions were classified as quantitative or qualitative on the basis of manipulations of task complexity and, by inference, mental engagement. Both types of interventions enhance aspects of children＇s cognition; however, their effects on metacognitive processes are unknown. The role of metacognitive processes and their regulation of children＇s behavior and academic performance are highlighted.

T1-weighted dual-echo MRI for fat quantification in pediatric nonalcoholic fatty liver disease

AIM： To determine in obese children with nonalcoholic fatty liver disease （NAFLD） the accuracy of magnetic resonance imaging （MRI） in assessing liver fat concentration. METHODS： A case-control study was performed. Cases were 25 obese children with biopsy-proven NAFLD. Controls were 25 obese children matched for age and gender, without NAFLD at ultrasonography and with normal levels of aminotransferases and insulin. Hepatic fat fraction （HFF） by MRI was obtained using a modification of the Dixon method.RESULTS： HFF ranged from 2% to 44% [mean, 19.0% （95% CI, 15.1-27.4）] in children with NAFLD, while in the controls this value ranged from 0.08% to 4.69% [2.0% （1.3-2.5）, P 〈 0.0001]. HFF was highly correlated with histological steatosis （r = 0.883, P 〈 0.0001） in the NAFLD children. According to the histological grade of steatosis, the mean HFF was 8.7% （95% CI, 6.0-11.6） for mild, 21.6% （15.3-27.0） for moderate, and 39.7% （34.4-45.0） for severe fatty liver infiltration. With a cutoff of 4.85%, HFF had a sensitivity of 95.8% for the diagnosis of histological steato- sis ≥ 5%. All control children had HFF lower than 4.85%; thus, the specificity was 100%. Alter 12 mo, children with weight loss displayed a significant decrease in HFF. CONCLUSION： MRI is an accurate methodology for liver fat quantification in pediatric NAFLD.

Noninvasive Parameters and hepatic fibrosis scores in children with nonalcoholic fatty liver disease

AIM:To evaluate the noninvasive parameters and hepatic fibrosis scores in obese children with nonalcoholic fatty liver disease(NAFLD).METHODS:A total of 77 children diagnosed with NAFLD via liver biopsy were included and divided into 2 subgroups according to the histopathologic staging of hepatic fibrosis:mild(stage 0-1)vs significant fibrosis(stage 2-4).Clinical and laboratory parameters were evaluated in each patient.The aspartate aminotransferase(AST)/alanine aminotransferase(ALT)ratio,AST/platelet ratio index(APRI),PGA index,Forns index,FIB-4,NAFLD fibrosis score,and pediatric NAFLD fibrosis index(PNFI)were calculated.RESULTS:No clinical or biochemical parameter exhibited a significant difference between patients with mild and significant fibrosis.Among noninvasive hepatic fibrosis scores,only APRI and FIB4 revealed a significant difference between patients with mild and significant fibrosis(APRI:0.67±0.54 vs 0.78±0.38,P=0.032 and FIB4:0.24±0.12 vs 0.31±0.21,P=0.010).The area under the receiving operating characteristic curve of FIB4 was 0.81,followed by Forns index(0.73),APRI(0.70),NAFLD fibrosis score(0.58),AST/ALT ratio(0.53),PGA score(0.45),and PNFI(0.41).CONCLUSION:APRI and FIB4 might be useful noninvasive hepatic fibrosis scores for predicting hepatic fibrosis in children with NAFLD.

Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children

AIM： To assess the frequency and the risk factors of stress-induced gastrointestinal （GI） bleeding in children admitted to a pediatric intensive care unit （PICU）. METHODS： The medical records of children aged between 1 month and 15 years admitted to the PICU between January 2002 and December 2002 were reviewed. Demographic data, indications for PICU admission, principle diagnosis, and basic laboratory investigations were recorded. Previously described factors for stress ulcer bleeding （mechanical ventilation, sepsis, acute respiratory distress syndrome, renal insufficiency, coagulopathy, thrombocytopenia, and intracranial pathology） were used as independent variables in a multivariate analysis. RESULTS： One hundred and seventy of two hundred and five medical records were eligible for review. The most common indication for PICU admission was respiratory failure （48.8%）. Twenty-five children received stress ulcer bleeding prophylaxis with ranitidine. The incidence of stress ulcer bleeding was 43.5%, in which 5.3% were clinically significant bleeding. Only mechanical ventilation and thrombocytopenia were significantly associated with stress ulcer bleeding using the univariate analysis. The odds ratio and 95% confidence intervals were 5.13 （1.86-14.12） and 2.26 （1.07-4.74）, respectively. However, the logistic regression analysis showed that mechanical ventilation was the only significant risk factor with the odds ratio of 14.1. CONCLUSION： The incidence of gastrointestinal bleeding was high in critically ill children. Mechanical ventilation was an important risk factor for gastrointestinal bleeding.

Tuberculous peritonitis in children:Report of nine patients and review of the literature

AIM:To present our experience with tuberculous peritonitis treated in our hospital from 2002-2007. METHODS: We reviewed the medical records of 9 children with tuberculous peritonitis. RESULTS: Nine patients (5 boys, 4 girls) of mean age 14.2 years were diagnosed with peritoneal tuberculosis. All patients presented with abdominal distention. Abdominal pain was seen in 55.5% and fever in 44.4% of the patients. Four cases had coexisting pleural effusion and two had pulmonary tuberculosis with parenchymal consolidation. Ultrasonography found ascites with septation in 7 patients. Two patients had only ascites without septation. Ascitic fluid analysis of 8 patients yielded serum-ascite albumin gradients of less than 1.1 gr/dL. Laparoscopy and laparotomy showed that whitish tuberculi were the most common appearance. Adhesions were also seen in three cases. The diagnosis of peritoneal tuberculosis was confirmed histo-pathologically in 7 patients and microbiologically in two. Two patients had been diagnosed by ascitic fluid diagnostic features and a positive response to antituberculous treatment. All patients completed the antituberculous therapy without any complications. CONCLUSION: Tuberculous peritonitis has to be clinically suspected in all patients with slowly progressive abdominal distension, particularly when it is accompanied by fever and pain. Laparoscopy and peritoneal biopsy are still the most reliable, quick and safe methods for the diagnosis of tuberculous peritonitis.

Treatment and follow-up of children with transient congenital hypothyroidism

Objective： To study the clinical therapy and prognosis in children with transient congenital hypothyroidism （CH）. Methods： Fifty-seven children with CH diagnosed after neonatal screening were treated with low-dosage levothyroxine （L-T4）. Follow-up evaluation included the determination of TT3, TT4 and TSH serum levels and the assessment of thyroid gland morphology, bone age, growth development and development quotients （DQ）. A full check-up was performed at age 2, when the affected children first discontinued the L-T4 treatment for 1 month, and one year later. Development quotients were compared with a control group of 29 healthy peers. Results： The initial L-T4 dosage administered was 3.21-5.81μg/（kg·d） with an average of （16.25±3.87）μg/d. Mean duration of therapy was （28.09±9.56） months. No significant difference was found between study group and control group in the DQ test （average score （106.58±14.40） vs （102.4±8.6）, P〉0.05） and 96.49% of the CH children achieved a test score above 85. Bone age, 99mTc scans and ultrasonographic findings were all normal, and evaluation of physical development was normal too, as were the serum levels of TT3, TT4 and TSH after one year of follow-up. Conclusion： AL-T4 dosage of 3.21-5.81μg/（kg·d） was found sufficient for the treatment of transient CH. The treated children showed satisfactory overall mental and physical development at age 2. So it is possible for CH children to stop taking medicine if their laboratory findings and physical development are all normal after regular treatment and 2-3 years of follow-up.