Objective This study estimated the investment in child development from three aspects-public health, public education, and family investment to establish the level of investment, to provide reference information for g...Objective This study estimated the investment in child development from three aspects-public health, public education, and family investment to establish the level of investment, to provide reference information for government decision making and to provide international comparisons. Methods Public investment in health was measured with macro data related to public health spending and child development in government expenditure. Public education investment was based on basic education data. Family investment evaluation was based on per capita family consumer spending data in different age groups to estimate the input for child development. Results Both public health investment level and the proportion of GDP rose for all age groups over time, but the overall investment level was still insufficient. Public investment in children＇s education has increased year by year, but the trends in all age groups are unbalanced with much lower investment in early childhood education. Private investment in children has increased over the period, but has declined as a percentage of GDP. International comparisons show that China＇s investment in child development is much lower than OECD countries. Conclusion The private investment in child development was the main way in China, with public finance contributing only a small proportion. Given the poor international comparisons, the government needs to review the balance of public investment to redirect more towards the development of children under the age of six to their health and education.展开更多
EDITOR'S NOTE: The National Working Committee for Children and Women (NWCCW) issued a national report on child development on May 27. The three-chapter report discusses the policies adopted and actions taken by th...EDITOR'S NOTE: The National Working Committee for Children and Women (NWCCW) issued a national report on child development on May 27. The three-chapter report discusses the policies adopted and actions taken by the government to protect the legitimate rights and interests of children in the last few years. It also illustrates the improvements and progress made in children's health and education, and pinpoints the problems and future challenges facing the nation on child development issues. The full text of the report follows:展开更多
Background: Unsafe drinking water,poor sanitation and hygiene,exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low-and middle-income countrie...Background: Unsafe drinking water,poor sanitation and hygiene,exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low-and middle-income countries.We implemented an integrated home-environmental intervention package(IHIP),comprising a kitchen sink,hygiene education and a certified improved biomass cookstove,and an early child development(ECD)programme to improve children´s health and developmental outcomes in the rural high-altitude Andes of Peru.Methods: We conducted a one-year cluster-randomised controlled trial among 317 children<36 months divided into 4 arms(IHIP+ECD,IHIP,ECD,and Control)and 40 clusters(10 clusters per arm).ECD status(socio-emotional,fine and gross motor,communication,cognitive skills,and an overall performance)measured with the Peruvian Infant Development Scale and the occurrence of self-reported child diarrhoea from caretakers were primary outcomes.Secondary outcomes included the occurrence of acute respiratory infections and the presence of thermo-tolerant faecal bacteria in drinking water.The trial was powered to compare each intervention against its control arm but it did not allow pairwise comparisons among the four arms.Primary analysis followed the intention-to-treat principle.For the statistical analysis,we employed generalised estimating equation models with robust standard errors and an independent correlation structure.Results: We obtained ECD information from 101 children who received the ECD intervention(individually and combined with IHIP)and 102 controls.Children who received the ECD intervention performed better in all the domains compared to controls.We found differences in the overall performance(64 vs.39%,odd ratio(OR):2.8;95%confidence interval(CI):1.6–4.9)and the cognitive domain(62 vs 46%,OR:1.9;95%CI:1.1–3.5).Data analysis of child morbidity included 154 children who received the IHIP intervention(individually and combined with ECD)and 156 controls.We recorded 110,666 child-days of information on diarrhoea morbidity and observed 1.3 mean episodes per child-year in the children who received the IHIP intervention and 1.1 episodes in the controls.This corresponded to an incidence risk ratio of 1.2(95%CI:0.8–1.7).Conclusions: Child stimulation improved developmental status in children,but there was no health benefit associated with the home-environmental intervention.Limited year-round access to running water at home and the possible contamination of drinking water after boiling were two potential factors linked to the lack of effect of the home-environmental intervention.Potential interactions between ECD and home-environmental interventions need to be further investigated.展开更多
I. Introduction 1. The children of today will run the families of the 21st century. Their survival, protection and development decide, for the most part, the quality of a people and lay the foundation of human progres...I. Introduction 1. The children of today will run the families of the 21st century. Their survival, protection and development decide, for the most part, the quality of a people and lay the foundation of human progress as a whole. The 1990 World Summit for Children endorsed the "World Declaration on the Survival, Protection and Development of Children" and the "Plan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s," (hereinafter referred to as "Declaration" and "Plan of Action" for short), In March 1991, Premier Li Peng signed the two documents on behalf of the Chinese Government, making a solemn commitment to this major undertaking. 2. The wholesome development of children has a bearing upon the future of China. The Communist Party of China and the Chinese Government have always paid close attention to the survival,展开更多
Background Epidemiological studies examining the direct and indirect effects of gestational diabetes mellitus(GDM)on offspring early childhood developmental vulnerability are lacking.Therefore,the aims of this study w...Background Epidemiological studies examining the direct and indirect effects of gestational diabetes mellitus(GDM)on offspring early childhood developmental vulnerability are lacking.Therefore,the aims of this study were to estimate the direct and indirect effects of GDM(through preterm birth)on early childhood developmental vulnerability.Methods We conducted a retrospective population-based cohort study on the association between gestational diabetes mellitus and early childhood developmental vulnerability in children born in Western Australia(WA)using maternal,infant and birth records from the Midwives Notification,Hospitalizations,Developmental Anomalies,and the Australian Early Development Census(AEDC)databases.We used two aggregated outcome measures:developmentally vulnerable on at least one AEDC domain(DV1)and developmentally vulnerable on at least two AEDC domains(DV2).Causal mediation analysis was applied to estimate the natural direct(NDE),indirect(NIE),and total(TE)effects as relative risks(RR).Results In the whole cohort(n=64,356),approximately 22%were classified as DV1 and 11%as DV2 on AEDC domains.Estimates of the natural direct effect suggested that children exposed to GDM were more likely to be classified as DV1(RR=1.20,95%CI:1.10-1.31)and DV2(RR=1.34,95%CI:1.19-1.50)after adjusting for potential confounders.About 6%and 4%of the effect of GDM on early childhood developmental vulnerability was mediated by preterm birth for DV1 and DV2,respectively.Conclusion Children exposed to gestational diabetes mellitus were more likely to be developmentally vulnerable in one or more AEDC domains.The biological mechanism for these associations is not well explained by mediation through preterm birth.展开更多
发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿...发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿的治疗方式选择存在较大争议,由于疾病预后以及手术创伤、费用、时长等因素影响着治疗方式的选择,因此至今尚没有明确的治疗方案。目前采用的手术方法主要包括闭合复位、单纯切开复位及骨盆截骨术,然而每种治疗方式下都有部分患儿存在严重并发症,如残余发育不良(residualacetabular dysplasia,RAD)和股骨头缺血性坏死(avascular necrosis,AVN)。由于DDH患儿术后并发症的影响因素复杂,且18~24月龄这一年龄段髋臼发育的特殊性,如何选择适合不同患儿的手术方法已成为当前临床治疗的难点。本文就18~24月龄DDH患儿的手术治疗研究进展进行综述,旨在为该年龄段患儿选择合适的手术方案提供参考依据。展开更多
Introduction: To compare the Brazilian conditional cash transfer program, the “Bolsa Família” with the similar programs found in Latin America regarding its effects in the children’s growth and development. Me...Introduction: To compare the Brazilian conditional cash transfer program, the “Bolsa Família” with the similar programs found in Latin America regarding its effects in the children’s growth and development. Methods: The systematic review contemplated the Scopus, Embase, Pubmed, Scielo and Lilacs data bases. The inclusion criteria were epidemiological quantitative, observational, descriptive and analytical studies that had as target public children contemplated by the income transfer program with health conditionalities in Latin America. Narrative reviews related to the research theme were excluded as well as systematic reviews with or without meta-analysis related to the research theme. Results: The titles and abridgements review from 1007 articles resulted in the selection of 17 complete studies. After the quality analysis of these, as well as the application of the inclusion criteria, 10 articles were included in this review. Among the types of epidemiologic studies selected to compose this systematic review, 3 are cohort analytical studies. Conclusion: Studies carried out in Brazil, Mexico, Ecuador and Nicaragua were selected and indicated the positive effects that the conditional income transfer brought to the anthropometric index from beneficiary children in the researched countries.展开更多
目的探讨股骨头骨化核对6~24月龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿治疗后发生股骨头缺血性坏死(avascular necrosis of femoral head,AVN)的影响。方法回顾性分析2018年1月至2022年1月期间在昆明市儿童医...目的探讨股骨头骨化核对6~24月龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿治疗后发生股骨头缺血性坏死(avascular necrosis of femoral head,AVN)的影响。方法回顾性分析2018年1月至2022年1月期间在昆明市儿童医院接受石膏固定术治疗的6~24月龄DDH患儿的髋关节临床资料。依据末次随访时患髋股骨头是否坏死分为:AVN(+)组(Kalamchi-MacEwen分型Ⅰ~Ⅳ型)、AVN(-)组(Kalamchi-MacEwen分型未见坏死);根据股骨头是否出现临床坏死分为临床AVN(+)组(Kalamchi-MacEwen分型Ⅱ~Ⅳ型)、临床AVN(-)组(Kalamchi-MacEwen分型Ⅰ型或未见坏死);根据手术年龄分为6~12月龄组、12~18月龄组和18~24月龄组。比较AVN(+)组与AVN(-)组患儿性别、患髋骨化核状态、侧别、手术年龄、手术方式、术前国际髋关节发育不良协会(International Hip Dysplasia Institute,IHDI)分型、术前髋臼指数(acetabular index,AI)值、外展角度,采用二元Logistic回归分析评估DDH术后发生AVN的独立影响因素,基于独立影响因素绘制受试者操作特征(receiver operating characteristic,ROC)曲线评估其对DDH术后发生AVN的诊断效能。对比临床AVN(+)组与临床AVN(-)组患髋的骨化核状态,分析骨化核状态对临床AVN的影响。对比6~12月龄组、12~18月龄组、18~24月龄组患髋AVN发生率、临床AVN发生率、再脱位发生率、残余髋臼发育不良(residual acetabular dysplasia,RAD)发生率。结果本研究共纳入221髋。AVN(+)组54髋,AVN(-)组167髋。患髋中有骨化核者AVN发生率为18.1%(27/149),无骨化核者ANV发生率为37.5%(27/72),有骨化核者AVN发生率显著低于无骨化核者(P=0.002)。多因素Logistic回归分析发现,骨化核状态(OR=3.064,95%CI:1.486~6.319)、外展角度(OR=1.184,95%CI:1.110~1.264)、术前IHDI分型(OR=3.821,95%CI:1.465~9.968)是DDH术后发生AVN的独立影响因素(P<0.05)。ROC曲线分析显示外展角度预测DDH术后发生AVN的最佳截断值为63.5°,曲线下面积(area under curve,AUC)为0.752,灵敏度为0.500,特异度为0.934。有骨化核者临床AVN发生率为14.1%,无骨化核者临床ANV发生率为26.4%,有骨化核者临床AVN发生率显著低于无骨化核者(P=0.026)。6~12月龄组、12~18月龄组、18~24月龄组AVN发生率分别为20.0%、31.7%、46.1%,临床AVN发生率分别为11.3%、25.0%、26.1%,再脱位发生率分别为1.7%、8.3%、13.0%,RAD发生率分别为27.0%、45.0%、54.3%;3个手术年龄组间比较,AVN发生率差异均无统计学意义(P=0.224),但临床AVN发生率、再脱位发生率和RAD发生率差异均有统计学意义(P<0.05)。结论骨化核状态、外展角度、术前IHDI分型是DDH患髋术后发生AVN的独立影响因素。骨化核出现对股骨头具有保护作用,可显著降低AVN及临床AVN的发生率,但随着年龄增大,临床AVN发生率、再脱位发生率和RAD发生率增高,会导致相对不良的预后,因此建议在有复位指征时尽早进行DDH治疗,无需等待骨化核出现。展开更多
Just like children are not small adults, pediatric studies are not just subgroup-adult studies. Clinical pharmacology aims to predict these effects based on drug, population and/or patient-specific pharmacokinetics(co...Just like children are not small adults, pediatric studies are not just subgroup-adult studies. Clinical pharmacology aims to predict these effects based on drug, population and/or patient-specific pharmacokinetics(concentration-time profiles) and-dynamics(concentration-effect profile). The most essential characteristics of childhood are growth and maturation. Both phenomena are most prominent during infancy making the claim that "an infant is not just a small child" as relevant compared to the paradigm that "a child is not just a small adult". From a clinical pharmacology perspective, the consequence of such a dynamic setting is extensive variability throughout childhood in both the pharmacokinetics and pharmacodynamics. Trial design probably has impact on recruitment to an even greater extent compared to adult studies. In general, if a study is designed well, with a clear clinical question with which parents and children can identify, they are likely to consider participation. Open communication with all stakeholders involved will most likely result in ethically correct, practically feasible, scientifically sound, and economical reasonable studies to provide children with the appropriate treatment. From an academic perspective, feasibility, relevance, applicability and costs of clinical pharmacological studies in children can be signifi cantly improved by new sampling concepts(e.g., saliva, urine, dried spot blood) and the systematic introduction of already known information into the trial design through model based pediatric drug development, that mainly affect feasibility of pharmacokinetic studies. In contrast, for the pharmacodynamic part of pediatric studies, development and validation of population specifi c biomarkers or robust outcome variables is urgently needed.展开更多
基金funded by National Key Project (973) of Study on Interaction Mechanism of Environment and Genetic of Birth Defect in China(No.2007CB5119001)State Key Funds of Social Science Project(Research on Disability Prevention Measurement in China,No.09&ZD072)+2 种基金National Health Baby Promotion Program(No.FP2000NO13)Education Ministry Key Program(No.02185)National Yang Zi Scholar Program,211 and 985 projects of Peking University(No.20020903)
文摘Objective This study estimated the investment in child development from three aspects-public health, public education, and family investment to establish the level of investment, to provide reference information for government decision making and to provide international comparisons. Methods Public investment in health was measured with macro data related to public health spending and child development in government expenditure. Public education investment was based on basic education data. Family investment evaluation was based on per capita family consumer spending data in different age groups to estimate the input for child development. Results Both public health investment level and the proportion of GDP rose for all age groups over time, but the overall investment level was still insufficient. Public investment in children＇s education has increased year by year, but the trends in all age groups are unbalanced with much lower investment in early childhood education. Private investment in children has increased over the period, but has declined as a percentage of GDP. International comparisons show that China＇s investment in child development is much lower than OECD countries. Conclusion The private investment in child development was the main way in China, with public finance contributing only a small proportion. Given the poor international comparisons, the government needs to review the balance of public investment to redirect more towards the development of children under the age of six to their health and education.
文摘EDITOR'S NOTE: The National Working Committee for Children and Women (NWCCW) issued a national report on child development on May 27. The three-chapter report discusses the policies adopted and actions taken by the government to protect the legitimate rights and interests of children in the last few years. It also illustrates the improvements and progress made in children's health and education, and pinpoints the problems and future challenges facing the nation on child development issues. The full text of the report follows:
文摘Background: Unsafe drinking water,poor sanitation and hygiene,exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low-and middle-income countries.We implemented an integrated home-environmental intervention package(IHIP),comprising a kitchen sink,hygiene education and a certified improved biomass cookstove,and an early child development(ECD)programme to improve children´s health and developmental outcomes in the rural high-altitude Andes of Peru.Methods: We conducted a one-year cluster-randomised controlled trial among 317 children<36 months divided into 4 arms(IHIP+ECD,IHIP,ECD,and Control)and 40 clusters(10 clusters per arm).ECD status(socio-emotional,fine and gross motor,communication,cognitive skills,and an overall performance)measured with the Peruvian Infant Development Scale and the occurrence of self-reported child diarrhoea from caretakers were primary outcomes.Secondary outcomes included the occurrence of acute respiratory infections and the presence of thermo-tolerant faecal bacteria in drinking water.The trial was powered to compare each intervention against its control arm but it did not allow pairwise comparisons among the four arms.Primary analysis followed the intention-to-treat principle.For the statistical analysis,we employed generalised estimating equation models with robust standard errors and an independent correlation structure.Results: We obtained ECD information from 101 children who received the ECD intervention(individually and combined with IHIP)and 102 controls.Children who received the ECD intervention performed better in all the domains compared to controls.We found differences in the overall performance(64 vs.39%,odd ratio(OR):2.8;95%confidence interval(CI):1.6–4.9)and the cognitive domain(62 vs 46%,OR:1.9;95%CI:1.1–3.5).Data analysis of child morbidity included 154 children who received the IHIP intervention(individually and combined with ECD)and 156 controls.We recorded 110,666 child-days of information on diarrhoea morbidity and observed 1.3 mean episodes per child-year in the children who received the IHIP intervention and 1.1 episodes in the controls.This corresponded to an incidence risk ratio of 1.2(95%CI:0.8–1.7).Conclusions: Child stimulation improved developmental status in children,but there was no health benefit associated with the home-environmental intervention.Limited year-round access to running water at home and the possible contamination of drinking water after boiling were two potential factors linked to the lack of effect of the home-environmental intervention.Potential interactions between ECD and home-environmental interventions need to be further investigated.
文摘I. Introduction 1. The children of today will run the families of the 21st century. Their survival, protection and development decide, for the most part, the quality of a people and lay the foundation of human progress as a whole. The 1990 World Summit for Children endorsed the "World Declaration on the Survival, Protection and Development of Children" and the "Plan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s," (hereinafter referred to as "Declaration" and "Plan of Action" for short), In March 1991, Premier Li Peng signed the two documents on behalf of the Chinese Government, making a solemn commitment to this major undertaking. 2. The wholesome development of children has a bearing upon the future of China. The Communist Party of China and the Chinese Government have always paid close attention to the survival,
基金Open Access funding enabled and organized by CAUL and its Member Institutions.GP was supported with funding from the National Health and Medical Research Council Project and Investigator Grants#1099655 and#1173991the Research Council of Norway through its Centres of Excellence funding scheme#262700GAT was supported with funding from the National Health and Medical Research Council Investigator Grant#1195716.
文摘Background Epidemiological studies examining the direct and indirect effects of gestational diabetes mellitus(GDM)on offspring early childhood developmental vulnerability are lacking.Therefore,the aims of this study were to estimate the direct and indirect effects of GDM(through preterm birth)on early childhood developmental vulnerability.Methods We conducted a retrospective population-based cohort study on the association between gestational diabetes mellitus and early childhood developmental vulnerability in children born in Western Australia(WA)using maternal,infant and birth records from the Midwives Notification,Hospitalizations,Developmental Anomalies,and the Australian Early Development Census(AEDC)databases.We used two aggregated outcome measures:developmentally vulnerable on at least one AEDC domain(DV1)and developmentally vulnerable on at least two AEDC domains(DV2).Causal mediation analysis was applied to estimate the natural direct(NDE),indirect(NIE),and total(TE)effects as relative risks(RR).Results In the whole cohort(n=64,356),approximately 22%were classified as DV1 and 11%as DV2 on AEDC domains.Estimates of the natural direct effect suggested that children exposed to GDM were more likely to be classified as DV1(RR=1.20,95%CI:1.10-1.31)and DV2(RR=1.34,95%CI:1.19-1.50)after adjusting for potential confounders.About 6%and 4%of the effect of GDM on early childhood developmental vulnerability was mediated by preterm birth for DV1 and DV2,respectively.Conclusion Children exposed to gestational diabetes mellitus were more likely to be developmentally vulnerable in one or more AEDC domains.The biological mechanism for these associations is not well explained by mediation through preterm birth.
文摘发育性髋关节脱位(developmental dysplasia of the hip,DDH)是指髋关节结构及功能上的异常,其治疗目的在于恢复髋臼和股骨头的同心圆复位,保证其正常的生长发育。国内外对不同年龄段DDH患儿的治疗方式比较成熟,但对于18~24月龄DDH患儿的治疗方式选择存在较大争议,由于疾病预后以及手术创伤、费用、时长等因素影响着治疗方式的选择,因此至今尚没有明确的治疗方案。目前采用的手术方法主要包括闭合复位、单纯切开复位及骨盆截骨术,然而每种治疗方式下都有部分患儿存在严重并发症,如残余发育不良(residualacetabular dysplasia,RAD)和股骨头缺血性坏死(avascular necrosis,AVN)。由于DDH患儿术后并发症的影响因素复杂,且18~24月龄这一年龄段髋臼发育的特殊性,如何选择适合不同患儿的手术方法已成为当前临床治疗的难点。本文就18~24月龄DDH患儿的手术治疗研究进展进行综述,旨在为该年龄段患儿选择合适的手术方案提供参考依据。
文摘Introduction: To compare the Brazilian conditional cash transfer program, the “Bolsa Família” with the similar programs found in Latin America regarding its effects in the children’s growth and development. Methods: The systematic review contemplated the Scopus, Embase, Pubmed, Scielo and Lilacs data bases. The inclusion criteria were epidemiological quantitative, observational, descriptive and analytical studies that had as target public children contemplated by the income transfer program with health conditionalities in Latin America. Narrative reviews related to the research theme were excluded as well as systematic reviews with or without meta-analysis related to the research theme. Results: The titles and abridgements review from 1007 articles resulted in the selection of 17 complete studies. After the quality analysis of these, as well as the application of the inclusion criteria, 10 articles were included in this review. Among the types of epidemiologic studies selected to compose this systematic review, 3 are cohort analytical studies. Conclusion: Studies carried out in Brazil, Mexico, Ecuador and Nicaragua were selected and indicated the positive effects that the conditional income transfer brought to the anthropometric index from beneficiary children in the researched countries.
文摘目的探讨股骨头骨化核对6~24月龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿治疗后发生股骨头缺血性坏死(avascular necrosis of femoral head,AVN)的影响。方法回顾性分析2018年1月至2022年1月期间在昆明市儿童医院接受石膏固定术治疗的6~24月龄DDH患儿的髋关节临床资料。依据末次随访时患髋股骨头是否坏死分为:AVN(+)组(Kalamchi-MacEwen分型Ⅰ~Ⅳ型)、AVN(-)组(Kalamchi-MacEwen分型未见坏死);根据股骨头是否出现临床坏死分为临床AVN(+)组(Kalamchi-MacEwen分型Ⅱ~Ⅳ型)、临床AVN(-)组(Kalamchi-MacEwen分型Ⅰ型或未见坏死);根据手术年龄分为6~12月龄组、12~18月龄组和18~24月龄组。比较AVN(+)组与AVN(-)组患儿性别、患髋骨化核状态、侧别、手术年龄、手术方式、术前国际髋关节发育不良协会(International Hip Dysplasia Institute,IHDI)分型、术前髋臼指数(acetabular index,AI)值、外展角度,采用二元Logistic回归分析评估DDH术后发生AVN的独立影响因素,基于独立影响因素绘制受试者操作特征(receiver operating characteristic,ROC)曲线评估其对DDH术后发生AVN的诊断效能。对比临床AVN(+)组与临床AVN(-)组患髋的骨化核状态,分析骨化核状态对临床AVN的影响。对比6~12月龄组、12~18月龄组、18~24月龄组患髋AVN发生率、临床AVN发生率、再脱位发生率、残余髋臼发育不良(residual acetabular dysplasia,RAD)发生率。结果本研究共纳入221髋。AVN(+)组54髋,AVN(-)组167髋。患髋中有骨化核者AVN发生率为18.1%(27/149),无骨化核者ANV发生率为37.5%(27/72),有骨化核者AVN发生率显著低于无骨化核者(P=0.002)。多因素Logistic回归分析发现,骨化核状态(OR=3.064,95%CI:1.486~6.319)、外展角度(OR=1.184,95%CI:1.110~1.264)、术前IHDI分型(OR=3.821,95%CI:1.465~9.968)是DDH术后发生AVN的独立影响因素(P<0.05)。ROC曲线分析显示外展角度预测DDH术后发生AVN的最佳截断值为63.5°,曲线下面积(area under curve,AUC)为0.752,灵敏度为0.500,特异度为0.934。有骨化核者临床AVN发生率为14.1%,无骨化核者临床ANV发生率为26.4%,有骨化核者临床AVN发生率显著低于无骨化核者(P=0.026)。6~12月龄组、12~18月龄组、18~24月龄组AVN发生率分别为20.0%、31.7%、46.1%,临床AVN发生率分别为11.3%、25.0%、26.1%,再脱位发生率分别为1.7%、8.3%、13.0%,RAD发生率分别为27.0%、45.0%、54.3%;3个手术年龄组间比较,AVN发生率差异均无统计学意义(P=0.224),但临床AVN发生率、再脱位发生率和RAD发生率差异均有统计学意义(P<0.05)。结论骨化核状态、外展角度、术前IHDI分型是DDH患髋术后发生AVN的独立影响因素。骨化核出现对股骨头具有保护作用,可显著降低AVN及临床AVN的发生率,但随着年龄增大,临床AVN发生率、再脱位发生率和RAD发生率增高,会导致相对不良的预后,因此建议在有复位指征时尽早进行DDH治疗,无需等待骨化核出现。
基金Supported by The Fund for Scientific Research,Flanders(Belgium)(FWO Vlaanderen)by a Fundamental Clinical Investigatorship(1800209N)A Research Grant(1506409N)
文摘Just like children are not small adults, pediatric studies are not just subgroup-adult studies. Clinical pharmacology aims to predict these effects based on drug, population and/or patient-specific pharmacokinetics(concentration-time profiles) and-dynamics(concentration-effect profile). The most essential characteristics of childhood are growth and maturation. Both phenomena are most prominent during infancy making the claim that "an infant is not just a small child" as relevant compared to the paradigm that "a child is not just a small adult". From a clinical pharmacology perspective, the consequence of such a dynamic setting is extensive variability throughout childhood in both the pharmacokinetics and pharmacodynamics. Trial design probably has impact on recruitment to an even greater extent compared to adult studies. In general, if a study is designed well, with a clear clinical question with which parents and children can identify, they are likely to consider participation. Open communication with all stakeholders involved will most likely result in ethically correct, practically feasible, scientifically sound, and economical reasonable studies to provide children with the appropriate treatment. From an academic perspective, feasibility, relevance, applicability and costs of clinical pharmacological studies in children can be signifi cantly improved by new sampling concepts(e.g., saliva, urine, dried spot blood) and the systematic introduction of already known information into the trial design through model based pediatric drug development, that mainly affect feasibility of pharmacokinetic studies. In contrast, for the pharmacodynamic part of pediatric studies, development and validation of population specifi c biomarkers or robust outcome variables is urgently needed.
