从“反儿童”到“向儿童”:角色游戏中教师指导的视角转向

在角色游戏中,有的教师忽视儿童游戏兴趣与需求,从成人视角出发组织游戏活动,视为“反儿童”现象,表现在游戏材料提供、游戏情节指导和游戏规则制订等方面。“反儿童”现象与教师不彻底的儿童观、不到位的游戏观以及曲折发展的游戏指导能力息息相关。唯有实现从“反儿童”到“向儿童”视角的转变,才能不断减少“反儿童”现象的发生。具体包括:首先,让儿童感受到自己被尊重、被认可;其次,对儿童的成长状态抱以求真态度,不夸大、不缩小儿童的真实发展情况;最后,注重儿童游戏体验与深度学习,明确游戏目的是儿童的经验生长而非其他。

20世纪以来美国联邦政府“反儿童贫困”政策的演变及启示——促进儿童健康的角度

儿童贫困是一个世界难题,各国政府都在行动,以各种形式致力于减少儿童贫困。"反儿童贫困"的关键在于家庭,通过提高儿童所在家庭的经济状况促进儿童身心健康,为儿童提供有质量的受教育机会,从而摆脱家庭贫困,打破贫困代际传递的怪圈,促进社会公平。保障儿童身心健康是反贫困的基本目标,20世纪以来,美国联邦政府围绕这一目标,开展了一系列旨在促进儿童健康的"反儿童贫困"政策及实践。美国的实践表明,"反儿童贫困"需要医学、保育与教育以及社会科学研究等领域合力发挥作用,需要整个社会的支持和国家资源的有效供给,需要法律法规的强有力的规定以及政策网络的共同作用。

Concentrations of gastric mucosal cytokines in children with food allergy and Helicobacterpylori infection

AIM： To measure the concentrations of chosen cytokines in the antrum mucosa depending on the kind of harmful pathogenic factors and to compare the concentrations with the values of controls without allergy and coexisting Helicobacter pylori （H pylori） infection. METHODS： The patients （97 children） were divided into three groups according to the data obtained from the case history, to the main cause of the disease and to the dominant clinical symptoms. Group Ⅰ： children with food allergy （Fa）; group Ⅱ： children infected with H pylori; group Ⅲ （control group）： children with functional disorders of the alimentary tract （without Fa and Hp infection）. H pylori infection was determined by the presence of anti-Hp antibodies in serum （ELISA method） and urease test performed during endoscopic examination. Cytokine concentration in homogenates of gastric mucosa was detected by ELISA method. RESULTS： The IL-2 concentration in gastric mucosa bioptates was the highest in children with Hp infection （116.5±179.5 pg/mg of the protein） and Fa and Hp infection （98.1±101.0 pg/mg）, while decreased in children with Fa （44.8±50.3 pg/mg） and controls （45.7±23.5 pg/mg）. The lowest mean concentration of IFN-y was observed in children with Hp infection （18.9±16.4 pg/mg）, with Fa and Hp infection （25.5±27.7 pg/mg）, with Fa （40.6±39.7 pg/mg） and controls （49.9±33.4 pg/mg）. The highest IL-4 concentrations were observed in children with Hp infection （35.3±52.8 pg/mg） and in children with Fa and Hp infection （37.2±51.7 pg/mg）, while lower IL-4 concentration （23.64-35.8 pg/mg） was found in children with Fa compared to the controls （22.7±13.8 pg/mg）. The analysis of IL-4 concentrations in children with Hp infection regarding the intensity of gastritis showed the highest value （62.2±61.2 pg/mg） in mild and moderate gastritis. The concentrations of IL-5 in the gastric mucosa of children with or without Fa did not differ significantly and were comparable to the control group. The highest mean IL-8 value was observed in Hp-infected children with or without Fa. The highest concentration of mucosal IL-10 was detected in children with Hp infection （79.3±41.2 pg/mg） and decreased in children with Fa and Hp infection （50.1±18.8 pg/mg） and in children with Fa （39.9±35.5 pg/mg）. The intensity and activity of the inflammation did not affect IL-10 concentrations in the gastric mucosa. In children with Hp infection, TNF-α concentration was the highest （45.9±49.3 pg/mg） and in children with Fa and Hp infection was low （45.3±32.6 pg/mg）, whereas decreased in children with Fa （21.7±34.2 pg/mg） and in controls （31.6±14.5 pg/mg）. CONCLUSION： The morphological changes of the gastric mucosa in children with Hp infection are comparable to those in children with Fa and coexisting Hp infection. Cytokine concentration in children with Fa and Hp infection is significantly different in IFN-7, IL-2, IL-8, and TNF-α.

ADRs and Children： Knowledge and Methodological Standard in PASS （Post Authorization Safety Studies）

PhV （pharmacovigilance） knowledge has the outcome of being inadequate in particular due to the lack of instruction. Pediatricians have to face the realization that over-the-counter medicines increments the peril of ADRs （adverse drug reactions） has become a public health concern. The purpose of this article is to disseminate knowledge of the PhV and to highlight the cultural and organizational difficulties for its implementation. The objectives of promoting the organization of specific training courses and research projects aimed at： （1） to foster the culture of iatrogenic disease in pediatrics; （2） to improve the appropriateness of prescribing drugs in children; （3） to enco.urage spontaneous reporting of ADRs in children; （4） to involve Pediatricians in PASS （post-authorization safety studies） according to GCP, GVP and ENCEPP Code of Conduct. An up to date proposal of PhV, a procedure of preparation improves the productivity of creating novel informative reports which can be utilized for a benefit/risk scrutiny making strides in medicine prescription. In this context, FP-MCRN （family paediatficians-medicines for children research network） established with the aim of developing competence, infrastructure and education for paediatric clinical trials, plays a crucial role in paediatric PhV, through an improvement of PhV training, a correct research methodology and very strong relationship with the families. The initial necessity is cultural, implementing culture of iatrogenic illnesses and a watchful evaluation of the importance of PASS by FPs （family pediatricians）. Participation in clinical trials that generates a precise database administered by FPs together with follow-up outcomes becomes relevant and vital for a scrupulous and accurate assessment of ADRs. PASS can foresee on one hand training and information regarding the proper use of drugs in children and possible iatrogenic pathologies caused by their improper use, the other to constitute a territorial survey in the prescriptive appropriateness and safety of pediatric drugs aimed at evaluating the risk-benefit balance on usage.

Adverse events of intravenous immunoglobulin infusions:a three-year retrospective study in China

Intravenous immunoglobulin(IVIG) is biological product, which is extensively used in pediatric patients, with high adverse effects on children among different brand preparations. In the present study, we aimed to describe the adverse events of pediatric patients given IVIG infusions in China. Data were collected from all patients receiving IVIG infusion at the largest children’s hospital in Ningbo of China form January 2015 to December 2017. Descriptive statistics was used. A total of 2100 patients received IVIG infusion. All the patients who experienced adverse reactions were children(0.48%), with the highest frequency of infusion among those age 1 to 3 years old(40%). Among 10 infusions with adverse reactions, the most common indication was Kawasaki disease(40%) followed by severe pneumonia(30%). Rash was the most common adverse event(80%), followed by chest pain & cough(50%) and cyanosis(40%). Adverse events were observed to occur most frequently within 30 min from onset of infusion. Most of the reactions occurred with the large dose and the indications of used for. Since the hospital changed the brand, the incidence of adverse reactions was decreased from 1.39% to 0.13%. In this study, 0.48% of pediatric patients given IVIG infusions experienced adverse events. Anaphylactoid reaction was the most common manifestation. Symptoms occurred within 30 min from onset of infusion, which were affected by the dose, the value of lgE, the indications and the different brands.

Clinical Research into Qufeng Zhidong Recipe Used to Treat 31 Children with Tic Disorder

Objective: To assess the therapeutic effect and adverse reaction of Qufeng Zhidong Recipe (a recipe for dispelling wind to stop abnormal movement) used to treat children with tic disorder (TD). Methods: The enrolled patients were randomized into a TCM group (31 cases) treated with Qufeng Zhidong Recipe and a Western medicine group (30 cases) treated with haloperidol and trihexyphenidyl. Two courses of treatment were observed with 12 weeks as one course. The therapeutic effect and adverse reaction were assessed with Yale Global Tic Severity Scale (YGTSS), Tic Symptom Score Scale (TSSS), TCM Syndrome Score Scale (TCMSSS), Treatment Emergent Symptom Scale (TESS) and laboratory examinations. Results: The total effective rate was 100% in the TCM group and 60% in the Western medicine group with statistical significance in difference (P<0.05). All the scores in the TCM group were better than those in the Western medicine group (P<0.05). Conclusion: Qufeng Zhidong Recipe can obviously relieve the symptoms and signs of TD children without toxic side-effects.