Add-on perceptual learning on refractive amblyopia in children

AIM:To evaluate the visual outcomes of standard amblyopic treatment add-on training via perceptual learning in refractive amblyopic children and to identify the risk factors for treatment failure.METHODS:Retrospective charts were reviewed in children with refractive amblyopia who received standard treatment and add-on Cambridge Visual Stimulator(CAM)training.The add-on CAM group that was enrolled had worn full-corrected glasses for at least 2mo before training.A control group received only the standard treatment.Treatment success was defined as best-corrected visual acuity(BCVA)≥20/25.The age,sex,initial BCVA,refractive errors,sessions and duration of training,and final BCVA were recorded.RESULTS:A total of 209 children(129 children in add-on CAM group and 80 children in control group)were enrolled.Seventy-six percent of unilateral and 87%of bilateral amblyopic children achieved treatment success.In children with unilateral or bilateral moderate amblyopia,the duration to reach BCVA≥20/25 was significantly shorter in add-on CAM group than in control group.Poor initial BCVA(P<0.001)and high astigmatism(P=0.007)were risk factors for treatment failure after add-on CAM training.Age,sex,and types of refractive error were not associated with treatment success.CONCLUSION:Add-on CAM training is an effective strategy for visual improvement and can shorten the treatment course when the effect of standard treatment is limited in amblyopic children.

Brain mechanism of acupuncture for children with anisometropic amblyopia: a resting functional magnetic resonance imaging study based on voxel-mirrored homotopic connectivity

AIM:To explore the brain mechanism of acupuncture for children with anisometropic amblyopia using the voxelmirror homotopic connectivity(VMHC)analysis method of resting functional magnetic resonance imaging(rs-fMRI)technology based on clinical effectiveness.METHODS:Eighty children with anisometropic monocular amblyopia were randomly divided into two groups:control(40 cases,1 case of shedding)and acupuncture(40 cases,1 case of shedding)groups.The control group was treated with glasses,red flash,grating,and visual stimulations,with each procedure conducted for 5min per time.Based on routine treatment,the acupuncture group underwent acupuncture of“regulating qi and unblocking meridians to bright eyes”,Jingming(BL1),Cuanzhu(BL2),Guangming(GB37),Fengchi(GB20)acupoints were taken on both sides,with the needle kept for 30min each time.Both groups were treated once every other day,three times per week,for a total of 4wk.After the treatment,the overall curative effect of the two groups and the latency and amplitude changes of P100 wave of pattern visual-evoked potential were counted.At the same time,nine children with left eye amblyopia were randomly selected from the two groups and were scanned with rsfMRI before and after treatment.The differences in the brain regions between the two groups were compared and analyzed with VMHC.RESULTS:Chi-square test showed a notable difference in the total efficiency rate between the acupuncture(94.87%)and control groups(79.49%).Regarding the P100 wave latency and amplitude,the acupuncture group had significantly shorter latency and higher amplitude of P100 wave than the control group.Moreover,the VMHC values of the bilateral temporal lobe,superior temporal gyrus,and middle temporal gyrus were notably increased in the acupuncture group after treatment.CONCLUSION:Acupuncture combined with conventional treatment can significantly improve the corrected visual acuity and optic nerve conduction in children with anisometropic amblyopia.Compared with the conventional treatment,the regulation of acupuncture on the functional activities of the relevant brain areas in the anterior cerebellum may be an effective acupuncture mechanism for anisometropic amblyopia.

Macular and peripapillary retinal nerve fiber layer thickness in children with hyperopic anisometropic amblyopia

AIM:To compare the retinal nerve fiber layer (RNFL) thickness and macular thickness in the amblyopic eye with that in the sound eye of children with hyperopic anisometropic amblyopia using optical coherence tomography (OCT). METHODS:A prospective, nonrandom, intraindividual comparative cohort study includes 72 children with hyperopic anisometropic amblyopia in a single center. Macular thickness, macular foveola thickness, and peripapillary RNFL thickness were compared between the amblyopia eyes and the contralateral sound eyes. ·RESULTS:There were 38 male and 34 female patients, with a mean age as 9.7 ±1.9 years (range, 5-16 years). Hyperopic was +3.62±1.16D (range +2.00D to +6.50D) in the amblyopic eyes, which was significantly higher in the control eyes with +0.76±0.90D (range 0D to +2.00D) (P 【 0.01). The mean peripapillary RNFL thickness was 113.9± 7.2μm and 109.2 ±6.9μm in the amblyopic eye and the normal eye, respectively, reaching statistical significance (P = 0.02). The mean macular foveola thickness was significantly thicker in the amblyopic eyes than the contralateral sound eyes (181.4±14.2μm vs 175.2±13.3μm, P 【0.01), but the 1mm, 3mm or 6mm macular thickness central macular thickness was not significantly different. Degree of anisometropia in the contralateral eyes was not significantly correlated with differences of peripapillary RNFL, macular foveola thickness or central macular thickness. CONCLUSION:Eyes with hyperopic anisometropic amblyopia are found thicker macular foveola and peripapillary RNFL than the contralateral eyes in children.

Effect of amblyopia training in regulating the amblyopic eye in children with ametropic amblyopia

Objective:To explore the effect of amblyopia training in regulating the amblyopic eye in children with ametropic amblyopia.Methods:A total of 50 children with ametropic amblyopia who were admitted in our hospital from March, 2012 to February, 2014 for amblyopia training were included in the study and served as the amblyopia group (n=90). The clinical efficacy and average time to enhance 1 line LogMAR vision in children with different degrees of amblyopia were recorded. The regulatory function indicators of amblyopic eye were detected. A total of 36 children with normal visions who came for physical examinations at the same stage were served as the control group (n=72).Results:The average time to enhance 1 line LogMAR vision for children with severe amblyopia in the amblyopia group was the shortest, secondly was the moderate amblyopia children, while the average time for children with mild amblyopia was the longest, and the comparison among each group was statistically significant. The accommodation amplitude and accommodation flexibility before and after treatment in the amblyopia group were significantly lower than those in the control group, while the accommodation lag was significantly higher than that in the control group. The accommodation amplitude and accommodation flexibility 3 months after treatment in the amblyopia group were significantly elevated, and those in children with mild and moderate amblyopia were significantly higher than those in children with severe amblyopia, while the accommodation lag was significantly reduced, and that in children with mild and moderate amblyopia was significantly lower than that in children with severe amblyopia.Conclusions:Amblyopia training for children with ametropic amblyopia can effectively improve the regulatory function, and is beneficial for the recovery.

Perceptual learning for treating amblyopia in children based on activation of visual signal pathway Relationship of curative effects and time

BACKGROUND： Conventional methods （such as occlusion therapy, fine manipulation, complementary, and alternative medicine） take effects slowly, are time and labor consuming, and have uncertain curative effects in the treatment of amblyopia. Perceptual learning, a new method for treating amblyopia, improves the ability to process signals from the cerebral optic nerve system by specific visual stimulation and visual learning, as well as activation of the visual signal pathway utilizing brain nervous system plasticity. OBJECTIVE： This study investigated and evaluated the curative effects of perceptual learning, which can directionally increase brain plasticity, on the treatment of amblyopia in children. The relationship between curative effect and time was also analyzed. DESIGN： A self-control experiment. SETTING： Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS： A total of 125 amblyopic children （250 amblyopic eyes）, 73 males, 52 females, averaging （6±2） years of age, received treatment at the Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region between September 2006 and February 2007 and were recruited for this study. All children presented with no structural disease of the eyeballs. Written informed consent for therapeutic regiments was obtained from each child＇s parent. The protocol received approval from the Hospital＇s Ethics Committee. METHODS： Visual function was tested with a perceptual learning system （Research Center for Human Health and Development of Sun Yat-sen University, National Engineering Technique Research Center for Medical Care Implement） for visual noise, position noise, contour discrimination, contrast sensitivity, grating stereogram, and random-dot fusion. These tests helped to evaluate the efficiency of visual information processing of these children, and to determine the degree of defects of the optic nerve cells and the connections of visual cortical neurons. According to results of visual function tests, individualized treatment was adopted for each amblyopia patient using perceptual learning system. One course of treatment lasted one month, and treatment was performed twice every day with two training procedures （each training procedure lasted for ten minutes）. There was a ten-minute time interval between the two training procedures. The training treatment was performed in a quiet and dark environment. Visual acuity and recovery of visual function were tested every month. Original training procedure was continued or adjusted according to the results of visual function. MAIN OUTCOME MEASURES： Visual function change; relationship of curative effects and curative time. RESULTS： A total of 125 amblyopia children were included in the final analysis. The total efficiency of perceptual learning for treating amblyopia in children was 75.2%. Visual acuity began to greatly increase 3 months after treatment （P 〈 0.05）. Visual acuity was best corrected from 0.60 ± 0.23 before treatment to 0.86 ± 0.26 after treatment （P 〈 0.05）. The mean time to reach improved levels with curative effects was （2.82 ± 1.30） months, and to reach a basically cured level was （2.87 ±1.40） months. Percentage of improved visual acuity was the highest [98% （39/40）] in children that received 3 months of treatment and the lowest [55% （31/56）] in children that received 1 month of treatment （P 〈 0.05）. The percentage of basically cured levels with curative effects increased with length of learning time and was the greatest in children that received 4 months of treatment [67% （31/46）, P 〈 0.05]. CONCLUSION： Perceptual learning rapidly and remarkably improves visual function of amblyopia children; however, the curative effects are first apparent two and three months after intervention.

Prevalence of amblyopia among preschool children in central south China

AIM: To determine the prevalence and factors associated with amblyopia among children aged 30-83 mo in central south of China.METHODS: A population-based, cross-sectional study was conducted in children aged 30-83 mo in Changsha(an urban city) and Zhangjiajie(a rural area) in central south of China. Clinical examinations including ocular alignment, ocular motility, visual acuity(VA), prism cover test, cycloplegic refraction, slit lamp examination and fundus examination were performed by trained study ophthalmologists and optometrists. Unilateral amblyopia was defined as a 2-line difference between eyes with VA<20/32 in the worse eye and with coexisting anisometropia [≥1.00 D spherical eutivalent(SE) for hyperopia, ≥3.00 D SE for myopia, and ≥1.50 D for astigmatism], strabismus, or past or present visual axis obstruction. Bilateral amblyopia was defined as VA in both eyes <20/40(≥ 48-month-old) and <20/50(< 48-month-old), with coexisting hyperopia ≥4.00 D SE, myopia ≤-6.00 D SE, and astigmatism ≥2.50 D, or past or present visual axis obstruction.RESULTS: There were 8042 children enrolled and 7713 children were screened. The amblyopia prevalence in children aged 30-83 mo was 1.09%(95% confidence interval, 0.86%-1.35%) with no age(P=0.81), gender(P=0.46) or area distribution(P=0.93) differences. Of these, 0.68% were unilateral cases and 0.41% were bilateral cases. Underlying causes included anisometropia(40%), binocular refractive error(36%), strabismus(14%) and deprivation(10%). Hyperopia combined with astigmatism was the frequent refractive error for ametropic and anisometropic amblyopia.CONCLUSION: In this rural and urban Chinese population, 1.09% of children with 30-83 mo of age had amblyopia, a prevalence rate similar to that of many other studies. Anisometropia and refractive error are the most common causes of unilateral and bilateral amblyopia respectively.

Improvement of visual acuity in children with anisometropic amblyopia treated with rotated prisms combined with near activity

·AIM: To evaluate the efficacy of a new modality for improving visual acuity (VA) in pediatric patients with anisometropic amblyopia. · METHODS: Retrospective and interventional case series. Medical records of 360 children with anisometropic amblyopia treated with a modality that included rotated prisms, lenses, and near activities from January 2008 to January 2012 were analyzed. Characteristics such as improvement of VA and contrast sensitivity in amblyopic eyes and resolution of amblyopia (VA ≤ 0.1logMAR or a difference of ≤ 2 lines in logMAR between the eyes) were assessed. ·RESULTS: Among the patients, the mean VA of the amblyopic eyes improved from 0.48logMAR (SD=0.16) to 0.12logMAR (SD =0.16) and the mean VA improvement was 0.36logMAR (SD =0.10, P【0.001). Resolution of amblyopia was achieved in 233 of 360 patients (64.72%). The mean time for resolution of amblyopia was 8.05 weeks (SD=4.83) or 14.14 sessions (SD=8.76). Among the study group, refraction error did not change significantly after treatment (P=0.437). We found that better baseline VA may be related to success and shorten the time to amblyopic resolution. ·CONCLUSION: VA and contrast sensitivity improved with rotated prisms, correcting lenses, and near activities in children with anisometropic amblyopia. The VA improvement by this modality was comparable to other methods. However, the time to resolution of amblyopia was shorter with this method than with other modalities. Rotated prisms combined with near acuity could provide an alternative treatment in children with anisometropic amblyopia who can’t tolerant traditional therapy method like patching.

A randomized study of network-based perception learning in the treatment of amblyopia children

AIM:To compare the effectiveness of network-based perception learning(NBPL) and traditional training in the treatment of amblyopia children.METHODS:This randomized controlled clinical trial recruited 56 participants aged 4-12 y with anisometropic and/or strabismic amblyopia. Participants were randomly divided into two groups:the NBPL group(n=28) who received patching and NBPL for 3 mo, and the control group(n=28) who got 3 mo of patching and traditional training. Best-corrected visual acuity(BCVA) in the amblyopic eye and stereoacuity were measured and compared at baseline, 1, 2, and 3 mo post-randomization.RESULTS:There were no significant differences in age, gender ratio, and BCVA between the two groups at baseline. At 3 mo, most patients gained lines(2 log MAR lines on average) of BCVA in both groups except one 11-year-old girl in the control group(P<0.05). But no significant difference in BCVA improvement of the amblyopic eye between the two groups was found(P=0.725), and amblyopia resolved(BCVA of 0.1 log MAR or better or within 1 log MAR line of the fellow eye) for 13(46.4%) participants in both groups. The number of patients with improvement of stereoacuity was 25 and 13 in the NBPL group and control group(P=0.041), respectively, and a significant difference exists in the distribution of stereopsis at 3 mo between the two groups(P=0.015). Besides, in patients with measurable stereopsis improvement degree and space for improvement in the two groups, the NBPL group also achieved better stereoscopic improvement than the control group(10/11 vs 4/11, P<0.05).CONCLUSION:The NBPL system has a significant effect on the improvement of BCVA and stereoacuity of amblyopia children and is better than traditional training in terms of stereoacuity improvement. Perceptual learning visual training may play a more important role in the treatment of amblyopia in the future.

Lamina cribrosa thickness in children with hyperopic anisometropic amblyopia

AIM：To determine lamina cribrosa thickness（LCT）in the optic nerve head region of the eyes in children with hyperopic anisometropic amblyopia and to compare this thickness with that of fellow eyes,hyperopic nonamblyopia,and age-matched controls.METHODS：Thirty-two patients（12.0±1.8y,mean±standard deviation）with hyperopic anisometropic amblyopia,31 subjects with age-and refractive error-matched hyperopic non-amblyopia（10.7±2.2y）,and 32 age-matched controls（11.2±2.0y）were included in this prospective,crosssectional study.LCT was measured using an enhanced depth-imaging program of a spectral domain optical coherence tomographic instrument in all participants,and the correlation between LCT and axial length was calculated.RESULTS：The mean LCT was 180.9±29.4μm in amblyopic eyes,247.7±19.0μm in fellow eyes,251.6±27.3μm in hyperopic non-amblyopic eyes,and 240.2±15.8μm in control eyes.Lamina cribrosa in amblyopic eyes was significantly thinner than fellow,hyperopic non-amblyopic,and control eyes（P〈0.05）.There was no significant correlation in LCT and axial length between amblyopic（P=0.16）and control（P=0.31）group.CONCLUSION：Lamina cribrosa of eyes with hyperopic anisometropic amblyopia is significantly thinner than that of fellow eyes,hyperopic non-amblyopia,and age-matched controls.The LCT profile in amblyopic eyes is different from that observed in fellow,hyperopic non-amblyopic,and control eyes.

Objectively-measured compliance to atropine penalization treatment in children with amblyopia: a pilot study

Background:To date,compliance to atropine penalization in amblyopic children has only been assessed through self-report.The goal of this pilot study is to measure compliance to atropine penalization objectively.Methods:Seven amblyopic children(3-8 years;20/40-20/125 in the amblyopic eye) were enrolled.None had been treated with atropine previously.Children were prescribed either a twice per week or daily atropine regimen by their physicians.Compliance was defined as the percentage of days in which the atropine eye drop was taken compared to the number of doses prescribed.We used medication event monitoring system(MEMS) caps to objectively measure compliance.The MEMS caps are designed to electronically record the time and date when the bottle is opened.The parents of the children were provided a calendar log to subjectively report compliance.Participants were scheduled for return visits at 4 and 12 weeks.Weekly compliance was analyzed.Results:At 4 weeks,objective compliance averaged 88%(range,57-100%),while subjective compliance was 98%(range,90-100%).The actual dose in grams and visual acuity(VA) response relationship(r=0.79,P=0.03) was significantly better than the relationship between regimen and response(r=0.41,P>0.05),or the relationship between actual dose in drops and response(r=0.52,P>0.05).Conclusions:Objective compliance to atropine penalization instructions can be monitored with MEMS,which may facilitate our understanding of the dose-response relationship.Objective compliance with atropine penalization decreases over time and varies with regimen.On average,subjective parental reporting of compliance is overestimated.

A Retrospective Study of Treatment Efficacy of 65 Children with Ametroic Amblyopia

Purpose: To investigate relationship between treatment efficacy and the severity of ametropic amblyopia, the type of anisometropia and patient age. Methods:A total of 65 children with ametropic amblyopia undergoing clinical treatment in the ophthalmology department of Shaoguan Hygienic Hospital of Women and Children between June 2005 and November 2011 were enrolled in this study. The treatment efficacy for those subjects with different severities of ametropic amblyopia, types of anisometropia and ages was recorded. Results: The near-recovery/recovery rate, improvement rate and ineffectiveness rate were 70.8%, 16.9% and 12.3%, respectively. The recovery rates in mild-, moderate- and severe amblyopia groups were 97.1%, 61.1% and 8.3% respectively (P<0.05)..The recovery rate for patients with hyperopic-, astigmatic- and myopic anisometropia were 75.8%, 78.3% and 33.3% respectively. The recovery rates did not differ between hyperopic- and astigmatic- anisometropia children(P>0.05), whereas a statistically significant difference was noted between myopic children compared with their hyperopic and myopic-anisometropia counterparts (all P<0.05). The recovery rate for patients aged 3 to 6 years was 86.8% and 48.1% for those aged between 7 and 10 years (P<0.05). Conclusion: The treatment efficacy in ametropic amblyopia is associated with the severity of amblyopia, type of anisometropia and patient's age. Older patients with more severe amblyopia had poorer treatment efficacy. The efficacy in patients with hyperopic and astigmatic anisometropia was better than that for myopic anisometropia subjects.

The effects of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents:a meta-analysis

Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).

Expert consensus on pediatric orthodontic therapies of malocclusions in children

Malocclusion,identified by the World Health Organization(WHO)as one of three major oral diseases,profoundly impacts the dental-maxillofacial functions,facial esthetics,and long-term development of~260 million children in China.Beyond its physical manifestations,malocclusion also significantly influences the psycho-social well-being of these children.Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition,by mitigating the negative impact of abnormal environmental influences on the growth.Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development,ranging from fetal stages to the early permanent dentition phase.From an economic and societal standpoint,the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated,underlining its profound practical and social importance.This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children,emphasizing critical need for early treatment.It elaborates on corresponding core principles and fundamental approaches in early orthodontics,proposing comprehensive guidance for preventive and interceptive orthodontic treatment,serving as a reference for clinicians engaged in early orthodontic treatment.

The optimal atropine concentration for myopia control in Chinese children: a systematic review and network Metaanalysis

AIM:To figure out whether various atropine dosages may slow the progression of myopia in Chinese kids and teenagers and to determine the optimal atropine concentration for effectively slowing the progression of myopia.METHODS:A systematic search was conducted across the Cochrane Library,PubMed,Web of Science,EMBASE,CNKI,CBM,VIP,and Wanfang database,encompassing literature on slowing progression of myopia with varying atropine concentrations from database inception to January 17,2024.Data extraction and quality assessment were performed,and a network Meta-analysis was executed using Stata version 14.0 Software.Results were visually represented through graphs.RESULTS:Fourteen papers comprising 2475 cases were included;five different concentrations of atropine solution were used.The network Meta-analysis,along with the surface under the cumulative ranking curve(SUCRA),showed that 1%atropine(100%)>0.05%atropine(74.9%)>0.025%atropine(51.6%)>0.02%atropine(47.9%)>0.01%atropine(25.6%)>control in refraction change and 1%atropine(98.7%)>0.05%atropine(70.4%)>0.02%atropine(61.4%)>0.025%atropine(42%)>0.01%atropine(27.4%)>control in axial length(AL)change.CONCLUSION:In Chinese children and teenagers,the five various concentrations of atropine can reduce the progression of myopia.Although the network Meta-analysis showed that 1%atropine is the best one for controlling refraction and AL change,there is a high incidence of adverse effects with the use of 1%atropine.Therefore,we suggest that 0.05%atropine is optimal for Chinese children to slow myopia progression.

Association of preschool children behavior and emotional problems with the parenting behavior of both parents

BACKGROUND Parental behaviors are key in shaping children’s psychological and behavioral development,crucial for early identification and prevention of mental health issues,reducing psychological trauma in childhood.AIM To investigate the relationship between parenting behaviors and behavioral and emotional issues in preschool children.METHODS From October 2017 to May 2018,7 kindergartens in Ma’anshan City were selected to conduct a parent self-filled questionnaire-Health Development Survey of Preschool Children.Children’s Strength and Difficulties Questionnaire(Parent Version)was applied to measures the children’s behavioral and emotional performance.Parenting behavior was evaluated using the Parental Behavior Inventory.Binomial logistic regression model was used to analyze the association between the detection rate of preschool children’s behavior and emotional problems and their parenting behaviors.RESULTS High level of parental support/participation was negatively correlated with conduct problems,abnormal hyperactivity,abnormal total difficulty scores and abnormal prosocial behavior problems.High level of maternal support/participation was negatively correlated with abnormal emotional symptoms and abnormal peer interaction in children.High level of parental hostility/coercion was positively correlated with abnormal emotional symptoms,abnormal conduct problems,abnormal hyperactivity,abnormal peer interaction,and abnormal total difficulty scores in children(all P<0.05).Moreover,paternal parenting behaviors had similarly effects on behavior and emotional problems of preschool children compared with maternal parenting behaviors(all P>0.05),after calculating ratio of odds ratio values.CONCLUSION Our study found that parenting behaviors are associated with behavioral and emotional issues in preschool children.Overall,the more supportive or involved the parents are,the fewer behavioral and emotional problems the children experience;conversely,the more hostile or controlling the parents are,the more behavioral and emotional problems the children face.Moreover,the impact of fathers’parenting behaviors on preschool children’s behavior and emotions is no less significant than that of mothers’parenting behaviors.

Nutrition impacts of non-solid cooking fuel adoption on under-five children in developing countries

This paper examines the nutrition impacts of using non-solid cooking fuel on under-five children in developing countries.We draw on data from more than 1.12 million children in 62 developing countries from the Demographic and Health Surveys(DHS).Results from both fixed effects(FE)and instrumental variable(IV)estimates show that using non-solid cooking fuel significantly improves the nutrition outcomes of under-five children.Compared with their peers from households mainly using solid fuel,children from households mainly using non-solid fuel exhibit a lower probability of experiencing stunting(by 5.9 percentage points)and being underweight(by 1.2 percentage points).Our further investigation provides evidence for several underlying mechanisms,such as improved indoor air quality,induced reduction in children’s respiratory symptoms,benefits on maternal health,and reduction in maternal time spent on fuel collection or cooking.Heterogenous analyses suggest that the nutrition benefits of using non-solid cooking fuel are more prominent among boys,children above three years old,and those from households of lower socioeconomic status,rural areas,and Southeast Asia.

Chinese herbal medicine combined with Western medicine for Mycoplasma pneumoniae pneumonia in children:An overview of systematic reviews

Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Methods:SRs of randomized controlled trials were searched using PubMed,the Cochrane Library,Embase,the Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,and the SinoMed Database.SRs on the use of CHM alone or in combination with Western medications for MPP in children were included.The study compared the effects of Western medicine alone with those of CHM.The evidence quality using the A Measurement Tool to Assess Systematic Reviews(AMSTAR)2,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020,and the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)criteria.The primary indicators were the total effective rate,fever subsidence time,and cough disappearance time.The secondary outcomes were pulmonary rale disappearance time,average hospitalization time,lung X-ray infiltrate disappearance time,immunological indices,and inflammatory cytokine levels.Results:Twelve relevant SRs were included;75%(9/12)were assessed as very low quality,and 25%(3/12)Were rated as low quality using the AMSTAR 2 criteria.According to the PRISMA 2020 checklist,the average SR score was 20.3 out of a 27 point maximum.In all SRs,CHM demonstrated improvement in symptoms and signs among children with MPP.The evidence quality using the GRADE criteria ranged from"very low"(>50%)to"moderate"(<5%).The most common downgrading factor was imprecision,followed by publication bias and inconsistency.Conclusion:This overview highlights the limited quality of the methodology and evidence of the included SRs.Although the included studies showed the beneficial effects of CHM on MPP in children,it was difficult to draw firm conclusions owing to methodological flaws.

Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis

AIM:To evaluate the effect of lens surgery on health-related quality of life(HRQoL)of preschool children with congenital ectopia lentis(CEL).METHODS:A prospective self-controlled study was conducted in Zhongshan Ophthalmic Center.Children aged from 5 to 7y whom were diagnosed with CEL and underwent phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation and their parents were enrolled in this study.All of them completed the child and proxy(parental)PedsQL™4.0 before and after the surgery.Their preoperative scores were compared to their postoperative ones.Subgroup analyses were performed based on gender and preoperative bilateral presenting visual acuity of the children.RESULTS:Thirty-two children with CEL successfully underwent surgery without any complications,among whom 8 had monocular surgery and 24 had binocular surgery.Preoperative and postoperative questionnaires were completed by 32 child-parent pairs.Surgical intervention could significantly improve the vision of affected children(P<0.001).The medians of physical,psychosocial and total health scores self-reported by the children were 68.75(62.50,81.25),65.00(60.00,80.00)and 67.39(60.87,78.26)preoperatively and were 93.75(87.50,100.00),90.00(83.33,96.67)and 89.13(85.32,95.65)postoperatively.The preoperative scores of the affected children were significantly lower in all scales than age-matched healthy children(P<0.001).All the postoperative scores were significantly higher than the preoperative scores in affected children and their parents(P<0.001).In the physical functioning evaluation,the preoperative score reported by parents of girls was higher than parents of boys(P=0.041),and the postoperative score of girls was higher than that of boys(P=0.036).CONCLUSION:CEL is associated with significantly worse quality of life in preschool children.Surgical intervention can significantly improve the HRQoL in affected children from both personal and family perspective.

Survey and clinical considerations of gender identity in lower primary school children

BACKGROUND Gender consciousness directly affects the development of gender identity,which is a continuous and lifelong process.Meanwhile,hospitalization is a part of many children's lives and has an impact on their gender development.AIM To investigate the current situation of gender identity in lower primary school children by conducting a survey of 202 hospitalized children in the lower grades and to provide a theoretical basis and foundation for the cultivation of gender identity and medical treatment of children based on the results.This study aims to inspire clinical medical staff to scientifically and reasonably arrange hospital wards for lower primary school children and pay attention to gender protection during the medical treatment process and to help children shape a unified and clear gender identity,which will enable them to better integrate into society and promote their personality development.METHODS The gender consciousness scale for elementary and middle school students was RESULTS Gender identity was already present in lower primary school children.The children's gender roles and gender equality consciousness were strong,exceeding the critical value,but their gender characteristics,gender identity,and gender ideal consciousness were weak.Children aged 6 had the weakest gender identity,and girls had significantly stronger gender identity than boys.CONCLUSION Gender identity is already present in lower primary school children,providing a basis and inspiration for the cultivation of gender identity and medical treatment of lower primary school children.Clinical medical staff should be aware of and understand these results and should scientifically and reasonably arrange hospital wards for lower primary school children.

Serum inflammatory markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for mycoplasma severity

BACKGROUND Mycoplasma pneumoniae pneumonia(MPP)significantly impacts pediatric health,necessitating markers for early severe disease identification.AIM To investigate the correlation between serum inflammatory marker and the severity of MPP in children.METHODS A prospective study was carried out from January 2023 to November 2023.A total of 160 children with MPP who underwent treatment were selected:80 had severe MPP and 80 had mild MPP.Clinical and laboratory data were collected at the time of hospital admission and during hospitalization.Receiver operating characteristic curves were utilized to assess the diagnostic and prognostic for severe MPP.RESULTS Fever duration and length of hospitalization in pediatric patients with severe MPP exceeded those with mild MPP.The incidence of pleural effusion,lung consolidation,and bronchopneumonia on imaging was markedly elevated in the severe MPP cohort compared to the mild MPP cohort.In contrast to the mild cohort,there was a notable increase in C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate,lactic dehydrogenase,D-dimer,and inflammatory cytokines[interleukin(IL)-6,IL-8,IL-10 and tumor necrosis factor(TNF)-α]in the severe MPP group were significantly higher.CONCLUSION Serum inflammatory markers(CRP,PCT,IL-6,D-dimer,IL-10 and TNF-α)were considered as predictors in children with severe MPP.