How are parental mental health and parenting practices associated with externalizing behaviors among young children with autism in China? A cross-sectional study and indirect effect analysis.

Children with autism are more likely to exhibit externalizing behaviors than children without autism. A cross-sectional study was undertaken to investigate how parental mental health status and parenting practices contributed to the variance in externalizing behaviors among families of young children with autism in Chinese mainland, and whether parenting behaviors had any indirect effects on the relationship between parental mental health symptoms and externalizing behaviors. Data were drawn from the baseline assessment of a quasi-experimental study of a parent training program delivered to Chinese caregivers of children with autism aged 3 to 6 from diverse backgrounds (N = 111). Results showed that parental mental health symptoms and parenting behaviors explained the variance in child externalizing behaviors. Parental mental health problems and parental over-reactivity were linked to higher levels of child externalizing behaviors, whereas positive parenting was associated with less frequent externalizing behaviors. Positive parenting partially explained the relationship between parental mental health symptoms and externalizing behaviors. The findings of this study highlight the importance of actively attending to the psychological and parenting needs of caregivers in autism treatment programs. It points to the need for the development of culturally sensitive strategies to promote parental mental health and increase the use of positive parenting skills among parents of children with autism.

Parenting Interventions That Promote Child Protection and Development for Preschool-Age Children with Developmental Disabilities: A Global Systematic Review and Meta-Analysis.

Global guidelines emphasize the critical role of responsive caregiving in terms of reducing violence against children and promoting early childhood development. However, there is an absence of global evidence synthesis on the effects of early childhood parenting programs for children with developmental disabilities. This systematic review and meta-analysis aims to investigate the effectiveness of parenting interventions delivered for preschool-age children with developmental disabilities in reducing violence against children, altering violence-related factors, and promoting child development. We searched for randomized controlled trials with inactive control. Estimates were pooled using robust variance estimations. Meta-regressions were conducted to explore sources of heterogeneity. In all, 33 studies met the inclusion criteria. The results showed that parenting programs improved child behavior, parental mental health, parenting practices, parental self-efficacy, parent-child interaction, child language skills, and child social skills post-intervention. No studies provided data on the actual occurrence of violence against children. Effects might vary by diagnosis, delivery modality, and world region. The findings supported the delivery of parenting programs to alter factors associated with violence against children and promote child language and social skills for families of young children with developmental disabilities, especially attention deficit hyperactivity disorder, autism, intellectual disability, and language disorders. More research using rigorous methods, long-term follow-ups, and transparent reporting is needed, particularly within more low- and middle-income countries.

Adaptations and staff experiences in delivering parenting programmes and other family support services in three community-based organisations in Cape Town, South Africa during the COVID pandemic.

We explore how organisations working on parenting programmes and other types of family support and violence prevention in low-resource settings experienced the pandemic. In August 2020-May 2021, we interviewed (1) staff from three community-based organisations delivering evidence-informed parenting interventions and other psychosocial services for families in Cape Town, South Africa, (2) staff from a parenting programme training organisation and (3) staff from two international organisations supporting psychosocial services in South Africa. Interviews (22) were thematically analysed, with findings in three areas. First, respondents noted changes in the context, including the job losses, food insecurity, and stress experienced by local communities, and reductions in organisational funding. Second, we found that in response to these context changes, the organisations shifted their focus to food provision and COVID prevention. Parenting and psychosocial programmes were adapted - e.g. by changing the physical delivery settings, reducing group sizes, and taking up digital and phone implementation. Participants reported improved perceptions of remote delivery as a feasible approach for working with families - but internet and phone access remained challenging. Third, the pandemic brought new responsibilities for staff, and both the challenges of working from home and the health risks of in-person work.

Controlled Trial of a Short-term Intensive Parent Training Program within the Context of Routine Services for Autistic Children in China.

Recent systematic reviews found limited rigorous research conducted to date of the effectiveness of parent training programs in reducing behavioral problems for autistic children in low- and middle-income countries. This study is aimed at evaluating the effectiveness of a short-term intensive parent training program for autistic children aged three to six in the context of routine service provision in China. A quasi-experiment was conducted involving the local implementing organization and using a waitlist control. Data were collected at baseline and immediate post-intervention. The primary outcome was child behavioral problems measured using the Child Behavior Checklist Externalizing scale. Between-group comparisons used a difference-in-differences design with propensity score weighting to reduce sources of bias. A process evaluation was undertaken in parallel to assess participant involvement, program acceptability, and delivery. The protocol was prospectively registered with ClinicalTrials.gov (NCT04257331). The final sample size was 111 (treatment: 63; comparison: 48). Results suggest that the program was associated with improvements in child externalizing behaviors (b = -2.71, 95% CI [-5.23, -0.18]), parental mental health symptoms (b = -5.96, 95% CI [-11.74, -0.17]), over-reactive parenting (b = -0.63, 95% CI [-0.98, -0.27]), and parental knowledge (b = 2.08, 95% CI [2.07, 2.17]). Exploratory analysis of factors related to implementation indicated that baseline parental mental health was related to participant engagement, and that satisfaction and engagement levels were potentially linked to positive treatment effects. Findings suggest that short-term intensive parent training programs that are provided by trained non-specialists, could potentially be used as an alternative to traditional prohibitively costly services that are delivered intensively for consecutive years in low-resource contexts. Follow-ups are needed to investigate its long-term benefits.

En revisiones sistemáticas recientes apenas se han encontrado investigaciones rigurosas que se hayan llevado a cabo hasta la fecha sobre la eficacia de los programas de formación parental para disminuir los problemas comportamentales de niños autistas en países de renta baja y media. En este estudio se pretende analizar la eficacia de un programa de formación parental intensivo a corto plazo para niños autistas de entre tres y seis años en el contexto de la prestación rutinaria de servicios en China. Se llevó a cabo un cuasiexperimento con la organización local a cargo de la aplicación y como control una lista de espera. Se recogieron datos de línea base e inmediatamente posteriores a la intervención. El resultado primario fueron los problemas comportamentales del niño medidos con la "Child Behavior Checklist Externalizing scale". Para las comparaciones entre grupos se utilizó un diseño de "diferencia en diferencias" con ponderación de la puntuación de propensión para disminuir las fuentes de error. En paralelo se llevó a cabo una evaluación de procesos para medir la implicación de los participantes, la aceptación del programa y su aplicación. El protocolo se registró prospectivamente en ClinicalTrials.gov (NCT04257331). La muestra final quedó constituida por 111 sujetos (de los cuales 63 constituían el grupo de tratamiento y 48 el de comparación). Los resultados indican que el programa se asociaba con la mejora de los comportamientos externalizadores infantiles (b = -2.71, 95% CI [-5.23, -0.18]), la salud mental parental (b = -5.96, 95% CI [-11.74, -0.17]), parentalidad sobrerreactiva (b = -2.71, 95% CI [-5.23, -0.18]) y conocimientos parentales (b = 2.08, 95% CI [2.07, 2.17]). El análisis exploratorio de los factores relativos a la aplicación indicaba que la salud mental parental en la línea base se relacionaba con la implicación de los participantes y que el grado de satisfacción y de compromiso se relacionaba potencialmente con los efectos positivos del tratamiento. Los resultados indican que los programas de formación parental intensivos a corto plazo impartidos por personal no especialista entrenado podrían utilizarse potencialmente como alternativa a los servicios con un coste prohibitivo dispensados de modo intensivo en años consecutivos en contextos de recursos limitados. Se necesitan estudios de seguimiento para valorar sus ventajas a largo plazo.

Parenting Programs That Address Physical Abuse in Childhood for Families of Children With Developmental Disabilities in Mainland China: Systematic Review and Meta-Regression.

Millions of children in China are diagnosed with developmental disabilities (DD), many of whom are subject to physical abuse. While a significant body of research suggests that parenting interventions can reduce the incidence and risk of such abuse, there is currently limited evidence of their effectiveness for this population or from non-English-speaking countries. This review involved searches in both English and Chinese databases to identify randomized controlled trials and quasi-experimental studies of parenting interventions for families of children with DD in mainland China. Multilevel meta-analyses were undertaken to examine the effectiveness of parenting programs. Subgroup analyses and meta-regression were conducted to investigate heterogeneity and identify potential moderators with a focus on intervention and delivery components. Risk of bias was assessed for each study. Thirty-one studies were included. The results showed that parenting interventions could reduce child emotional and behavioral problems (CEBP) and improve the parent-child relationship, although only one study directly measured the actual incidence of abuse. Programs for autism and epilepsy had stronger treatment effects. Teaching knowledge about CEBP, skills to improve parental mental health, and techniques to cultivate empathy were associated with program success; however, positive reinforcement was associated with more problems. The results also supported the delivery of programs with longer duration, a combination of group and individual sessions, efforts to build rapport, ongoing communication outside the programs, and delivery in hospitals or service agencies. Further research is needed, however, in addition to improvements in the quality of research and reporting.

Associations between childhood maltreatment and educational, health and economic outcomes among middle-aged Chinese: The moderating role of relative poverty.

BACKGROUND: Despite substantial evidence in developed countries showing that child maltreatment can lead to serious life-long consequences, relatively few studies so far have examined the associations between childhood maltreatment and adulthood outcomes in developing countries, such as China. It also remains unclear as to the impact of relative poverty on the long-term development of maltreated children. OBJECTIVE: This study aims to investigate the associations between childhood maltreatment and educational, health, and economic outcomes among middle-aged Chinese, as well as explore the moderating effects of relative poverty. PARTICIPANTS AND SETTING: The participants of this study were the middle-aged respondents (aged 45 to 59) in the 2011, 2013, and 2015 China Health and Retirement Longitudinal Studies (CHARLS) and the CHARLS Life History Survey (N = 24,114). METHODS: Physical abuse and emotional neglect were measured to investigate childhood maltreatment. Subjective and objective indicators were used to examine relative poverty. A broad range of midlife outcomes were explored, including educational attainment, physical health, mental health, cognitive functions, labor force participation, wage expenditure, and financial strain. Data analyses were conducted using fixed effects model for panel data and a propensity score matching approach. RESULTS: Childhood physical abuse and emotional neglect were both significantly associated with lower levels of midlife educational attainment, cognitive functions, individual wages, and household expenditures, as well as higher rates of chronic diseases, depressive symptoms, poverty, and welfare involvement. Childhood physical abuse also predicted higher risks of difficulty performing the activities of daily living (ADL), unemployment, and fewer work hours. Early-life exposure to relative poverty was linked to a greater likelihood of childhood maltreatment and mid-life adversities. It further aggravated the negative impacts of childhood maltreatment on middle-age outcomes. CONCLUSION: Child maltreatment had a profound effect on long-term child development and midlife outcomes in Chinese contexts. Relative poverty in early life was a moderator that exacerbated the outcomes associated with childhood maltreatment.

A virtuous circle: Stakeholder perspectives of a short-term intensive parent training programme delivered within the context of routine services for autism in China.

LAY ABSTRACT: While much knowledge about autism derives from high-income countries, most people diagnosed with autism reside in low- and middle-income countries, where little is documented in terms of local interventions. This is also true for parent training programmes for families of autistic children. An evaluation was conducted to understand the effects of a short-term intensive parent training programme delivered in routine services for families of autistic children in China. This study reported results from the in-depth interviews with 14 participating caregivers and group discussions with eight group leaders. The interviews and discussions were aimed at learning (1) to what extent the programme components were deemed acceptable, (2) what affected caregivers' attendance and engagement in the programme and (3) what affected group leaders' delivery of the programme. Findings suggested that future parent training programmes provide adequate opportunities for caregivers to practice and receive feedback; group support; coaching experience tailored to individual challenges; more autism-related knowledge, resources and activities for children and extended family members; and organisational support to group leaders. This study highlights the value of qualitative research and points to the need for more empirical studies to address the recommendations, so that research findings can be better utilised to promote practices.

Global estimates of violence against children with disabilities: an updated systematic review and meta-analysis.

BACKGROUND: Previous meta-analysis evidence shows that children (aged 0-18 years) with disabilities experience high amounts of violence. During the past decade, there has been a substantial increase in the volume of available data, and we therefore aimed to update the evidence and provide a current global estimate of violence against children with disabilities. METHODS: For this systematic review and meta-analysis, we searched 18 English-language international databases for observational studies published in English or Chinese between Aug 17, 2010, and Sept 16, 2020, and three Chinese databases for studies published from database inception to Sept 16, 2020. We used search terms structured around the concepts of disability, child, and violence-defining violence as physical, emotional, or sexual violence, or neglect, and considering disability as physical, mental, intellectual, and sensory impairments, and chronic diseases. We also searched 11 grey-literature repositories and hand searched the reference lists of included records for observational studies. We double screened records for studies that measured violence against children with disabilities. We excluded studies that included only people who had experienced violence or that did not provide separate estimates for children if adults were also included. Two authors independently extracted data and appraised study quality. We pooled estimates using three-level, mixed-effects meta-analyses, and did subgroup analyses. This study was prospectively registered with PROSPERO, CRD42020204859. FINDINGS: We found and screened 26 204 records, of which we excluded 25 844. We assessed 386 full text articles and finally included 98 studies (with 16 831 324 children) in our analysis. Our results showed that the overall prevalence of violence against children with disabilities was 31·7% (95% CI 27·1-36·8; I2=99·15%; 16 807 154 children, 92 studies) and the overall odds ratio of children with versus without disabilities experiencing violence was 2·08 (1·81-2·38; I2=91·5%; 16 811 074 children, 60 studies). Sensitivity analyses suggested a high degree of certainty for these estimates, although there was a high degree of heterogeneity across most estimates. There was some risk of publication bias, although the included studies were, on average, of medium quality. The estimates of violence differed by the type of violence, disability, and perpetrator. Children in economically disadvantaged contexts were especially vulnerable to experiencing violence. INTERPRETATION: This review shows that children with disabilities experience a high burden of all forms of violence, despite advances in awareness and policy in the past 10 years. Our results indicate a need for increased partnerships across disciplines and sectors to protect children with disabilities from violence. Additional well designed research is also needed, especially in under-represented and economically disadvantaged populations. FUNDING: There was no funding source for this study.

Early-life exposure to parental mental distress and adulthood depression among middle-aged and elderly Chinese.

Although mental illness among the middle-aged and the elderly has become a global public health issue and there is a burgeoning interest in the intergenerational transmission of mental health concerns in recent years, the long-term impact of parental mental health problems on child mental health conditions in developing countries remains unknown. Using the China Health and Retirement Longitudinal Study (CHARLS), which provides both contemporaneous and retrospective data collected from a nationally representative sample of Chinese residents aged 45 years and above, this study employed a multilevel modeling approach to investigate the association between early-life exposure to parental mental distress and adulthood depression among the middle-aged and elderly Chinese. Our study showed that childhood parental mental health problems predicted mid- and late-life depression in Chinese contexts and the result remained robust to a suite of robustness checks. Our exploration of potential pathways of the relationship found the following adversities that were associated with the exposure to parental mental distress in early life and may have contributed to the depression among the middle-aged and elderly: higher rates of childhood physical abuse by parents, poor childhood health, lower levels of educational attainment, poor physical health and individual economic status in adulthood. Further, our heterogeneity analysis indicated that the transmission effect was stronger for the elderly than the middle-aged and that the improvement of childhood SES mitigated the intergenerational transmission. We also found that childhood parental mental distress was potentially a moderator, which inhibited the recovery from depression. The findings will inform the design, implementation, and evaluation of relevant public health policies. It highlights the need for more efforts to prevent and mitigate the profound impacts of childhood parental mental distress on the late-life well-being of child generations.

Factors Associated With Violence Against Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Regression of Nationally Representative Data.

BACKGROUND: This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle-income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level. METHODS: We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type. RESULTS: We identified 8,346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence. CONCLUSION: A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children.

Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes.

BACKGROUND: Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. METHODS: A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. RESULTS: A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29-86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48-86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12-36 months). The mean Neer scores were 80.5 ± 7.6 (range 62-93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1-6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). CONCLUSION: A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.

The Science of Scale for Violence Prevention: A New Agenda for Family Strengthening in Low- and Middle-Income Countries.

Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low- and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.

Evaluating the dissemination and scale-up of two evidence-based parenting interventions to reduce violence against children: study protocol.

Background: Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs. Methods: The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and after program implementation, (4) barriers and facilitators to sustained program delivery, and (5) costs and resources needed for implementation.Primary data collection, focused on three case study projects, will include interviews and focus groups with program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary data analysis of routine data collected within ongoing implementation and existing research studies will explore family enrolment and attendance, as well as family reports of parenting practices, violence against children, child behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on staff sociodemographic and professional background, and their competent adherence to the program, collected as part of staff training and certification. Discussion: This project will be the first study of its kind to draw on multiple data sources and methods to examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study reports on the implementation of two specific parenting programs, we anticipate that our findings will be of relevance across the field of parenting, as well as other violence prevention and social programs.

[Application of bridge wire splint fixation on ankle dorsiflexion in femoral shaft fractures in young children].

OBJECTIVE: To explore the technique and therapeutic effect of bridge wire splint fixation with ankle dorsiflexion for the treatment of femoral shaft fractures in young children. Methods:From June 2006 to June 2012,45 young children with femoral shaft fractures were treated by bridge wire splint fixation with ankle dorsiflexion,which was designed according to arch bridge mechanical principle and structure. There were 31 males and 14 females with an average age of 3.2 years old ranging from 8 months to 5.5 years old; 14 cases were upper 1/3 femoral fractures,26 cases were middle 1/3 femoral fractures,5 cases were lower 1/3 femoral fractures; 20 cases were transverse fractures, 14 cases were oblique fractures,6 cases were spiral frac- tures, and 5 cases were comminuted fractures. X-ray, follow-up imaging changes,clinical curative effect and complications were assessed. RESULTS: Forty-five patients were followed up for 6 to 21 months (averaged 12 months). All fractures were reached clinical bone healing after 5 to 7 weeks (averaged 6 weeks) fixation. Seven cases appearred limb soft tissue complications, including buttocks bedsore,dorsal foot and Achilles tendon epidermal necrosis, and healed after dressing and removal of external fixation. During follow-up,the original overlap angle and lateral displacement were remodeled, and limbs were restored to the normal line of force and bone structure. According to Flynn standard, 35 cases got excellent results, 8 cases good, 2 cases fair. CONCLUSION: The bridge wire splint fixation with ankle dorsiflexion for the treatment of femoral. shaft fractures in young children (less than 6 years old) is safe,feasible, simple,and has raliable effect, which can be applied in primary hospitals.

[Surgical treatment of antero-medial rotatory instability of knee joint caused by motorcycle].

OBJECTIVE: To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. METHODS: Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. RESULTS: Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0 degrees and the flexion of the knee joint was 110-170 degrees (mean, 155 degrees). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 +/- 3.76 at last follow-up, which was significantly higher (t = 53.785, P = 0.000) than preoperative score 37.54 +/- 3.43. CONCLUSION: In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.

[Effectiveness comparison between two different methods of anterior transposition of the ulnar nerve in treatment of cubital tunnel syndrome].

OBJECTIVE: To compare the effectiveness of anterior subcutaneous transposition and anterior submuscular transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. METHODS: Between June 2006 and October 2008, 39 patients with cubital tunnel syndrome were treated separately by anterior subcutaneous transposition (anterior subcutaneous transposition group, n = 20) and anterior submuscular transposition (anterior submuscular transposition group, n = 19). There was no significant difference in gender, age, duration, and clinical classification between 2 groups (P > 0.05). RESULTS: All incisions healed by first intention in 2 groups. In anterior submuscular transposition group, 17 patients (89.5%) had abruptly deteriorated symptoms after the symptom of ulnar nerve compression was abated, and 1 patient (5.3%) had cicatrix at elbow; in the anterior subcutaneous transposition group, 10 patients (50.0%) had disesthesia at cubital anterointernal skin after operation; and there was significant difference in the complication between 2 groups (chi2 = 9.632, P = 0.002). The patients were followed up 24 to 36 months, 28 months on average. There was no significant difference in grip strength, pinch power of thumb-to-ring finger and thumb-to-little finger, or two-point discrimination of distal little fingers between 2 groups (P > 0.05), but significant differences were found between before operation and after operation in 2 groups (P < 0.05). According to the Chinese Medical Society of Hand Surgery Trial upper part of the standard evaluation function assessment, the results were excellent in 5 cases, good in 12 cases, fair in 1 case, and poor in 2 cases in the anterior subcutaneous transposition group; the results were excellent in 6 cases, good in 10 cases, fair in 2 cases, and poor in 1 case in the anterior submuscular transposition group; and there was no significant difference between 2 groups (u = 0.346, P = 0.734). According to disability of arm-shoulder-hand (DASH) questionnaires, the score was 22 +/- 7 in anterior subcutaneous transposition group and was 19 +/- 6 in anterior submuscular transposition group, showing no significant difference (t = 1.434, P = 0.161). CONCLUSION: Both anterior subcutaneous transposition and anterior submuscular transposition have good effectiveness in treating cubital tunnel syndrome; and anterior submuscular transposition has less complication than that of submuscular transposition.

[Comparison of efficacy between bridge wire splints and Bryant traction for the treatment of femoral shaft fractures in children].

OBJECTIVE: To compare clinical effects between bridge wire splint fixation and traditional Bryant traction for the treatment of femoral shaft fractures in children. METHODS: From June 2006 to June 2009,38 children with femoral shaft fractures were treated with bridge wire splint fixation and Bryant traction. In bridge wire splint group, there were 15 males and 6 females, ranging in age from 8 months to 5.3 years, with an average of (2.3 +/- 0.6) years. According to fracture site classification, 5 patients were upper 1/3 femoral fractures, 9 patients were middle 1/3 femoral fractures,and 7 patients were lower 1/3 femoral fractures. In Bryant traction group,there were 10 males and 7 females, ranging in age from 10 months to 3.2 years, with an average of (2.2 +/- 0.4) years. According to fracture site classification, 4 cases were upper 1/3 femoral fractures, 10 patients were middle 1/3 femoral fractures, 3 patients were lower 1/3 femoral fractures. The clinical features, X-ray healing time,weight-bearing time and complications of the two groups were compared. RESULTS: Comparison of fracture healing time: bridge wire splint group was (6.0 +/- 0.3) weeks and Bryant traction group was (6.2 +/- 0.4) weeks; the time of weight-bearing in bridge wire splint group was (6.1 +/- 1.0) weeks and in Bryant traction group was (6.4 +/- 1.2) weeks; there was no significant difference between two groups. There was a significant difference in soft tissue complication between bridge wire splint group occurred in 3 cases and 13 cases in Bryant traction group. According to the criteria of clinical efficacy,in Bryant traction group, 12 patients got an excellent result, 4 good and 1 fair; in bridge wire splint group, the data were 17, 3 and 1 respectively,and there was no significant difference between the two groups. CONCLUSION: Both of bridge wire splint fixation and traditional Bryant traction for the treatment of femoral shaft fractures in children have good efficacy. Compared with Bryant traction,bridge wire splint fixation is simple, safe and has reliable effect.