[Influence of disposable diaper dependence on emotional behavior and related factors of preschool-aged children].

Objective: To investigate the influence of disposable diaper dependence (DDD) on emotional behavior and related factors of preschool-aged children. Methods: A total of 3 000 preschool-aged children from 16 kindergartens in Zhengzhou of Henan Province from October 2019 to March 2020 were selected and their parents were investigated by using a basic information questionnaire (including usage of disposable diapers), Strengths and Difficulties Questionnaire (SDQ) and Children's Sleep Questionnaire (PSQ). The differences in baseline and clinical data were compared between the DDD children and normal children, and multiple linear regression models were used to analyze the factors associated with emotional behavior in DDD children. Results: A total of 3 000 questionnaires were distributed and 2 775 (92.50%) were valid. The children ranged in age from 3 to 5 years, including 1 438 boys (51.82%) and 1 337 girls (48.18%). There were 98 (3.53%) children in DDD group and 2 677 (96.47%) children in normal group. The proportion of children living in cities in the DDD group was 58.16%, significantly higher than that of 41.84% in the normal children group (P<0.001). The abnormal detection rate of various factors in SDQ in DDD children, from high to low, were hyperactivity (n=14, 14.29%), peer communication problems (n=12, 12.24%), prosocial behavior (n=11, 11.22%), emotional symptoms (n=10, 10.20%) and conduct problems (n=7, 7.14%). The detection rates of abnormal total difficulty scores in DDD group and normal children were 7.14% (7 cases) and 0.78% (21 cases), respectively, with statistically significant differences (P<0.001). The proportions of emotional symptoms and hyperactivity disorder in DDD group were higher than those in normal group, and the differences were statistically significant (P<0.05). The PSQ score of children in DDD group was 3.01±2.02 which was not significantly different from the PSQ score of the normal group (2.71±2.10, P=0.157). The multi-factor analysis showed that caregiver's education level (ß=-1.135,95%CI:-1.910 to -0.359), urinary incontinence (ß=2.222, 95%CI: 1.105-3.339), fecal incontinence (ß=3.833, 95%CI: 2.691-4.975), urinary and fecal incontinence (ß=5.522, 95%CI: 4.145-6.899), and recurrent urinary tract infections(ß=3.523,95%CI: 1.798-5.248)were the independent influencing factors of emotional behavioral problems in DDD children (P<0.05). Conclusions: Children with DDD are more likely to have emotional behavioral problems than normal children. Caregiver's education level, urinary incontinence and recurrent urinary tract infections were influencing factors of emotional behavioral problems in DDD children.

[Epidemiological investigation and analysis of the effect of using diapers on daytime urinary incontinence on children].

Objective: To investigate the relationship between the incidence of daytime urinary incontinence(DUI)and the usage of diapers. Methods: The stratified sampling method was used to investigate the relationship between the incidence of DUI and the usage of diapers on children from 3 to 10 years old from 30 kindergarten and primary schools in Henan Province, China. The survey was carried out in the way of anonymous questionnaire. Results: A total of 8 560 qualified questionnaires(96.2%) were collected and used for statistical analysis. The overall incidence of DUI was 3.52%. With the age increasing, the incidence of DUI was decreased(χ(2)(trend)=75.690, P<0.001) from 6.06% for 3 years old children to 1.82% for 10 years old children. With the time of usage diapers increased, the rate of urination training was significantly reduced(χ(2)(trend)=84.260, P<0.001), and the incidence of DUI was significantly increased(χ(2)(trend)=18.824, P<0.001). With the increase of using diapers, the incidence of DUI increased (χ(2)(trend)=9.234, P<0.01). With the delay of the starting time of urination training, the incidence of DUI was increasing( χ(2)(trend)=9.775, P<0.01). Logistic regression analysis showed that the increase of time of using diapers(OR=1.017, 95% CI: 1.006-1.027, P<0.01)and the increase of frequency of using diapers(OR=1.290, 95% CI: 1.002-1.025, P<0.05)contribute to DUI significantly. Urination training starts from 0 to 6 months was a protective factor against DUI(OR=0.529, 95% CI: 0.345-0.811, P<0.01). Conclusions: The usage of diapers is the risk factor of DUI. It's better to start urination training earlier to help reduce the incidence of DUI in children.

Epidemiological investigation of a tap water-mediated hepatitis E virus genotype 4 outbreak in Zhejiang Province, China.

An outbreak of acute hepatitis recently occurred in a nursing home in Zhejiang Province, China. The objectives of this study were to confirm the outbreak and identify the aetiology, source and transmission patterns. All residents and staff in or near the nursing home during the period from 1 October 2014 to 21 May 2015 were investigated regarding hygiene and for epidemiological information including water and food (eating meat especially pork products). Serum and stool specimens were collected for detection of hepatitis E virus (HEV) antibodies using ELISA and RNA using RT-PCR. Samples that were RNA positive were genotyped. Of 185 senior residents and 24 staff in the nursing home, there were 37 laboratory-confirmed cases during the outbreak. Of these cases, 12 patients (three deaths) were symptomatic with jaundice, a common clinical symptom for hepatitis E infection. HEV strains were isolated from three cases and they formed a single cluster within genotype 4d. A case-control study was conducted to investigate potential risk factors for the outbreak and the results revealed that cases more often washed their dishes and rinsed their mouths using tap water than the controls (P < 0·05). Based on hygiene investigation and meteorological information, it is likely that HEV-infected sewage and faeces contaminated the water network on rainy days. Collectively, these results suggest that the outbreak of HEV genotype 4 infection was most likely caused by contaminated tap water rather than food.

Epidemiology of human infections with avian influenza A(H7N9) virus in the two waves before and after October 2013 in Zhejiang province, China.

We compared the epidemiological and clinical features of avian influenza A(H7N9) virus infections in the population in Zhejiang province, China, between March and April 2013 (first wave) and October 2013 and February 2014 (second wave). No statistical difference was found for age, sex, occupation, presence of underlying conditions, exposure history, white blood cell count, lymphocyte percentage and illness timeline and duration (all P > 0.05). The virus spread to 30 new counties compared to the first wave. The case-fatality rate was 22% in the first wave and 42% in the second (P = 0.023). Of those infected, 66% in the first wave and 62% in the second wave had underlying conditions. The proportion of those exposed to live poultry markets were 80% and 66%, respectively. We recommend permanent closure of live poultry markets and reformation of poultry supply and sales.

Prognosis and survival of 128 patients with severe avian influenza A(H7N9) infection in Zhejiang province, China.

No published studies have discussed details of the prognosis and survival of patients with severe avian influenza A(H7N9) infection. In this study we analysed 128 laboratory-confirmed cases of severe H7N9 infection in Zhejiang province, the most affected region during the H7N9 epidemic in mainland China. We found that an increase in patient age by 5 years was associated with a 1.41 [95% confidence interval (CI) 1.19-1.67] times odds ratio for fatality. In addition, the time interval between the first clinical visit after symptom onset and hospital admission was inversely associated with survival time since admission. Of the 47 patients who died of the disease, when the time interval between the first clinical visit and hospital admission increased by 1 day, the duration of survival was 0.78 times (95% CI 0.62-0.98) as long. Our results suggest that patients with severe influenza H7N9 infection at older ages were at a higher risk of fatality, and that a delay in hospital admission was associated with more rapid death. More studies are required to corroborate our major findings.