Quality of childcare and delayed child development in left-behind children in China.

BACKGROUND: Inequalities in job opportunities and income prompts many Chinese parents to leave rural regions to work in urban regions. Their children are left behind in rural regions, subjected to worse quality of childcare that jeopardizes their development. This study aimed to examine the association between quality of childcare and delayed child development in under-three years children left behind in China. METHODS: Cross-sectional national survey was conducted in children left behind in rural China in 2017. Exploratory and confirmatory factor analysis was used to develop a quality of childcare index. Mutlilevel analyses determined factors associated with quality of childcare and child development on a province and individual level. RESULT: The largest population of at-risk children left behind were found in higher-GDP provinces. Children left behind had the lowest mean quality of childcare score. Multilevel analysis found that province level accounted for a great proportion of variance observed. CONCLUSIONS: While migration to urban regions for work may improve household income, a trade-off in worse quality of childcare and developmental delays exists. With improving household income often being the greatest contributing factor for parental migration, policies to reduce inequalities in job opportunities and wealth between rural and urban regions are required. IMPACT: Previous studies identified higher prevalence of developmental delays in children left behind in China. However, quality of childcare has not been examined. Based on WHO's Nurturing Care Framework, we developed a quality of childcare index to assess its association with child development in children left behind. Greatest proportion of children left behind at-risk of developmental delays resided in higher-GDP states, indicating a trade-off in worse quality of childcare and developmental delays. Since improving household income is the main factor for parental migration, policies to close inequalities in job opportunities and wealth between rural and urban regions are required.

Microglial depletion impairs glial scar formation and aggravates inflammation partly by inhibiting STAT3 phosphorylation in astrocytes after spinal cord injury.

Astrocytes and microglia play an orchestrated role following spinal cord injury; however, the molecular mechanisms through which microglia regulate astrocytes after spinal cord injury are not yet fully understood. Herein, microglia were pharmacologically depleted and the effects on the astrocytic response were examined. We further explored the potential mechanisms involving the signal transducers and activators of transcription 3 (STAT3) pathway. For in vivo experiments, we constructed a contusion spinal cord injury model in C57BL/6 mice. To deplete microglia, all mice were treated with colony-stimulating factor 1 receptor inhibitor PLX3397, starting 2 weeks prior to surgery until they were sacrificed. Cell proliferation was examined by 5-ethynyl-2-deoxyuridine (EdU) and three pivotal inflammatory cytokines were detected by a specific Bio-Plex ProTM Reagent Kit. Locomotor function, neuroinflammation, astrocyte activation and phosphorylated STAT3 (pSTAT3, a maker of activation of STAT3 signaling) levels were determined. For in vitro experiments, a microglia and astrocyte coculture system was established, and the small molecule STA21, which blocks STAT3 activation, was applied to investigate whether STAT3 signaling is involved in mediating astrocyte proliferation induced by microglia. PLX3397 administration disrupted glial scar formation, increased inflammatory spillover, induced diffuse tissue damage and impaired functional recovery after spinal cord injury. Microglial depletion markedly reduced EdU+ proliferating cells, especially proliferating astrocytes at 7 days after spinal cord injury. RNA sequencing analysis showed that the JAK/STAT3 pathway was downregulated in mice treated with PLX3397. Double immunofluorescence staining confirmed that PLX3397 significantly decreased STAT3 expression in astrocytes. Importantly, in vitro coculture of astrocytes and microglia showed that microglia-induced astrocyte proliferation was abolished by STA21 administration. These findings suggest that microglial depletion impaired astrocyte proliferation and astrocytic scar formation, and induced inflammatory diffusion partly by inhibiting STAT3 phosphorylation in astrocytes following spinal cord injury.

Correlates of suicidal ideation in rural Chinese junior high school left-behind children: A socioecological resilience framework.

Introduction: Suicide is one of the top five causes of adolescent mortality around the world. The socioecological resilience framework in explaining the risk factors and protective factors for suicidal ideation in left-behind children (LBC) has not been well explored. The current study aims to compare the prevalence of suicidal ideation in LBC and non-LBC, and explore its correlations with resilience factors among LBC. Methodology: This study was part of an epidemiological survey conducted by UNICEF exploring mental health outcomes in left-behind children. We implemented a cross-sectional study collecting data from 11 provinces and 1 municipal, with 5,026 participants (3,359 LBC, 1,667 controls) in year one junior high school living in impoverished areas of rural China. Data on suicidal ideation, self-harm, resilience factors including health-risk behaviors, psychological wellbeing as it was measured by the Strengths and Difficulties Questionnaire, peer relationship within the school environment, and family support were collected. Results: Overall prevalence of suicidal ideation among LBC was 7.2% which is significantly different from 5.5% reported by NLBC (χ2 = 4.854, p = 0.028). LBC reported a higher prevalence of self-harm (16.4%) than NLBC (13.0%; χ2 = 10.232, p = 0.001), but there was no difference in the prevalence of suicide plan, suicide attempt or help-seeking. LBC had significantly poorer psychological feeling, and greater emotional and behavioral difficulties peer relationship in the school environment than controls. In the multiple logistic regression, history of self-harm was the greatest predictor for suicidal ideation among LBC (OR = 2.078, 95% CI: 1.394-3.100, p < 0.001). Health risk behavior including previous smoking attempt, poor psychological feeling, and emotional and behavior difficulties, and poor peer relationship within school environment, were also significant risk factors for suicidal ideation among LBC. Conclusion: The prevalence of suicidal ideation and self-harm was greater among left-behind than non-left-behind children. Our results show resilience factors including previous self-harm, emotional and behavioral problems, smoking, and poor peer relationship are significantly associated with suicidal ideation in left-behind adolescents.

Emotional and Behavioral Problems of Left-Behind Children in Impoverished Rural China: A Comparative Cross-Sectional Study of Fourth-Grade Children.

PURPOSE: Children who are left behind when their parents migrate for work have a high prevalence of emotional and behavioral problems, which affect social function and increase family burden. To date, no national survey has been conducted on the emotional and behavioral problems of left-behind children (LBC) in China. This study aimed to investigate the emotional and behavioral outcomes of primary school LBC in the fourth grade in impoverished rural China and the possible influences of family environment and parenting practices. METHODS: A cross-sectional study was carried out in 27 rural counties in the central and western parts of China from November 2016 to January 2017. The method of quota sampling was adopted to achieve a representative sample using postweighting adjustment. The survey sample was distributed proportionately across each county. LBC were defined as children aged <16 years who had two parents leave home to work or one parent leave home while the other lost the capacity to rear their children. The term "non-left-behind children" (NLBC) refers to children who have at least one parent who has not migrated for work. The Strengths and Difficulty Questionnaire (SDQ) was applied to measure children's emotional and behavioral problems. RESULTS: After the weighted calculations were performed, there were 1,147 LBC and 3,953 NLBC. The proportion of abnormal SDQ total scores (>17) was significantly higher in the LBC group than in the NLBC group (15.6% vs. 11.6%; p < .01). Binary regression analysis showed that high levels of insomnia (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.04-2.27), loneliness (OR 1.65, 95% CI 1.13-2.43), and self-harm (OR 1.92, 95% CI 1.17-3.16) may increase the risk of abnormal SDQ total scores in LBC. CONCLUSIONS: LBC showed a higher prevalence of abnormal SDQ total scores than NLBC. Insomnia, loneliness, and self-harm behavior were associated with abnormal SDQ total scores in LBC.

Impacts on antibiotic-resistant bacteria and their horizontal gene transfer by graphene-based TiO2&Ag composite photocatalysts under solar irradiation.

In recent years, photocatalysis has been considered as a promising method, which provides measures to environmental pollution. Antibiotic resistant bacteria (ARB) and their antibiotic resistance genes (ARGs), as the emerging environmental pollutants, are released into the environment, resulting in antibiotic resistance spread. TiO2-based nanocomposites, as the most common photocatalytic material, may influence ARB and ARGs under photocatalytic conditions. However, the research on this aspect is rare. A novel nanocomposite synthesized from Ag, TiO2 and graphene oxide (GO), was selected as a representative of nanomaterials for investigation. The experimental results indicated that TiO2/Ag/GO nanocomposites significantly affected ARB vitality. 100 mg/L TiO2/Ag/GO will reduce bacterial survival to 12.2% in 10 min under simulated sunlight irradiation. Chloramphenicol as the most representative antibiotic in the water, reduces the effect of ARB inactivation under photocatalytic conditions. The addition of TiO2/Ag/GO could affect tetracycline antibiotic resistance. The level of bacterial tolerance to tetracycline had a significant reduction. The horizontal gene transfer was promoted from 1 to 2 folds with the addition of TiO2/Ag/GO. Even high TiO2/Ag/GO concentration (100 mg/L) sample had a limited promotion, suggesting that TiO2/Ag/GO will not increase the risk of antibiotic resistance spread compared to other nano materials.

[Relationship between gene mutations and intelligence in children with Duchenne muscular dystrophy].

OBJECTIVE: To study the level of intelligence in children with Duchenne muscular dystrophy (DMD), and the relationship between the level of intelligence and gene mutations. METHODS: One hundred and two children with DMD between January 2009 and March 2011 were enrolled. DMD gene detection was performed through the multiplex ligation-dependent probe amplification (MLPA) in 84 cases. The level and the structure of intelligence were evaluated by Chinese Wechsler Intelligence Scale for Children (C-WISC) in 50 children with DMD (≥6 years old; DMD group) and in 50 age-and gender-matched healthy children (control group). RESULTS: The average intelligence quotient (IQ) was 84±21 in 102 children with DMD. Thirty patients (29.4%) had the full intelligence quotient (FIQ) less than 70. The FIQ, verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ) and the scores of 11 sub-tests of intelligence in the DMD group were significantly lower than those in the control group (P<0.01). The IQ in patients with gene mutations at exon 56-79 was the lowest (59.3±11.9), followed by in patients with gene mutations at exon 45-55 (88.6±1.9), at exon 1-29 (97.5±9.6) and at exon 30-44 (102.8±3.8) (P<0.01). CONCLUSIONS: The FIQ, VIQ and PIQ in children with DMD are lower than those in healthy children. There is association between mental retardation and gene mutations.

[Comparative study on sensory integration function in children with primary nocturnal enuresis].

OBJECTIVE: To study the sensory integration function in children with primary nocturnal enuresis (PNE). METHODS: The sensory integration function was assessed by the Childhood Sensory Integration Ability Development Checklist in 70 children with PNE and was compared with that in 74 normal children(control group). RESULTS: The incidence of sensory integration dysfunction (76%) in the PNE group were significantly higher than that in the control group (35%; P<0.01). Severe sensory integration dysfunction occurred in more children in the PNE group compared with the control group (39% vs 18%; P<0.01). The scores of all sensory integration indexes revealed by sensory integration function testing in the PNE group were significantly lower than those in the control group (P<0.01). CONCLUSIONS: The majority of children with PNE have sensory integrative dysfunction which presents in various aspects. It is necessary to assess the sensory integration function in children with PNE.

[Intelligence level and structure in school age children with fetal growth restriction].

OBJECTIVE: To study the intelligence level and structure in school age children with fetal growth restriction (FGR). METHODS: The intelligence levels were tested by the Wechsler Children Scales of Intelligence (C-WISC) in 54 children with FGR and in 84 normal children. RESULTS: The full intelligence quotient (FIQ), verbal IQ (VIQ) and performance IQ (PIQ) in the FGR group were 105.9+/-10.3, 112.4+/-11.2 and 97.1+/-10.6 respectively, and they all were in a normal range. But the PIQ was significantly lower than that in the control group (104.8+/-10.5; p<0.001), and the picture arrangement and the decipher subtest scores were significantly lower than those in the control group (p<0.01). The scores of perception/organization and memory/attention factors in the FGR group were 99.8+/-11.1 and 116.3+/-14.4, respectively, which were inferior to those in the control group (104.6+/-11.5 and 113.4+/-14.5 respectively; p<0.05). CONCLUSIONS: The total intelligence level of children with FGR is normal, but there are imbalances in the intelligence structure and dysfunctions in performance ability related to right cerebral hemisphere. Performance trainings should be done from the infancy in children with FGR.

[Attentiveness in school children: effect of cesarean section birth].

OBJECTIVE: To study the effect of cesarean section birth based on different indications on attentiveness in school children. METHODS: A total of 308 school children were assigned to three groups according to their birth model: natural delivery (n = 105), cesarean section due to social factors (n = 101) or medical factors (n = 102). The integrated visual and auditory continuous performance test (IVA-CPT) was performed for assessing attentiveness. RESULTS: The IVA-CPT demonstrated that there were significant differences in the quotients of combination control, auditory response control, combination attention, auditory attention, visual attention, auditory vigilance, visual concordance, visual vigilance and visual attention among the three groups (p<0.05). The results of the IVA-CPT in the group of cesarean section due to medical factors was obviously poorer than that of the natural delivery group and the group of cesarean section due to social factors. However no significant differences were observed between the groups of natural delivery and of cesarean section due to social factors. CONCLUSIONS: Cesarean section itself has no significant impacts on attentiveness in school children, while medical indications for cesarean section may contribute to major cause of attention deficit disorder.

[Gender analysis on prenatal care in rural areas of Xinjiang and Anhui province].

OBJECTIVE: To introduce the gender-specific view to the prenatal care and analysing the health behavior and its influencing factors. METHODS: Random sampling in cluster was used to select those study population and face to face interview was carried out at their residence in Xinjiang and Anhui province. RESULTS: The overall socioeconomic status of women in rural areas of Xinjiang and Anhui province was low and 93.2% of the women had education level on junior middle school or below. Politically women were less interested in these issues with only 63.1% of them ever participated in the election program or voting. In household daily life, women's status was almost equal to or even higher than men, but men always called the shots when something important in family happened. Men still held the power of decision making. In 47.3% of the families, the husband played a decisive role on decision making. In 37.7% of the families, husbands controlled the money. When getting into expensive expenditure, 35.2% of the families having men made the final approval. When there were different opinions between the couples, husband usually made the final decision in 44.2% of all the families compared to 6.3% of the families that wives made the final decision. 73.9% of women under survey had undergone prenatal examination and the rate on household deliveries reached 30.3%. Both gender consciousness and educational level had influenced the effect on prenatal care. CONCLUSION: It is important to better prenatal health service in rural areas and to improve socioeconomic status on gender consciousness of women.

[Study on status of nutrition in children under three years old in rural area in China].

OBJECTIVE: To understand the nutrition status of children under three years in rural area of western China and to explore the influencing factors so as to provide reasonable suggestions for policy making. METHODS: Use PPS sampling method to investigate the 13,532 children under three years old. Height and weight were used as nutritional indexes. RESULTS: The prevalence of stunting (height for age Z-score < -2), underweight (weight for age Z-score < -2) and wasting (weight for height Z-score < -2) were 12.4%,11.8% and 5.7% respectively. Boys, minority and the children from western China had higher prevalence rate. The prevalence rates of the Han nationality children's underweight and stunting were 9.5% and 9.8%, but these rates of the minority children were 15.6% and 16.5% respectively, which were obviously higher than the Han ethnicity children with significant differences between them (P <0.01).The prevalence of malnutrition was rising with age and the peak age of stunting, underweight and wasting appeared at 21 months, 12 months and 15 months, respectively. Compared with growth reference of NCHS/WHO, the HAZ, WAZ and WHZ left moved 0.59,0.60 and 0.26 units which indicated the whole nutritional status of children from program area impaired to some extent. Underweight inclined to have higher two-week prevalence rates of diarrhea and flu than in the normal children,achieving 15.9% and 13.5%, but with significant differences between them (P<0.01). We administered non-conditional logistic regression analysis to identify the influencing factors of malnutrition. Under-6-month children who were not taken care by their mothers showed higher risk of stunting. Over-6-month children stunting had significant relationship with age, gender, sibling order, nationality,maternal educational level,special cooking for children and residential region. Underweight of over-6-month children significantly related to age, nationality, and maternal educational level, yolk supply during 6-8 month old and living region. CONCLUSION: Malnutrition was really prevalent among children in China,suggesting that intervention should be done according to the influencing factors.