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1.
J Pediatr ; 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31928800

RESUMO

OBJECTIVES: To describe the mortality patterns, comorbidities, and attendance at accident and emergency departments among children with Down syndrome in Hong Kong. STUDY DESIGN: This is a population-based, retrospective cohort study of live births of children with Down syndrome delivered between 1995 and 2014, as identified from territory-wide hospitalization data in Hong Kong. The Kaplan-Meier product limit method was adopted to estimate the survival probabilities of children with Down syndrome by selected demographic and clinical characteristics. Cox regression analyses were conducted to examine associations of comorbidities and accident and emergency department accident and emergency departments attendances with mortality patterns. RESULTS: There were 1010 live births of children with Down syndrome in Hong Kong within the study period and the average rate of live births with Down syndrome was 8.0 per 10 000 live births (95% CI, 6.8-9.30). The rate of live births with Down syndrome over the past 2 decades decreased from 11.8 per 10 000 live births in 1995 to 3.4 per 10 000 in 2014. Eighty-three patients with Down syndrome died during this period. The overall 6-month and 1- and 5-year survival probabilities were 95.8%, 94.4%, and 92.6%, respectively. There was a significant decrease in mortality rates over the study period, particularly among those born between 2000-2004 and 2005-2009 compared with those born between 1995 and 1999 (P < .05). Patients with Down syndrome without congenital cardiovascular anomalies and without low birth weight had lower mortality rates than those with these diagnoses. CONCLUSIONS: Over the past 2 decades, the early life mortality of children with Down syndrome in Hong Kong has improved significantly along with a reduction in Down syndrome live births.

2.
Vaccine ; 38(5): 1025-1031, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31786002

RESUMO

BACKGROUND AND OBJECTIVES: Human papillomavirus (HPV) vaccination and cervical screening prevent cervical cancer effectively. However, there are concerns whether vaccination leads to high-risk sexual behaviors and less intention for cervical screening. We aimed to evaluate the influence of HPV vaccination on high-risk sexual behaviors, and intention for cervical screening among young Chinese females. We also reported the latest HPV vaccination uptake in Hong Kong. METHODS: A population-based survey was conducted between September 2016 and January 2017. Subjects were school-age girls from twenty-five secondary schools (in-school) and community females between 18 and 27 years (out-school). Demographics, vaccine-related attitudes, intention for cervical screening and participants' sexual behaviors were examined. RESULTS: We surveyed 2260 females from in-school (n = 1664) and out-school (n = 596) settings. 11.5% in-school and 23.5% out-school participants received at least one dose of HPV vaccine. Vaccination was not associated with age (in-school Odds Ratio [OR] 0.99, p = 0.87; out-school OR 1, p = 0.94), ethnicity (in-school OR 0.82, p = 0.72; out-school OR 0, p = 0.98), maternal education (in-school OR for secondary school 1.19, p = 0.43; for post-secondary school 1.28, p = 0.48), underage sex (in-school OR 1.22, p = 0.80; out-school OR 0.63, p = 0.67), earlier sexual exposure (in-school ß 0.01, p = 0.99; out-school ß 0.13, p = 0.68), multiple sex partners (in-school OR 3.27, p = 0.22; out-school OR 1.16, p = 0.43), and unprotected sex (in-school OR 1.14, p = 0.78; out-school OR 0.60, p = 0.10). Out-school females with higher personal education level was associated with higher vaccine uptake (post-secondary OR 3.4, p < 0.001; bachelor's degree or above OR 3.71, p < 0.001). More vaccinated females intended for cervical screening (in-school 23.6% vs. 21.1%; out-school 53.6% vs. 43.6%). Costs and knowledge were important factors for non-vaccination and non-intention for cervical screening. CONCLUSIONS: HPV vaccination was not associated with earlier and high risk sexual behavior among Chinese young females. Vaccinated Chinese young females had a higher intention for cervical screening.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31754063

RESUMO

BACKGROUND: The study aimed to examine the impact of household composition and satisfaction with family life on sexual behaviours among high school male and female students (aged 11-22 years) in Hong Kong. METHOD: High schools were randomly selected, and the final sample comprised 25 schools. Students were divided into two groups ('living with both biological parents' vs 'not living with both biological parents'). Students were asked to rate their satisfaction with family life on a five-point Likert scale in a self-administered questionnaire. Dependent variables were sexual experience, sexual harassment, sexting and nude chats. Multiple logistic regression was used to analyse the results. RESULTS: 3907 students were included in the analysis. 202 students (5.2%) were sexually active. 505 students had ever (13.0%) sexually harassed others and 303 students (7.8%) had ever been sexually harassed by others. 58 students (1.5%) had ever had nude chats. 1005 students (25.8%) had sexted in the last 12 months. Students who lived with both biological parents were less like to be sexually active, to sext and to have nude chats than those who did not. Students who had higher family life satisfaction were less likely to be sexually active, to sexually harass others, to be sexually harassed by others, to sext and to have nude chats than students who had lower satisfaction with their family life. CONCLUSIONS: Sexual health programmes and interventions should consider family functioning. Students who have low family satisfaction and those who do not live with both their biological parents should be targeted for sexual health interventions.

4.
Transl Psychiatry ; 9(1): 239, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570690

RESUMO

Intimate partner violence (IPV) against women negatively impacts infant health. However, its impact on infant's biology, in particular on telomere length (TL) is unknown. The aim of this study was to examine the association between IPV against women before childbirth and cord blood TL in their newborn. A total of 774 pregnant women in the 20th-24th week of gestation were recruited at a public hospital in Hong Kong. The mothers' exposure to IPV before childbirth, demographic characteristics, obstetric outcomes, health and mental health were measured at the time of recruitment and 4 weeks after childbirth. Umbilical cord blood was collected by midwives at the time of delivery. The newborn TL was quantified using quantitative PCR method and expressed in T/S ratio (the ratio of telomere repeat copy numbers to single-copy gene numbers). After adjusting for a number of confounding variables, the mothers' exposure to any IPV before childbirth (ß = -0.08, 95% CI = -0.14, -0.01) was associated with shorter TL. Specifically, psychological abuse against women before childbirth (ß = -0.08, 95% CI = -0.15, -0.02) and sexual abuse against women before childbirth (ß = -0.22, 95% CI = -0.43 to -0.01) were significantly associated with reduced newborn TL. This study is the first to provide evidence of an association between IPV against women before childbirth and TL shortening in their newborns. Through TL- dependent transcription and epigenetic mechanisms, our finding suggests maternal exposure to IPV may exert a life-long impact on the offspring's health.

5.
Crisis ; : 1-9, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31512939

RESUMO

Background: Child abuse and suicide among the young population is a serious and prevalent problem. Many studies have demonstrated that people with adverse childhood experiences, such as child abuse, are likely to develop suicidal behavior. This study evaluates the connection between child abuse and suicidal behavior in the Hong Kong community where incidents of child abuse have been on the rise over the past decade. Aims: To determine the association between child abuse and attempted suicide in the child population of Hong Kong using hospital electronic medical records system. Method: From January 1, 1995 to July 31, 2016, patients with admission age < 18 years with the diagnosis of child abuse or influenza infection (comparison group) were included in this study (n = 54,256). In secondary data analysis, an association was found between children who had experienced child abuse and the outcome measure of hospital admission for attempted suicide compared with influenza infection. Results: The adjusted hazard ratio of attempting suicide in children who experienced sexual abuse and physical abuse compared with the influenza-infected group was 6.48 (95% CI [4.56, 9.19]) and 4.83 (95% CI [3.67, 6.34]). The age at onset of adverse incidents was negatively associated with the attempted suicide timing. Female patients had a 1.64 higher risk of repeating attempted suicide. In addition, nearly 5% of children who had experienced child abuse attempted suicide in the 10 years after their admission, and more than 36% of patients had a record of repeated suicide attempt in the 20 years after the initial admission. Limitations: The accuracy of the diagnosis, selection bias, insufficiency of study period, Berkson's bias, incomplete socioeconomic status, as well as the absence of psychiatric diagnosis are the limitations. Conclusion: Our results indicate that there is a significant association between child abuse and suicide attempts in Hong Kong. If confirmed, the study (a) demonstrates that hospital admission records are a critical source for identifying children with a high risk for suicidal behavior; (b) may inform policy makers that additional and long-term intervention programs should be provided to children so as to reduce subsequent suicide attempts.

6.
Bull Emerg Trauma ; 7(3): 256-262, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31392225

RESUMO

Objective: To determine the mortality, morbidity, types of intracranial hemorrhages, and factors associated with length of stay (LOS) associated with accidental traumatic brain injury (TBI) at a pediatric intensive care unit (PICU) of a regional trauma center in an Asian city. Methods: This study is a retrospective review of types of head injury, mortality and morbidity demographics of patients admitted to a PICU with TBI. All patients with accidental TBI were included, namely road traffic injury (RTI) and fall, and their demographics compared. Non-accidental injuries (NAI) were excluded. Results: 95 children (78% males) were admitted to a PICU with RTI or falls from 2002 to 2017. They accounted for 3.7% of PICU admissions. Comparing with falls, victims of RTI were older (p<0.001) and more likely to suffer from skull fracture (p=0.017). There were 4 deaths with falls (6.8%) but none with RTI. Subarachnoid hemorrhages, extradural hemorrhages, the use of mechanical ventilation, inotropes and neurological supports were associated with longer LOS in PICU in these injuries (p<0.001). Conclusion: A longer PICU LOS is associated with extradural and subarachnoid hemorrhages, usage of inotropes, mechanical ventilation and neurological supports in falls and RTI. Three-quarters of victims are males. Preventive health education should be especially directed to boys to reduce severe TBI in this Asian city.

7.
J Child Health Care ; 23(3): 495-506, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31220930

RESUMO

This study aims to assess the family functioning and health-related quality of life (HRQOL) in Chinese boys with Duchenne muscular dystrophy (DMD) and their parents using Pediatric Quality-of-Life Family Impact Module (PedsQL FIM) and Pediatric Quality-of-Life Inventory (PedsQL) 4.0. Findings from 15 families with DMD were compared with 15 unaffected families. The HRQOL, as measured by the mean PedsQL 4.0 Generic Core Scale scores for the boys with DMD were significantly lower than those of age-matched healthy boys, for overall (p < 0.05, parent-report; p <0.001, self-report), physical (p < 0.001, parent-report and self-report), and social (p < 0.05, parent-report) functioning, but the emotional functioning is not affected. The parent-child concordance of our affected DMD families was generally in the moderate-to-good agreement range (intraclass correlation coefficients from 0.51 to 0.73), except for emotional (0.28) and social (0.31) functioning. The PedsQL FIM total score showed an inverse relationship with the affected child's age (correlation coefficient: -0.55; p < 0.01) and the disease stage (correlation coefficient: -0.63; p < 0.01) confirming that parental HRQOL and overall family functioning worsened as the child increased in age with advancing disease stage.

8.
JMIR Mhealth Uhealth ; 7(5): e12794, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31094354

RESUMO

BACKGROUND: Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers. OBJECTIVE: This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life. METHODS: A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as "intervention" or "control" by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. RESULTS: The final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was -0.65 (95% CI -1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels. CONCLUSIONS: The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers. TRIAL REGISTRATION: HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384.


Assuntos
Depressão Pós-Parto/diagnóstico , Educação em Saúde/normas , Aplicativos Móveis/normas , Mães/psicologia , Adulto , Análise de Variância , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Educação em Saúde/métodos , Educação em Saúde/estatística & dados numéricos , Hong Kong/epidemiologia , Humanos , Aplicativos Móveis/estatística & dados numéricos , Mães/estatística & dados numéricos , Gravidez , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Método Simples-Cego
9.
J Interpers Violence ; : 886260519849661, 2019 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-31130045

RESUMO

There is inconsistent evidence on the association between prenatal substance exposure and child behavioral problems. Children affected by maternal substance misuse are vulnerable to physical abuse and neglect. Few studies have examined factors contributing to internalizing and externalizing problems in these children. This study, with a focus on children with prenatal substance exposure, investigated whether family characteristics (the duration of maternal substance misuse postpartum or the existence of a sibling) moderated the association between adverse exposure (physical abuse or neglect) and behavior (internalizing or externalizing problems). We recruited 54 Hong Kong Chinese mothers with registered records of substance misuse during pregnancy and their children (2-9 years). Mothers completed questionnaires on drug use patterns during pregnancy and postpartum, abusive and neglectful parenting behaviors in the preceding year, and children's current behavioral problems. Moderated regression analyses tested whether abusive and neglectful parenting behavior interacted with family characteristics to affect child behavioral problems. The existence of a sibling moderated the relationship between neglect experience and internalizing problems, with a positive relationship observed only among single children (adjusted B [95% confidence interval] = 3.70 [0.98, 6.41], p = .012). The duration of maternal substance misuse postpartum moderated the relationship between physical abuse experience and externalizing problems, with a positive relationship observed only among children of mothers abusing substances beyond the child's infancy period (adjusted B [95% confidence interval] = 6.86 [2.34, 11.38], p = .008). The results show that the impact of physical abuse and neglect experiences depend on the type of behavior assessed and family and child characteristics. Positive sibling relationship and early detoxification in the mother can foster healthy behavioral development for children exposed prenatally to maternal substance misuse.

10.
Artigo em Inglês | MEDLINE | ID: mdl-30934827

RESUMO

Previous studies point to a link between parenting style and child maltreatment, but evidence from a Chinese context is lacking. We investigated the association between parenting style and child maltreatment in Hong Kong, and examined whether family socio-economic status and child gender moderate this relationship. Using stratified random sampling, 7585 children in Grade 1 to Grade 3 of 51 schools in Hong Kong were recruited and their parents were invited to complete the questionnaire. The past year weighted prevalence for minor physical abuse, severe/very severe physical abuse, psychological abuse, and neglect were 63.9%, 23.4%, 84.1%, and 23.2%, respectively. Authoritarian parenting was associated with all types of child maltreatment (prevalence ratio (PR) range: 1.10⁻1.53; p < 0.001), whereas authoritative parenting was associated with a lower risk of all types of child maltreatment (PR range: 0.89⁻0.97; p < 0.001). Child maltreatment is prevalent in Hong Kong and is strongly associated with parenting style. The association was significantly stronger among girls and those with higher family socioeconomic status. Education to empower parenting skills may alleviate the burden of child maltreatment.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Educação Infantil/psicologia , Poder Familiar/psicologia , Criança , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pais/psicologia , Abuso Físico , Prevalência , Inquéritos e Questionários
11.
Trauma Violence Abuse ; : 1524838019833005, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813848

RESUMO

BACKGROUND:: Rejection sensitivity (RS) is a personality disposition characterized by oversensitivity to social rejection; individuals who are sensitive to social rejection tend to anxiously or angrily expect, readily perceive, and overreact to it. The associations between (a) RS and aggression and (b) RS and victimization have been studied in recent years. However, the strength of these associations varied considerably between studies. This review aimed to synthesize the primary literature to improve our insight into these associations. METHOD:: A comprehensive literature search yielded 52 studies (with a total of 66,405 participants and producing 203 effect sizes) on the RS-aggression and RS-victimization associations. Three-level meta-analytic models were used to synthesize effect sizes and to examine potential moderators of the RS-aggression association and the RS-victimization association, respectively. RESULTS:: There was a small but significant association between RS and aggression (pooled r = .183; p < .001) and a slightly below moderate and significant association between RS and victimization (pooled r = .298; p < .001). The RS-aggression association was stronger for angry RS than for anxious RS and stronger for reactive aggression than for proactive aggression. Similar results were obtained in analyzing the longitudinal associations only. CONCLUSIONS:: RS is significantly associated with aggression and victimization. The implications of the results for clinical practice as well as directions for future research are discussed.

12.
Artigo em Inglês | MEDLINE | ID: mdl-30897839

RESUMO

This study examined the health profile of children with different types of disabilities and explored the disability-specific associations with various types of health and functioning using a large nonclinical sample of children. A cross-sectional school survey was conducted during 2016 and 2017. A total of 4114 children (aged 6⁻18 years) receiving primary or secondary education, or their proxy, in Hong Kong participated in the study. Disabilities were categorized as (a) physical disabilities; (b) learning and developmental disabilities; (c) intellectual disabilities; (d) internalizing disorders or mental illness; and (e) autism spectrum disorder. Health-related quality of life (QoL), sleep-related QoL, activities of daily living (ADL), emotional functioning, and social functioning were assessed and compared between children with disabilities and those without. The results showed that children with disabilities showed poorer physical functioning, health-related QoL, and emotional and social functioning than their counterparts without disabilities. Disability-specific associations with health were found: (a) physical disabilities and intellectual disabilities were associated with greater difficulties in ADL; (b) language impairment and Attention deficit/ hyperactivity disorder (ADHD) were negatively associated with sleep-related QoL; (c) all types of disabilities but hearing impairment were negatively associated with health-related QoL (HRQoL); and (d) language impairment, ADHD, internalizing disorder, as well as autism spectrum disorder were associated with greater abnormal behavioral difficulties. The findings warrant the development of tailor-made intervention programs and give insights to effective resource allocation for the children in need.


Assuntos
Saúde da Criança , Deficiências do Desenvolvimento/fisiopatologia , Crianças com Deficiência , /fisiopatologia , Atividades Cotidianas , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Espectro Autista/fisiopatologia , Criança , Estudos Transversais , Emoções , Feminino , Hong Kong , Humanos , Relações Interpessoais , Masculino , Qualidade de Vida , Sono
14.
Artigo em Inglês | MEDLINE | ID: mdl-30903997

RESUMO

BACKGROUND: Drug allergy, or drug hypersensitivity, is a potentially fatal disorder, and patients labeled with drug allergies have restricted access to first-line treatments. Full knowledge of the characteristics associated with drug allergies and severe reactions during allergy evaluation is beneficial for appropriate risk stratification. OBJECTIVE: We sought to determine whether certain clinical characteristics are associated with drug allergies in Chinese children. METHODS: Charts were reviewed for ethnic Chinese patients less than 18 years old referred to our tertiary allergy center for suspected drug allergies and completed skin and drug provocative testing between 2005 to 2017. Univariate and multivariate analyses were performed on the age of onset of drug allergies, gender, and other atopy versus drug allergies. RESULTS: Out of 75 children, 18 (24%) had IgE-mediated drug allergies, while 8 (10.7%) had delayed drug hypersensitivities, with a cumulative 26 subjects (34.7%) with any drug hypersensitivity. There were positive independent associations between drug hypersensitivities onset age vs IgE-mediated drug allergies (odds ratio (OR) = 14.9, 95% confidence intervals (CIs) = 1.5-148.3, P = 0.017) and between male gender and IgE-mediated drug allergies (OR = 4.4, CIs = 1.2-16.4, P = 0.019). Age 13 years was the best cut-off for IgE-mediated drug allergies according to the receiver operating characteristic curve (P = 0.026). Older age group (OR = 24.0, CIs = 1.4-417.8, P = 0.024) and atopic dermatitis (OR = 8.2, CIs = 1.4-49.8, P = 0.015) were correlated with delayed drug hypersensitivities. CONCLUSIONS: While several previous studies suggested a higher prevalence of IgE-mediated drug allergies in younger adult females, older boys were more likely to have drug allergies for Chinese children.

15.
J Interpers Violence ; : 886260519835880, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30862240

RESUMO

This study aimed to examine the associations between different types of child maltreatment and health-related quality of life (HRQoL) and emotional and social problems in adolescents, and to examine the moderating effect of social support on those associations. A cross-sectional survey was conducted between January and June 2016 in Hong Kong. The sample comprised 351 parent and adolescent dyads from low-income families. The parents reported on child maltreatment (physical abuse, psychological aggression, and neglect), and the adolescents reported on their HRQoL, emotional problems, and social problems. The adolescents' perceived social support was included as a potential moderator. Results of the study show that child physical abuse was strongly associated with emotional and social problems ( B = 0.91-1.45, p < .05). Lower overall HRQoL was associated with psychological aggression ( B = -3.96, p < .05) and neglect ( B = -4.14, p < .05). Physical functioning was affected by psychological aggression ( B = -3.16, p < .05), and emotional functioning was affected by neglect ( B = -4.82, p < .05). Social functioning was impacted by all three types of maltreatment ( B = -9.16 to -5.26, p < .05). This study extends previous literature by showing the varying effects of different types of child maltreatment on children's health in the context of low-income families. The findings of this study also support that peer social support may buffer the effects of child physical abuse on adolescents' emotional and social problems.

16.
Pediatr Res ; 85(4): 449-455, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30679794

RESUMO

BACKGROUND: This study aims to study prospectively specific sleep patterns and risk of ADHD after adjusting for potential confounders such as obstructive sleep apnoea (OSA) and methylphenidate use. METHODS: A population-representative sample of 514 Chinese preschool children was recruited when in kindergarten (K3). Parents reported on their socioeconomic status and children's sleep duration. The cohort was reassessed 3 years later when the children were in Grade 3 (P3). Parents reported on children's sleep patterns and ADHD symptoms. Information on OSA diagnosis and methylphenidate use was retrieved from health records. RESULTS: Among the 514 parent-child dyads (mean [SD] age, 5.52 [0.33] years), 411 were reassessed (80.0% retention; 9.35 [0.33] years) at follow-up. There were no significant baseline differences between follow-up and drop-out groups. A gradient relationship was observed between probable ADHD in P3 and sleep duration in K3. The risk of probable ADHD was 15.5 per 100 for children with <8 h of sleep in K3, whereas it was 1.1 per 100 for children with 11-12 h of sleep in K3. The adjusted risk ratio was 14.19 (p = 0.02). CONCLUSIONS: Sleep deprivation in early childhood is associated with higher risk of ADHD in middle childhood.

17.
J Pediatr ; 208: 74-80, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30612814

RESUMO

OBJECTIVE: To examine the mediating effects of socioemotional and behavioral functioning in the association between physical activity and academic achievement in Chinese children. STUDY DESIGN: Chinese children (n = 17 318; aged 6-11 years) from the Shanghai Children's Health, Education and Lifestyle Evaluation study in 2014 were the source of data. Children reported the time spent in moderate-to-vigorous physical activities (MVPA) during weekdays and weekends. Parents rated their children's socioemotional and behavioral difficulties. Head teachers rated the academic performance of each student. A mediation analysis with multiple mediators was performed to test the mediation effects of 5 socioemotional and behavioral variables (emotional problems, conduct problems, hyperactivity and inattention, peer relationship, and prosocial behaviors) in the association between MVPA and academic achievement, adjusting for demographic and health-related variables. RESULTS: Results revealed that MVPA was positively associated with academic performance (b = 0.78; SE = .01; P < .001). Conduct problems, hyperactivity and inattention, and peer problems showed significant mediating effects in the association between MVPA and academic achievement, with hyperactivity and inattention being the strongest mediator (b = 0.38; SE = 0.04; P < .001) accounting for 49% of the total effect. CONCLUSIONS: This study provides evidence that MVPA is associated with fewer socioemotional difficulties, which, in turn, is associated with better academic achievement. Promoting physical activity among school-aged children may benefit their overall development.

18.
J Neurooncol ; 141(2): 393-401, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30460632

RESUMO

BACKGROUND: Intracranial germ cell tumors (GCT) are more common in Asia than in the West, accounting for about 15% of brain tumors in Asian children. The survival rate for intracranial GCT is excellent, but there are concerns about the effects of radiotherapy on neuropsychological function and quality of life of patients. METHODS: Intracranial germ cell tumors (GCT) are more common in Asia than in the West, accounting for about 15% of brain tumors in Asian children. The survival rate for intracranial GCT is excellent, but there are concerns about the effects of radiotherapy on neuropsychological function and quality of life of patients. Intracranial GCT survivors in Hong Kong aged ≥ 6 years who received cranial irradiation in the past 15 years were recruited. Neurocognitive function and performance status were assessed by the Hong Kong Wechsler Intelligence scale and Karnofsky/Lansky performance scales (KPS), respectively. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales. A chart review was performed for tumor characteristics and complications related to the tumor and its treatment. RESULTS: Twenty-five intracranial GCT survivors were recruited. Longer length of time since treatment was associated with lower IQ scores. Larger tumor size was associated with lower KPS scores. Hemiparesis, poor manual dexterity, and complications with multi-organ involvement were associated with significantly lower KPS scores. Higher irradiation dosage was associated with lower PedsQL physical scores. CONCLUSIONS: The majority of GCT survivors had average intellectual functioning, satisfactory performance status and relatively good quality of life, except in the physical aspect. Comprehensive evaluation and long-term follow-up of GCT survivors are essential to provide timely support and improve long-term outcomes.


Assuntos
Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/radioterapia , Irradiação Craniana/efeitos adversos , Neoplasias Embrionárias de Células Germinativas/psicologia , Neoplasias Embrionárias de Células Germinativas/radioterapia , Qualidade de Vida , Adolescente , Sobreviventes de Câncer/psicologia , Criança , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Desempenho Psicomotor , Dosagem Radioterapêutica , Estudos Retrospectivos
19.
Biol Blood Marrow Transplant ; 25(3): 424-435, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30412784

RESUMO

Cord blood (CB) is an alternative stem cell source for allogeneic hematopoietic stem cell transplantation (HSCT). The unique advantages of using CB as a stem cell source are a degree of permissibility for HLA mismatch, rapid availability, and relatively risk-free cell collection. Because HLA is highly polymorphic and population-specific, optimal HLA-matched unrelated donors or cord blood units (CBUs) might not be available. In view of the possibility that matched CBUs that include noninherited maternal antigens (NIMAs) might contain acceptable HLA mismatches, we attempted to determine the degree of alloreactivity of CB mononuclear cells (MNCs) on stimulation by the maternal, paternal, and unrelated stimulator cells. Suppression of T cell proliferation, cytotoxicity, and a cytokine profile indicating suppressed Th1 and elevated IL-10 and TGF-ß1 responses were observed in the mixed lymphocyte reaction in response to NIMAs. The increases in IL-10 and TGF-ß1 production may be due to the Th2 response and/or regulatory T cells (Tregs). The reduced IL-10 and TGF-ß1 production after CD25 depletion could have been due to removal of Tregs from the CB cells. Thus, Tregs appear to play an important role in the CB MNC response to NIMAs, possibly due to the induction of IL-10 and TGF-ß1. We hope that our work can provide some evidence of the beneficial effect of NIMAs.


Assuntos
Sangue Fetal/imunologia , Histocompatibilidade/imunologia , Tolerância Imunológica , Linfócitos T Reguladores/imunologia , Adulto , Feminino , Antígenos HLA/imunologia , Humanos , Interleucina-10/metabolismo , Teste de Cultura Mista de Linfócitos , Mães , Fator de Crescimento Transformador beta1/metabolismo
20.
JAMA Netw Open ; 1(7)2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30533601

RESUMO

Importance: Although 13-20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available. Objective: To study whether CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training) reduces the hazard for depression in at-risk adolescents identified in primary care, as compared to a general health education attention control (HE). Design: The Promoting AdolescenT Health (PATH) study compares CATCH-IT and HE in a phase 3 single-blind multicenter randomized attention control trial. Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months post-randomization. Setting: Primary care. Participants: Eligible adolescents were 13-18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment. Of 2,250 adolescents screened for eligibility, 446 participants completed the baseline interview and 369 were randomized into CATCH-IT (n=193) and HE (n=176). Interventions: CATCH-IT is a 20-module (15 adolescent modules, 5 parent modules) online psychoeducation course that includes a parent program, supported by three motivational interviews. Main Outcomes and Measures: Time-to-event for depressive episode; depressive symptoms at 6 months. Results: Mean age was 15.4 years, and 68% were female; 28% had both a past episode and subsyndromal depression; 12% had a past episode only, 59% had subsyndromal depression only, and 1% had borderline subsyndromal depression. The outcome of time-to-event favored CATCH-IT but was not significant with intention-to-treat analyses (N=369; unadjusted HR=0.59; 95% CI 0.27, 1.29; p=0.18; adjusted HR=0.53; 95% CI 0.23, 1.23, p=0.14). Adolescents with higher baseline CES-D10 scores showed a significantly stronger effect of CATCH-IT on time-to-event relative to those with lower baseline scores (p=0.04). For example, for a CES-D10 score of 15 (significant sub-syndromal depression), HR=0.20 (95% CI 0.05, 0.77), compared to CES-D10 of 5 (no sub-syndromal depression), HR=1.44 (95% CI, 0.41, 5.03). In both CATCH-IT and HE groups, depression symptoms declined and functional scores increased. Conclusions and Relevance: CATCH-IT may be better than HE for preventing depressive episodes for at-risk adolescents with sub-syndromal depression. CATCH-IT may be a scalable approach to prevent depressive episodes in adolescents in primary care.

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