Chinese Childhood Research Articles

The Financial Well-Being Scale: Reliability, Validity, and Clinical Correlates Among Childhood Trauma Survivors

Purpose This study examined the reliability, validity, and clinical correlates of the financial well-being as measured using the CFPB Financial Well-Being Scale (FWBS) among Chinese childhood trauma survivors. Methods The sample consisted of childhood trauma survivors in a survey project ( n = 151), with a subsample at follow-up approximately 5 months after baseline ( n = 71). Participants first completed validated screening measures of financial well-being and mental health symptoms at baseline (T1), and then reported their symptoms again at follow-up (T2). Results Financial well-being is reliably and validly measured using the FWBS in this sample. T1 financial well-being significantly predicted disturbances in self-organization ( β = −.238, p = .01) and depressive symptoms ( β = −.239, p < .01) at T2. Discussion Financial well-being is a reliable and valid construct in this sample. Financial well-being predicted psychological symptoms among childhood trauma survivors. Trauma care services should take financial well-being into consideration.

Experiences of Exercise-Related Worry Among Chinese Childhood Cancer Survivors and Their Carers: A Qualitative Study.

The low levels of physical activity in childhood cancer survivors have increasingly garnered attention from nursing scholars. Exercise-related worry is a prominent barrier, yet the understanding of such experiences among childhood cancer survivors and their primary caregivers remains scarce. The aim of this study was to further understand the factors contributing to exercise-related worry from the perspective of childhood cancer survivors and their primary caregivers. In this qualitative study, we conducted face-to-face semistructured interviews with childhood cancer survivors (n = 20) and carers (n = 20) in 2 hospitals in China. The interviews were analyzed according to thematic analysis. Two main themes and 8 subthemes emerged: (1) internal factors: changes in the perception of physical activity (threat perception from the disease, active avoidance of stressful events, lack of safety due to past experiences), and (2) external factors: weak support system (limited peer support, family strength, feeling abandoned by the tumor team, reintegration into school, external environmental constraints). In summary, exercise-related worry is from internal factors and can be influenced by external factors. There are various factors contributing to the concerns of exercise in childhood cancer survivors, which may be a key factor for their significantly lower levels of physical activity compared to guideline recommendations. The findings of this study call for healthcare professionals to provide additional assistance for childhood cancer survivors with exercise-related worry and establish personalized mechanisms for supporting physical activity in pediatric cancer survivors within the Chinese healthcare system.

Clinical Features and Prognosis of Acute T-cell Lymphoblastic Leukemia in Children--Multi-Center Data Analysis in Fujian

To evaluate the efficacy of acute T-cell lymphoblastic leukemia (T-ALL) in children and explore the prognostic risk factors. The clinical data of 127 newly diagnosed children with T-ALL admitted to five hospitals in Fujian province from April 2011 to December 2020 were retrospectively analyzed, and compared with children with newly diagnosed acute precursor B-cell lymphoblastic leukemia (B-ALL) in the same period. Kaplan-Meier analysis was used to evaluate the overall survival (OS) and event-free survival (EFS), and COX proportional hazard regression model was used to evaluate the prognostic factors. Among 116 children with T-ALL who received standard treatment, 78 cases received the Chinese Childhood Leukemia Collaborative Group (CCLG)-ALL 2008 protocol (CCLG-ALL 2008 group), and 38 cases received the China Childhood Cancer Collaborative Group (CCCG)-ALL 2015 protocol (CCCG-ALL 2015 group). The efficacy and serious adverse event (SAE) incidence of the two groups were compared. Proportion of male, age≥10 years old, white blood cell count (WBC)≥50×109/L, central nervous system leukemia, minimal residual disease (MRD)≥1% during induction therapy, and MRD≥0.01% at the end of induction in T-ALL children were significantly higher than those in B-ALL children (P <0.05). The expected 10-year EFS and OS of T-ALL were 59.7% and 66.0%, respectively, which were significantly lower than those of B-ALL (P <0.001). COX analysis showed that WBC≥100×109/L at initial diagnosis and failure to achieve complete remission (CR) after induction were independent risk factors for poor prognosis. Compared with CCLG-ALL 2008 group, CCCG-ALL 2015 group had lower incidence of infection-related SAE (15.8% vs 34.6%, P =0.042), but higher EFS and OS (73.9% vs 57.2%, P EFS=0.090; 86.5% vs 62.3%, P OS=0.023). The prognosis of children with T-ALL is worse than children with B-ALL. WBC≥100×109 /L at initial diagnosis and non-CR after induction (especially mediastinal mass has not disappeared) are the risk factors for poor prognosis. CCCG-ALL 2015 regimen may reduce infection-related SAE and improve efficacy.

Examining the Executive Functioning of Children with ASD, ADHD, and Comorbid ASD and ADHD with the Taiwanese Traditional Chinese Childhood Executive Functioning Inventory (TC-CHEXI)

&lt;p&gt;背景和目的：CHEXI已被證明是一種跨文化、免費下載、方便且心理計量特質合宜的工具，用於評估社區兒童的執行功能。本研究使用台灣版「繁體中文兒童執行功能量表」（TC-CHEXI）評估由兒科精神科醫生診斷患有自閉症類障礙、注意力不足過動症以及兩者共病的兒童的執行功能，以探索該工具如何幫助我們了解臨床樣本的執行功能。方法：共有87名兒童的主要照顧者參加；包括 18名患有自閉症類障礙的兒童（17名男孩）、46名患有注意力不足過動症的兒童（34名男孩）和23名共病診斷的兒童（22名男孩）。本研究使用注意力不足過動症兒童執行功能量表做為效標，檢驗TC-CHEXI在臨床樣本中的效標關聯效度。此外探討了TC-CHEXI與自閉症兒童行為評定量表和修訂版重複行為量表間的相關性。最後在控制了年齡、性別和智商之後比較三組的執行功能。結果：使用TC-CHEXI檢驗臨床樣本的執行功能，顯示與預期相符的執行功能障礙。此外，TC-CHEXI在臨床樣本中，被證實具有良好的效標關聯建構效度。結論：TC-CHEXI是心理計量學上可靠且有效的執行功能評估工具，可用於社區樣本，協助吾人進行自閉症類障礙與注意力不足過動症初步的篩檢。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Background and purposes: The CHEXI has been shown to be a cross-cultural, free-to-download, convenient and psychometrically proper tool to evaluate the exec-utive functioning (EF) of children in community. The present study evaluated the EF of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and comorbidity of ASD and ADHD as diagnosed by a pediatric psychiatrist by using the Taiwanese Traditional-Chinese CHEXI (TC-CHEXI) in or-der to explore how the tool can help us understand the EF in clinical samples. Methods: In total, the primary caregivers of 87 children participated; they com-prised 18 children with ASD (17 boys), 46 children with ADHD (34 boys), and 23 children with comorbid ASD and ADHD (22 boys). The Executive Functions Rating Scale for Children with ADHD was used to investigate the criterion-related validity of the TC-CHEXI. The correlations of the TC-CHEXI with the Behavioral Rating Scale for Children with Autism and the Repetitive Behaviors Scale-Revised were also explored. Group comparisons on their EF subcomponents were conducted with age, gender, and IQ controlled for. Results: The findings suggest that examining with the TC-CHEXI, the EF of the clinical samples comprised of ASD/ADHD were shown to be dysfunctional as expected. Furthermore, the TC-CHEXI was noted to have criteria-related construct validity in clinical settings. Conclusion: The results showed that the TC-CHEXI is a psychometrically reliable and valid EF assessment tool to be used in community settings for primary screening of ASD/ADHD.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

"How I Am Brought into the Light": Representations of Childhood by Missionary Schoolgirls in East China, 1917–1930

Abstract: This article explores how missionary-educated Chinese schoolgirls applied childhood pedagogy that they learned at school to what they perceived to be the pressing demands of Chinese nationalism in the early twentieth century. Although there have been many studies of Christian schools in China from the missionary perspective, we know much less about how Chinese women themselves made sense of the education they received at missionary schools. Based on a study of two elite mission schools for girls in Republican-era East China, this article explores how girls applied child-rearing practices, hygiene, and domestic education to the children whom they taught in the vicinities of their schools. Like their missionary educators before them, they carved out new roles for themselves by claiming authority to speak for a downtrodden "other": Chinese children. In doing so, missionary schoolgirls created new knowledge about Chinese childhood in the early twentieth century.

The associations between spiritual well-being, hope and psychological symptoms in Chinese childhood cancer patients: A path analysis.

We aimed to test a model in which hope and spiritual well-being acted as protective factors against anxiety and depressive symptoms in childhood cancer patients (CCPs). We hypothesized that hope and spiritual well-being were mutually reinforcing factors that would both reduce anxiety and depressive symptoms. Using path analysis, the hypothetical model was tested on a cross-sectional sample of 412 Chinese CCPs aged 8-17years. Self-reported measures were used to obtain data on participants' social and clinical characteristics, spiritual well-being, hope, anxiety and depressive symptoms. The hypothetical model was supported. Results suggested that sex, treatment type and diagnosis predicted spiritual well-being; diagnosis and time since diagnosis predicted hope. Spiritual well-being and hope were mutually predictive and mutually reinforcing, and were both negatively associated with anxiety and depressive symptoms. This model predicted 40% of the variance in spiritual well-being, 37% in hope, 39% in depressive symptoms, and 28% in anxiety. Spiritual well-being and hope were mutually reinforcing and served as protective factors against anxiety and depressive symptoms. These support the value for integrating spiritual and hope elements in developing interventions for CCPs to improve their spiritual and psychological well-being along the disease trajectory.

Homoharringtonine-Based Induction Regimen Improved the Remission Rate and Survival Rate in Chinese Childhood AML: A Report From the CCLG-AML 2015 Protocol Study.

Homoharringtonine (HHT) is commonly used for the treatment of Chinese adult AML, and all-trans retinoic acid (ATRA) has been verified in acute promyelocytic leukemia (APL). However, the efficacy and safety of HHT-based induction therapy have not been confirmed for childhood AML, and ATRA-based treatment has not been evaluated among patients with non-APL AML. This open-label, multicenter, randomized Chinese Children's Leukemia Group-AML 2015 study was performed across 35 centers in China. Patients with newly diagnosed childhood AML were first randomly assigned to receive an HHT-based (H arm) or etoposide-based (E arm) induction regimen and then randomly allocated to receive cytarabine-based (AC arm) or ATRA-based (AT arm) maintenance therapy. The primary end points were the complete remission (CR) rate after induction therapy, and the secondary end points were the overall survival (OS) and event-free survival (EFS) at 3 years. We enrolled 1,258 patients, of whom 1,253 were included in the intent-to-treat analysis. The overall CR rate was significantly higher in the H arm than in the E arm (79.9% v 73.9%, P = .014). According to the intention-to-treat analysis, the 3-year OS was 69.2% (95% CI, 65.1 to 72.9) in the H arm and 62.8% (95% CI, 58.7 to 66.6) in the E arm (P = .025); the 3-year EFS was 61.1% (95% CI, 56.8 to 65.0) in the H arm and 53.4% (95% CI, 49.2 to 57.3) in the E arm (P = .022). Among the per-protocol population, who received maintenance therapy, the 3-year EFS did not differ significantly across the four arms (H + AT arm: 70.7%, 95% CI, 61.1 to 78.3; H + AC arm: 74.8%, 95% CI, 67.0 to 81.0, P = .933; E + AC arm: 72.9%, 95% CI, 65.1 to 79.2, P = .789; E + AT arm: 66.2%, 95% CI, 56.8 to 74.0, P = .336). HHT is an alternative combination regimen for childhood AML. The effects of ATRA-based maintenance are comparable with those of cytarabine-based maintenance therapy.

Psychometric evaluation of the Chinese version of the Herth Hope Index (HHI) in Chinese children with cancer

Hope plays an extremely important role in protecting childhood cancer patients from psychological distress caused by cancer. The availability of a valid and reliable instrument that can accurately assess hope is crucial for the development of interventions to enhance hope among childhood cancer patients. This study aimed to examine the psychometric properties of the Chinese version of the Herth Hope Index (HHI). Chinese childhood cancer patients aged 8–17 years (n = 412) were invited to participate in this cross-sectional study. Participants completed the Chinese translated version of the HHI, the Center for Epidemiology Studies Depression Scale for Children and the Paediatric Quality of Life Inventory 3.0 Cancer Module. Exploratory factor analysis and confirmatory factor analysis were conducted to assess the structural validity of the HHI. Content validity, convergent validity, internal consistency, and test–retest reliability at 2 weeks were also examined. The content validity index for items ranged from 0.8 to 1.0, and that for the scale was 0.9, demonstrating appropriate content validity. There was a positive correlation between HHI and Center for Epidemiology Studies Depression Scale for Children scores and a negative correlation between HHI and Paediatric Quality of Life Inventory 3.0 Cancer Module scores. The results indicated that the Chinese version of the HHI showed reasonable convergent validity and discriminant validity. Exploratory factor analysis yielded a three-factor model, which could explain 82.74% of the total variance. The confirmatory factor analysis results showed that χ2/df was 2.20, comparative fit index was 0.98, goodness of fit index was 0.94, and root-mean-square error of approximation was 0.07. Cronbach’s alpha was 0.78, indicating good internal consistency. The findings of the study showed that the Chinese version of the HHI (11-item) is a reliable and valid instrument for assessing hope among Chinese childhood cancer patients. Evidence-based interventions can be provided to enhance hope in this population.

Adaptation and psychometric evaluation of the Chinese version of the functional assessment of chronic illness therapy spiritual well-being scale among Chinese childhood cancer patients in China.

Spiritual well-being is a strength for childhood cancer patients to cope with cancer. The availability of a valid and reliable instrument for assessing spiritual well-being is crucial. This study translated and adapted the Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp) for Chinese childhood cancer patients and examined the psychometric properties and factor structure in this population. This was a methodological study. The FACIT-Sp was translated into Chinese. Adaptation was based on our qualitative study. For psychometric evaluation, a convenience sample of 412 were recruited based on the suggested sample size for the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Childhood cancer patients were included if they aged 8-17 years, with parental consent to participate, able to communicate that they were being treated for cancer, and able to communicate and read Chinese. Participants answered the Chinese version of the adapted FACIT-Sp, the Center for Epidemiology Studies Depression Scale for Children (CES-DC), and the Pediatric Quality of Life Inventory 3.0 Cancer Module (PedsQL). Content validity, convergent validity, internal consistency and test-retest reliability were examined. Both EFA and CFA assessed the structural validity of the adapted FACIT-Sp. The content validity index values for items ranged 0.8-1.0 and that for the scale was 0.84, indicating appropriate content validity. The scale had good internal consistency, with a Cronbach's alpha of 0.815. The FACIT-Sp scores positively correlated with the CES-DC scores, and negatively correlated with PedsQL scores, suggesting that the Chinese version of the adapted FACIT-Sp had reasonable convergent validity. EFA yielded a four-factor (meaning, peace, faith, and connection with others) model. The CFA results revealed that the four-factor model achieved a better fit than the original three-factor model (Chi-Square Mean/Degree of Freedom = 2.240 vs. 3.557, Comparative Fit Index = 0.953 vs. 0.916, Goodness of Fit Index = 0.909 vs. 0.884, Root Mean Square Error of Approximation = 0.078 vs. 0.112). The Chinese version of the adapted FACIT-Sp is a reliable and valid instrument for assessing spiritual well-being among Chinese childhood cancer patients. This instrument can be applied in clinical settings for routine assessment.

Trends of overweight and obesity prevalence in school-aged children among Henan Province from 2000 to 2019.

Overweight and obesity are harmful to human health. However, the latest trends of Chinese childhood overweight and obesity prevalence are not available. The aim of this study was to examine the trends from 2000 to 2019 among students in China. We analyzed data of 66,072 students in the Chinese National Survey on Students' Constitution and Health from 2000 to 2019. Overweight and obesity were defined based on the standard formulated by the International Obesity Task Force (IOTF standard), the World Health Organization (WHO standard), and the Working Group on Obesity in China (WGOC standard), respectively. The χ2-test was used to test the trends of overweight and obesity prevalence and logistic regression was conducted to evaluate the prevalence odds ratios of boys vs. girls and urban vs. rural areas. The prevalence of obesity/overweight and obesity combined was 6.03/23.58% (IOTF standard), 10.56/25.88% (WGOC standard) and 10.75/29.69% (WHO standard) in 2019. From 2000 to 2019, according to the WGOC standard, the prevalence increased from 2.51 to 10.56% for obesity and increased from 9.81 to 25.88% for overweight and obesity combined (P for trend < 0.001). Obesity/overweight and obesity were greater problems in boys than girls and urban than rural areas, but urban-rural differences decreased over time. Overweight and obesity prevalence increased significantly in children and adolescents in China from 2000 to 2019. The prevalence of overweight and obesity in rural areas may contribute to a large percentage of children with overweight and obesity.

Homoharringtonine-Based Induction Regimens Combined with ATRA-Based Maintenance in Chinese Pediatric AML: A Report from the Cclg-AML 2015 Protocol Study

Introduction Acute myeloid leukemia (AML) is a heterogeneous group of hematological malignancy. Classical induction therapy of DAE composed of etoposide (VP-16), cytarabine arabinoside (Ara-C) and anthracycline (DNR) is commonly applied in childhood AML, but etoposide has been reported to increase the risk of secondary cancer, especially for AML with MLL rearrangement. Although homoharringtonine (HHT) is commonly used for the treatment of Chinese adult AML, the efficacy and safety of HHT-based induction therapy have not been confirmed for childhood AML. And whether survival of pediatric AML will benefit from maintenance therapy without increasing toxicity is a matter of debate. All-trans retinoic acid (ATRA)-based therapy has been less reported and verified among non-APL AML patients. Here, we seek to evaluate the efficacy and safety of HHT-based induction regimens combined ATRA-based maintenance therapy for Chinese childhood AML (Chinese Clinical Trial Registry: ChiCTR-IPR-15006816). Methods The 2015 open-label, multicenter, randomized Chinese Children's Leukemia Group (CCLG) study was performed across 35 centers in China between July 2015 and October 2019. Newly diagnosed 0- to 18-year-old children with AML were first randomly assigned to receive HHT-based (H arm) or etoposide-based (E arm) induction regimens [HHT (3 mg/m2 per day from days 1 to 5) or VP-16 (100 mg/m2 per day from days 1 to 5) combined with DA regimen (D: 40 mg/m2 per day on days 1, 3 and 5; A: 100 mg/m2 every 12 hours from day 1 to 7)] and then randomly allocated to receive cytarabine-based (AC arm) or ATRA-based (AT arm) maintenance therapy. The primary endpoint is the complete remission (CR) rate after two courses of induction therapy between H arm and E arm. The secondary endpoints include the 3-year overall survival (OS) and 3-year event-free survival (EFS) of patients in the intent-to-treat population among four arms (H+AT arm, H+AC arm, E+AT arm and E+AC arm). What we should explained is that the study was initially designed as a multicenter randomized controlled trial, however, due to a shortage of HHT, which lasted for half a year in some local hospitals, we had to give priority to ensuring patient benefit and assign these patients to the E arm until HHT became available, and then patients in the H arm were supplemented in those hospitals. So patients were unevenly distributed among the four arms. Results We enrolled 1253 intent-to-treat de novo AML patients, of whom 895 were included in the induction therapy analysis, and 554 received maintenance therapy (Figure 1). The median age was 75.0 months (IQR 36.0-118.0), and 57% of the patients were male. The median follow-up time was 29.4 months (IQR 8.4-47.4). 185 of 1253 patients (14.8%) were lost to follow-up, of whom 70.0% patients have been followed for over 12 months. The CR rates were 88.3% in the H arm versus 83.3% in the E arm (p=0.03). The CR rate of patients with t(8;21)/AML1-ETO was higher in the H arm than in the E arm (94.7% vs. 87.5%, p=0.018). According to the intention-to-treat analysis, the 3-year OS and EFS were significantly higher in the H arm than in the E arm [3-year OS: 69.2% vs. 62.8%, p=0.025 (Figure 2); 3-year EFS 61.1% vs. 53.4%, p=0.022]. Among patients who were enrolled in maintenance therapy (per-protocol population), the 3-year EFS (H+AT arm: 70.7%, 95% CI 61.1-78.3; H+AC arm: 74.8%, 95% CI 67.0-81.0, p=0.933; E+AC arm: 72.9%, 95% CI 65.1-79.2, p=0.789; E+AT arm: 66.2%, 95% CI 56.8-74.0, p=0.336) did not differ significantly across the four arms. In subgroup analysis, patients with AML1-ETO positivity in the H+AT arm had significantly better OS (82.4% vs. 66.4%, p=0.043) and EFS (73.6% vs. 52.8%, p=0.013) than those in the E+AC arm. Conclusions Our study demonstrated, in childhood AML, HHT-based induction regimens (DAH) could significantly obtain higher complete remission rate compared with patients who received etoposide-based regimens, especially for those with AML1-ETO positive. And The HTT-based regimen resulted in a significantly improved 3-year OS and EFS compared with VP-16-based regimen. More patients with AML1-ETO positive who took DAH achieved complete remission, and these patients had longer overall survival and event-free survival, than those who took DAE. And ATRA-based maintenance has comparable effects to cytarabine-based maintenance in terms of OS and EFS. ATRA may be an alternative option for pediatric AML. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical Features and Prognosis of Chinese Childhood Pulmonary Arterial Hypertension-Related Gene Mutation Carriers

Background: The impact of PAH-related gene mutations on the clinical phenotype are not yet fully understood, especially in childhood.

Corneal Endothelial Characteristics in Normal Chinese Han Children and Youngsters: A Study from the Specular Microscopy Descriptions

Objective To observe the morphological changes of corneal endothelial cells in healthy Chinese children and youngsters and analyze the sensitive and specificity of the endothelial assessments. Methods 14,670 Chinese healthy volunteers enrolled were examined by specular microscopy, and the endothelial descriptive indexes: the central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in average cell size (CV), the percentage of regular hexagonal cells (hexagonality, HEX), cell size of minimal cell (Smin), cell size of maximal cell (Smax), average cell size (Savg), and size of standard deviation of cell area (Ssd) as well as sex and age were analyzed. Results The average age of this study is 17.36 ± 7.58 (4–30) years. There is no sex predominance: 7,260 male (49.5%) and 7,410 female (50.5%). The mean CCT, ECD, CV, HEX, Smin/max, Savg, and Ssd are 529.94 ± 31.53 (437–644) μm, 3,051.28 ± 375.49 (2,031–4,074) cells/mm2, 28.34 ± 4.36 (18–40) %, 61.21 ± 10.29 (17–89) %, (147.79 ± 21.94 to 678.29 ± 120.96) μm2, 332.74 ± 44.62 μm2, and 95.02 ± 23.17 μm2, respectively. The CCTs keep consistency. The ECD decreased rate is 1.02%/year. The curve of ECD and hexagonality expresses the same linear tender. The CCT and endothelial evaluation indexes have no sex predominant (p > 0.05); the quantitative indicators: CCT, ECD, and HEX are significant negative associated with age (p = 0.001 or p < 0.001); the variability indexes: the CV, Smin, Smax, Savg, and Ssd are positive correlation (p < 0.001). The coefficients of CCT, HE, and Smin are -0.35, -0.59, and 1.17, respectively. Conclusions The ECD decrease rate is 1.02%/year of the normal Chinese Han childhood to the earlier adulthood. The ages 4 to 12, 13 to 20, and 21 to 30 can be named as the childhood, puberty and adulthood from endothelial biologic identity. The HEX is the sensitivity marks for the polymorphisms while the S min is the specificity indicator CVs upon the Topcon Noncon Specular microscopy results.

Sleep disruption and its contributing factors in Chinese survivors of childhood cancer: A cross-sectional study.

This study provided information about sleep disruption, particularly its prevalence and severity among Hong Kong Chinese childhood cancer survivors. Additionally, we identified the factors influencing sleep disruption and explored how fatigue, depressive symptoms and physical activity (PA) affect sleep disruption. Four hundred two survivors 6-18years old and 50 age- and gender-matched healthy counterparts were assessed for depressive symptoms, fatigue, PA and subjective sleep quality. Demographic and clinical information were collected. Multiple logistic regression analyses were conducted to identify any factors contributing to poor sleep. Mean scores of depressive symptoms, fatigue for children and that for adolescents, and PA in survivors were 16.1 (SD=11.1), 24.6 (SD=10.3), 27.7 (SD=7.8), and 3.08 (SD=2.9), respectively. 44.8% of the survivors were poor sleepers, which was more that in healthy counterparts. The three most common sleep problem were prolonged sleep latency (31.9%), daytime dysfunction (23.4%), and sleep disturbance (22.9%). The time since last treatment (children: AOR=0.54, 95% CI=0.30-0.96, p=0.04; adolescents: AOR=0.80, 95% CI=0.70-0.92, p<0.01) and PA levels (children: AOR=0.46, 95% CI=0.260-0.82, p=0.01; adolescents: AOR=0.70, 95% CI=0.49-0.98, p=0.04) were negatively associated with sleep disruption, while depressive symptoms (children: AOR=1.31, 95% CI=1.04-1.64, p=0.02; adolescents: AOR=1.07, 95% CI=1.01-1.13, p=0.03), fatigue (children: AOR=1.15, 95% CI=1.00-1.31, p=0.04; adolescents: AOR=1.08, 95% CI=1.02-1.15, p=0.01), number of treatment received (children: AOR=16.56, 95% CI=1.27-216.82, p=0.03; adolescents: AOR=7.30, 95% CI=2.36-22.56, p<0.01), and co-sleeping (children: AOR=29.19, 95% CI=1.65-511.57, p=0.02; adolescents: AOR=4.63, 95% CI=1.22-17.61, p=0.02) were positively associated with sleep disruption. Physical activity made the largest contribution to reduce sleep disruption. It is crucial to advocate for the adoption and maintenance of PA in survivorship.

Prognostic Relevance of Structural Maintenance of Chromosomes 4 Overexpression in Pediatric Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Abnormal expression of structural maintenance of chromosomes (SMC) 4 has been observed in multiple tumors and plays a vital role in cancer development. However, the association between SMC4 expression and clinical characteristics in Chinese childhood patients with ALL is unknown. Thus, this study aimed to investigate the relationship between SMC4 expression and clinical features and prognosis in these patients. Real-time quantitative polymerase chain reaction (PCR) was performed to detect the expression of SMC4 in Chinese pediatric ALL patients and in patients achieving complete remission (CR). Then, the relationships between SMC4 expression and clinical features, such as gender, age, white blood cell (WBC) count, French-American-British (FAB) classification, immunophenotype, fusion gene, prednisone response, and minimal residual disease (MRD) were determined. Furthermore, survival and prognostic factor analyses were carried out to examine the prognostic value of SMC4 expression. The expression level of SMC4 was significantly higher in bone morrow cells of newly diagnosed pediatric ALL patients than in those of healthy controls (p = 0.006), especially in B-cell precursor ALL (BCP ALL). Moreover, SMC4 expression was correlated with different clinical parameters. Furthermore, a decrease of SMC4 expression was detected in BCP ALL patients achieving CR. The high SMC4 expression group had both worse event-free survival rate and poorer overall survival rate. However, multivariate analysis showed that SMC4 expression was not an independently predictive factor of BCP ALL outcome. These results revealed that SMC4 expression in BM was associated with various clinical outcomes in pediatric patients with ALL, although it was not an independent outcome factor.

Genetic Diagnosis Spectrum and Multigenic Burden of Exome-Level Rare Variants in a Childhood Epilepsy Cohort.

Childhood epilepsy is a considerably heterogeneous neurological condition with a high worldwide incidence. Genetic diagnosis of childhood epilepsy provides the most accurate pathogenetic evidence; however, a large proportion of highly suspected cases remain undiagnosed. Accumulation of rare variants at the exome level as a multigenic burden contributing to childhood epilepsy should be further evaluated. In this retrospective analysis, exome-level sequencing was used to depict the mutation spectra of 294 childhood epilepsy patients from Shanghai Children’s Medical Center, Department of Neurology. Furthermore, variant information from exome sequencing data was analyzed apart from monogenic diagnostic purposes to elucidate the possible multigenic burden of rare variants related to epilepsy pathogenesis. Exome sequencing reached a diagnostic rate of 30.61% and identified six genes not currently listed in the epilepsy-associated gene list. A multigenic burden study revealed a three-fold possibility that deleterious missense mutations in ion channel and synaptic genes in the undiagnosed cohort may contribute to the genetic risk of childhood epilepsy, whereas variants in the gene categories of cell growth, metabolic, and regulatory function showed no significant difference. Our study provides a comprehensive overview of the genetic diagnosis of a Chinese childhood epilepsy cohort and provides novel insights into the genetic background of these patients. Harmful missense mutations in genes related to ion channels and synapses are most likely to produce a multigenic burden in childhood epilepsy.

Studying teacher professional development: how a Chinese kindergarten teacher brings play practices into the program

ABSTRACT Research has suggested that system-wide professional development needs to embrace ongoing and sustainable processes such as critical reflection, being within a community of practice and the co-creation of new practices within and across early childhood systems. However, there is little research on how professional development can be designed in a personally meaningful way to support sustained learning. The research reported here is part of a wider study on the professional development of early childhood teachers. Video observations of one teacher’s interactions with children and interviews with that teacher are analysed to investigate how Chinese early childhood teachers’ professional development may be meaningfully designed through an Educational Experiment (EE). A Conceptual PlayWorld model as the intervention for the educational experiment was used to create new conditions. The theoretical problem for teachers and researchers was how to bring new play practices into kindergarten programs. We argue that the educational experiment creates a new kind of social situation for teachers, amplifies reflective practice and in so doing, acts as an important source of professional development for sustained practice change.

Individual, Interpersonal, and Home Environmental Factors Influencing Health Behaviors Among Chinese Childhood Cancer Survivors: A Structural Equation Analysis.

Childhood cancer survivors (CCSs) are at increased risk of chronic health conditions, which could be controlled with health behaviors. However, the health behaviors and related factors of Chinese CCSs remain unclear. The aims of this study were to examine multiple health behaviors among Chinese CCSs and explore the individual, interpersonal, and home environmental factors affecting health behaviors. This cross-sectional study recruited 204 participants from 3 grade-A tertiary hospitals in Guangzhou, China. Participants provided data on health behaviors (smoking, drinking, drug use, screen time, internet addiction, dietary behaviors, physical activity, and sleep behaviors) and their determining factors. Structural equation modeling was used to analyze the data. Chinese CCSs reported low rates of smoking, drinking, and drug use (0%-6.4%), but only 51% of survivors met screen time recommendations, and 24.5% of them had Internet addiction. Few survivors reported frequent soft-drink, sugar, and fast-food intake (2.0 to 7.4%), but many were finicky eaters (55.4%) or seldom drank milk (41.7%). In addition, 67.6% and 47.5% of survivors did not meet physical activity and sleep time recommendations. Childhood cancer survivors' health behaviors were influenced by the individual (age, education level, and time since diagnosis), interpersonal (peer and family support), and home environmental (residential location, parents' educations level, and household income) factors. There were suboptimal health behaviors among Chinese CCSs. Targeted interventions should consider their individual, interpersonal, and home environmental factors. Knowledge of health behaviors and related factors of Chinese CCSs would help healthcare professionals develop further interventions to improve their care of this population.

Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors

BackgroundSleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure.MethodsA convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis.ResultsThe Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70.ConclusionThe Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost.Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.

The Play of Art: Propensity and Pedagogy in Contemporary Chinese Early Childhood Education

The standard educational gesture—in defense of its perceived secondary status relative to the “real world”—is to embed everything within its purview, such that even conceiving education as an art becomes a pedagogic imperative. In Anji County, China, we find an early childhood program (Anji Play) that uncouples play from this hierarchy of educational subordinations. Anji Play also appears to mirror Western examples of the integration of play and art, while at the same time suggesting a distinctly Chinese approach to play and to aesthetics. This article introduces some elements and principles of Anji Play, while proposing that they may prompt us to rethink the relations among art, play, and education in light of the current historical, cultural, and theoretical context.