Objective To compare and evaluate the costeffectiveness of different screening protocol for type 2 diabetes (T2DM) or impaired glucose regulation (IGR)，and to suggest the protocol.Methods The population for survey was selected as a stratified cluster sample from 8 urban and 10 rural areas in Beijing. Fasting capillary blood glucose (FCBG) was determined in 19 593 children and adolescents aged 6 to 18 years in 4 urban and 3 rural areas using haemosaccharometer model Ⅱ(Roche Diagnostic, (Shanghai) Ltd ). OGTT was performed in those with FCBG≥5.6 mmol·L-1 following initial screening. The diagnosis of diabetes mellitus was reached according to the criteria of WHO, the diagnosis of type 2 diabetes mellitus was reached according to the highrisk criteria of screening for type 2 diabetes of ADA and the criteria raised by Dean. The whole study population was divided into different groups according to clinical features,general population, overweight/obese, obese group and those with other T2DM risk factors, including acanthosis nigricans, family history of T2DM and puberty, the response rate, final diagnosis rate, and costeffectiveness of different screening protocol were calculated, then the best subgroup fit for screening was chosen and the screening protocol was suggested.ResultsThe response rate of abnormal FCBG among general population(48%), was significantly lower than those among overweight and obese group (59.29% and 68.00%, respectively). General population had the lowest final diagnosis rate(1.67/1 000 cases), highest total direct medical cost (112.1 thousands yuan) and highest cost per case (3.5 thousands yuan). Obese group had the highest final diagnosis rate(8.09/1 000 cases), lowest total direct medical cost (16.2 thousands yuan) and lowest cost per case (1.1 thousands yuan). Compared with the general population, 2 cases of T2DM were misdiagnosed in obese group, 15 and 12 cases of IGR were misdiagnosed in obese and overweight group respectively. Screening T2DM and IGR should be performed in overweight children. Choosing risk factors correlated with T2DM including overweight, nthosis nigricans, family history of T2DM and puberty, with the number of risk factors increased, the compliance rate and the prevalence of T2DM/IGR were increased, total cost and cost per case were declined. However, if a subject had 3 or more risk factors, the sensitivity of screening was declined, 83.3% of T2DM would be misdiagnosed when screening was performed in those who had 4 risk factors.Conclusions The study group recommended that screening for T2DM and IGR should be performed in highrisk children. Those with 2 or more risk factors aged 8-18 years should be recommended to be screened when considering cost and effectiveness simultaneously.
Objective To explore the effects of serum leptin and adiponectin concentrations on the pathogenesis of obesity-related hypertension for children and adolescents.Methods A total of 3 502 schoolchildren (1 784 boys and 1 718 girls) aged 6-18 years were recruited from the BCAMS study, which was a crosssectional representative populationbased survey on metabolic syndrome for children and adolescents in Beijing. In this study, participants were categorized into four groups (Control group, HBP group, OB group and OB+HBP group) according to the sex, age-specific body mass index (BMI) cutoffs recommended by the Working Group on Obesity in China, and systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) equal to or greater than the 95th percentile for age and gender of schoolchildren in Beijing in 2004. Blood samples were obtained after a 12hour fast, and the levels of plasma insulin, serum leptin and adiponectin were measured by sensitive, specific doubleantibody sandwich enzyme-linked immunosorbent assays (ELISA). Variables including insulin, leptin and adiponectin were skewed distribution and natural logarithmical transformations were performed. Analysis of variance, Spearman correlation, and multivariate regression analysis were conducted.Results Higher BMI, SBP and DBP, lower insulin, leptin and adiponectin levels were found in boys than in girls. There were no differences in BMI, serum leptin and adiponectin levels between the control group and the HBP group. Higher BMI, plasma insulin and serum leptin, and lower adiponectin levels were found in the OB group and OB+HBP group than those in the control group or HBP group. BMI, plasma insulin levels of the participants in the OB+HBP group, but only boys′ serum leptin levels were higher than those in the OB group. Both SBP and DBP had positively correlated with leptin (r=0.260-0.643, P<0.01）and negatively correlated with adiponectin (r=-0.171-0.332, P<0.01) for both genders. After adjusting for insulin or BMI, above correlations became weak or disappeared. The odds ratios (OR) and 95% confidence interval (95%CI) for the prediction of hypertension were elevated in children in the upper quartile of leptin level ［2.75(2.28-3.32)］ compared with that in the lower quartile. The figures were 1.59(1.31-1.92) in the lower quartile of adiponectin level compared with in the upper quartile. When BMI was included in the models, all ORs for the prediction of hypertension were not significant for both hyperleptinaemia and hypoadiponectinaemia.Conclusions Levels of blood pressure, plasma insulin, serum leptin were higher and serum adiponectin was lower in overweight children than in control group. Leptin and adiponectin may be related to blood pressure through obesity or insulin resistance.
Objective To investigate the relationship between obesity and lipids disturbance and Nonalcoholic Fatty Liver Disease （NAFLD）in schoolchildren.Methods This was a casecontrol study. 4 elementary schools and 4 middle schools were selected from Haidian district in Beijing with representative cluster sampling.659 obese children and 603 normal weight children aged 7 to 18 years were recruited from the 8 schools with uncompletely randomized sampling as the case and control groups. Data of anthropometric measurements including weight and height were collected from March to May, 2007. Body Mass Index （BMI）was calculated by weight（in kilograms）/height2（in meters）. Obsity and normal weight were determined according to the sex-, age-specific body mass index (BMI) cutoffs, recommended by the Working Group on Obesity in China. Liver was tested by ultrasonography (Toshiba SA340A), and abnormal hepatic sonograms were diagnosed. Elevated glutamatepyruvate transaminase was diagnosed by ALT≥40.0 U·L-1 and elevated glutamicoxalacetic transaminase was determined by AST≥45.0 U·L-1. Nonalcoholic fatty liver was diagnosed according to the diagnostic criteria of nonalcoholic fatty liver disease recommended by the Fatty Liver and Alcoholic Liver Disease Study Group of Chinese Liver Disease Association.Serum levels of TG≥1.70 mmol·L-1, TC≥5.20 mmol·L-1, HDLC≤1.03 mmol·L-1 and LDLC≥3.12 mmol·L-1 were defined as raised TG, raised TC, Low HDLC and elevated LDLC, respectively. TG was skewed distribution and natural logarithmical transformations were performed. Analysis of covariance adjusted for gender and age, Chisquare test and binarylogistic regression analysis were conducted to analyze the relationship between obesity and lipid profiles, fatty liver and NAFLD in different groups. Chi-square test for trend was used to analyze the changes of lipid profiles and NAFLD with obesity aggravated.Results Hepatic sonograms test demonstrated that 186 students had fatty liver and 68 children were diagnosed as NAFLD. The prevalence of fatty liver tested by Ultrasonography was 28.0%(184/656) and that of NAFLD was 10.2%(67/656) in obese children, while those were 0.3%(2/603) and 0.2%(1/603) in normal weight group, respectively. The levels of TG, TC, LDLC, HDL-C were 1.16(0.87-1.52) mmol·L-1, （4.24±0.03） mmol·L-1,（1.30±0.01） mmol·L-1 and （2.46±0.02） mmol·L-1 in obese group were significantly higher than those ［TG 0.85(0.65-1.07) mmol·L-1, TC（4.08±0.03） mmol·L-1, LDL-C（1.59±0.01） mmol·L-1 and HDL-C（2.04±0.02） mmol·L-1 ］in normal weight group (P<0.01). The prevalence rates of HTG ［17.3%(114/659)］, HTC［9.6%（63/659）］, HLDL-C［13.2%（7/659）］, LHDL-C［19.3%（27/659）］, elevated ALT/AST［14.7%（97/659）］/［3.6%（24/659）］, fatty liver［28.0%（184/659）］and NAFLD［10.2%（67/659］ were significantly higher in obese group than those［HTG 3.6%（2/603）、HTC 4.8%（29/603）、LHDL-C 5.1%（31/603）、HLDL-C 2.0%（12/603）、elevatedALT/AST 0.8%（5/603）/0.8%（5/603）、fatty liver 0.3%(2/603)、NAFLD 0.2%（1/603）］ in normal weight group. The levels of lipids profiles of TG［1.40(0.93-2.08)mmol·L-1］, TC（4.44±0.09） mmol·L-1, HDL-C（1.23±0.03） mmol·L-1 and LDL-C（2.70±0.07）mmol·L-1 in obese children with NAFLD were higher than those［TG 1.13(0.85-1.49) mmol·L-1, TC（4.22±0.03） mmol·L-1, HDL-C（1.31±0.01）mmo·L-1 and LDL-C（2.43±0.02）mmol·L-1in obese children without NAFLD. The dyslipidmias in obese children with NAFLD was more serious comparing with that in obese children without NAFLD (P<0.001)，the changes of HTG was especially significant. Further more dyslipidmias, liver function disturbance, fatty liver tested by hepatic sonograms and NAFLD were aggravated with the increase of obesity by. Chi-square test for trend except HTG.Conclusions Dyslipidmias, liver function disturbance, fatty liver and NAFLD were more serious in obese schoolchildren than in those with normal weight. The dyslipidmias and fatty liver were aggravated with the increase of obesity. Ultrasonographic test of liver should be done in midrange for significant obese schoolchildren.
Objective To analyze unidimension，internal reliability and external reliability of the Fine Motor Function Measure Scale （FMFM）for Children with Cerebral Palsy.Methods 696 children with cerebral palsy participated in the study. 481 males（69.1%）and 215 females，the average age was 30.0 months（SD:25.9months），ranged from 2 to 183 months；Types of CP in the children were spastic quadriplegia（n=239，34.3%），spastic diplegia（n=212，30.4%），spastic hemiplegia（n=185，26.6%），athetoid（n=30，4.3%），dystonic（n=21，3.0%），ataxic（n=9，1.3%）.The 86 test items formed FMFM sampling scale. All samples were measured by FMFM sampling scale at least once.86 test items of FMFM sampling scale and 696 samples were analyzed by Rasch analysis using the partial credit model（PCM）. Unidimension of scale was determined by item misfit criterion(FITI), and the FITI was set as meansquare values (MnSq) from 0.6 to 1.4, At the same time ultimate selected items of the FMFM were determined.Then test-free person measurement and sample-free item calibration of these items components of FMFM were analyzed. The first 23 samples were included for testretest reliability study with a interval of 1 to 7 days. 49 samples were selected for interscorer reliability analysis.ResultsAfter three screenings, 25 items were deleted from 86 items of FMFM sampling scale. Among the remained 61 items, the misfit items were 3, less than 5% of all, suggesting that the majority items of this measure were good in unidimension, The mean standard error of item difficulty measuring was 0.09 (range 0.06-0.15), and the reliability of items was 1.00, showing that these items had good reliability. The item separation value was 38.09, showing that these items had good stratification of difficulty.The mean standard error of the sample ability measure was 0.30 (range 0.21-1.05). The reliability of samples was 0.99, showing that the FMFM had good reliability. The item separation value was 9.13, showing that the FMFM had good stratification of difficulty. finally formal FMFM Scale of 61 items was composed. At the same time the difficulty order and criterion of the ultimate selected item were determined. Correlations between sample ability scores of different item conditions were analyzed and results indicated that FMFM had good test-free person measurement, The Pearson correlation between sample ability scores under different item conditions was very high(r=0.976-0.995). Correlations between items difficulty values of different sample conditions were also analyzed and results confirmed that FMFM had good sample-free item calibration. The Pearson correlation between item difficulty under three sample conditions was very high(r=0.993-0.998). FMFM had good testretest reliability （ICC=0.989 3，95%CI：0.975 3-0.995 4）as well as good interscorer reliability（ICC=0.996 1,95%CI：0.993 2-0.997 8）.Conclusions FMFM had excellent unidimension，internal reliability and external reliability，which would lay good foundation for future usage of FMFM. Further studies about validity and responsiveness of FMFM are needed.
Objective Otolaryngologic or ear, nose,and throat(ENT)problems are common in children with Down syndrome. In this retrospective study, we aimed to compare the sleep architecture and principal variables of polysomnography(PSG) between children with Down syndrome and other children without sleepdisordered breathing and Down syndrome, and to determine the characteristics of sleep architecture and principal variables of PSG in children with Down syndrome.Methods From 2005 to 2007, ten children with Down syndrome were enrolled in Down group(male:7 vs female:3). The median patient age were 8 years and 2 months old, with a range of 7 years and 8 months to 9 years and 11 months. With the median age of 8 years and 9 months, fourteen children with vocal nodule and six children with sudden deafness were enrolled in control group from 2004 to 2007. All children underwent overnight PSG monitoring. The children in control group with sleep-disordered breathing and Down syndrome were excluded. The sleep architecture and obstructive apnea index(OAI), hypopnea index(HI), lowest oxygen saturation (LSaO2), arousals index and leg movement index were compared between the Down group and control group. Respiratory event and OSAHS were diagnosed according to the general criterion (Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi) published in Chin J Otorhinolaryngol Head Neck Surg in february, 2007). An apneahypopnea index greater than 5times/hr or obstructive apnea index greater than 1 times/hr and lowest oxygen saturation less than 92% were required for defining the presence of OSAHS. Chromosome karyotyping assay was used to dignose the Down syndrome.Results ①The two groups were matched for gender, age and body mass index（P＞0.05）。②When compared with that of control group, the stageⅠ%,StageⅡ%, StageⅢ% and StageⅣ% of Down group were not significantly different. The rapid eye movement%(REM%) of the Down group was 11.3% while REM% of control group was 20.5%. The decrease of REM% was significantly different between the Down group and the control group（Z=-2.6,P=0.009﹚.③An increase of OAI, HI and leg movement index and decrease of SaO2 in Down group were more significant than that in control group(median: 5.6, 3.8, 18.8, 61 versus median: 0.27, 0.63, 7.6, 94 )（P＜0.05﹚.The median arousals index of the Down group was 13.7 while that of control group was 6.2, however, the difference of arousals index between the Down group and the control group was not significant（Z=-0.441, P=0.659）.④All Down syndrome children had respiratory pauses during sleep, 6 of them justfied the diagnosis of OSAHS. Five of the 6 children were boys.Conclusions Sleepdisordered breathing could be observed in children with Down syndrome. Baseline PSG was recommended in children with Down syndrome. However, larger and more detailed population studies were requried to further define an association between OSAHS and Down syndrome(age,sex,etc.).
Objective The prevalence rates of asthma and other atopic disorders have increased steadily over the past few decades. The underlying mechanisms for this phenomenon remain largely unknown. Since the natural mutation rate is low, altered environmental and life style conditions are thought to play an important role. High exposure to house dust mite allergens has been shown to predispose to allergic sensitization and to the development and persistence of asthma. The prenatal period and early childhood are considered to be critical for the establishment and maintenance of a normal Th1/Th2 balance. Immune modulation at this stage may be a way forward in the prevention of allergy.The aim of the study is to investigate the effect of maternal house dust mite allergen exposure during pregnancy and infant exposure in the early life on the development of asthma in an animal model. The aim is to address the best period of allergen avoidance in the prevention of allergic disease.Methods Wistar rats were divided into 4 groups according to the different treatment, control、M Der p-N Der p-、M Der p+ N Der p+ and M Der p+N Der p- (M=mater, N=neonate, "- " the rats were treated with NS instead of Der p). A presensitization of 5 000SBU Der p was done at the 11th, 18th day of pregnancy and/or the 2nd,9th,16th day of the infant rats. All rats except control group were sensitized by intraperitoneal and subcutaneous injections of ovalbumin (OVA) and AI(OH)3 twice, then received 6 consecutive airway allergen challenges by aerosolization to develop asthma animal model when they were 30day old. The plasma samples were obtained to determine the OVA-specific IgE antibody titers. The peripheral blood mononuclear cells (PBMC) were cultured to measure the cytokine production. Bronchoalveolar lavage and differential cell counts of BAL fluid were performed. At last, the lung tissue was prepared for analysing the pathological changes of asthma. Results In the groups which mater and infant were both exposed to Der p (M Der p+ N Der p+), IL-4 level（pmol·L-1） was significantly higher(116.64±9.19 vs 51.34±1.56, P<0.05) and IFN-γlevel（pmol·L-1） was lower (31.03±10.37 vs 95.44±8.39, P<0.05)than those in the M Der p-N Der p- group, as a result, the ratio of IL-4/IFN-γ(3.76 vs 0.54) was markedly increased, which indicated a Th2 profile, the plasma OVAspecific IgE level was increased significantly(0.476±0.016 vs 0.111±0.007, P<0.05) ,and the asthma like inflammation reaction was also shown by a marked eosinophil(57.08±4.37 vs 24.50±0.93, P<0.05)and other inflammatory cell influx into the lungs. As to the M Der p+N Der p- group, there was no significant difference(P>0.05) .The Th2 bias of M Der p+ N Der p+ group was more obvious than that of M Der p+N Der p- group.Conclusions The results underline the importance of pregnancy and very early life period in the future development of asthma. It suggests that maternal allergen encounter in pregnancy may have a major influence on infant immune development. Indoor allergen avoidance as part of primary prevention strategies can still be recommended in the management of children apt to asthma.
