Promoting hierarchical treatment is the key to solve the irrational utilization of pediatric medical resources, but there is a lack of relevant studies on the current status of implementation of hierarchical diagnosis and treatment for children.
To describe the healthcare-seeking behavior of children with upper respiratory tract infection, including number of visits and health-seeking institutions and explore the main influencing factors of first visit of priamry care (community health services) .
Two questionnaires were administered to the parents of children attending the pediatric outpatient department of the Third Affiliated Hospital of Sun Yat-sen University and the Community Health Service Center in Shipai Street, Tianhe District in the same administrative district from March to July in 2019 and from February to July in 2022 using convenience sampling method, respectively. The included subjects were divided into the 2019 group (n=419) and 2022 group (n=307) according to the survey time. The questionnaire on the healthcare-seeking behavior and its influencing factors of children with upper respiratory tract infection using Anderson model as a theoretical guide was involved, univariate and multivariate Logistic regression analyses were used to explore the influencing factors of the first visit of children with upper respiratory tract infection in primary care.
Among the 419 participated children in 2019, 301 (71.84%) visited for the first time, 87 (20.76%) for the second time and 31 (7.40%) for the third time and fourth time, with 47.49%, 27.12% and 16.13% visited the conmmunity health services centers, respectively. Among the 307 participated children in 2022, 219 (71.34%) visited for the first time, 72 (23.45%) for the second time and 16 (5.21%) for the third time or fourth time, with 41.04%, 39.77% and 43.75% visited the conmmunity health services centers, respectively. The results of multivariate Logistic regression analysis showed that the nearest medical institution was not a community health service center〔OR=0.220, 95%CI (0.147, 1.056), P<0.001〕, the education level of parents was high school or below〔OR=0.584, 95%CI (0.365, 0.936), P=0.025〕, parental assessment of disease severity was less severe and general〔OR (95%CI) =0.399 (0.207, 0.768), 0.388 (0.226, 0.665); P=0.006, 0.001〕, children aged under 3 years old〔OR=0.537, 95%CI (0.309, 0.930), P=0.027〕were correlated with less likely to choose community health service center for their first visit compared with the nearest medical institution was a community health service center, the education level of parents was bachelor's degree and above, parental assessment of disease severity was severe and very severe, children aged 7-13 years old. Parents were more awareness〔OR=2.139, 95%CI (1.284, 3.564), P=0.003〕 and in favor of hierarchical medical system〔OR=2.841, 95%CI (1.937, 5.779), P=0.004〕 were more likely to choose a community health service center for their first visit.
Multiple visits are more common in children with upper respiratory tract infection, the proportion of primary care visits is low. The education level of parents, awareness and and attitudes of hierarchical medical system, assessment of disease severity, the age of children and the nearest medical institution are influencing factors for children with upper respiratory tact infection to choose primary care for their first visit. Strengthening the publicity and education of common disease in children and hierarchical medical system, improving the accessibility of community health service centers and pediatric care conditions would be possible approaches to promote primary care for common children diseases.
Global developmental delay (GDD) is a common neurodevelopmental disorder in childhood whose clinical manifestations are diverse. Currently, there are few large sample analyses of the gender differences of clinical manifestations in GDD children in China.
To investigate the gender differences of clinical data in GDD children.
Seven hundred and ninety-nine GDD children who received initial inpatient treatment from Department of Child Rehabilitation, Third Affiliated Hospital of Zhengzhou University from January 2020 to February 2022 were recruited. Clinical data including maternal data in pregnancy and the perinatal period, and general data, measurement results of EEG, brain MRI, the Chinese version of Gesell Developmental Scales-Revised of the children and comorbidity rate were retrospectively collected. Gender differences of clinical data of GDD children were analyzed.
The ratio of male children (n=568) to female children (n=231) was 2.46∶1. The age of first visit in male children〔19.0 (8.8, 33.0) 〕 was older than that of female children〔12.7 (6.8, 27.0) 〕 (P<0.05). The chief complaint was motor retardation (51.1%, 118/231) in female children, and language retardation (41.4%, 235/568) in male children. There were significant differences in chief complaint, birth season, gestational age at birth, gestational age at birth in relation to birth weight, birth weight classification and fine motor classification between male and female children (P<0.05). Male children had lower rates of fetal intrauterine distress, EEG abnormalities and microcephaly and higher rate of autism spectrum disorder than female children (P<0.05) .
There are gender differences in some clinical data of children with GDD. Male children have higher prevalence of GDD, and females have more clinical symptoms.
Unintentional injuries are major threats to children's health, but most of them are preventable. Since the incidence and characteristics of distribution of unintentional injuries vary across regions, it is necessary to formulate preventive measures according to local characteristics.
To investigate the clinical characteristics of unintentional injuries in children in Ningbo, providing a theoretical basis for the development of relevant preventive and treatment measures.
This study retrospectively recruited 0-17-year-old children with unintentional injuries (including babies, toddlers, preschoolers, gradeschoolers and teens grouped by age) from Department of Emergency, Ningbo Women and Children's Hospital from August 2020 to July 2021. Clinical data were collected, including age, gender, registered residence, the way of getting to the hospital and pre-hospital emergency care, visit time, injury-to-admission time, places of occurrence of injury, cause of injury, site of injury, outcome of treatment, hospitalization time and hospitalization expenses. ICD-10 was used to classify the unintentional injuries, the children were divided into infancy (n=1 225), early childhood (n=5 116), preschool (n=4 447), school age (n=3 219) and adolescence (n=1 766) according to their age, and compared the types of unintentional injuries across the children by clinical data.
Altogether, 15 773 cases〔including 9 608 males (60.91%) 〕were included, with a mean age of (5.3±3.6) years and a male to female ratio of 1.56∶1. Children with fall/fall injuries, burns and scald, cavity foreign body, poisoning, blunt instrument injury and electric shock injuries are mainly early childhood, road traffic injuries are mainly preschool age, and sharp instrument injuries are mainly school age. Most of the children were from rural areas〔59.15% (9 329/15 773) 〕. Children with rural household registration were mainly affected by falls/fall injuries, road traffic accidents, burns, foreign body aspiration, sharp instrument injuries, electric shocks and drowning. Children who suffered from falls, road traffic accidents and drowning mainly arrived at the hospital by self-driving. Children with fall/fall injuries, road traffic injuries, burns, poisoning, sharp device injuries, electric shock injuries and drowning are mainly treated without pre-hospital emergency rescue. Unintentional injuries occurred more frequently in summer〔27.27% (4 301/15 773) 〕. Road traffic injuries and burns are mainly in summer, blunt instrument injuries and electric injuries are mainly in autumn, and bites are mainly in spring and autumn. Unintentional injuries peaked in July and bottomed in February. Visits due to unintentional injuries peaked at 12:00 at noon and 20:00 in the evening. The injury-to-admission time in children with traffic injuries was shorter than that of those with the other injuries (P<0.05). The majority of injuries〔91.27% (14 396/15 773) 〕occurred at home. The top three causes of unintentional injuries were falls〔78.46% (12 375/15 773) 〕, traffics accidents〔5.29% (12 375/15 773) 〕, and burns〔3.70% (583/15 773) 〕. Most unintentional injuries occurred in the head 〔31.79% (5 015/15 773) 〕. Infant, preschool and school-age children mainly have head injuries, and preschool and adolescent children mainly have both upper limbs. Children with drowning had higher hospitalization rate, longer hospitalization time and higher hospitalization expenses than those with other types of unintentional injuries (P<0.05) .
Among Ningbo's children, unintentional injuries, mainly including falls/fall injuries and traffic injuries, highly occur in toddler age, with rural boys as the major suffering group, summer as the high-incidence season, and head as the major site. Different characteristics of children are associated with the type of unintentional injuries. And the type of unintentional injuries is associated with the way of getting to the hospital, injury-to-admission time, the use of pre-hospital emergency care and outcome of hospitalization. Thus, it is important to strengthen the preventive propaganda of unintentional injuries according to children's features to reduce the incidence of such injuries, and to develop rational clinical treatment strategies according to the types of unintentional injuries in children.
