| Objectives:1.We screened children with attention deficit hyperactivity disorder(ADHD)in local areas of China and investigated related factors of ADHD to provide theoretical evidence for early detection of ADHD.2.We studied the associations between phthalate esters(PAEs)exposure and children behavioral and growth development to explore the adverse effects of PAEs on children behavioral and growth development.And to provide scientific evidence for prevention and control of ADHD.Methods:1.During the period from December 2015 to May 2016,751 children from two primary schools of Liuzhou were enrolled by random cluster sampling.After parents' informed consent,ADHD related factors and ADHD symptoms were investigated by a self-designed questionnaire and SNAP-IV Rating Scale(Parental Version).Chi-square test and multivariate logistic regression were used to analyze the factors of ADHD,and odds ratio(OR)and 95% confidence interval(CI)were calculated.2.After parents' informed consent,height and weight of 271 children were measured,and their urine samples at different time points collected.Urinary concentrations of seven PAEs metabolites were measured by high performance liguid chromatography-mass spectrometry.Linear regression were used to analyze the relationship between urinary PAEs metabolites and children growth and behavioral development,and the non-standardized partial regression coefficient(?)and 95%confidence interval(CI)were calculated.Results:1.Among 742 children,96 children were positive SNAP-IV screening,including 76 boys and 20 girls.Univariate analysis showed that child gender,father's character,mother's character,mother's mood during pregnancy,adverse environment exposure during pregnancy,mother's depression or anxiety during pregnancy or postpartum,passive smoking,parents' marital status and relationship,family discipline,factories near house 1 km,child moving times,father's work outside the city,father drinking,child's habit of licking plastic toys,child sleep time,child partial eclipse were related to positive ADHD screening.Multivariate logistic regression analysis showed that male(OR=2.39,95%CI: 1.41,4.04),father impatient(OR=3.78,95%CI: 1.95,7.32),poor mother's mood(OR= 2.09,95%CI: 1.26,3.44),passive smoking(OR=2.88,95%CI: 1.73,4.80),parents' non-married status(OR=3.08,95%CI: 1.56,6.07),the habit of licking plastic toys(OR=1.97,95%CI: 1.28,3.07)were associated with positive ADHD screening.2.The detection rate of PAEs metabolites were 98.31%~100%.Multiple regression analysis showed that MEHHP was positively related to attention deficit,and the ? was0.369(95%CI: 0.031,0.707).MMP,MEHHP and MEOHP concentrations were negatively correlated with child height,and the ? were-0.010(95%CI:-0.016,0.003),-0.013(95%CI:-0.024,-0.002),-0.017(95%CI:-0.028,-0.005),respectively.MEP concentration was positively related to child weight,and the ? was 0.03(95%CI: 0.002,0.059).MEHHP,MEOHP and MEHP concentrations were negatively associated with child weight,and the ? were-0.069(95%CI:-0.114,-0.025),-0.085(95%CI:-0.131,-0.039),-0.075(95%CI:-0.120,-0.030),respectively.MEP concentration was positively related to BMI,and the ? was 1.184(95%CI: 0.368,2.000).MEHHP,MEOHP and MEHP concentrations were negatively associated with BMI,and the ?were-1.704(95%CI:-2.983,-0.425),-2.012(95%CI:-3.348,-0.677),-2.283(95%CI:-3.577,-0.989).Conclusions:Boy should be screened preferentially for ADHD in order to find susceptible children as early as possible.The universal access to basic knowledge of ADHD should be available for everybody.Furthermore,professional pregnancy counseling and surpport should be provided for maternal and their families,including effective stress management,mental adjustment and non-smoking environment.Good family relationship and good children habits are also recommended to parents.And PAEs exposure has adverse effects on children behavioral and growth development.Further studies with greater sample size are needed. |
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