According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.

Objeetive To explore the effectiveness of early warning assessment and management for maternity on perinatal outcomes.Methods From January 1,2013,a cohort prospective study was conducted on 49 261 pregnant women who registered initially at 6-13 gestational weeks and were followed up at 246 community health centers from 17 districts or counties of Shanghai.The first screening was conducted in community health centers for gestational age verification,medical history collection and physical examination.The pregnant women would be marked as green alert if all of the above three indices were normal.A woman would be transferred to level two or above hospitals if the first screening results were abnormal and the early warning signs were divided into five categories,including green alert (normal),red alert (complicated with sever mobility and complications during pregnancy),orange alert (complicated with sever mobility and complications during pregnancy,but not as severe as that of red alert),purple alert (concomitant communicable diseases during pregnancy),yellow alert (complicated with milder mobility and complications during pregnancy compared with that of red alert).The low risk pregnancy referred to yellow alert,and the high risk ones referred to orange,red or purple alert.We offered corresponding management and follow-up program for women with different warning signs,and analyzed the in-process indices such as screening-transport time,transport-diagnosis time,diagnosis-feedback time,feedback-initial-follow-up time,times of follow-up and regular or irregular follow-up.The association between in-process indices and perinatal outcomes (women with severe diseases during pregnancy and delivery,maternal mortality,preterm and low birth weight children and neonatal mortality) in both low and high risk pregnant women were analyzed using logistic regression model.Results Out of the 49 261 pregnant women,10 485(21.28％) were positive in the first screening and 38 776 (78.72％) were negative.For early warning classification,36 250(73.59％) were classified as green alert,12 277(24.92％) as yellow alert,625(1.27％) as orange alert,8(0.02％) as red alert,and 101(0.21％) as purple alert.The regular follow-up rate for low risk pregnant women was 82.7％(10 153/12 277),and that of high risk women was 74.1％(544/734).Prolonged feedback-initial-follow-up time increased the risk of maternal mortality (OR=1.051,95％CI:1.015-1.088,P=0.008) among low and high risk pregnant women.The increased times of follow-up for risk pregnancies decreased the occurrence of critical illed complications (OR=0.851,95％CI:0.725-0.999,P=0.049) and maternal mortality (OR=0.534,95％CI:0.307 0.930,P=0.014).Prolonged diagnosis-feedback time increased the risk of preterm birth (OR=l.009,95％CI:1.004-1.015,P=0.000).Prolonged feedback-initial-follow-up time increased the risk of neonatal mortality (OR=1.019,95％CI:1.001-1.038,P=0.045).However,the increase of followup times decreased the risk of preterm birth (OR=0.803,95％CI:0.762-0.847,P＜0.001),low-birth weight (OR=0.882,95％ CI:0.775-0.873,P＜0.001) and neonatal mortality (OR=0.653,95％CI:0.543-0.785,P＜0.001),so did regular follow-up (OR=0.432,95％CI:0.353-0.528;OR=0.494,95％CI:0.392-0.621;OR=0.226,95％CI:0.117-0.435;all P＜0.001).Conclusions The system of early warning assessment and management for pregnancy is effective on perinatal outcomes to some in both low and high risk gravidas extend and is worthwhile to be generalized and to form long-term mechanism.

Objective To explore the prenatal and perinatal risk factors for developmental coordination disorder (DCD) in children so as to provide a basis for etiological studies and early diagnosis on DCD.Methods Stratified clustered sampling was used to select 160 classes from randomly selected 15 public nursery schools which were distributed throughout the five main districts in Suzhou city.A total of 4 001 children were included in the study.Multilevel logistic regression and structural equation model (SEM) were used to analyze the risk factors of DCD.Results Results from the multilevel logistic regression model showed that when factors as:class internal clustering,children' s gender,age and Kaup value etc.,were under control,factors as acute fetal distress,premature and newborn pathological jaundice would be included in the model (OR values were 7.030,3.374,1.993,with all their Ps＜0.001),and showing these variables were related to DCD.Results of SEM showed that the related coefficient between ‘Minimal Brain Dysfunction' and ‘Motor coordination skill' was-0.18 with statistical significance (P＜0.05).It also indicated that the minimal brain dysfunction would negatively impact on the children' s motor skill.Conclusion There were risk factors of DCD noticed during the prenatal and peri-natal periods.Practitioners working at the maternity and child health care areas should improve the skills in assessing and monitoring the prenatal and peri-natal risk factors related to DCD,and to better carry out early screening,diagnosis,treatment and prevention of DCD.

OBJECTIVEA population-based study on developmental coordination disorder (DCD) was conducted in Suzhou to explore the impacts of family and kindergarten environment on pre school children with DCD so as to provide a basis for etiological research and early intervention.

METHODStratified clustered sampling was used to select 160 classes from randomly selected 15 public nursery schools distributed throughout the five main districts in Suzhou city. A total of 4 001 children were included in the study. The family environment scale on motor development for urban preschool children (FESMDPU) which was established by our study group and early childhood environment rating scale-revised (ECERS-R) which has been applied well in China were used to assess the family and kindergarten's environment. The multilevel logistic regression was used to analyze the risk factors of DCD when kindergarten environment were considered as "context variables" and the family environment as "individual variables".

RESULTAccording to DSM-IV criteria, a total of 330 children were diagnosed as DCD. The prevalence of DCD was 8.3%. However, there were differences between the two groups in age, gender and Kaup index (all P < 0.05). The results of ECERS-R and FESMDPU showed that the scores of "class space and faculty" "class activity" "class interaction" "family material environment" "family rearing environment" in DCD group were 48.00, 51.00, 49.00, 39.00, and 30.00, respectively, which were higher than those of control group (45.00, 50.00, 47.00, 41.00, 31.00) with statistical significance (U = 455 446.000, 550 787.000, 508 109.000, 543 159.000, and 490 119.000, P < 0.05 for all comparisons) . The score of ECERS-R and FESMDPU were grouped into different levels using the method of K-MEANS. The school and family environment were compared after the clustering. The results showed that the distribution of the rates in different levels between the DCD and control group were different with statistical significance (χ(2) = 51.091, 9.295, 35.464, 15.174, 13.500, P < 0.05 for all comparisons) . There was no significant difference between DCD and non-DCD children in parents' schooling years and family per-capita income of every month (all P > 0.05). The results of the multilevel logistic regression model showed that when children's gender, age and Kaup index were controlled, "class space and faculty" "class activity" "class interaction" "family material environment" "family rearing environment" were included in the model (OR was 3.486, 1.840, 1.623, 1.531, and 1.379, respectively, P < 0.05 for all) .

CONCLUSIONThe prevalence of DCD in study area was higher than that reported by European and American countries. The family and kindergarten environment may affect the incidence of DCD in preschool children. Parents and preschool educational and child health care practitioners should conduct the early prevention and intervention on DCD based on the risk factors of environment in preschool children.

Child ; Child Development ; Child, Preschool ; China ; epidemiology ; Cross-Sectional Studies ; Environment ; Family ; Female ; Humans ; Logistic Models ; Male ; Motor Skills ; Motor Skills Disorders ; epidemiology ; psychology ; Psychometrics ; methods ; Psychomotor Performance ; Risk Factors ; Urban Population