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Real-life experience on COVID-19 and seasonal influenza vaccines co-administration in the vaccination hub of the University Hospital of Palermo, Italy. 意大利巴勒莫大学医院疫苗接种中心联合接种 COVID-19 和季节性流感疫苗的实际经验。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-03-18 DOI: 10.1080/21645515.2024.2327229
Claudio Costantino, Walter Mazzucco, Arianna Conforto, Livia Cimino, Alessia Pieri, Sara Rusignolo, Nicole Bonaccorso, Floriana Bravatà, Laura Pipitone, Martina Sciortino, Marcello Tocco, Elena Zarcone, Giorgio Graziano, Fabio Tramuto, Carmelo Massimo Maida, Alessandra Casuccio, Francesco Vitale

With the pandemic, there has been a global reduction in influenza virus circulation, with WHO reporting, during 2021/22 season, laboratory testing positivity rate for influenza of less than 3%. Influenza surveillance systems anticipated a peak of influenza cases in the Northern Hemisphere during 2022/2023 season and the Italian Ministry of Health recommended the routinary co-administration of influenza with bivalent COVID-19 vaccines for the 2022/2023 season. At the Vaccination Hub of the University Hospital (UH) of Palermo, more than 700 subjects received influenza and COVID-19 booster doses in co-administration, during the 2021/2022 season. A cross-sectional study analyzing attitudes and factors associated with adherence to influenza and COVID-19 seasonal vaccines co-administration was conducted at the Vaccination Hub of the UH of Palermo, from October to December 2022. Among the 1,263 respondents, 74.7% (n = 944) received the co-administration of seasonal influenza and COVID-19 vaccines. The main reason reported for accepting it was confidence in the recommendations of the Health Ministry (41.3%). At the multivariable analysis, subjects aged ≤ 59 y old (AdjOR: 2.48; CIs95%: 1.89-3.65), male (AdjOR: 1.51; CIs95%: 1.27-1.75), Health-care professionals (HCPs) (AdjOR: 1.66; CIs95%: 1.08-2.57) and those who received co-administration during 2021/2022 (AdjOR: 41.6; CIs95%: 25.5-67.9) were significantly more prone to receive co-administration during 2022/23 season. From data obtained, the role of HCPs in accepting and then promoting co-administration of COVID-19 and influenza vaccines is crucial, as well as receiving co-administration in the previous season that represented the main drive for accepting it in the following seasons, supporting safety and effectiveness of this procedure.

随着流感大流行,全球流感病毒流通量减少,世卫组织报告,在 2021/22 季度,流感实验室检测阳性率低于 3%。流感监测系统预计,2022/2023 季度北半球将出现流感病例高峰,意大利卫生部建议在 2022/2023 季度常规联合接种 COVID-19 二价流感疫苗。在巴勒莫大学医院(UH)的疫苗接种中心,超过700名受试者在2021/2022年接种季节接受了流感和COVID-19强化剂联合接种。2022年10月至12月,巴勒莫大学医院疫苗接种中心开展了一项横断面研究,分析了与坚持联合接种流感疫苗和COVID-19季节性疫苗相关的态度和因素。在1,263名受访者中,74.7%(n = 944)接受了季节性流感和COVID-19疫苗联合接种。据报告,接受联合接种的主要原因是对卫生部建议的信心(41.3%)。在多变量分析中,年龄≤ 59 岁(AdjOR:2.48;CIs95%:1.89-3.65)、男性(AdjOR:1.51;CIs95%:1.27-1.75)、医疗保健专业人员(HCPs)(AdjOR:1.66;CIs95%:1.08-2.57)和在 2021/2022 年期间接受过联合用药者(AdjOR:41.6;CIs95%:25.5-67.9)在 2022/23 年期间接受联合用药的可能性显著增加。从获得的数据来看,HCPs 在接受并随后促进 COVID-19 和流感疫苗联合接种方面的作用至关重要,而在上一季节接受联合接种则是下一季节接受联合接种的主要动力,这支持了这一程序的安全性和有效性。
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引用次数: 0
Politics and confidence toward the COVID-19 vaccination: Points to be considered. 接种 COVID-19 疫苗的政治和信心:需要考虑的问题。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-03-19 DOI: 10.1080/21645515.2024.2330169
Somsri Wiwanitkit, Viroj Wiwanitkit
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引用次数: 0
Exploring the impact of the COVID-19 pandemic on perceptions of national scheduled childhood vaccines among Māori and Pacific caregivers, whānau, and healthcare professionals in Aotearoa New Zealand. 探索 COVID-19 大流行对新西兰奥特亚罗瓦毛利人和太平洋地区护理人员、毛利人以及医疗保健专业人员对国家儿童计划疫苗的看法的影响。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-01-11 DOI: 10.1080/21645515.2023.2301626
Nadia A Charania, Daysha Tonumaipe'a, Te Wai Barbarich-Unasa, Leon Iusitini, Georgina Davis, Gail Pacheco, Denise Wilson

In Aotearoa New Zealand, there has been a marked decrease in the uptake of routine childhood vaccinations since the onset of the COVID-19 pandemic, particularly among Māori and Pacific children. This Māori and Pacific-centered research used an interpretive description methodology. We undertook culturally informed interviews and discussions with Māori and Pacific caregivers (n = 24) and healthcare professionals (n = 13) to understand their perceptions of routine childhood vaccines. Data were analyzed using reflexive thematic analysis and privileged respective Māori and Pacific worldviews. Four themes were constructed. "We go with the norm" reflected how social norms, health personnel and institutions promoted (and sometimes coerced) participants' acceptance of routine vaccines before the pandemic. "Everything became difficult" explains how the pandemic added challenges to the daily struggles of whānau (extended family networks) and healthcare professionals. Participants noted how information sources influenced disease and vaccine perceptions and health behaviors. "It needed to have an ethnic-specific approach" highlighted the inappropriateness of Western-centric strategies that dominated during the initial pandemic response that did not meet the needs of Māori and Pacific communities. Participants advocated for whānau-centric vaccination efforts. "People are now finding their voice" expressed renewed agency among whānau about vaccination following the immense pressure to receive COVID-19 vaccines. The pandemic created an opportune time to support informed parental vaccine decision-making in a manner that enhances the mana (authority, control) of whānau. Māori and Pacific-led vaccination strategies should be embedded in immunization service delivery to improve uptake and immunization experiences for whānau.

在新西兰奥特亚罗瓦,自 COVID-19 大流行以来,儿童常规疫苗接种率明显下降,特别是在毛利族和太平洋裔儿童中。这项以毛利人和太平洋裔人为中心的研究采用了解释性描述方法。我们对毛利族和太平洋岛屿族裔的护理人员(24 人)和医疗保健专业人员(13 人)进行了有文化背景的访谈和讨论,以了解他们对常规儿童疫苗的看法。我们采用反思性主题分析法对数据进行了分析,并对毛利人和太平洋岛民各自的世界观进行了优选。共构建了四个主题。"我们遵循规范 "反映了社会规范、卫生人员和机构如何在大流行之前促进(有时是强迫)参与者接受常规疫苗。"一切都变得困难重重 "解释了大流行如何给大家庭网络和医疗保健专业人员的日常工作增加了挑战。与会者指出,信息来源如何影响人们对疾病和疫苗的认识以及健康行为。"需要采取针对特定种族的方法 "强调了以西方为中心的战略的不适宜性,这种战略在最初的大流行应对措施中占主导地位,不能满足毛利人和太平洋裔社区的需求。与会者主张开展以毛利人为中心的疫苗接种工作。"人们现在找到了自己的声音",这表达了在接种 COVID-19 疫苗的巨大压力下,毛利人对疫苗接种的重新认同。这次大流行为支持家长在知情的情况下做出疫苗接种决策创造了有利时机,从而增强了毛利人的mana(权威、控制)。毛利人和太平洋岛屿族裔主导的疫苗接种战略应纳入免疫接种服务中,以提高毛利人的接种率和免疫接种体验。
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引用次数: 0
No immunological interference or concerns about safety when seasonal quadrivalent influenza vaccine is co-administered with a COVID-19 mRNA-1273 booster vaccine in adults: A randomized trial. 成人在接种季节性四价流感疫苗的同时接种 COVID-19 mRNA-1273 强化疫苗不会产生免疫干扰或安全性问题:随机试验。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-03-21 DOI: 10.1080/21645515.2024.2327736
Abdi Naficy, Adrienne Kuxhausen, Harry Seifert, Andrew Hastie, Brett Leav, Jacqueline Miller, Kate Anteyi, Agnes Mwakingwe-Omari

The objective of the study was to assess the safety and immunogenicity of mRNA-1273 COVID-19 booster vaccination when co-administered with an egg-based standard dose seasonal quadrivalent influenza vaccine (QIV). This was a phase 3, randomized, open-label study. Eligible adults aged ≥ 18 years were randomly assigned (1:1) to receive mRNA-1273 (50 µg) booster vaccination and QIV 2 weeks apart (Seq group) or concomitantly (Coad group). Primary objectives were non-inferiority of haemagglutinin inhibition (HI) and anti-Spike protein antibody responses in the Coad compared to Seq group. 497/498 participants were randomized and vaccinated in the Seq/Coad groups, respectively. The adjusted geometric mean titer/concentration ratios (95% confidence intervals) (Seq/Coad) for HI antibodies were 1.02 (0.89-1.18) for A/H1N1, 0.93 (0.82-1.05) for A/H3N2, 1.00 (0.89-1.14] for B/Victoria, and 1.04 (0.93-1.17) for B/Yamagata; and 0.98 (0.84-1.13) for anti-Spike antibodies, thus meeting the protocol-specified non-inferiority criteria. The most frequently reported adverse events in both groups were pain at the injection site and myalgia. The 2 groups were similar in terms of the overall frequency, intensity, and duration of adverse events. In conclusion, co-administration of mRNA-1273 booster vaccine with QIV in adults was immunologically non-inferior to sequential administration. Safety and reactogenicity profiles were similar in both groups (clinicaltrials.gov NCT05047770).

这项研究的目的是评估mRNA-1273 COVID-19强化疫苗与蛋基标准剂量季节性四价流感疫苗(QIV)联合接种时的安全性和免疫原性。这是一项 3 期随机开放标签研究。年龄≥18岁的合格成人被随机分配(1:1)接种mRNA-1273(50微克)强化疫苗和QIV,接种间隔为2周(Seq组)或同时接种(Coad组)。主要目标是Coad组与Seq组相比,血凝素抑制(HI)和抗斯派克蛋白抗体反应无劣效。Seq/Coad组分别有497/498名参与者被随机分配并接种疫苗。调整后的 HI 抗体几何平均滴度/浓度比(95% 置信区间)(Seq/Coad)分别为:A/H1N1:1.02(0.89-1.18);A/H3N2:0.93(0.82-1.05);A/H3N2:1.00(0.89-1.14),B/山形为1.04(0.93-1.17);抗穗抗体为0.98(0.84-1.13),因此符合方案规定的非劣效性标准。两组最常报告的不良反应是注射部位疼痛和肌痛。就不良反应的总体频率、强度和持续时间而言,两组相似。总之,在成人中将 mRNA-1273 强化疫苗与 QIV 联合接种在免疫学上并不劣于连续接种。两组的安全性和反应性特征相似(clinicaltrials.gov NCT05047770)。
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引用次数: 0
The seroepidemiology of immunoglobulin G antibodies against pertussis toxin and filamentous hemagglutinin in the east of China during the COVID-19 pandemic. COVID-19大流行期间中国东部地区百日咳毒素和丝状血凝素免疫球蛋白G抗体的血清流行病学研究。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-03-22 DOI: 10.1080/21645515.2024.2331438
Xiang Sun, Tingting Zhang, Jinning Sun, Juan Zhou, Qiang Chen, Chengmei Jia, Yan Xu, Yun Wu, Zhiguo Wang, Wen Wang

This study employed sero-epidemiological methods to estimate the incidence of pertussis within a healthy population located in eastern China. The aim was to gain deeper insights into the epidemiological characteristics and burden of pertussis within the country. Blood samples were collected from healthy individuals in Jiangsu Province between June 2019 and December 2022. The levels of IgG antibodies against pertussis toxin (anti-PT) and filamentous hemagglutinin (anti-FHA) in the serum were quantitatively measured using enzyme-linked immunosorbent assay (ELISA). Additionally, pertussis case data reported in Jiangsu Province were collected from the China Information System for Disease Control and Prevention and compared with the results of this study. In 2022, the reported incidence of pertussis stood at 1.0 per 100,000 individuals, marking the highest rate observed in the past two decades. Among 1,909 patients examined, the geometric mean concentration (GMC) of anti-PT IgG antibody was 20.2 (18.5-21.9) IU/ml, while that of anti-FHA IgG antibody was 27.0 (25.4-28.7) IU/ml. The IgG-PT and IgG-FHA seropositivity rate (>20.0 IU/ml) was highest in the 1 ~ 2 y old group and decreased rapidly to the lowest in the 3 ~ 4 y old group and then increased gradually with age. The estimated rate of pertussis infection based on seroprevalence was approximately 25,625-fold higher than the reported notification rate in the ≥15 year age group. Our findings highlight decreased immunity post-vaccination, stressing the importance of additional booster shots for adolescents and adults to maintain immunity and reduce severe illness. Additionally, they offer vital guidance for policymakers to enhance immunization strategies.

本研究采用血清流行病学方法对中国东部健康人群的百日咳发病率进行了估计。目的是更深入地了解百日咳在中国的流行病学特征和负担。研究人员在2019年6月至2022年12月期间采集了江苏省健康人群的血样。采用酶联免疫吸附试验(ELISA)定量检测血清中百日咳毒素(抗-PT)和丝状血凝素(抗-FHA)的IgG抗体水平。此外,研究人员还从中国疾病预防控制信息系统中收集了江苏省的百日咳病例数据,并将其与本研究结果进行了比较。2022年,百日咳的报告发病率为每10万人1.0例,是近二十年来观察到的最高发病率。在接受检查的 1909 名患者中,抗 PT IgG 抗体的几何平均浓度(GMC)为 20.2(18.5-21.9)IU/ml,而抗 FHA IgG 抗体的几何平均浓度(GMC)为 27.0(25.4-28.7)IU/ml。IgG-PT和IgG-FHA血清阳性率(>20.0 IU/ml)在1~2岁组最高,在3~4岁组迅速降至最低,然后随着年龄的增长而逐渐升高。根据血清流行率估计的百日咳感染率比报告的≥15 岁年龄组的感染率高出约 25 625 倍。我们的研究结果突显了接种疫苗后免疫力下降的问题,强调了青少年和成年人接种更多加强针剂以保持免疫力和减少重症的重要性。此外,这些结果还为政策制定者加强免疫策略提供了重要指导。
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引用次数: 0
HV&I Reviewer Highlight. HV&I 评审员亮点。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-03-27 DOI: 10.1080/21645515.2024.2333691
Ronald Ellis, Adam Weiss
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引用次数: 0
Factors associated with HPV vaccine hesitancy among college students: A cross-sectional survey based on 3Cs and structural equation model in China. 大学生对 HPV 疫苗犹豫不决的相关因素:基于3C和结构方程模型的中国横断面调查。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-02-05 DOI: 10.1080/21645515.2024.2309731
Cheng Chen, Ting Chen, Mingzhao Huang, Yan Huang, Luying Zhang, Pindong Li

Despite the high effectiveness of HPV vaccines in preventing infection, vaccine hesitancy remains a concern, particularly in China. This study aimed to explore college students' attitudes toward HPV vaccination and identify associated factors. Data was collected through a cross-sectional survey using self-administered questionnaires in four cities from May to June 2022. Chi-square tests and logistic regression analyses were conducted to identify factors. Additionally, an integrated structural equation model (SEM) based on the 3Cs (confidence, convenience, complacency) was developed to understand underlying factors contributing to hesitancy. The results from 2261 valid questionnaires were enlightening. A significant 89.47% (59.4% for females) considered HPV vaccination necessary, with 9.82% remaining neutral and only 0.71% deeming it unnecessary. Factors like higher education, being a medical student, residing in urban areas, having medical insurance, more extraordinary living expenses, a family history of tumors, and a solid understanding of HPV played a role in perceiving the vaccine as necessary. Among the 1438 female respondents, 84.36% had no hesitancy toward HPV vaccination, 13.53% expressed hesitancy, and 2.11% refused vaccination. Factors like age, understanding of HPV, medical staff recommendations, living expenses, and family history influenced hesitancy levels. SEM revealed that the 3Cs significantly affected vaccine hesitancy. Factors like price, booking process, vaccination times, trust in vaccines, medical staff recommendations, efficiency, and risk perception collectively influenced hesitancy. In conclusion, this study found high acceptance of HPV vaccination but acknowledged the complexity of hesitancy factors. It recommends medical staff disseminate scientific knowledge, offer recommendations, simplify booking procedures, and expand vaccination sites to address vaccine hesitancy effectively.

尽管 HPV 疫苗在预防感染方面效果显著,但疫苗接种犹豫仍是一个令人担忧的问题,尤其是在中国。本研究旨在探讨大学生对接种HPV疫苗的态度,并找出相关因素。研究于 2022 年 5 月至 6 月在四个城市通过自填问卷的方式进行横断面调查,收集数据。研究采用了卡方检验和逻辑回归分析来确定相关因素。此外,还建立了一个基于 3C(自信、便利、自满)的综合结构方程模型(SEM),以了解导致犹豫不决的潜在因素。2261 份有效问卷的结果很有启发性。89.47%的受访者(女性占 59.4%)认为有必要接种人乳头瘤病毒疫苗,9.82%的受访者持中立态度,只有 0.71%的受访者认为没有必要。高学历、医学生、居住在城市地区、有医疗保险、生活费用较高、有肿瘤家族史、对 HPV 有深入了解等因素在认为有必要接种疫苗方面起到了一定的作用。在 1438 名女性受访者中,84.36% 对接种 HPV 疫苗没有犹豫,13.53% 表示犹豫,2.11% 拒绝接种。年龄、对 HPV 的了解程度、医务人员的建议、生活费用和家族病史等因素影响了受访者的犹豫程度。SEM 显示,3C 显著影响疫苗接种的犹豫程度。价格、预约流程、接种时间、对疫苗的信任、医务人员的建议、效率和风险意识等因素共同影响了犹豫程度。总之,这项研究发现,人们对 HPV 疫苗接种的接受度很高,但也承认犹豫因素的复杂性。研究建议医务人员传播科学知识、提供建议、简化预约程序并扩大接种点,以有效解决疫苗接种犹豫不决的问题。
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引用次数: 0
The role of vaccine literacy and health literacy in the health prevention decision-making process. 疫苗知识和健康知识在健康预防决策过程中的作用。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-03-06 DOI: 10.1080/21645515.2024.2321675
Claudia Isonne, Carolina Marzuillo, Paolo Villari, Valentina Baccolini
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引用次数: 0
Bridging the gap: The future of biosimilars regulations. 缩小差距:生物仿制药法规的未来。
IF 4.1 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-06-17 DOI: 10.1080/21645515.2024.2362450
Anan S Jarab, Shrouq R Abu Heshmeh, Ahmad Z Al Meslamani

Biosimilar vaccines and immunotherapeutic are innovative approaches in medical research. This commentary addresses the current disparities in regulations of biosimilar vaccines and immunotherapeutic products across different nations. It also navigates the benefits of global regulatory alignment and challenges that may be encountered. The current discrepancies in regulations across different countries, which pose significant challenges for the development and approval of biosimilar vaccines and immunotherapeutic products. These disparities often lead to delayed market access, increased development costs, and hindered innovation. The commentary stresses that such obstacles could be mitigated through harmonized regulations, resulting in faster approvals, reduced healthcare costs, and improved patient outcomes. Moreover, the commentary explores the specific complexities associated with biosimilar vaccines and immunotherapeutic, such as the intricate evaluation of biosimilarity due to their molecular composition and immunogenic properties. In conclusion, the editorial advocates for collaborative efforts to overcome the challenges in achieving global regulatory harmonization for biosimilars. This includes establishing uniform standards, fostering international cooperation among regulatory agencies, and promoting educational initiatives for healthcare providers and regulators. The ultimate goal is to ensure that patients worldwide have timely access to safe, effective, and affordable biosimilar treatments.

生物仿制疫苗和免疫疗法是医学研究的创新方法。本评论探讨了目前不同国家对生物仿制疫苗和免疫治疗产品监管的差异。它还介绍了全球统一监管的好处和可能遇到的挑战。目前不同国家的法规存在差异,这给生物仿制疫苗和免疫治疗产品的开发和审批带来了巨大挑战。这些差异往往导致市场准入延迟、开发成本增加和创新受阻。评注强调,这些障碍可以通过统一法规来缓解,从而加快审批速度、降低医疗成本并改善患者疗效。此外,评论还探讨了与生物仿制疫苗和免疫疗法相关的特殊复杂性,例如由于其分子组成和免疫原性,对生物仿制性的评估错综复杂。最后,社论倡导各方共同努力,克服在实现生物仿制药全球统一监管方面的挑战。这包括建立统一标准、促进监管机构之间的国际合作以及推动针对医疗服务提供者和监管机构的教育活动。最终目标是确保全球患者能够及时获得安全、有效和负担得起的生物仿制药治疗。
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引用次数: 0
Parental knowledge on the respiratory syncytial virus before the nirsevimab immunization program: Attitudes toward immunization in an autonomous community of Spain. 尼舍韦单抗免疫计划实施前家长对呼吸道合胞病毒的了解:西班牙一个自治区对免疫接种的态度。
IF 4.8 4区 医学 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2024-12-31 Epub Date: 2024-06-10 DOI: 10.1080/21645515.2024.2357439
Matilde Zornoza Moreno, Jaime Jesús Pérez Martín, Mª Cruz Gómez Moreno, Mª Pilar Ros Abellán

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in young children and associated with most bronchiolitis- and pneumonia-related hospitalizations. A new preventive monoclonal antibody (MAb), nirsevimab, has been launched in the United States, Luxembourg, and France, and was recently approved to be given in a population-based manner throughout Spain. This study aimed to have a first pre-immunization insight into the Spanish parental knowledge about bronchiolitis, RSV, and nirsevimab immunization. Parents in Murcia with children <2 years of age up to the date of September 1, 2023, were selected to complete a questionnaire. The primary endpoint was the parental knowledge about bronchiolitis, RSV, and nirsevimab. A total of 3,217 responses were analyzed. The majority (95.8%) were aware of bronchiolitis. Meanwhile, 46.6% of the respondents knew about RSV, most of them only after the first child's birth. Information about RSV or bronchiolitis was mainly obtained from family members, with only 4.8% reporting having been informed by Health care Professionals (HCPs). Only 11.2% of respondents were aware of nirsevimab. Nonetheless, these were not entirely satisfied with the information received (score of 3.3 out of 5) and shared that HCPs should be the primary source of information. The present survey then highlights the need for better and more efficient educational strategies directed to all parents/legal guardians. It also sheds some light on the different factors that should be considered to improve awareness of RSV immunization to decrease its burden in Spain and beyond.

呼吸道合胞病毒(RSV)是幼儿下呼吸道感染的主要病因,也与大多数支气管炎和肺炎相关的住院治疗有关。一种新的预防性单克隆抗体(MAb)--nirsevimab 已在美国、卢森堡和法国上市,最近又获准在西班牙全国范围内以人群为基础使用。这项研究的目的是在免疫前首次了解西班牙家长对支气管炎、RSV 和 nirsevimab 免疫的认识。穆尔西亚有孩子的家长
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