Plasma albumin and other indicators as risk factors for delayed neurocognitive recovery in elderly patients undergoing orthopedic surgery.

Problem behaviors, also known as deviant behavior or behavioral abnormality, are a type of maladaptive behavior exhibited during an individual's socialization development, which consists primarily of internalizing problems and externalizing problems []. Externalizing problems are outer-directed and involve acting out, defiant non-compliant behaviors. Internalizing problems are more inner-directed and involve withdrawal, depression and anxiety []. Research has shown that children with externalizing problems tend to exhibit uncontrollable behaviors, which can negatively affect their academic performance, peer relationships and mental health []. Furthermore, children with more internalizing problems are likely to exhibit more withdrawn behaviors and depression in adolescence and young adulthood []. The preschool is a critical term for identifying and reducing problem behaviors. Timely interventions for children’s deviant behaviors during this period can prevent them from developing into permanent problem behaviors []. Therefore, it is necessary to investigate the factors that contribute to preschool children’s problem behaviors. A positive home environment is crucial for children to develop healthy behaviors [, ]. Parenting activities essentially involve interactions between parents and children. When parents experience burnout during parenting, these interactions, which should be full of love and care, can become a negative influence. This can affect the physical and mental health and development of their children []. Studies have found that parental burnout is closely related to the behavioral development of preschool children [, ]. Therefore, it is important to explore the relationship between parental burnout and preschool children’s problem behaviors, as well as the influencing mechanisms, in order to reduce these problem behaviors. Parental burnout, a syndrome characterized by intense exhaustion, results from a significant and prolonged stress associated with parenthood in the absence of sufficient resources for coping []. Research has shown that parental burnout can lead to negative emotional and psychological symptoms, such as emotional exhaustion, role boredom, detachment from their children, and feelings of ineptitude in their parenting role []. Parents of preschool children tend to experience more parenting stress due to their immature cognitive development and other aspects of their development. If parents chronically lack the necessary resources to cope with stress, they may experience burnout []. According to the Family Systems Theory, the family is a dynamic system in which members interact with each other in behaviors and emotions []. When parents experience emotional exhaustion while parenting, it suggests that they have reached the limits of their role, leading to a gradual emotional detachment from their children and a decrease in the frequency and quality of parent–child interactions []. Research has shown that low levels of parenting self-efficacy are associated with increased internalizing problems in later childhood []. Parental burnout can also lead to parental neglect and violence towards children [], which ultimately leads to problem behaviors in children. A study by Yuan et al. [] found that parental burnout may affect children’s problem behaviors through three domains: the home environment, the parents, and the children. When parents experience high levels of parental burnout, they may reduce positive interactions with their children and adopt negative parenting styles, resulting in children exhibiting more problem behaviors such as aggressive behavior, noncompliance, and difficulties in emotion regulation []. Accordingly, we propose Hypothesis 1: Parental burnout was significantly and positively related to preschool children’s problem behaviors. According to the McMaster Model of Family Functioning, the fundamental role of the family is to create an environment that fosters the physical, psychological and well-being of its members. However, dysfunctional family functioning can lead to reduced security and increased anxiety among family members, particularly children []. When parents experience parental burnout, it can affect family functioning, including couple relationships and parent–child interactions, which in turn can negatively affect children's behavioral and emotional development []. Research has shown that parents who experience parental burnout exhibit emotional exhaustion. This not only triggers parent–child conflict and reduces the quality and frequency of parent–child interactions but also weakens emotional connections between family members. It also interferes with the normal functioning of the family system and reduces the overall family functioning []. Children from families with negative functioning, such as apathy, conflict and isolation, may exhibit more problem behaviors and fewer prosocial behaviors []. Dysfunctional families tend to have reduced family cohesio