Associations between multiple sleep dimensions and suicide and non-suicidal self-injury: a cross-sectional study of 3828 Chinese young people.

PURPOSE: Suicide and non-suicidal self-injury (NSSI) are preventable concerns in young people. Suicidal ideation (SI), suicidal plans (SP) and suicidal attempt (SA) are closely related to death. Sleep problems are known risk factors for suicide and NSSI. This study aimed to explore the relationship between sleep, suicidality and NSSI. METHODS: Participants were 3,828 middle school and college students aged 11-23 years from urban and rural areas of Henan Province. Sleep, suicidal phenomena and NSSI were assessed by applying self-reported questionnaires. Chi-squared tests were utilized to demonstrate the demographic data and sleep variables. The correlation between sleep, suicidality and NSSI were explored by using binary logistic regression, while adjusting socio-demographic characteristics with multivariate models. RESULTS: Sleep variables except mid-sleep time were related to suicidal phenomena (P < 0.05). Greater social jet lag (SJL) [≥ 2 h (h)] was associated with increased risk of SI [Odds ratios (OR) = 1.72, 95% confidence intervals (CI):1.40-2.11], SP (OR = 2.10, 95%CI:1.59-2.79) and SA (OR = 1.50, 95%CI:1.00-2.26). Non-only child participants with SJL (≥ 2 h) had significantly increased odds of SI (OR = 1.75, 95%CI: 1.41-2.18) and SP (OR = 2.25, 95%CI: 1.66-3.05). Eveningness chronotype had the strongest correlation with SI (OR = 3.87, 95%CI:2.78-5.38), SP (OR = 4.72, 95%CI:2.97-7.50), SA (OR = 6.69, 95%CI:3.08-14.52) and NSSI (OR = 1.39, 95%CI:1.02-1.90). CONCLUSION: Overlong or short sleep duration, SJL, eveningness chronotype and other sleep abnormalities (e.g., daytime dysfunction, low sleep efficiency) were associated with a higher prevalence of SI, SP and SA. Additionally, eveningness was significantly correlated with NSSI among young people. These findings suggested the importance of assessing and intervening in sleep habits to prevent suicide and NSSI in young people.

Feature fusion method for pulmonary tuberculosis patient detection based on cough sound.

Since the COVID-19, cough sounds have been widely used for screening purposes. Intelligent analysis techniques have proven to be effective in detecting respiratory diseases. In 2021, there were up to 10 million TB-infected patients worldwide, with an annual growth rate of 4.5%. Most of the patients were from economically underdeveloped regions and countries. The PPD test, a common screening method in the community, has a sensitivity of as low as 77%. Although IGRA and Xpert MTB/RIF offer high specificity and sensitivity, their cost makes them less accessible. In this study, we proposed a feature fusion model-based cough sound classification method for primary TB screening in communities. Data were collected from hospitals using smart phones, including 230 cough sounds from 70 patients with TB and 226 cough sounds from 74 healthy subjects. We employed Bi-LSTM and Bi-GRU recurrent neural networks to analyze five traditional feature sets including the Mel frequency cepstrum coefficient (MFCC), zero-crossing rate (ZCR), short-time energy, root mean square, and chroma_cens. The incorporation of features extracted from the speech spectrogram by 2D convolution training into the Bi-LSTM model enhanced the classification results. With traditional futures, the best TB patient detection result was achieved with the Bi-LSTM model, with 93.99% accuracy, 93.93% specificity, and 92.39% sensitivity. When combined with a speech spectrogram, the classification results showed 96.33% accuracy, 94.99% specificity, and 98.13% sensitivity. Our findings underscore that traditional features and deep features have good complementarity when fused using Bi LSTM modelling, which outperforms existing PPD detection methods in terms of both efficiency and accuracy.

A noval pulmonary function evaluation method based on ResNet50 + SVR model and cough.

Traditionally, the clinical evaluation of respiratory diseases was pulmonary function testing, which can be used for the detection of severity and prognosis through pulmonary function parameters. However, this method is limited by the complex process, which is impossible for patients to monitor daily. In order to evaluate pulmonary function parameters conveniently with less time and location restrictions, cough sound is the substitute parameter. In this paper, 371 cough sounds segments from 150 individuals were separated into 309 and 62 as the training and test samples. Short-time Fourier transform (STFT) was applied to transform cough sound into spectrogram, and ResNet50 model was used to extract 2048-dimensional features. Through support vector regression (SVR) model with biological attributes, the data were regressed with pulmonary function parameters, FEV1, FEV1%, FEV1/FVC, FVC, FVC%, and the performance of this models was evaluated with fivefold cross-validation. Combines with deep learning and machine learning technologies, the better results in the case of small samples were achieved. Using the coefficient of determination (R2), the ResNet50 + SVR model shows best performance in five basic pulmonary function parameters evaluation as FEV1(0.94), FEV1%(0.84), FEV1/FVC(0.68), FVC(0.92), and FVC%(0.72). This ResNet50 + SVR hybrid model shows excellent evaluation of pulmonary function parameters during coughing, making it possible to realize a simple and rapid evaluation for pneumonia patients. The technology implemented in this paper is beneficial in judge the patient's condition, realize early screening of respiratory diseases, evaluate postoperative disease changes and detect respiratory infectious diseases without time and location restrictions.

Sleep-Body Composition Relationship: Roles of Sleep Behaviors in General and Abdominal Obesity in Chinese Adolescents Aged 17-22 Years.

This study aimed to investigate the association between sleep behaviors and body composition, which was measured by bioelectrical impedance analysis (BIA) among Chinese adolescents. Overall, 444 students (65.3% females, 19.12 ± 1.177 years) completed questionnaires describing sleep characteristics. Sleep characteristics were derived from subjective means. Body composition was obtained from BIA by InBody 720 (Biospace Co. Ltd., Seoul, Republic of Korea). Regression models tested relationships between sleep and body composition after adjustment for covariates. Students with weekday nap duration (>30 min/d) exerted higher waist-height ratio (WHtR) (B = 0.013, FDR-corrected p = 0.080). Average sleep duration (≤7 h/d) was linked to more WHtR (B = 0.016, FDR-corrected p = 0.080). People with high social jetlag showed gained visceral fat area (B = 7.475), WHtR (B = 0.015), waist to hip ratio (B = 0.012), fat mass index (B = 0.663) and body fat percentage (B = 1.703) (all FDR-corrected p < 0.1). Individuals with screen time before sleep (>0.5 h) exhibited higher visceral fat area (B = 7.934, FDR-corrected p = 0.064), WHtR (B = 0.017, FDR-corrected p = 0.080), waist to hip ratio (B = 0.016, FDR-corrected p = 0.090), fat mass index (B = 0.902, FDR-corrected p = 0.069) and body fat percentage (B = 2.892, FDR-corrected p = 0.018). We found poor sleep characteristics were closely related to general and abdominal obesity.

Temporal trends in physical fitness among Chinese children and adolescents from 2000 to 2019 and analysis of social-ecological factors.

This study aimed to estimate temporal trends in physical fitness (PF) by regions, age groups and nutritional status among Chinese children and adolescents and to longitudinally examine PF determinants based on social-ecological model. Participants (n = 68,265) aged 7-18 were from five successive national surveys (2000 to 2019). Six tested items of PF were calculated as PF indicator (PFI), which was used to divide participants into two categories: low vs. moderate/high. One-way analysis of variance was used to compare difference and change trend of PFI. Linear regression evaluated relationship between PFI and body mass index (BMI), and logistic regression assessed association between PFI and factors of behaviours and lifestyles on individual-, family- and school-level based on the social-ecological model. PFI declined sharply from 2000 to 2010, increased slightly from 2010 to 2014 and then edged down in 2019. Students with moderate BMI and students in urban areas tended to have higher PFI, and larger increase of PFI was found in students aged 7-9 and 13-15 after 2010. Several determinants on individual-, family- and school-level related to PFI. Efforts to develop PF mainly include increasing PA and reducing sedentary behaviours by facilitating home-school collaboration and emphasizing age-, region- and BMI-specific actions.

Unhealthy lifestyles and clusters status among 3637 adolescents aged 11-23 years: a school-based cross-sectional study in China.

BACKGROUND: Unhealthy lifestyles are risk factors for non-communicable diseases (NCDs) and tend to be clustered, with a trajectory that extends from adolescence to adulthood. This study investigated the association of diets, tobacco, alcohol, physical activity (PA), screen time (ST) and sleep duration (SD) in a total of six lifestyles, separately and as cumulative lifestyle scores, with sociodemographic characteristics among school-aged adolescents in the Chinese city of Zhengzhou. METHODS: In the aggregate, 3,637 adolescents aged 11-23 years were included in the study. The questionnaire collected data on socio-demographic characteristics and lifestyles. Healthy and unhealthy lifestyles were identified and scored, depending on the individual score (0 and 1 for healthy and unhealthy lifestyles respectively), with a total score between 0 and 6. Based on the sum of the dichotomous scores, the number of unhealthy lifestyles was calculated and divided into three clusters (0-1, 2-3, 4-6). Chi-square test was used to analyze the group difference of lifestyles and demographic characteristics, and multivariate logistic regression was used to explore the associations between demographic characteristics and the clustering status of unhealthy lifestyles. RESULTS: Among all participants, the prevalence of unhealthy lifestyles was: 86.4% for diet, 14.5% for alcohol, 6.0% for tobacco, 72.2% for PA, 42.3% for ST and 63.9% for SD. Students who were in university, female, lived in country (OR = 1.725, 95% CI: 1.241-2.398), had low number of close friends (1-2: OR = 2.110, 95% CI: 1.428-3.117; 3-5: OR = 1.601, 95% CI: 1.168-2.195), and had moderate family income (OR = 1.771, 95% CI: 1.208-2.596) were more likely to develop unhealthy lifestyles. In total, unhealthy lifestyles remain highly prevalent among Chinese adolescents. CONCLUSION: In the future, the establishment of an effective public health policy may improve the lifestyle profile of adolescents. Based on the lifestyle characteristics of different populations reported in our findings, lifestyle optimization can be more efficiently integrated into the daily lives of adolescents. Moreover, it is essential to conduct well-designed prospective studies on adolescents.

Effects of behaviors and surrounding environment on myopia before and during the COVID-19 pandemic: a longitudinal analysis of children and adolescents in China.

Aim: To investigate the relationship between related factors and visual acuity of Chinese school students before and during the COVID-19 pandemic. Subject and methods: Chinese students from primary and secondary schools were included from the Chinese National Surveys on Students' Constitution and Health CNSSCH (2019). A total of 1496 participants completed follow-ups in June and December 2020, respectively. Generalized estimating equations were used to test the differences in visual environment. Logistic regression models were utilized to examine the roles of behaviors and surrounding environment changes associated with myopia before and during the pandemic. Results: The prevalence of myopia was 47.7%, 55.6%, and 57.2% in baseline and two follow-ups, respectively. Significant differences existed for gender, learning level, and region (all P < 0.05). The proportion of new myopia and myopia torsion was the highest in the primary schools. Multivariate logistic regression analysis found that screen time ≥ 4h/d (OR = 2.717), poor eye habits (OR = 1.477), insufficient lighting for studying at night (OR = 1.779), desk or roof lamps only (OR = 1.388), and poor sleep quality (OR = 4.512) were the risk factors for myopia (all P < 0.05), and eye exercises (OR = 0.417), milk intake (OR = 0.758), and eggs intake (OR = 0.735) were the protective factors for myopia (all P < 0.05). Conclusion: Prevalence of myopia increased among Chinese students before and during the COVID-19. It is necessary to pay more attention to the pupils' visual acuity, especially in primary school students, in the future. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01900-w.

The association between various dimensions of sleep parameters and mental health: A large cross-sectional study of 13554 Chinese students.

OBJECTIVES: We aimed to investigate the association between multiple sleep variables and mental health among Chinese students aged 9-22. METHOD: We stratified the included 13,554 students by educational levels. Sleep parameters contained sleep duration on school days and weekends, napping time, chronotype and social jetlag (SJL), which were calculated via questionnaires. Individual psychological well-being and distress were assessed by Warwick-Edinburgh mental Well-being scale and the Kessler Psychological Distress Scale 10 respectively. The multiple linear and binary logistic regression were applied to analyze the association of sleep with mental health. RESULTS: Short sleep on school days showed significantly positive association with psychological problems. While among senior high school students, we found reverse result that sleeping less might negatively associated with more severe distress (7-8 h: aOR = 0.67, 95% CI: 0.46, 0.97). The association of sleep duration with mental health was attenuated a lot on weekends. The chronotype was significantly related with mental health in primary and junior high school: intermediate chronotype (vs late chronotype) was associated with greater wellbeing (ß = 1.03, 95% CI: 0.09, 1.96; ß = 1.89, 95% CI: 0.81, 2.97) and less distress (aOR = 0.78, 95% CI: 0.60, 1.00; aOR = 0.73, 95% CI: 0.58, 0.91). The relationship between SJL, napping duration and psychological health problems were also observed in some educational levels. CONCLUSION: Sleep deprivation on school days, late chronotype and SJL were positively associated with worse mental health in our study, which differed among various educational stages.

Associations of multiple sleep dimensions with overall and abdominal obesity among children and adolescents: a population-based cross-sectional study.

BACKGROUND: The relationship of insufficient sleep with the increased risk of obesity has been reported, but less is known about other sleep dimensions in the sleep-obesity associations. OBJECTIVES: To assess the associations of multiple sleep dimensions with overall and abdominal obesity among Chinese students. METHODS: This was a cross-sectional study involving 10,686 Han students aged 9-18 from Chinese National Survey on Students' Constitution and Health (CNSSCH). We collected sex, age, regions, parental educational levels, physical activity duration and sleep-related information by questionnaire survey, and also conducted anthropometric measurements including height, weight and waist circumference (WC). Unadjusted and adjusted binary logistic regression models were used to estimate the associations of sleep-related dimensions with obesity-related indicators. RESULTS: Short sleep duration was associated with higher body mass index (BMI), larger WC and higher waist-to-height ratio (WHtR) in 9-12 and 16-18 age groups, whereas prolonged sleep duration on weekday was associated with higher BMI in 13-15 age group. Non-habitual midday napping and midday napping ≤0.5 h/d (vs 0.5 to 1 h/d) increased the risk of higher BMI in 13-15 age group, and the former was also associated with larger WC in 9-12 age group. Late bedtime was associated with larger WC and higher WHtR in 9-12 age group and with higher BMI and WHtR in 13-15 age group. Students aged 9-12 with social jet lag ≥2 h were found to have greater BMI after adjustment (Odds Ratio: 1.421; 95% confidence interval: 1.066-1.894). CONCLUSIONS: Short or overlong sleep duration, late bedtime and great social jet lag were associated with higher prevalence of overall or abdominal obesity, while moderate midday napping can effectively decrease the risk. Those findings may assist in developing preventive strategies to combat obesity epidemic.

Associations between sleep characteristics and risk for high blood pressure among students aged 9-18: A cross-sectional study in China.

OBJECTIVE: The aim was to investigate the association of multidimensional sleep indicators with high blood pressure (HBP) of Chinese students. METHODS: Participants in this cross-sectional study included 11561 students aged 9-18. Sleep was characterized by sleep timing (e.g., bedtime), sleep duration and sleep consistency (e.g., bedtime/wake-up time deviations and social jet lag (SJL)). We used odds ratios (OR) and 95% confidence intervals (95% CI) to assess the relationship between sleep and HBP. RESULTS: Primary school students who slept 8.00-9.00h had a lower risk of HBP compared with sleeping >10h (OR 0.370, 95%CI 0.208, 0.658), while junior middle school students reporting ≤8.00h on weekday night had a lower risk of HBP compared with sleeping >10h (OR 0.303, 95%CI 0.111, 0.829). Moreover, compared with deviations = 0h, the OR (95%CI) for wake-up time deviations <0h and bedtime deviations >0h in primary school students with HBP were 0.314 (0.125, 0.790) and 2.155 (1.205, 3.853). Furthermore, compared with SJL = 0h, senior high school students reporting SJL = 0.01-0.50h, SJL = 0.51-1.00h and SJL = 1.01-2.00h had greater risk of HBP (OR 1.566, 95%CI 1.039, 2.361; OR 1.760, 95%CI 1.177, 2.631; OR 1.660, 95%CI 1.124, 2.452, respectively). Bedtime at night was associated with HBP for three educational periods students, however, there was no significant association between mid-day nap and HBP. CONCLUSIONS: Sleep timing, sleep duration and sleep consistency are associated with high blood pressure in children and adolescents.

Association between attitudes toward the COVID-19 vaccines and mental health among 140,259 college students in China.

Background: With the launch of the COVID-19 vaccines, the vaccination rate has become a hot issue of concern. However, the evidence for the relationship between college students' attitudes toward vaccines and anxiety and depressive symptoms has been limited. Methods: In total, 140,259 college students were recruited using a cluster sampling method in Zhengzhou, Xinxiang, Xinyang city of Henan Province, China, May 21-27, 2021. Anxiety symptoms were determined by the Generalized Anxiety Disorder tool (GAD-7) and depressive symptoms were determined by the Patient Health Questionnaire (PHQ-9). Multiple logistic regression was performed to estimate the association between students' attitudes toward the vaccines and anxiety and depressive symptoms. Results: The results indicate that 22.45% of students are unclear whether the vaccine can protect them from infection and 45.57% are unclear whether the vaccine is safe and has no side effects. In addition, after adjusting, the model showed that students who think vaccines can protect them and are safe had 0.128 (95%CI 0.110-0.150; Ptrend < 0.001) times lower risk of anxiety compared to their counterparts who think vaccines can neither protect them nor are safe. Similar ORs were found in depression (aOR = 0.157; 95%CI 0.137-0.180). Conclusion: This large-scale study has shown an association between symptoms of anxiety and depression and reluctance to obtain vaccination. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01830-7.

Trends of overweight and obesity prevalence in school-aged children among Henan Province from 2000 to 2019.

Objectives: Overweight and obesity are harmful to human health. However, the latest trends of Chinese childhood overweight and obesity prevalence are not available. The aim of this study was to examine the trends from 2000 to 2019 among students in China. Methods: We analyzed data of 66,072 students in the Chinese National Survey on Students' Constitution and Health from 2000 to 2019. Overweight and obesity were defined based on the standard formulated by the International Obesity Task Force (IOTF standard), the World Health Organization (WHO standard), and the Working Group on Obesity in China (WGOC standard), respectively. The χ2-test was used to test the trends of overweight and obesity prevalence and logistic regression was conducted to evaluate the prevalence odds ratios of boys vs. girls and urban vs. rural areas. Results: The prevalence of obesity/overweight and obesity combined was 6.03/23.58% (IOTF standard), 10.56/25.88% (WGOC standard) and 10.75/29.69% (WHO standard) in 2019. From 2000 to 2019, according to the WGOC standard, the prevalence increased from 2.51 to 10.56% for obesity and increased from 9.81 to 25.88% for overweight and obesity combined (P for trend < 0.001). Obesity/overweight and obesity were greater problems in boys than girls and urban than rural areas, but urban-rural differences decreased over time. Conclusion: Overweight and obesity prevalence increased significantly in children and adolescents in China from 2000 to 2019. The prevalence of overweight and obesity in rural areas may contribute to a large percentage of children with overweight and obesity.

Multidimensional self-rating biological rhythm disorder and its association with depression and anxiety symptoms among adolescents aged 11-23 years: a school-based cross-sectional study from China.

BACKGROUND: Depression and anxiety are topical concerns worldwide, especially among adolescents. Besides, biological rhythm disorder as a candidate mechanism for mood disorders is highly prevalent, but relevant research among adolescents in China is presently limited. We conducted the present study to investigate the distribution of multi-dimensional self-rating biological rhythm disorder and the association of self-rating biological rhythm disorders with depression and anxiety symptoms among Chinese adolescents in different academic stages. METHODS: In the cross-sectional study, 3693 students aged 11-23 from Zhengzhou City, Henan Province, China were included. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) were used to evaluate symptoms of depression and anxiety, respectively. Additionally, the Self-Rating of Biological Rhythm Disorder for Adolescents (SBRDA) was used to assess status of biological rhythm disorders. Multivariate logistic regression was developed to explore factors potentially associated with symptoms of depression and anxiety stratified by academic stages. RESULTS: Among all participants, 44.14 and 36.15% suffered from depression and anxiety symptoms, respectively. On average, participants scored 74.66 ± 19.37 on the measure of total biological rhythm disorder. Adjusted for demographic confounding factors, the logistic regression analysis showed higher scores of total biological rhythm disorder were associated with more severe depression (OR = 14.38, 95%CI: 11.38-18.16) and anxiety symptoms (OR = 11.63, 95%CI: 9.14-14.81). The similar results were also found in the stratified analysis by academic stages. CONCLUSIONS: Self-rating biological rhythm disorders are significantly associated with depression and anxiety symptoms among adolescents. Discrepancy across academic stages should also be taken into account in establishing public health strategies.

[Development and Application of Medical Device Recall Event Tracking System].

A medical device recall event tracking system was designed, which can enable the users to obtain the recall, early warning and other information related to medical devices in time. The tracking system can timely obtain and release the recall information of medical devices, effectively improve the quality control of hospital medical devices, reduce the use risk of medical devices, and ensure the life safety of patients.

Attitude toward COVID-19 vaccines and its association with depressive symptoms in 386,924 Chinese primary school students during COVID-19 epidemic normalization.

AIM: Before Chinese primary school students were generally vaccinated against the COVID-19 vaccine, this study evaluated the willingness of this population and its influencing factors before vaccination, and evaluate its association between attitudes toward the vaccine and depressive symptoms. METHODS: A cross-sectional study involved 386,924 primary school students using a cluster sampling method during May 21-27, 2021. The Chinese version of the Children Depression Inventory (CDI) was used to assess depressive symptoms. Multiple logistic regression analysis models were used to estimate the relationship between attitudes toward COVID-19 vaccines and depressive symptoms. RESULTS: Among the participants, the prevalence of depressive symptoms was higher in higher grades. The prevalence was higher in fifth and sixth grade students than third and fourth grade students and first and second grades (10.22% vs. 6.07% vs. 3.04%). In addition, 20.79% of students do not know whether the vaccine can protect him from the COVID-19 infection, and 40.60% of students do not know whether the vaccine is safe. Of note, in terms of attitudes toward COVID-19 vaccines, students with more positive attitudes have a lower risk of depressive symptoms (adjusted odds ratio (aOR) = 0.151; 95% confidence interval (CI): 0.140-0.164). CONCLUSION: Based on these findings, it is necessary for the government and schools to promote vaccine safety and reliability information in a timely manner to increase vaccination uptake.

Prevalence and risk factors of depressive symptoms among 140,259 college students during the COVID-19 epidemic normalization in China: A cross-sectional survey.

Objective: College students are one of the most vulnerable populations to the COVID-19 pandemic's mental health effects. During the coronavirus disease 2019 (COVID-19) outbreak, we wanted to see how common depressive symptoms were among college students and what factors contributed to that. Methods: Between 21 and 27 May 2021, 140,259 college students from three cities in Henan Province, China, were involved. The Patient Health Questionnaire-9 was used to determine depressive symptoms (PHQ-9). Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% CIs for potential depressive symptom factors. Results: Mild depressive symptoms and above are present in 21.12% of college students. Women had a higher prevalence of mild depressive symptoms than men (61.38 vs. 59.75%), and depressive symptoms were most prevalent among rural students and least prevalent among city students (21.44 vs. 20.29%). Participants with depressive symptoms are also more likely to have a poor-behavioral status. From none-to-severe depressive symptoms, 78.88, 15.78, 2.80, 1.67, and 0.88% had them. Gender, residential location, and behavioral status were found to be associated with depressive symptoms after adjusting for potential confounders. Conclusion: This cross-sectional study identified the factors that influence the prevalence of depression in college students. It found that the government should pay more attention to mental health issues affecting college students in combating the COVID-19 epidemic normalization.

Prevalence and Associated Factors for Elevated Depressive Symptoms in 386,924 Primary Students during the COVID-19 Pandemic Normalization in China.

We aimed to assess the prevalence of elevated depressive symptoms and its associated factors during the coronavirus disease 2019 (COVID-19) pandemic among primary students in China. We included 386,924 students aged 6-12 years from three cities in Henan province, China, over the period 21-27 May 2021. The overall prevalence of depressive symptoms was 5.8%. Participants with high depressive symptoms were more likely to be senior urban primary students, and exhibited an insignificant increase in hand washing frequency, non-mask wearing behavior, higher error rates of cognition tests, and greater levels of worry and fear. The associated factors for high depressive symptoms were found to include age, sex, grade, location, worry level, fear level, cognitive status, and change in lifestyle after gaining knowledge about COVID-19. Our results suggest that governments need to focus on factors affecting the mental health of school-age children while combating COVID-19, as it would facilitate better decision making on the international and national level.

Association between mask wearing and anxiety symptoms during the outbreak of COVID 19: A large survey among 386,432 junior and senior high school students in China.

AIM: To evaluate the association between mask wearing practice and the risk of anxiety symptoms during the COVID-19 epidemic among Chinese students aged 12-18 years old. METHODS: Totally, 386,432 junior and senior high school students were recruited using a cluster sampling method across three cities of Henan Province in China during February 4-12, 2020. Mask wearing practice was defined according to its type and the behavior exhibited in relation to wearing a mask. Presence of anxiety symptoms was determined by Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression was performed to estimate the association between mask wearing and anxiety symptoms. RESULTS: Among the participants, compared with students who completely adhered to the all the mask wearing practice, students who did not adhere to all the mask wearing practice had 1.97 times more likely to suffer from anxiety symptoms (adjusted odds ratio (aOR) = 1.97; 95% confidence interval (CI): 1.74-2.22). Furthermore, compared with students who did not know the proper type of mask, students who knew the proper type of mask had a lower risk of anxiety symptoms (aOR = 0.78; 95%CI: 0.76-0.80). Students who adhered to proper behavior of mask wearing was associated with 34% decreased odds for anxiety symptoms (aOR = 0.68; 95%CI: 0.62-0.74). CONCLUSIONS: To conclude, proper mask wearing may be an important attribute that play a significant role in reducing the risk of anxiety symptoms among junior and senior school student. However, since this study is a cross-sectional study, prospective studies are needed to further verify.

Worry and fear during the COVID-19 epidemic normalization: Analyzing prevalence and risk factors among 182,991 high school students in China.

It is worth paying attention to the level of worry and fear of students during the normalization of the epidemic. We conducted the cross-sectional study that included 182,991 high school students using an online survey to assess worry and fear levels and its influencing factors in three cities in Henan Province, China, from May 21 to May 27, 2021. Worry and fear levels were measured using a five-item Likert-type scale. Multinomial logistic regression was used to analyze the risk factors. Approximately 65.42% of students reported being high worry about the coronavirus disease 2019 (COVID-19) epidemic, and about 41.44% of students reported being high fear about the COVID-19 epidemic. In addition, compared with female, male had lower odds of suffering from a high worry, and compared with senior high school students, junior high school students were more likely to suffer from a high worry. Students lived in rural had highest odds increased likelihood of high worry. Similar results in fear levels. During the normalization period of the COVID-19 epidemic, many students have high levels of worry and fear. This study has implications for potential influencers of worry and fear levels in follow-up work.

Prevalence and associated factors of anxiety among 538,500 Chinese students during the outbreak of COVID-19: A web-based cross-sectional study.

This study was conducted on elementary school students in Henan Province, China, from February 4th to 11th, 2020, during the coronavirus disease 2019 (COVID-19) epidemic. The purpose of the study was to examine the prevalence of anxiety among students and identify the related risk factors contributing to anxiety. Demographic information and psychological status were assessed by using self-reported measures. The generalized anxiety disorder tool (GAD-7) and a multiple logistic regression model were used to assess anxiety and identify potential influencing factors. Cross-sectional data indicated that the overall anxiety prevalence was 13.4%. The prevalence of anxiety symptoms was highest among rural primary school students and lowest among city students. Three groups of students in different regions were surveyed, and the prevalence of anxiety symptoms was significantly higher among students with poor knowledge of COVID-19 than among students with good knowledge of COVID-19. After adjusting for potential confounding factors, it was found that location, knowledge, and practice were related to anxiety. This study showed that the prevalence of anxiety symptoms was higher among Chinese primary school students. The influencing factors found in this study may help relevant staff improve the mental health of children during the epidemic.