[Research progress on the impacts of pregnancy and puerperium-related factors on refractive errors in children].

Refractive error is a common ophthalmic disease in children. It refers to the mismatch between the axial length and the refractive power that results in visual blur, which is usually driven by the interaction of genetic and environmental factors. The impacts of pregnancy and puerperium-related factors on refractive error in children have gradually gained attention. According to the different stages of pregnancy, this review summarizes the impacts of four aspects on refractive error in children, including lifestyle during pregnancy, complications and comorbidities during pregnancy, adverse pregnancy outcomes and other factors, which aims to provide perinatal healthcare clues for the prevention and control of refractive error in children, achieve prevention beforehand and reduce the public health burden of refractive error in children.

[Relationship between sleep status and occasional hypertension in preschool children in three provinces in the middle and lower reaches of the Yangtze River in China].

Objective: To understand the prevalence of occasional hypertension in preschool children in three provinces in the middle and lower reaches of the Yangtze River in China, and analyze the relationship between their sleep status and occasional hypertension. Methods: From October to November 2017, a total of 24 842 preschool children from 109 kindergartens in 11 cities in Hubei, Anhui and Jiangsu provinces were selected by intentional sampling method. A self-made questionnaire was used to collect basic information about the subjects, and the sleep status data was collected by the Children's Sleep Habits Questionnaire. Physical examinations were performed on the subjects, and height, weight and blood pressure were measured on-site. The difference in occasional hypertension detection rate among preschool children with different characteristics was compared, and the correlation between sleep status and occasional hypertension detection rate was analyzed by the multivariate logistic regression model. Results: The age of the subjects was (4.4±1.0) years, including 12 729 boys (51.2%). The prevalence of occasional hypertension was 31.8% (7 907/24 842). The prevalence of occasional hypertension among preschool children in three provinces of the middle and lower reaches of the Yangtze River was 31.8%. There were statistically significant differences in the detection rate of occasional hypertension among preschool children of different genders, age groups, family residence, family economic status and parents' education level (all P values<0.05). The detection rate of occasional hypertension in children with less than 10 hours of sleep was higher than those with sufficient sleep, and the difference was statistically significant (P<0.05). The results of multivariate logistic regression analysis showed that after adjusting for factors such as gender, age, family residence, family economic status, parental education level, parental smoking history, and physical constitution, the ORs (95%CI) for less than 10 hours of sleep, turning on the lights while sleeping, and poor sleep quality were 1.09 (1.03-1.15), 1.17 (1.07-1.28) and 1.04 (0.91-1.18), respectively, compared with the corresponding reference group. Conclusion: The detection rate of occasional hypertension is high in preschool children in the middle and lower reaches of the Yangtze River and there is a positive correlation between insufficient sleep and turning on the light when sleeping and occasional hypertension in preschool children.

[Maternal mobile phone screen time during pregnancy and children's internalizing and externalizing behavioral problems].

The behavioral problems of children and adolescents are becoming more and more serious, and the prevalence rate is increasing year by year. The overall trend is increasing, which has become one of the important public health issues of global concern. There are many influencing factors for behavioral problems in children and adolescents, including genetic, psychosocial, family and early life environment. Among them, maternal screen exposure during pregnancy is a contributing factor that deserves attention and has practical intervention significance. This study systematically evaluated the association between maternal mobile phone screen time during pregnancy and children's internalizing and externalizing behavioral problems, its potential biological mechanisms and relevant intervention measures, in order to create a good intrauterine environment for fetal neurodevelopment and further reduce the occurrence of children's behavioral problems.

[The role of methylation of placental glucocorticoid response gene in the association between pregnancy-related anxiety in the third trimester and birth outcomes].

Objective: To investigate the role of methylation of placental glucocorticoid response gene in the association between pregnancy-related anxiety in the third trimester and birth outcomes. Methods: Based on a prospective cohort study, singleton live births and their mothers from the Ma'anshan Birth Cohort Study (MABC) were included as participants in this study. The maternal pregnancy-related anxiety symptoms in the third trimester of pregnancy were evaluated by using the Pregnancy-related Anxiety Questionnaire. The neonatal birth outcomes were collected from medical records. The placental tissues from 300 pregnant women with pregnancy-related anxiety and 300 without pregnancy-related anxiety were collected to detect the methylation of FKBP5, NR3C1 and HSD11B2 genes using the Methyl Target approach. The methylation factors were extracted by exploratory factor analysis. Linear regression or logistic regression models were used to analyze the association between pregnancy-related anxiety in the third trimester, methylation factor scores, and birth outcomes. The mediating role of methylation factors in the association between pregnancy-related anxiety in the third trimester and birth outcomes was analyzed by using the Process procedure. Results: The mean age of 2 833 pregnant women was (26.60±3.60) years old. After adjusting for confounding factors, pregnancy-related anxiety in the third trimester increased the risk of small-for-gestational-age (OR=1.32, 95%CI:1.00-1.74). A total of 5 methylation factors were extracted, and the factor 5 was loaded with FKBP5 CpGs 18-21. Pregnancy-related anxiety in the third trimester was negatively correlated with the factor 5 (ß=-0.24,95%CI:-0.44--0.05). The factor 5 was positively correlated with the gestational age (ß=0.17, 95%CI:0.06-0.27). In addition, the factor 2 (ß=0.02,95%CI:0.00-0.04) and factor 3 (ß=0.03,95%CI:0.01-0.05) were positively correlated with 5-min Apgar score after delivery. However, this study did not found the mediating role of the scores of the factor characterized by FKBP5 in the relationship between pregnancy-related anxiety and birth outcomes. Conclusion: Pregnancy-related anxiety in the third trimester may reduce the methylation level of FKBP5 CpGs 18-21 in placental tissues and is associated with the risk of small-for-gestational-age.

[Selection and application of implementation strategies in implementation research].

Implementation research is a discipline that attempts to promote the application of evidence-based interventions in different settings and populations by using various methods and measures. Implementation strategies are the central part of implementation research, and as the field of implementation science evolves, more and more implementation strategies have been developed to facilitate the application of evidence-based interventions in the real world. To help researchers better understand and apply implementation strategies, this study will introduce implementation strategies in three aspects: classification, selection and application, and report.

[Research progress on influencing factors of early adiposity rebound in children and the effect on adolescent development in girls].

With the increasing rate of overweight and obesity in children worldwide, adiposity rebound(AR)closely related to obesity has become the spotlight, and early AR phase has a broad impact on pubertal development in girls, but the specific mechanism of action isn't very clear.This paper is review of the prevalence of early AR at home and abroad, and its influencing factors, the impact of AR on the adolescent development of girls and related mechanisms, to identify high-risk individuals with early AR, early AR to identify early adolescent development, and take early intervention measures to promote children's health.

[Association between circadian rhythm disorder and comorbidity of anxiety and depression in adolescents].

Adolescents are in a transition period from children to adults, during which they are prone to a variety of emotional disorders, with anxiety and depression being the most common disorders. Anxiety and depressive symptoms are highly correlated and the comorbidity of anxiety and depression is common. At the same time, the most prominent behavioral changes in adolescence are the emergence of getting up late and sleeping late, and the circadian rhythm begins to delay. Previous studies have shown that circadian rhythm is closely related to anxiety and depression, but the association between circadian rhythm disorder and comorbidity of anxiety and depression remains unclear. This article reviews the prevalence, association and potential biological mechanism of circadian rhythm disorder and comorbidity of anxiety and depression in adolescents, so as to provide a possible reference for the prevention and control of comorbidity of anxiety and depression in adolescents.

[Application of entropy weight TOPSIS comprehensive method in the evaluation of students' physical health level].

Objective: To comprehensively evaluate the physical health level of students of different school-age segments in four regions of Anhui province using the entropy weight approximation ideal solution ranking method (TOPSIS), and to provide a scientific method and basis for conducting school health work evaluation. Methods: Using the physical fitness survey data of four regions in Anhui province, the entropy weight method was used to draw the weights of various indicators for different school-age segments of men and women. Then, the TOPSIS method was used to evaluate the school-age segments of men and women in the four regions. Finally, the physical health level of students in four regions was classified according to the results of entropy weight TOPSIS and the rank sum ratio method. Results: A total of 10 127 students were included in this study, with an average age of (11.85±3.82) years, including 5 050 males (49.8%) and 5 072 urban students (50.1%). The results of the entropy weight method showed that the weight of body mass index of boys was similar to that of girls in each school-age segment. According to the TOPSIS and rank sum ratio analysis, the physical health level of students in the four regions of Anhui province was different. The physical health score of Suzhou was 0.617 4 points, which was classified as the best grade. The scores of Hefei and Wuhu were 0.556 3 and 0.411 2, which were classified as middle. Jiju City scored 0.381 9 points, which was classified as poor. Conclusion: TOPSIS combined with rank sum ratio can reflect the level of students' physical health, which can be applied to the evaluation of students' physical health and provide a basis for monitoring students' physical health.

[Research progress on the comorbidity of anxiety and depression in children and adolescents].

Anxiety and depression, as two emotional disorders with high incidence in children and adolescents, have become major public health issues for health and life safety. Anxiety and depression often exist in the form of comorbidities due to the common clinical manifestations, behavioral characteristics, genetic and environmental etiological mechanisms, which have short-term and long-term adverse health effects. This article summarizes the prevalence and characteristics of the comorbidity of anxiety and depression in children and adolescents, reviews the etiological models and influencing factors of the comorbidity of anxiety and depression, and reveals the underlying etiological mechanism, in order to provide a reference for the prevention and control of the comorbidity of anxiety and depression in children and adolescents.

[Progress in researches on the effect of artificial light at night on infertility].

Infertility is a serious social and public health problem, and the causes of infertility are also the focus of many researchers in recent years. Since the invention of the electric light, people's exposure to night light has increased rapidly, and the adverse effects on human health have also begun to enter the vision of researchers. Studies have shown that artificial lighting at night can affect the circadian rhythm of organisms and the secretion of melatonin (melatonin), and regular circadian rhythms and sufficient melatonin are conducive to successful reproduction. This article reviews the current research status of the effects of artificial lighting at night on infertility in recent years, which provides a new direction for researchers to study the influencing factors of infertility.

[New understanding and research opportunities of metabolically healthy obesity].

The paradox of obesity and metabolically healthy obesity are being challenged. More and more studies have disputed the potential mechanism and prognostic value of metabolically healthy obesity. The study of metabolically healthy obesity is helpful to clarify the potential causes of obesity paradox and the potential mechanism of different degrees of obesity harm to the population. From the perspective of evidence-based medicine, combined with the relevant literature at home and abroad, this study reviewed the new understanding of metabolically healthy obesity, lifestyle factors, the impact of fat factors on metabolically healthy obesity, and the new opportunities of metabolically healthy obesity research, in order to explore whether metabolically healthy obesity can maintain and gradually reduce weight for a long time, so as to improve cardiovascular disease In order to achieve the purpose of primary prevention of related diseases.

[Longitudinal correlation between cell phone use and sleep quality in college students].

Objective: To investigate the current situation of cell phone use and sleep quality among college students, establish a sleep quality trajectory model and explore the influence of cell phone use on the sleep quality trajectory. Methods: Based on data from the College Student Behavior and Health Cohort Study 2019-2020, a latent class growth modeling was used to establish a sleep quality trajectory model among college students. The baseline influencing factors of sleep quality trajectories among college students were analyzed by χ2 test, and the effects of cell phone use on sleep quality trajectories were analyzed by binary logistic regression. Results: A total of 1 092 college students were included in the analysis. The detection rates of cell phone use and poor sleep quality were 24.5% and 13.3%. Latent class growth model identified two groups of sleep quality trend trajactories: an improved sleep quality group (86.0%) and a decreased sleep quality group (14.0%). The result of binary logistic regression showed that the cell phone use was a risk factor of sleep quality trajectories. Conclusion: The cell phone use during college period could increase the risk of poor sleep quality. Targeted intervention measures about cell phone use should be adopted to improve the sleep quality among college students.

[Prevention and control of myopia needs to integrate the cultural and social-economic spatiotemporal factors among children and adolescents in China].

The high incidence of myopia in children and adolescents has become an important public health issue. There is still a debate about the priority between genetic and environmental factors of myopia, which makes researchers realize that the related research on the prediction index of myopia natural process and the effective methods of prevention and control still lags behind the social demand. Therefore it needs innovative thinking and a deep understanding of the role of the changes of the times, reduce learning and screen time under low natural light and artificial lighting, at the same time increase daytime outdoor activities, so as to provide new strategies and actions for the prevention and control of myopia among children and adolescents in China.

[Research progress on the relationship between allostatic load and depression in adolescents].

Adolescence is not only an important stage of growth and development, but also a critical period for the formation of social and psychological cognition. The increasing incidence rate of depression in adolescents has caused serious global burden of disease. Allostatic load is a comprehensive index including multiple physiological system disorders. In the key stage of brain development, allostatic load plays an important role in the occurrence and development of mental diseases. This paper summarized the evaluation methods and prevalence of adolescent allostatic load, reviewed the relationship between allostatic load and adolescent depression, and revealed the possible physiological and neurobiological mechanisms, in order to provide scientific basis for prevention and control of adolescent depression.

[A cohort study of maternal pregnancy-related anxiety at different trimesters and infants' neurobehavioral development].

Objective: To investigate the influence and critical period of pregnancy-related anxiety during pregnancy on the neurobehavioral development of infants. Methods: The subjects of this study were derived from the Ma'anshan Birth Corhot. From May 2013 to September 2014, a total of 3 474 pregnant women who registered in Ma 'anshan Maternal and Child Health Care Center were enrolled in the study. A total of 2 242 mother-infant pairs who completed three times assessments of maternal anxiety and at least once assessment of infants' neurobehavioral development were included in the final analysis. Maternal pregnancy-related anxiety was assessed by the Pregnancy-Related Anxiety Questionnaire during the first, second and third trimesters of pregnancy. When their children were at 6 and 18 months, their neurobehavioral development was evaluated using the Ages & Stages Questionnaire-China. The influence of maternal pregnancy-related anxiety on the neurobehavioral development of infants was analyzed by bi-nominal logistic regression. Results: The age of 2 242 pregnant women was (26.62±3.65) years, and the proportion of boys, low birth weight and exclusive breastfeeding for 6 months was 50% (1 120/2 242), 1.7% (38/2 242) and 11.5% (252/2 191), respectively. The detection rates of pregnancy-related anxiety during the first, second and third trimester were 24.9% (558), 28.6% (642) and 30.3% (674), respectively. After controlling confounding variables and other two trimester's anxiety, only pregnancy-related anxiety during the third trimester (not first or second trimester) significantly increased the risk of developmental delay in the domain of communication (relative risk, RR = 3.52, 95% confidence interval, CI: 1.89-6.58) and personal-social (RR=2.46, 95%CI: 1.10-5.49) at the 6 months of age, as well as in the domain of fine motor (RR=2.07, 95%CI: 1.11-3.85), problem-solving domains (RR=2.31, 95%CI: 1.24-4.31). Conclusion: Maternal pregnancy-related anxiety was associated with the risk of neurobehavioral development of infants, and the third trimester may be the critical period.

[The development and national norm of the assessment of spinal health of youths].

Objective: To develop the Assessment of Spinal Health of Youths (ASHY), and evaluate its reliability and construct validity and further definite the national norm. Methods: According to literature review and expert consultation, the ASHY included 37 items within 4 dimensions, named symptoms of neck-shoulder and low back, the dysfunction of neck-shoulder and low back, daily risk behaviors and health-seeking behaviors. Between December 2015 and March 2016, a total of 15 096 students were purposively selected from Shenyang, Zhengzhou, Shenzhen and Jiangxi province. Item analysis, factor analysis and reliability evaluation methods were used to select items and evaluate the questionnaire. Between November 2017 and January 2018, a total of 14 500 students were purposively selected from Shenzhen, Zhengzhou, Nanchang and Guiyang. These data were used to develop a national norm of ASHY in adolescents. Results: The ASHY consisted of 4 dimensions covering 34 items. Variance cumulative contribution rate was 68.37%. Internal consistency test showed that Cronbach's α coefficient of the questionnaire was 0.91 and Cronbach's α coefficient of each dimension was between 0.76 and 0.93. The split-half coefficient of the questionnaire was 0.78 and ranged from 0.62 to 0.77 for each dimension. Confirmatory factor analysis results showed that the value of RMSEA was 0.067, and the values of NFI, RFI, CFI, GFI, AGFI were all above 0.80, which had a good fitting degree. The 90th percentile was used as the cutoff point about total scores of 92 for junior high school students, 102 for senior high school students and 98 for the overall middle school students. Conclusions: The ASHY is consistent with the evaluation standard of psychometrics. It can be used as a tool to evaluate the spinal health in adolescents.

[Association of thallium exposure during pregnancy with maternal blood pressure and hypertensive disorder complicating pregnancy].

Objective: To investigate the association of thallium exposure during pregnancy with pregnant blood pressure changing and hypertensive disorder complicating pregnancy(HDCP). Methods: A total of 3 240 pregnant women who had establish maternal health care manual in Ma'anshan Maternal and Child Health-Care Hospital and met the inclusion and exclusion criteria were included in this study between May 2013 and September 2014.We collected their general demographic characteristics and blood pressure through questionnaire and medical records. Meanwhile we measured serum thallium concentrations by experimental technology. We use multiple logistic regression to analyze the association between thallium exposure during pregnancy and HDCP. Mixed linear model were used to analyze the association between thallium concentration and maternal systolic blood pressure (SBP) or diastolic blood pressure(DBP) in different trimesters Results: The age of 3 240 pregnant woman was (26.61±3.64) years, and the detection rate of HDCP was 5.9%(191).The median (P25, P75) of thallium concentrations in first trimester, second trimester and third trimester were 62.96 (50.79, 77.04), 62.19 (50.87, 75.26), 48.84 (38.00, 66.00) ng/L, respectively. Multiple logistic regression results suggested after adjusting various confounding factors, the risk of HDCP in pregnant women with high concentrations of thallium (>77.04 ng/L) in the first trimester is 1.75 (95%CI:1.01-3.03) times higher than which with low concentrations(<50.82 ng/L). Mixed linear model results suggested there are positive correlation between thallium concentrations with maternal DBP in first trimester (ß=1.12, 95%CI: 0.39-1.85). Conclusion: Exposure to high levels of thallium during first trimester may increase the risk of HDCP, and the exposure of thallium may be effective to DBP of pregnant.

[Effect of early-life antibiotic exposure on allergic symptoms in children aged 6-11 months and 18-23 months based a birth cohort study].

Objective: To analyze the associations between prenatal and 1-year-old exposure to antibiotics and allergic symptoms in children aged 6-11 months and 18-23 months. Methods: In this study, a prospective birth cohort study was adopted. A total of 2 122 pregnant women were enrolled in Maternal and Child Health Care Center of Ma'anshan from June 2015 to June 2016, and they were followed up from the beginning of pregnancy to children's 24 months of age. Excluding 564 pairs of mothers and children who were lost to follow-up or with incomplete information on the use of antibiotics and children's allergic symptoms, a total of 1 558 pairs of mothers and children were included in the analysis of this study. The parents and children's general demographic information, early-life antibiotic exposure and other data were collected, the information about allergic symptoms in children aged 6-11 months and 18-23 months were investigated by reference to the "International Study of Asthma and Allergies in Childhood (ISAAC)". The univariate and multivariate binary unconditional logistic regression model was used to was used to estimate associations between the effects of early-life antibiotic exposure on allergic symptoms in 2-year-old children. Results: The antibiotic usage rate of pregnant women during pregnancy was 3.4% (53), and the antibiotic usage rates of children between 0 to 2 months, 3 to 5 months, and 6 to 11 months were separately 15.2%(237), 15.5%(242) and 17.3%(269). The total prevalence of allergic diseases in children aged 6 to 11 months was 24.1% (375 children), and the total prevalence of allergic diseases in children aged 18 to 23 months was 22.0% (342 children). After adjust parental (maternal) education level, family monthly income per capita, parental (maternal) allergy history, parental (maternal) age at pregnancy, mother's Body Mass Index (BMI) before pregnancy, exposure to second-hand smoke during pregnancy, delivery method, child gender, birth weight, preterm birth, the use of antibiotics when children were 3-5 months old (RR=1.61,95%CI:1.19-2.17) and 6-11 months old (RR=1.43,95%CI:1.06-1.93) were the risk factors for allergic symptoms at 6-11 months of age; and the use of antibiotics when children were 0-2 months old (RR=1.41, 95%CI: 1.03-1.95), 3-5 months old (RR=1.54, 95%CI: 1.12-2.11) and 6-11 months old (RR=1.58, 95%CI: 1.17-2.14) were the risk factors for allergic symptoms at 18-23 months of age. Conclusion: Children's exposure to antibiotics within 1 year of age was a risk factor for allergic symptoms in children aged 6-11 months and 18-23 months, children should avoid unnecessary antibiotic use in infancy.

[The relationship between migration time and the prevalence of myopia of children and adolescents aged 6-18 years old in Shenzhen].

Objective: To analyze the relationship between migration time and the prevalence of myopia of children and adolescents aged between 6 and 18 years old in Shenzhen. Methods: From April to May 2019, 26 618 children and adolescents from 14 schools in six streets of Baoan District, including Fuyong, Shajing, Xin'an, Xixiang, Songgang and Shiyan, were included in the study by using random cluster sampling method. The demographic characteristics, migration status, self-reported myopia, screen time in the last seven days, outdoor activities in the last one month and other information were collected through the questionnaire. The differences of myopia among children and adolescents with different characteristics were compared by χ2 test, and the relationship between migration time and the prevalence of myopia was analyzed by multivariate unconditional logistic regression model. Results: The age of 26 618 study participants was (12.37±3.49) years old, and the overall prevalence of myopia was 49.4%. Multivariate logistic regression analysis showed that after controlling for relevant confounding factors, compared with migrant children and adolescents of migrant workers who migrated for 1-2 years, those of migrant workers who had migrated for more than 6 years had a higher risk of myopia [OR (95%CI): 1.48 (1.14-1.92)]. After being grouped by phase of school, in the lower grade group of primary school, the children and adolescents of migrant workers who had migrated for more than 6 years had a higher risk of myopia compared with those of migrant workers who migrated for 1-2 years [OR (95%CI): 1.96 (1.20-2.74)]. In the high school group, compared with the children and adolescents of migrant workers who migrated for 1-2 years, those of migrant workers who had migrated for 3-5 years and ≥6 years had a higher risk of myopia [OR (95%CI): 6.03 (1.29-28.15) and 6.52 (1.51-28.11), respectively]. Conclusion: The migration time is related to the prevalence of myopia of the children and adolescents of migrant workers.

[Healing the schism between public health and medicine, promoting the integration of prevention and treatment].

It has been nearly 30 years since the publication of "Healing the Schism: Epidemiology, Medicine, and the Public's Health" by Professor Kerr L. White. Although scholars have been calling for strengthening the integration of public health and clinical medicine in Chinese medical education and eliminating barriers between public health professionals and clinicians, these effects are not obvious. The epidemic situation of COVID-19 has become an open course for Chinese citizens on the treatment, prevention and control of infectious diseases. Consequently, the public has higher expectations on the modernization of public health governance, and the social atmosphere of bridging the gap between public health and clinical medical education has been establishing. In the future, when combating with novel infectious diseases and public health emergencies, the response capacity of public health system and treatment capacity of clinical system in China will be significantly improved, and the situation of insufficient integration of medical treatment and prevention is bound to be reversed.