The Minhang Pediatric Biobank cohort study: protocol overview and baseline characteristics.

BACKGROUND: Little has been done to establish biobanks for studying the environment and lifestyle risk factors for diseases among the school-age children. The Minhang Pediatric Biobank (MPB) cohort study aims to identify factors associated with health and diseases of school-aged children living in the urban or suburban area of Shanghai. METHODS: This population-based cohort study was started in all sub-districts/towns of Minhang district of Shanghai in 2014. First-grade students in elementary school were enrolled during the time of their routine physical examinations, with self-administered questionnaires completed by their primary caregivers. Additional information was extracted from multiple health information systems. Urine and saliva samples were collected during the baseline survey and follow-up visits. RESULTS: At the end of 2014 academic year, a total number of 8412 children and their parents were recruited, including 4339 boys and 4073 girls. All the participants completed the baseline survey and physical examination, and 7128 urine and 2767 saliva samples were collected. The five most prevalent childhood diseases in this population were dental caries, bronchitis, pneumonia, asthma and overweight/obese. CONCLUSIONS: The MPB cohort has been successfully established, serving as a useful platform for future research relating to the genetic, environmental and lifestyle risk factors for childhood diseases.

Effects of school myopia management measures on myopia onset and progression among Chinese primary school students.

BACKGROUND: Schools play an organizational role in managing myopia-related behavioral habits among students. We evaluated the effects of school myopia management measures on myopia onset and progression in a school-based prospective 1-year observational study. METHODS: In total, 8319 children from 26 elementary schools were included. Online questionnaire completed by a parent, in which school myopia management experience including outdoor activities in recess or physical education class, teachers' supervision, and teaching facilities. Variables were defined as implemented well or poorly, according to the Comprehensive Plan to Prevent Myopia among Children and Teenagers. Children underwent ophthalmic examinations, and the incidence and progression of myopia from 2019 to 2020 were estimated. Multilevel logistic regression models were constructed to analyze the association between school management measures and myopia development in 8,9 years and 10,11 years students. RESULTS: From 2019 to 2020, the incidence of myopia among primary school students was 36.49%; the mean difference of spherical equivalent in myopic children was - 0.29 ± 1.22 diopters. The risk of incident myopia was reduced by 20% in 8,9 years participants with well-implemented class recess compared with those with poorly implemented class recess (adjusted odds ratio [aOR]: 0.80, p = 0.032). PE outdoor time was significantly associated with myopia incidence in 10,11 years students (aOR: 0.76, p = 0.043). Compared with poorly implemented reading and writing posture, desk and chair height, 10,11 participants with well-implemented desk and chair height were less likely to have rapid myopic progression (p = 0.029, p = 0.022). CONCLUSION: In Shanghai, children's myopia is associated with better implementation of school myopia management measures. The present findings suggest that outdoor activities during class recess or PE class, providing suitable desks and chairs, and adequate instruction in reading and writing postures might protect against pathological eye growth. An age-specific myopia prevention and control programs in school is of primary importance.

Breastfeeding is associated with reduced risks of central obesity and hypertension in young school-aged children: a large, population-based study.

BACKGROUND: Previous studies examined the effects of breastfeeding on measured values of body circumferences or blood pressure during childhood. However, limited data are available for the association between child feeding and a specific disease diagnosed as central obesity or hypertension. Hence, we aimed to examine whether the type and duration of breastfeeding are associated with obesity/central obesity or hypertension in young school-aged children. METHODS: We matched the data obtained from a cross-sectional survey in 2019 with retrospective breastfeeding information recorded in the database. Heights, weights, waist circumferences, and blood pressures of 8480 children in first grade of primary schools in Shanghai, China were measured to diagnose obesity, central obesity, and hypertension. Data on child feeding was collected retrospectively from clinical records. Associations between the type/duration of breastfeeding and children's measured values of body mass index, waist circumference, and blood pressure were analysed by linear regression. Associations between the type/duration of breastfeeding and risks of obesity, central obesity, and hypertension were analysed by generalised linear models. RESULTS: Breastfeeding duration was inversely associated with blood pressure values in children in the first grade. Each month's increase in the duration of any breastfeeding was associated with a 0.07 mmHg decrease in systolic blood pressure (P < 0.01) and a 0.05 mmHg decrease in diastolic blood pressure (P < 0.01). Any breastfeeding > one month was associated with a reduced risk of hypertension (adjusted risk ratio 0.84; 95% CI 0.73, 0.96, P = 0.01). Exclusive breastfeeding > one month was associated with a reduced risk of central obesity (adjusted risk ratio 0.76; 95% CI: 0.60, 0.96, P = 0.02). Any breastfeeding > 12 months was linked with a lower risk of hypertension (adjusted risk ratio 0.83; 95% CI 0.70, 0.98, P = 0.03). CONCLUSIONS: Lack of breastfeeding is associated with higher risks of central obesity and hypertension during middle childhood. As a potential component of the public health strategy to reduce population levels of metabolic and cardiovascular diseases, breastfeeding could be a vital prevention strategy.

A longitudinal study on association between puberty development and thyroid function of school aged girls in Minhang District, Shanghai / 中国学校卫生

Objective@#To observe the association between puberty development and thyroid function among school-aged girls in Minhang District of Shanghai, in order to explore the effect of puberty development on thyroid function. @*Methods@#The study was based on a cohort of adolescent girls recruited in iodine-suitable areas of Minhang District, and the baseline and follow-up survey have been carried out from January to March 2019. The method of phased cluster sampling was used to select one junior high school in the east, south, north and middle of Minhang District, Shanghai, respectively. Finally, 464 new junior high school girls were included in the Cohort study for physical examination, and girls were followed up from January to March 2021. The Puberty Development Scale (PDS) was used to assess the stage of puberty. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were determined for each participant. Thyroid homeostasis structure parameters (THSPs) was calculated. Changes of Thyroid hormones at baseline and follow-up were compared by Wilcoxon signed rank sum test. Multiple linear regression analyses were used to evaluate the associations of thyroid hormones (THs) and THSPs changes with pubertal develepment.@*Results@#Serum TSH levels of female studentds decreased significantly, while their FT3 and FT4 levels increased significantly during the study period ( Z=-10.53, -4.71, -12.46, P <0.01). In multiple linear regression analysis after adjustment for co-variables (including baseline age, change of BMI and waist circumference), FT4 and thyroid feedback quantile-based index (TFQI) in the higher puberty category scores changes (△PCS) group were further reduced compared with those in the low △PCS group ( β =-0.66, -0.55 ). Compared to the late puberty at baseline and follow-up (BLFL) group, FT4 and TFQI showed higher decline in the pre-puberty at baseline and late puberty at follow-up (BPFL) group with the pre-puberty at baseline and end of puberty at follow-up (BPFT) group ( β =-0.55, -0.44)( P <0.05). There were no association of △TSH, △FT3, △FT4/FT3 and TSH index changes (△TSHI) with △PCS or the puberty pattern.@*Conclusion@#Serum TSH decreases while serum FT3 and FT4 increase among girls during puberty. Both the initial stage and the velocity of pubertal development are related to thyroid hormone fluctuations.

Discrepancy of human papillomavirus vaccine uptake and intent between girls 9-14 and their mothers in a pilot region of Shanghai, China.

Human papillomavirus (HPV) vaccine uptake remains low in China, especially among girls. Recently, China has initiated a pilot program on HPV immunization for girls aged 9-14 years. We conducted a cross-sectional online survey in Minhang district of Shanghai, a pilot region for the program, to investigate HPV vaccination status among mothers and their daughters 9-14. A total of 1031 parents and 1122 daughters 9-14 were included. Of them, 18.6% of mothers and 4.5% of daughters had been vaccinated with HPV vaccines or made an appointment; additionally, 62.7% and 78.4% intended to receive vaccination but did not make an appointment. Notably, 6.2% of parents did not intend to receive vaccination for themselves (or their wives) but intended to vaccinate their daughters. Moreover, we calculated parental knowledge and awareness scores toward HPV infection and vaccination. Both scores were significantly higher among the parents who had received HPV vaccination than those who intended to across mothers' vaccination status (P < .001 for knowledge and P = .019 for awareness), whereas similar between the two groups across daughters' vaccination status (P = .694 and P = .737). Parents believed mothers had a significantly higher susceptibility to HPV infection and lower health consequences, compared to daughters 9-12 (P = .002 and P < .001) or those 13-14 (both P < .001). In conclusion, HPV vaccine uptake remains a discrepancy between mothers and their daughters 9-14. However, their intents to receive HPV vaccination were both high. Parental knowledge and awareness may improve vaccination intent for daughters 9-14 in China. It warrants a certain health education toward susceptibility to HPV infection and health consequences.

Longitudinal association between the timing of adiposity peak and rebound and overweight at seven years of age.

BACKGROUND: The timing of adiposity peak (AP) or adiposity rebound (AR) is a determinant of overweight or obesity in adolescence and adulthood. However, limited studies have reported the association in young school-age children. We aimed to evaluate this association and explore the role of health behaviours in it. METHODS: Routinely collected, sequential, anthropometric data from the 1st to 80th months of age were used to estimate AP and AR timings in 2330 children born in Shanghai between 2010 and 2013. Multivariate regression analyses were applied to identify the associations between the AP or AR timings and the risk of developing overweight or obesity in first-grade school children. The roles of health behaviours, including dietary patterns, physical activity level, sleep and snacking habits, and screen time, were also evaluated. RESULTS: Children with a late AP or an early AR were at higher risk of overweight but not obesity or central obesity in their first grade. A high physical activity level was associated with a lower risk of having overweight in children with a late AP, and limited screen time was associated with a decreased risk of having overweight or obesity in children with an early AR. The absence of a late-night snacking habit in children with a non-early AR indicated a decreased risk of having overweight. However, this association was not observed among children with an early AR. CONCLUSION: The timings of AP and AR are tied to overweight in middle childhood. Prevention strategies are suggested to move forward to control late AP and early AR.

Effect of breastfeeding duration on age at adiposity rebound in children / 中国学校卫生

Objective@#To explore the effect of breastfeeding duration on age at adiposity rebound, and provide a scientific theoretical basis for identifying early life factors of obesity in children and adolescents, while promoting early intervention.@*Methods@#In September 2019, first graders from a primary school in Minhang District, Shanghai, were selected to participate in this study, and their growth information was retrospectively collected. The natural cubic spline function was used to fit the body mass index trajectory of the subjects from 1 to 80 months, and age at adiposity rebound was calculated. A total of 6 148 subjects were selected, and complete data of adiposity rebound timing and breastfeeding duration were obtained. A multiple linear regression model was used to analyze the relationship between these two variables.@*Results@#The average breastfeeding duration of all children included in the study was (3.71±3.28) months, and most of the subjects (69.63% for male and 70.45% for female) were breastfed for less than 4 months. A positive linear relationship was found between them [male, B =0.16(0.02-0.30), female, B =0.34(0.18- 0.51 ), total, B =0.23(0.12-0.34), P <0.05]. The linear relationship was determined using the multivariate model.@*Conclusion@#Breastfeeding duration independently affected age at adiposity rebound. Prolonging the duration of breastfeeding within 24 months of age may help to delay the timing of adiposity rebound,and thus reduce later risks of overweight and obesity.

Influence of birth weight and infancy growth patterns on weight status among first grade primary school pupils / 中国学校卫生

Objective@#To explore the influence of birth weight and growth patterns during infancy on overweight and obesity among first grade primary school pupils, so as to provide a theoretical basis for the formulation of early life prevention and intervention policies.@*Methods@#In 2019, data related to routine physical examinations were collected for primary school pupils in the Minhang District of Shanghai, and information regarding birth and follow ups was collected retrospectively. Physical examination data of 4 434 pupils at 12 months of age were obtained. A multiple linear regression model was used to analyze the relationship between growth patterns during infancy and body mass index (BMI) in the first grade of primary school. A generalized linear model was employed to analyze the relationship between birth weight and growth patterns during infancy and overweight and obesity in the first grade of primary school. A hierarchical analysis was conducted.@*Results@#A linear relationship was observed between growth patterns during infancy and BMI and the BMI Z score of first grade primary school pupils [ β(β 95%CI)=0.30(0.24-0.35),0.12(0.10- 0.15 ), P <0.01]. In addition to subjects classified as small for gestational age (SGA), catch up growth during infancy was identified among subjects who were classified as appropriate for gestational age (AGA) and large for gestational age (LGA). LGA at birth and catch up growth during infancy were independent risk factors for overweight and obesity among first grade primary school children ( RR =1.31-1.55, P <0.05). The hierarchical analysis showed that catch up growth increased the risk of overweight and obesity among first grade primary school pupils classified as AGA [ RR(RR 95%CI )=1.74(1.42-2.14),1.87(1.56-2.26)], and increased the risk of obesity among first grade primary school pupils classified as SGA and LGA [ RR(RR 95%CI )=3.74(1.04-13.49),3.24(1.62-6.46)]( P <0.05). Among those who exhibited catch up growth during infancy, LGA increased the risk of obesity among first grade primary school pupils ( RR= 2.60 , 95%CI=1.35-5.02, P <0.01), but not the risk of being overweight ( P =0.13).@*Conclusion@#Birth weight and growth patterns during infancy have an impact on overweight and obesity among children in the first grade of primary school. It is suggested that attention should be paid to growth and physical development in early life for those classified as LGA and AGA, and catch up growth in children should be closely monitored.

Adiposity peak and rebound in early life among primary school students with different body mass index patterns / 中国学校卫生

Objective@#To explore the characteristics of the adiposity peak and rebound in early life among first year primary school students with different body weight measures, so as to provide scientific evidence for the development of prevention interventions to manage childhood overweight and obesity.@*Methods@#A total of 2 330 first year primary school students who received routine physical examinations from September to December in 2019 were selected. According to body mass index (BMI) status, participants were divided into three categories:healthy weight, overweight, and obese. The BMI growth trajectories of the three groups were fitted by gender using the generalized additive mixed model from 1 to 80 months, retrospectively. Each subject s age at the adiposity peak and rebound, and associated BMI values, were calculated.@*Results@#The prevalence of overweight and obesity was 16.31 % (380/ 2 330 ) and 16.09% (375/2 330), respectively. For first year students with obesity, the BMI value continued to be higher than their overweight or healthy weight counterparts during the first 80 months of life. The age at the adiposity peak for these students, whose BMI status varied, was about nine months. However, the BMI of children with overweight or obesity was much higher than that of healthy weight subjects. Age at adiposity rebound was 72 months for healthy weight children, 52 to 55 months in children defined as overweight, and 22 to 23 months in children with obesity. For healthy weight children, the fitted value of BMI at the adiposity rebound was less than that of overweight and obese children.@*Conclusion@#Age at the adiposity peak was largely similar among first year students with different BMI patterns; however, age at adiposity rebound was different. Age at adiposity rebound among children with obesity was much earlier than that of other subjects, and their BMI values were much higher.

Sensitivity to COVID-19 Vaccine Effectiveness and Safety in Shanghai, China.

Several COVID-19 vaccines have been on the market since early 2021 and may vary in their effectiveness and safety. This study characterizes hesitancy about accepting COVID-19 vaccines among parents in Shanghai, China, and identifies how sensitive they are to changes in vaccine safety and effectiveness profiles. Schools in each township of Minhang District, Shanghai, were sampled, and parents in the WeChat group of each school were asked to participate in this cross-sectional Internet-based survey. Parents responded to questions about hesitancy and were given information about five different COVID-19 vaccine candidates, the effectiveness of which varied between 50 and 95% and which had a risk of fever as a side effect between 5 and 20%. Overall, 3673 parents responded to the survey. Almost 90% would accept a vaccine for themselves (89.7%), for their child (87.5%) or for an elderly parent (88.5%) with the most ideal attributes (95% effectiveness with 5% risk of fever). But with the least ideal attributes (50% effectiveness and a 20% risk of fever) these numbers dropped to 33.5%, 31.3%, and 31.8%, respectively. Vaccine hesitancy, age at first child's birth, and relative income were all significantly related to sensitivity to vaccine safety and effectiveness. Parents showed a substantial shift in attitudes towards a vaccine based on its safety and effectiveness profile. These findings indicate that COVID-19 vaccine acceptance may be heavily influenced by how effective the vaccine actually is and could be impeded or enhanced based on vaccines already on the market.

Pre-Birth and Early-Life Factors Associated With the Timing of Adiposity Peak and Rebound: A Large Population-Based Longitudinal Study.

Background: The late occurrence of adiposity peak (AP) and the early occurrence of adiposity rebound (AR) are considered the earliest indicators for obesity and its related health conditions later in life. However, there is still limited information for their upstream factors. Therefore, in this study, we aimed to identify the parental and child factors associated with the timing of AP and AR in the early stage of life. Methods: This is a population-based longitudinal study conducted in Shanghai, China. The BMI data of children born between September 2010 and October 2013 were followed from birth to 80 months. Subject-specific body mass index trajectories were fitted by non-linear mixed-effect models with natural cubic spline functions, and the individual's age at AP and AR was estimated. The generalized linear regression models were applied to identify the upstream factors of late occurrence of AP and early occurrence AR. Results: For 7,292 children with estimated AP, boys were less likely to have a late AP [adjusted risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.77-0.90, p < 0.001], but preterm born children had a higher risk of a late AP (adjusted RR = 1.25, 95% CI: 1.07-1.47, p < 0.01). For 10,985 children with estimated AR, children with breastfeeding longer than 4 months were less likely to have an early AR (adjusted RR = 0.80, 95% CI: 0.73-0.87, p < 0.001), but children who were born to advanced-age mothers and who were born small for gestational age had a higher risk of having an early AR (adjusted RR = 1.21, 95% CI: 1.07-1.36, p < 0.01; adjusted RR = 1.20, 95% CI: 1.04-1.39, p = 0.01). Conclusions: Modifiable pre-birth or early-life factors associated with the timing of AP or AR were found. Our findings may help develop prevention and intervention strategies at the earliest stage of life to control later obesity and the health conditions and diseases linked to it.

Analysis of thyroid hormone level and its influencing factors among pubertal girls in Minhang District of Shanghai / 中国学校卫生

Objective@#To investigate thyroid hormone concentration and associated factors among pubertal girls in Minhang District of Shanghai.@*Methods@#From January to March 2019, a stratified sampling method was used to select junior high schools from the east, south, north, and middle areas in Minhang district. A total of 386 girls of grade 6 in selected schools were included in the study. Physical examination was conducted, and their urine and blood samples were collected to determine urinary iodine concentration (UIC) and thyroid function. Puberty Development Self-rating Scale (PDS) was used to define the pubertal stage. Logistic regression models were conducted to analyze the associations between pubertal stage and thyroid function.@*Results@#The median urinary iodine concentration was 163.57(106.57, 232.96) μg/L. The geometric mean values of TSH, TT3, FT3 and FT4 were 0.29 mU/L, 0.26 nmol/L, 0.68 pmol/L and 1.18 pmol/L.The mean value of TT4 was 91.64 nmol / L. The abnormal rates of TGAb and TPOAb were 6.22% and 4.15%. The rate of abnormal TGAb combined with abnormal TPOAb was 3.68%. Girls in puberty and post-puberty had the lower level of TT4 (OR=0.47,0.43) as compared with girls in pre-puberty stage. Obese girls had higher level of TT3(OR=9.08, 95%CI=1.52-54.07). With the increase of exercise time(0.5-1, >1 h/d), FT4 level was increased (OR=2.45, 2.19). TSH levels were significantly higher in girls with higher TGAb and TPOAb. Girls had higher TT4 or FT4 levels if their TGAb levels were higher and TPOAb levels were normal.@*Conclusion@#There is an association between pubertal stage, obesity, exercise and thyroid function in school-aged girls during puberty in iodine sufficient areas. TSH, FT4 and TT4 levels are correlated with TGAb and TPOAb levels.

The regulation of SKF38393 on the signaling pathway of dopamine D1 receptor in hippocampus during chronic sleep deprivation.

BACKGROUND: Hippocampal functions are sensitive to sleep deficiency. Dopamine D1 receptor (D1R) in hippocampus can regulate the expression of cAMP response element binding protein (CREB) through PKA, MAPK and phosphoinositide pathway, but which pathway plays the major role in hippocampus during Chronic sleep deprivation (CSD) is unclear. METHODS: The CSD model was created, SKF rats were administered the D1R agonist (SKF38363), and hippocampus from each animal was dissected for following molecular detection. The gene and protein levels of CREB and key molecules in D1R pathways were measured by real-time PCR and western blotting, respectively. RESULTS: Both the gene and protein expression of CREB in hippocampus decreased by CSD and improved significantly by SKF38393 (p<0.05). Both the gene and protein expression of PKA in hippocampus decreased by CSD and improved significantly by SKF38393 (p<0.05). SKF38393 just significantly improved the gene level of CaMK IV and the protein level of p-CaMK IV (p<0.05) in CSD rats, but it cannot improve the protein expression of ERK1/2 and p-ERK1/2. DISCUSSION: CSD significantly decreased the expression of CREB in hippocampus. As the key molecules, PKA and CaMK IV play an important role during the improvement of hippocampus by the activation of D1R, and this process might be improved during CSD through the PKA and phosphoinositide pathway.

Influence of SKF38393 on changes of gene profile in rat prefrontal cortex during chronic paradoxical sleep deprivation.

Chronic paradoxical sleep deprivation (CSD) can induce dramatic physiological and neurofunctional changes in rats, including decreased body weight, reduced learning and memory, and declined locomotor function. SKF38393, a dopamine D1 receptor agonist, can reverse the above damages. However, the mechanism of CSD syndrome and reversal role of SKF38393 remains largely unexplained. To preliminarily elucidate the mechanism of the neural dysfunction caused by CSD, in the present study we use gene chips to examine the expression profile of more than 28,000 transcripts in the prefrontal cortex (PFC). Rats were sleep deprived by modified multi-platform method for 3 weeks. Totally 59 transcripts showed differential expressions in CSD group in contrast to controls; they included transcripts coding for caffeine metabolism, circadian rhythm, drug metabolism and some amino acid metabolism pathway. Among the 59 transcripts, 39 increased their expression and 20 decreased. Two transcripts can be specifically reversed with SKF38393, one of them is Homer1, which is related to 20 functional classifications and coding for Glutamatergic synapse pathway. Our findings in the present study indicate that long-term sleep deprivation may trigger the changes of some certain functions and pathways in the PFC, and lead to the dysfunction of this advanced neuron, and the activation of D1 receptor by SKF38393 might ameliorate these changes via modulation of some transcripts such as Homer1, which is involved in the Ca(2+) pathway and MAPK pathway related to Glutamatergic synapse pathway.

Effects of chronic REM sleep restriction on D1 receptor and related signal pathways in rat prefrontal cortex.

The prefrontal cortex (PFC) mediates cognitive function that is sensitive to disruption by sleep loss, and molecular mechanisms regulating neural dysfunction induced by chronic sleep restriction (CSR), particularly in the PFC, have yet to be completely understood. The aim of the present study was to investigate the effect of chronic REM sleep restriction (REM-CSR) on the D1 receptor (D1R) and key molecules in D1R' signal pathways in PFC. We employed the modified multiple platform method to create the REM-CSR rat model. The ultrastructure of PFC was observed by electron microscopy. HPLC was performed to measure the DA level in PFC. The expressions of genes and proteins of related molecules were assayed by real-time PCR and Western blot, respectively. The general state and morphology of PFC in rats were changed by CSR, and DA level and the expression of D1R in PFC were markedly decreased (P < 0.01, P < 0.05); the expression of phosphor-PKAcα was significantly lowered in CSR rats (P < 0.05). The present results suggested that the alteration of neuropathology and D1R expression in PFC may be associated with CSR induced cognitive dysfunction, and the PKA pathway of D1R may play an important role in the impairment of advanced neural function.