Association between maternal urinary selenium during pregnancy and newborn telomere length: results from a birth cohort study.

BACKGROUND: Newborn telomere length is considered as an effective predictor of lifespan and health outcomes in later life. Selenium is an essential trace element for human health, and its antioxidation is of great significance for the prevention of telomere erosion. METHODS: We recruited 746 mother-newborn pairs in Wuhan Children's Hospital between 2013 and 2015. Urine samples were repeatedly collected at three time points during pregnancy, and umbilical cord blood samples were collected right after parturition. Urinary selenium concentration was detected using inductively coupled plasma mass spectrometry, and newborn telomere length was measured using quantitative real-time polymerase chain reaction. We applied general estimating equations to examine the trimester-specific association between maternal urinary selenium during pregnancy and newborn telomere length. RESULTS: The median of creatinine-corrected selenium concentrations during pregnancy were 16.29, 18.08, and 18.35 µg/g·creatinine in the first, second, and third trimesters, respectively. Selenium concentrations in all the three trimesters were significantly associated with newborn telomere length. Per doubling of maternal urinary selenium concentrations was associated with 6.44% (95% CI: 0.92, 12.25), 6.54% (95% CI: 0.17, 13.31), and 6.02% (95% CI: 0.29, 12.09) longer newborn telomere length in the first, second, and third trimesters, respectively, after adjusting for potential confounders. CONCLUSIONS: This is the first study to provide evidence for the effect of maternal selenium levels on fetal telomere erosion. Findings from our study suggested that maternal urinary selenium was positively associated with newborn telomere length, indicating that intrauterine selenium exposure might have effect on initial setting of human telomere length.

Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes.

CONTEXT: Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence regarding the association between higher glycated hemoglobin A1c (HbA1c) within the normal range and adverse birth outcomes is limited. OBJECTIVE: We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. DESIGN AND SETTING: The data were abstracted from the Information System of Guangdong Women and Children Hospital, China, from September 2014 to March 2018. PATIENTS: A total of 5658 pregnant women with normal gestational HbA1c were included in this analysis. MAIN OUTCOME MEASURES: The adverse birth outcomes include preterm birth, macrosomia, and large for gestational age (LGA). RESULTS: Among 5658 subjects, the rates of preterm birth, macrosomia, and LGA were 4.6% (261/5658), 3.5% (200/5658), and 5.7% (325/5658), respectively. The results of multivariate logistic regression model showed that each 1% increase in maternal HbA1c was positively associated with increased risks of preterm birth (OR 1.58; 95% CI, 1.08-2.31), macrosomia (OR 1.70; 95% CI, 1.10-2.64), and LGA (OR 1.38; 95% CI, 0.98-1.96). The association between gestational HbA1c and preterm birth was more evident among women with prepregnancy body mass index (BMI) ≤ 24 kg/m2. CONCLUSIONS: Gestational higher HbA1c level within the normal range is an independent risk factor for preterm birth, macrosomia, and LGA. Intervention for reducing HbAc1 may help to prevent adverse birth outcomes.

Association of dietary selenium intake with telomere length in middle-aged and older adults.

BACKGROUND: Growing evidence suggested that lifestyle factors including dietary habits may influence the telomere length which is a reliable marker of biological aging and predictor for chronic diseases. However, the role of dietary selenium intake in telomere length maintenance is rarely examined. OBJECTIVE: We aimed to test the relationship between dietary selenium intake and telomere length among middle-aged and older adults in America. METHODS: A total of 3194 United States adults older than 45 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) in 1999-2000 and 2001-2002. Leukocyte telomere length was measured using the quantitative real-time polymerase chain reaction (qPCR). Dietary selenium intake was assessed by a trained interviewer using 24-h dietary recall method. Generalized linear models were performed to evaluate the association of dietary selenium intake with telomere length. The restricted cubic spline analysis was used to further explore the nonlinear dose-response relationship between dietary selenium intake and telomere length. RESULTS: After adjusting potential confounders, every 20 µg increase in dietary selenium intake was associated with 0.42% (95% CI: 0.02%, 0.82%) longer telomere length in all participants. In the subgroup analyses, dietary selenium intake was related to longer telomere length in females (Percentage change: 0.87%; 95% CI: 0.26%, 1.49%) and non-obese participants (Percentage change: 0.53%; 95% CI: 0.04%, 1.02%), but not in males (Percentage change: 0.04%; 95% CI: -0.49%, 0.57%) and obese participants (Percentage change: 0.21%; 95% CI: -0.47%, 0.91%). The restricted cubic spline analysis showed a linear association between dietary selenium intake and telomere length. CONCLUSIONS: This study indicated that the increased dietary selenium intake was associated with longer telomere length among middle-aged and older adults in America. These findings require further corroboration from future prospective studies.

Exposure to arsenic during pregnancy and newborn mitochondrial DNA copy number: A birth cohort study in Wuhan, China.

BACKGROUND: Arsenic (As) is a widely distributed environmental chemical with potentially different toxicities. However, little is known about the impact of maternal As exposure on newborn mitochondrial DNA copy number (mtDNAcn), which may lie on the pathway linking As exposure to adverse health impacts. OBJECTIVES: We aimed to explore whether maternal As exposure was associated with newborn mtDNAcn. METHODS: We conducted a birth cohort study of 762 mother-infant pairs in Wuhan, China, 2013-2015. Cord blood mtDNAcn was determined using qPCR. Maternal urinary As levels in each trimester were quantified by ICP-MS. Multiple informant models were used to examine the associations of repeated urinary As levels with cord blood mtDNAcn. RESULTS: The median urinary As levels in the first, second, and third trimesters were 17.2 µg/L, 16.0 µg/L, and 17.0 µg/L, respectively. In the multivariate model, each doubling increase in the first-trimester urinary As level was associated with a 6.6% (95% CI: -12.4%, -0.5%) decrease in cord blood mtDNAcn. The highest versus lowest quintile of first-trimester urinary As level was associated with a 19.0% (95% CI: -32.9%, -2.2%) lower cord blood mtDNAcn. No significant associations of urinary As levels in the second and third trimesters with cord blood mtDNAcn were observed. The inverse relationship between first-trimester urinary As level and cord blood mtDNAcn was more pronounced among female infants. CONCLUSIONS: First-trimester As exposure was related to decreased cord blood mtDNAcn. The potential health impacts of decreased mtDNAcn in early life need to be further clarified.

Prenatal exposure of rare earth elements cerium and ytterbium and neonatal thyroid stimulating hormone levels: Findings from a birth cohort study.

BACKGROUND: Prior studies have suggested exposure to heavy metals and endocrine disrupting chemicals could disturb the homeostasis of thyroid stimulating hormone (TSH), but no epidemiology study concerning the influence of rare earth elements (REE) exposure during pregnancy on neonatal TSH levels. The present study aimed to investigate the relationships between prenatal REE exposure and neonatal TSH levels. METHODS: A total of 7367 pregnant women were recruited from Wuhan Children's Hospital between September 2012 and October 2014 in Wuhan, China. Urinary concentrations of cerium (Ce), and ytterbium (Yb) were measured by inductively coupled plasma mass spectrometry (ICP-MS). Immunofluorescence assay was used to detect neonatal TSH levels. The associations between REE exposure and neonatal TSH levels were evaluated using multivariate linear regression models. RESULTS: The geometric means of maternal urinary Ce and Yb concentrations were 0.060 µg/g creatinine and 0.025 µg/g creatinine, respectively. The results showed that per doubling of maternal urinary Ce and Yb were associated with 4.07% (95% CI: -5.80%, -2.31%), 5.13% (95% CI: -6.93%, -3.30%) decreased neonatal TSH levels respectively in the adjusted model. Sex stratified analysis demonstrated that the decreased neonatal TSH levels were observed both in male infants and female infants, and the decrease was greater in male infants in urinary Ce. There were no significant interactions between maternal urinary Ce, Yb and infant sex (Ce: P for interaction = 0.173, Yb: P for interaction = 0.967). CONCLUSIONS: Our findings demonstrated that increased maternal urinary Ce and Yb were associated with decreased neonatal TSH levels. Further researches from different populations are warranted to verify the association and to explore the mechanisms.

Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children.

BACKGROUND: Childhood trauma has been regarded as a risk factor for adolescent depression. Resilience has been found to be a protective factor for adolescent mental health. However, it is not clear about the role of resilience in the relationship between childhood trauma and depression. METHODS: School attending adolescents (n=6406) aged 9-17 years were drawn from five primary schools, three middle schools and two high schools in Wuhan city of China in 2015. The participants were invited to complete self-report questionnaires, including demographics, childhood trauma, resilience and depressive symptoms. RESULTS: Resilience played a partially mediating role in the relationship between childhood trauma and depressive symptoms. Resilience also moderated the association of childhood trauma with depressive symptoms. LIMITATION: The limitations of this study include cross-sectional study and self- reported instruments. CONCLUSIONS: We conclude that resilience may play an important role in the relationship between childhood trauma and depressive symptoms. Our results suggest that enhancing resilience may provide new possibilities for prevention and intervention of depression in adolescents.

[Association between mothers' body mass index before pregnancy or weight gain during pregnancy and autism in children].

OBJECTIVE: To explore the relationship between mothers' body mass index (BMI) before pregnancy or weight gain during pregnancy and autism in children. METHODS: From 2013 to 2014, the 181 children with autism and 181 healthy children matched by sex and age from same area were included in this study. According to mothers' BMI before pregnancy, the selected cases were divided into 3 groups: low, normal and high group. Then 3 groups were divided into 3 subgroups based on mother' s weight gain during pregnancy: low, normal and high group, according to the recommendations of Institute of Medicine. Logistic regression analysis and χ(2) test were conducted with SPSS 18.0 software to analysis the relationship between mothers' BMI before pregnancy or weight gain during pregnancy and autism in children. RESULTS: The age and sex distributions of case group and control group were consistent (χ(2)=0.434, P>0.05). The mothers' BMI before pregnancy of case group was higher than that of control group (χ(2)=9.580, P<0.05) ,which was (21.28±3.80) kg/m(2) for case group and (19.87±2.83) kg/m(2) for control group. The proportion of cases in high BMI group (10.5%) was much higher than that in control group (2.8%) . The risk of children with autism in high BMI group was 3.7 times higher than that in normal BMI group (OR=3.71, 95% CI: 1.34-10.24). In normal BMI group, the proportion of mothers who had excessive weight gain during pregnancy was higher in case group (44.1%) than in control group (33.9%). In high BMI group, the proportion of mothers who had excessive weight gain was higher in case group (52.6%) than in control group (20.0%) . In normal BMI group (χ(2) =8.690, P<0.05) and high BMI group (χ(2)=4.775, P<0.05), the weight gain during pregnancy was associated with autism in children. Logistic regression analysis showed that mothers' BMI before pregnancy (unadjusted OR=1.89, 95% CI: 1.26-2.85, adjusted OR=1.52, 95% CI: 1.19-2.27) and weight gain during pregnancy were the risk factors for autism in children (unadjusted OR=1.63, 95% CI: 1.08-1.25, adjusted OR=1.64, 95% CI: 1.21-2.21). CONCLUSION: Overweight or obesity before pregnancy and excessive weight gain during pregnancy were associated with autism in children, suggesting that women who plan to be pregnant should pay attention to body weight control.

[Association between guardian's first notice of autism symptom of children and time to seek medical care].

OBJECTIVE: To understand the symptoms of autism of children that caused the first notice of guardian, related risk factors and the influence on the time to seek medical care. METHODS: The children with autism aged <5 years were selected from autism rehabilitation centers in Wuhan, Changsha, Haikou, Liuzhou and Changsha between September 2012 and April 2014, and their guardians were retrospectively surveyed by using questionnaire. SPSS 13.0 software was used for statistical analysis. RESULTS: A total of 415 children with autism were included in the study. Including 355 boys (85.54%) and 60 girls (14.46%), the sex ratio was 5.9 : 1. The most common concern of guardian were: language dysplasia (20.72%); ignoring of people or lack of interaction with others (18.55%); repeat and weird action pattern (14.94%). The age when the first symptom occurred, which causing guardians' concern, ranged from 8 months to 28 months, the time when guardian began to concern varied with symptom (χ² =46.64, P<0.000 1). Guardian's educational level, guardian's contact time with the children, guardian's intimate degree with the children, the age of guardian, family type and tie had no statistical association with the fist autism symptom that caused guardian's concern. The age of the children at first medical care seeking ranged from 10.5 months to 33 months, the time of the first medical care seeking varied with symptom (χ² =46.10, P<0.000 1). Up to 90.74% of the guardians delayed the medical care seeking of the children with autism, but the symptom specific differences in medical care delay had no statistical significance (χ² =9.46, P=0.579 6). CONCLUSION: The symptom of the children with autism causing guardian's first notice were mainly verbal communication barrier, social interaction barrier and restricted interests and behaviors. Guardian's educational level and intimate degree with children had no correlation with the symptom which caused guardian's first notice. The time when guardian began to concern and the time for children's medical care varied with guardian's first notice.

[1:2 matched case-control study on the risk factors related to congenital heart disease during the peri-conceptional period].

OBJECTIVE: To explore the possible risk factors during the periconceptional period relevant on the occurrence of congenital heart diseases (CHD) in the offspring. METHODS: A 1:2 matched case-control study was designed. From January 2012 to January 2014 in a district from Wuhan city, HuBei province, children were proved by MCH institutions through the "free screening for congenital heart disease" program. Cases with CHD were screened out by conventional auscultation, echocardiography figure and confirmed by physicians from the high-level hospitals. According to age, gender, community paired healthy children were chosen as controls. EpiData 3.1 software was used to input data, using SPSS 11.5 software to analyze the possible risk factors under simple and multiple factors logistic regression. RESULTS: Information from parents of 138 cases and 276 controls was collected. 27 major factors from the conditional logistic regression analysis showed that factors as:mental stress during early pregnancy, calcium supplement in the early stage of pregnancy, pregnancy malnutrition, having histories of abnormal childbearing, women with multiparous experiences and residence nearby sources of pollution (enterprises) etc. were associated with the incidence of congenital heart disease in the offspring. Data from the multivariate logistic regression analysis showed that factors as:mental stress during early pregnancy (HR = 3.35, 95%CI: 1.28-8.79), pregnancy malnutrition during pregnancy (HR = 1.50, 95% CI:1.10-2.03) and with abnormal childbearing history (HR = 1.62, 95% CI:1.03-2.57) were risk factors. However, calcium supplement during early pregnancy (HR = 0.40, 95% CI:0.25-0.65) could reduce the risk of CHD. CONCLUSION: The occurrence of CHD might be related to factors as:mental stress during early pregnancy, calcium supplement during early pregnancy, pregnancy malnutrition and having histories of abnormal childbearing. Peri-conceptional care should be strengthened to reduce the incidence of congenital heart disease.

Head circumference growth reference charts of children younger than 7 years in Chinese rural areas.

BACKGROUND: The head circumference growth reference charts for children in China are presently based on urban children. However, the references may not apply to rural children because of the differences between urban and rural areas, such as economy, culture, and dietary habits. Our objective was to provide a reliable continuous set of head circumference growth reference charts for male and female children less than 7 years of age in Chinese rural areas. METHODS: Children in our study were identified by multistage stratified cluster sampling from rural areas of 10 provinces in China. Questionnaire survey and anthropometric measurements were conducted in data collection. Head circumference was measured with a nonelastic tape on a line passing over the glabella and posterior occipital protrusion in children. We compared the fiftieth percentile of our cross-sectional data with the data of Chinese cities, World Health Organization, and the United States. RESULTS: A total of 95,904 children (48,722 boys and 47,182 girls) were included in the study. We present age- and sex-appropriate head circumference growth charts younger than 7 years for Chinese rural areas. The head circumference percentiles of the children in rural China are much smaller than the children in Chinese urban areas, World Health Organization, and the US percentiles after 2 years old. CONCLUSIONS: Head circumference percentiles can be applied in growth monitoring, but current head circumference growth references promulgated in urban China may not be suitable for rural areas in China. Providing head circumference growth reference charts for rural Chinese children who are younger than 7 years old is very important.

[Prenatal factors associated with high BMI status of infants and toddlers].

OBJECTIVE: To explore prenatal related factors of high BMI status in children at 1 and 2 years of age. METHOD: A total of 2 220 newborns from Shenyang, Wuhan and Guangzhou were recruited in this birth cohort, thereafter they were followed up to two years of age.Self-administered questionnaires were used to collect such variables as social-demographic characteristics and feeding practice, etc. The anthropometric measures of children were collected by trained health staff. The data were subjected to multiple logistic regression analysis to determine the related factors for high BMI among infants and toddlers. RESULT: The number of children with high BMI status were 550 (32.80%) at one year of age and 309 (26.23%) at two, respectively. The number of boys with high BMI status were 178 and girls 309 at age two years. The prevalence of high BMI status among boys (29.1%) at age two was significantly higher than that of girls (23.1%) (χ² = 5.52, P = 0.02). Logistic regression analysis showed that after the adjustment for sex, parental educational level, family economic status and other confounding factors, maternal passive smoking during pregnancy [OR:aged one:1.38 (1.05-1.82);aged two:1.48 (1.05-2.09)], maternal pre-pregnancy overweight and obesity [aged one:1.29 (1.05-1.58); aged two:1.35 (1.04-1.76)], paternal overweight and obesity [aged one:1.50 (1.21-1.87); aged two:1.47 (1.11-1.95)] and birth weight [aged one:1.53 (1.05-1.82); aged two:1.87 (1.33-2.63)]were identified to be associated with high BMI status in children. CONCLUSION: Maternal passive smoking during pregnancy, paternal and maternal (pre-pregnancy) overweight or obesity and high birth weight are found to be important related factors for high BMI status in young children. Childhood overweight/obesity prevention should be considered starting as early as before pregnancy.

[Survey on overweight and obesity of preschool children in rural areas from ten provinces of China].

OBJECTIVE: To analyze the status of overweight and obesity among preschool children in rural areas of ten provinces in China. METHODS: Using data from "Physical development of rural children under the age of 7 from ten provinces of China in 2006", preschool children were selected as the object of study. Overweight, mild obesity, moderately obese, severe obesity were defined as:weight was over 10%, 20%, 30%, 50% than the same sex under height population reference mean. SPSS 13.0 software was used for statistical analysis. χ² test was used to compare rates. RESULTS: A total number of 38 923 preschool children were included in the study. The overall prevalence of overweight was 4.18%, with boy's higher than girl's (χ² = 4.343 6, P = 0.037 1) and the highest rate of overweight (5.80%) was seen in the 3-year-old group. The overall prevalence of obesity was 1.21% , with majority as mild (0.78%). There was no significant difference between boys and girls (χ² = 0.389 0, P = 0.532 8). The 6 to 7 year old group had the highest rate of obesity (1.42%). In the ten provinces, the prevalence rates of overweight were 1.38%-7.62% and the obesity were 0.57%-3.08% . The prevalence rates of overweight and obesity showed the highest in Jilin and lowest in Guangxi. CONCLUSION: The overall prevalence rates of overweight and obesity among preschool children in rural areas of China were low, with 3 to 4-year-olds appeared in the age of high incidence of overweight and obesity. The overall prevalence rates of overweight and obesity in northern area were higher than in other areas.

[Study on the psychological-health status and its relationship with social capital among left behind children in rural area, Macheng, Hubei province].

OBJECTIVE: To understand the status of mental health among left-behind children in rural area and to explore its relationship with social capital. METHODS: A sample of 1 031 left behind children, aged 10-18 years, was randomly selected from six schools of two townships in Macheng city of Hubei province where large number of rural parents were working in the urban area. Data from a cross-sectional survey was collected among the sampled students from primary, middle and high schools, using self-designed questionnaires which targeting the 'left-behind' condition and social capital Mental Health Inventory of Middle-School Students (MMHI-60). Chi-square test was used to compare the differences in mental health among different groups. Spearman correlation and logistical regression analysis were applied to assess the relationship between social capital and mental health. RESULTS: The prevalence of mental problems was 54.12%. Results from linear χ² test indicated that the detection rates of mental problems were parallel with the monthly pocket money and the reduction in the frequency of contacting migrant father/mother (P < 0.01). Results from the multiple logistic regression analysis indicated that students who were senior(OR = 2.410-2.682, P < 0.001), and who reported not caring about their parents (OR = 2.048-2.420, P < 0.001)were at increased risks for mental health problems. After controlling the demographic characteristics and conditions of staying relevant factors, family social capital(OR = 0.845, 95%CI:0.801-0.891), neighborhood social capital (OR = 0.867, 95%CI:0.826-0.910)and school social capital(OR = 0.893, 95%CI:0.863-0.923) were all associated with declined risks of mental health problems, in which the family social capital was the most important one. CONCLUSION: The prevalence of mental health problems was high among the left-behind children in rural area. Much attention should be paid to assist these children in improving their mental health status. One promising approach appeared to be improving social capitals which would include family social capital, neighborhood social capital, and school social capital to assist these children from avoiding mental health problems.

[Duration of breastfeeding and its relevant influencing factors on under 2-years-old in rural areas of 10 provinces in China].

OBJECTIVE: To understand the current status and relevant factors influencing the duration of breastfeeding in rural areas in China. METHODS: Children under two years old were selected as subjects from the study on "Physical growth among the under 7-years-old children from the rural areas of ten provinces in China in 2006". Kaplan-Meier method was used to estimate the survival curves and Cox multivariate stepwise regression was used to identify the relevant factors on the duration of breastfeeding. RESULTS: Median of the duration for breastfeeding was 12 months in rural areas of 10 provinces in China. Results of this study suggested that factors as sex, birth order, areas of residency, nationality, initiation of formula, parents' education levels, maternal services and family income were correlated with the duration of breastfeeding. CONCLUSION: Duration of breastfeeding among rural children under 2-years of age was short in the 10 provinces of China. Factors as level of education, residential areas and family income of the parents as well as sex of the children were correlated with the duration of breastfeeding. Intervention program should be implemented to improve the current status on breastfeeding.

Agricultural exposures and farm-related injuries among adolescents in rural China.

This cross-sectional study explored the incidence of farm injuries and the relationship between agricultural exposures and injury among 2053 adolescents aged 13-19 years in Macheng, China. A comprehensive self-administered questionnaire was given to adolescents. The cumulative incidence rate of farm injury was 19.8%. Adolescents who were male, aged 10-15 years, left behind, working more days each month and living on the plains, reported higher rates. Specific agricultural exposures, such as large animals, pesticides and operating farm machinery were associated with higher injury rates. Prevention programmes are needed to reduce farm injuries.

[Influencing factors on underweight and stunting among children aged 0 - 3 years in rural areas from ten provinces in China].

OBJECTIVE: To analysis the influencing factors on underweight and stunting among children aged 0 - 3 years in rural areas from ten provinces in China. METHODS: Children under study were identified by multi-stage stratified cluster from rural areas of ten provinces in China. The ascertainment methods mainly included questionnaire and anthropometric measurements. RESULTS: There were 58 926 children under investigation, with 50.91% were boys. The overall rates on underweight and stunting were 5.05% and 10.49% respectively. The rate in the 6 month-olds (1.97%, 3.79%) was the lowest, while the highest were in the 24 month-olds (7.80%) and the 36 month-olds (16.83%). Age, sex, birth weight, gestational weeks as well as maternal education and fathers' schooling were factors significantly related to childhood underweight and stunting (P < 0.0001). CONCLUSION: The status of underweight and stunting among children aged 0 - 3 years in rural areas was impressive, with birth weight was the key factor influencing the growth of children. Perinatal health care should be improved to promote the growth of children.

Undernutrition status of children under 5 years in Chinese rural areas - data from the National Rural Children Growth Standard Survey, 2006.

PURPOSE: To assess the nutritional status among rural children under five years in China relative to WHO Child Growth Standards 2006, and to explore risk factors for undernutrition. DESIGN: Cross-sectional study of rural areas in 10 provinces of China. A total of 84,009 children under five recruited through multi-level sampling. MAIN FINDINGS: A total of 17.92% of children have at least one form of undernutrition. The prevalence of stunting, underweight and wasting, were 14.59%, 7.19% and 3.07%, respectively. The corresponding mean z-score in height-for-age, weight-for-age, and weight-for-height were -0.732, -0.410 and -0.001. An upward trend with age in stunting and underweight was observed, and higher risks noticed among older children in contrast with children under 6 months in terms of stunning and underweight. The inter-provincial variation of undernutrition remains very large. Low birth weight, multi parity, preterm birth, multiple birth, maternal illiteracy, low provincial GDP, and low household income are identified as significant factors associated with stunting. Parity shows no corresponding significant relationship with underweight, and wasting was not found to be associated with either preterm or multiple births. CONCLUSION: The nutritional status among children under five in rural areas of China, although greatly improved in the past decades, still lags behind the WHO Child Growth Standards. Stunting and underweight occur mostly before two years of age. Intervention strategies and programs should be developed to target the preventable risk factors.

[Study on nonfatal injuries among home-stranded children in rural environment of Hubei province].

OBJECTIVE: To understand the characteristics of nonfatal injuries among home-stranded children in the rural environment of Hubei province, and to evaluate the effect on child injury due to their parents going out for work. METHODS: Cross-sectional study and cluster sampling surveys were applied in September 2006 to survey students in six schools in Macheng city, Baiguo town and Songpu town. RESULTS: 3019 students were surveyed, 1182 students were home-stranded children, constituting a rate to 39.15%. Male and female children accounted for 61.51% and 38.49% of students respectively. The rates of home-stranded male and female students were 39.92% and 37.98% respectively. Home-stranded students who had both parents accounted for a 62.29%, and those who had one parent at home accounted for 37.71%. Among these students, the total injury rate was 179.1 per thousand, while for home-stranded children it was 253.0 per thousand. Male home-stranded children had the highest injury rate, higher than the rate for females. The three leading causes of injury were fall (84.6 per thousand), mechanical (40.6 per thousand) and animal related injures (36.4 per thousand). The main injury sites were at home, school and on the street. The total length of stay in the hospital was 208 days, and the total cost was RMB 47 268 Yuan, and the average cost per person was RMB 201 Yuan. CONCLUSION: There was a high proportion of home-stranded children in school of Macheng and two towns. Injuries were more serious than general students. It causes a high injury burden to these home-stranded children. It is important to pay close attention to these children and to improve their safety.

Study on self-consciousness of children with learning disabilities and related factors.

OBJECTIVE: To study the self-consciousness of children with learning disabilities (LD) and to identify related factors. METHODS: Five hundred and sixty pupils graded from 1 to 6 in an elementary school were investigated. According to the pupil rating scale revised screening for learning disabilities (PRS), combined Raven's test (CRT) and achievement of main courses, 35 of 560 pupils were diagnosed as LD children. Thirty-five children were selected from the average children and 35 from advanced children in academic achievement equally matched in class, gender, and age with LD children as control groups. The three groups were tested by Piers-Harris children's self-concept scale. Basic information of each subject was collected by self-made questionnaire. RESULTS: Compared with the average and advanced children, LD children got significantly lower scores in self-concept scale. Based on logistic regression analysis, 3 factors were identified, including family income per month, single child and delivery model. CONCLUSION: The results suggest that self-consciousness of children with LD is lower than that of normal children.