Dietary pattern and risk of hyperuricemia: an updated systematic review and meta-analysis of observational studies.

Objectives: The associations of posteriori dietary patterns with the risk of hyperuricemia (HUA) are contradictory. Several fair-quality observational studies with inconsistent results have been published following a prior review. Herein, we carried out an updated systematic review and meta-analysis to quantitatively analyze the aforementioned relationships. Methods: Our analysis protocol has been registered with PROSPEPO (Number: CRD42022376745). English publications were searched in Embase, PubMed, and Web of Science from inception to January 1, 2024. Summary odds ratio (OR) and 95% confidence intervals (CIs) were calculated by a random-effects model. We also conducted subgroup, sensitivity, and meta-regression analyses and publication bias assessments. Results: Thirteen studies with a total of 163,192 participants were included in the current meta-analysis. Our finding revealed that the plant-based pattern was linked with a 17% decreased risk of HUA (OR = 0.83, 95%CI = 0.72-0.94, I2 = 72.9%, n = 10). There was no evidence of publication bias in the present analysis. The results of subgroup analyses were generally consistent with the main findings. In meta-regression analyses, no evidence of heterogeneity was detected in the subgroups. Furthermore, our analyses indicated that the animal-based food pattern (OR = 1.36, 95%CI = 1.25-1.47, I2 = 26.7%, n = 11) and sweet food pattern (OR = 1.24, 95%CI = 1.06-1.46, I2 = 0, n = 2) was related to an increased risk of HUA. Conclusion: The plant-based pattern is inversely correlated with HUA risk, whereas animal-based food patterns and sweet food patterns are positively correlated with HUA risk.

Cluster randomised controlled trial to assess a tailored intervention to reduce antibiotic prescribing in rural China: study protocol.

INTRODUCTION: Up to 80% of patients with respiratory tract infections (RTI) attending healthcare facilities in rural areas of China are prescribed antibiotics, many of which are unnecessary. Since 2009, China has implemented several policies to try to reduce inappropriate antibiotic use; however, antibiotic prescribing remains high in rural health facilities. METHODS AND ANALYSIS: A cluster randomised controlled trial will be carried out to estimate the effectiveness and cost effectiveness of a complex intervention in reducing antibiotic prescribing at township health centres in Anhui Province, China. 40 Township health centres will be randomised at a 1:1 ratio to the intervention or usual care arms. In the intervention group, practitioners will receive an intervention comprising: (1) training to support appropriate antibiotic prescribing for RTI, (2) a computer-based treatment decision support system, (3) virtual peer support, (4) a leaflet for patients and (5) a letter of commitment to optimise antibiotic use to display in their clinic. The primary outcome is the percentage of antibiotics (intravenous and oral) prescribed for RTI patients. Secondary outcomes include patient symptom severity and duration, recovery status, satisfaction, antibiotic consumption. A full economic evaluation will be conducted within the trial period. Costs and savings for both clinics and patients will be considered and quality of life will be measured by EuroQoL (EQ-5D-5L). A qualitative process evaluation will explore practitioner and patient views and experiences of trial processes, intervention fidelity and acceptability, and barriers and facilitators to implementation. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Biomedical Research Ethics Committee of Anhui Medical University (Ref: 20180259); the study has undergone due diligence checks and is registered at the University of Bristol (Ref: 2020-3137). Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals in China, the UK and internationally. TRIAL REGISTRATION NUMBER: ISRCTN30652037.

The association between essential trace element mixture and cognitive function in Chinese community-dwelling older adults.

BACKGROUND: The evidence about the effect of essential trace element (ETE) mixture on cognitive function amongst older adults is limited. This study aims to evaluate the associations of single ETEs and ETE mixture with cognitive function using a representative sample of community-dwelling older adults in China. METHODS: A total of 3814 older adults were included in the study. Urinary concentrations of selenium (Se), vanadium (V), cobalt (Co), strontium (Sr), and molybdenum (Mo) were detected by inductively coupled plasma mass spectrometry. Cognitive function in older adults was assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Linear regression and Bayesian kernel machine regression (BKMR) were performed to explore the associations of single ETEs and ETE mixture with cognitive function, respectively. RESULTS: Linear regression showed that urinary levels of Se and V were positively associated with MMSE scores in the adjusted single-element models. BKMR also showed marginally positive associations of Se and V with MMSE scores. Moreover, higher urinary levels of ETE mixture were significantly associated with increased MMSE scores in a dose-response pattern, and Se was the most important contributor within the mixture. Both Se and V demonstrated positive additive effects on the associations of other ETEs with MMSE scores, whereas Co had a negative additive effect. CONCLUSIONS: V and Se are positively associated with cognitive function, individually and as a mixture. ETE mixture exhibits a linear dose-response association with improved cognitive function, with Se being the most important component within the mixture. Mixture analyses rather than single ETE analyses may provide a real-world perspective on the relationship between ETE mixture and cognitive function. Further cohort studies are needed to clarify the association of multiple ETEs with cognitive function.

Meta-analysis of the mental health status of left-behind children in China.

The aims of this study were to systematically evaluate and comparatively analyse the mental health status of left-behind children (LBC) in China and to provide a scientific basis for mental intervention and healthy education for LBC. Six electronic databases were searched for studies (published from 1 January 2010 to 5 March 2018) of the mental health of LBC using the Mental Health Test scale. We only selected original articles that either reported the incidence of serious mental health status or the means and standard deviations of each factor score of the scale. The pooled rates and weighted mean difference were calculated. The results indicated that the incidence of serious mental health status of LBC is nearly 2.7 times higher than that of non-LBC. The scores for most of the factors analysed by the Mental Health Test of LBC were higher than those of non-LBC. In addition, the mental health status of left-behind girls is worse than that of left-behind boys. Except for impulsive tendency, there was no significant difference in the mental health status of LBC in primary and junior high schools. In terms of the different types of guardianship, the mental health status of LBC under a grandparent's guardianship and parental peer' guardianship is more serious than that of LBC under a single-parent guardianship. The mental health status of LBC is poor, particularly for left-behind girls. The primary mental problems faced by LBC are learning anxiety, social anxiety and physical symptoms. It is necessary to develop more targeted measures to prevent and manage LBC.

The resilience status of Chinese left-behind children in rural areas: a meta-analysis.

The resilience has become the main trend of the left-behind children's (LBC) mental health research. To evaluate the resilience status of Chinese LBC in rural areas, a meta-analysis was performed. Relevant studies were identified using electronic databases from 1990 to 2017. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) were calculated with fixed and random effects models. A total of 14 cross-sectional studies with 9777 individuals were included in this meta-analysis. The results showed there was significant difference in the aspects of family support and RSCA (Resilience Scale for Chinese Adolescents) total score between LBC and non-left-behind children (NLBC). After stratification subgroup, significant difference in RSCA total score was also found in subgroup with sample size ≥700 and target population (LBC) between LBC and NLBC. In addition, there was no significant difference in resilience of male and female among LBC (P >0.05). We also found RSCA total score of LBC whose one parents migratingwere higher than both parents (P <0.05) and the time of parental migration (≤2 years) were higher than others (>2 years). In conclusion, more attention should be paid to the LBC, especially both parents migrating or parental migration (>2 years).

Association between circulating leptin levels and multiple sclerosis: a systematic review and meta-analysis.

AIM: Leptin, synthesised by adipocytes, has been identified as a hormone that can influence inflammatory activity. Several studies have investigated leptin levels in patients with multiple sclerosis (MS), but the results are not consistent. This study aims to derive a more precise evaluation on the relationship between circulating leptin levels and MS. DESIGN: A comprehensive literature searched up to July 2017 was conducted to evaluate the association of circulating leptin levels and MS. The random-effect model was applied to calculate pooled standardised mean difference (SMD) and its 95% CI. MAIN OUTCOME MEASURES: Circulating leptin levels of patients with MS and healthy controls. RESULTS: Of 2155 studies identified, 33 met eligibility criteria and 9 studies with 645 patients with MS and 586 controls were finally included in the meta-analysis. Meta-analysis revealed that, compared with the healthy control group, the MS group had significantly higher plasma/serum leptin levels, with the SMD of 0.70% and 95% CI (0.24 to 1.15). Subgroup analyses suggested that the leptin levels of patients with MS were associated with region, age, study sample size, measurement type, gender and blood sample type. CONCLUSION: Overall, our study suggests that patients with MS have a significantly higher leptin level than in healthy controls. Further mechanism studies and longitudinal large cohort studies are still needed to further reveal the role of leptin in the pathogenesis of MS.

Systematic review and meta-analysis found higher levels of behavioural problems in male left-behind children aged 6-11 years.

AIM: Left-behind children (LBC) now account for more than 1 in 5 Chinese children, and they often suffer from behavioural problems when their parents leave their rural homes to seek work in urban areas. The primary aim of this meta-analysis was to compare the incidence rates and factor scores of behavioural problems in LBC, who now account for more than one-fifth of Chinese children, and non-LBC. METHODS: This systematic review and meta-analysis explored the children's characteristic behavioural problems using the Achenbach Child Behaviour Check List. A subgroup analysis was conducted to compare the different behavioural problems of LBC with different characteristics. The meta-analysis assessed 1405 papers and analysed 13 papers from 2007 to 2015, covering 10 264 LBC and 8909 non-LBC from 2 to 19 years of age. RESULTS: The incidence rates of behavioural problems were higher in LBC than non-LBC. The highest risks were noted in boys aged between 6 and 11 years of age, who were more likely to be withdrawn and be affected by somatic complaints, schizophreniform disorder, compulsive behaviour and depression. CONCLUSION: Interventions and policies are urgently needed to tackle behavioural issues among LBC, especially high-risk males aged 6-11 years.

The association between vitamin D level and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: An update systematic review and meta-analysis.

AIM: Recently, increasing studies have been carried out to explore the association between vitamin D level and the development of diabetic peripheral neuropathy (DPN) in patients with diabetes mellitus (DM). However, because of the shortcoming in study design and sample size, there is still no clear conclusion. We performed this meta-analysis to examine the exact impact of vitamin D deficiency on DPN in type 2 diabetic patients. METHODS: Various databases were searched to identify the potential articles which explored the association between vitamin D level and diabetic peripheral neuropathy in type 2 diabetes. We pooled OR to assess the correlation between vitamin D deficiency and DPN using the random-effects model. The standardized mean difference (SMD) with 95% CI of vitamin D was also calculated to evaluate the vitamin D level between DPN and non DPN in T2DM. RESULTS: There was obvious heterogeneity in those included ten studies (I2 = 94.1%, Cochran Q test P < 0.001) using mean and standard deviation (SD) of vitamin D level. In Caucasian, vitamin D level was significantly lower in DPN patients compared with diabetic patients without DPN (SMD = -0.56, I2 = 16.9%). In Asian, the pooled OR value of vitamin D deficiency was 1.22 (95%CI: 1.17-1.27). Sensitivity analysis showed one study had great influence on this meta-analysis and it still existed after excluded that one. There was no evidence of public bias in meta analysis as showed in Begg test and Egger test. CONCLUSION: This meta-analysis indicates that vitamin D deficiency is associated with the generation and development of DPN in Caucasian with T2DM, and in Asian, diabetic patients with vitamin D deficiency are 1.22 times to suffer from DPN compared with normal vitamin D level. Vitamin D supplementation is urgently needed to prevent the development of DPN in T2DM.

Effect of Cholesteryl Ester Transfer Protein Gene TaqIB Polymorphism on the Risk of Ischemic Stroke: A Meta-Analysis.

BACKGROUND: The association between cholesteryl ester transfer protein (CETP) TaqIB polymorphism and ischemic stroke (IS) risk has generated conflicting results. To investigate whether the TaqIB polymorphism of the CETP gene was associated with the risk of IS, a meta-analysis was performed. METHODS: Studies were retrieved by searching PubMed, Web of Science, the Chinese National Knowledge Infrastructure, the Chinese Wanfang Database, and the Chinese VIP Database before January 16, 2017. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to assess the association. Depending on the heterogeneity the fixed-effects model or the random-effects model was used. RESULTS: A total of 6 case-control studies were identified with 1494 cases and 1370 controls. Overall, an association of CETP TaqIB polymorphism with IS was found in the 4 genetic models (B2B2 versus B1B1: OR = .63, 95% CI = .51-.79, P < .001; B1B2 + B2B2 versus B1B1: OR = .75, 95% CI = .64-.87, P < .001; B2B2 versus B1B2 + B1B1: OR = .70, 95% CI = .57-.85, P < .001; B2 versus B1: OR = .78, 95% CI = .70-.87, P < .001). In the subgroup analysis by ethnicity, similar risks were also observed in Asian population. CONCLUSIONS: This meta-analysis indicates that CETP TaqIB polymorphism is associated with IS risk, and the B2 allele is a protective factor for IS.

A prospective study of psychological resilience and depression among left-behind children in China.

This prospective study examined the longitudinal effects of psychological resilience on depression in a Chinese sample of left-behind children. A total of 386 left-behind children completed both a baseline and a 1-year follow-up survey. The prevalence of depression at the baseline and 1-year follow-up was 12.7 and 8.5 per cent, respectively. Multivariate analysis revealed that older age and baseline depressive symptoms were positively associated with follow-up depression, while psychological resilience and quality of life were negatively related to follow-up depression. Our findings provided preliminary evidence that higher psychological resilience was a significantly protective factor of developing depression among left-behind children.

Association of vitamin D receptor gene polymorphisms with susceptibility to childhood asthma: A meta-analysis.

BACKGROUND: As for the association of vitamin D receptor (VDR) gene polymorphisms with susceptibility to pediatric asthma, results of published studies yielded conflicts. A systematic review was conducted on the relationship between childhood asthma and VDR gene polymorphisms, including ApaI (rs7975232), BsmI (rs1544410), FokI (rs2228570), and TaqI (rs731236). METHODS: PubMed, Web of Science, CBM (Chinese Biomedical Database), CNKI (China National Knowledge Infrastructure), and Wanfang (Chinese) database were searched for relevant studies. Pooled odds ratios (OR) with 95% confidence interval (CI) were calculated. RESULTS: Overall results suggested that there was a statistically significant association between ApaI polymorphism and childhood asthma in homozygote model (OR = 1.674, 95%CI = 1.269-2.208, P < 0.001) and allele model (OR = 1.221, 95%CI = 1.084-1.375, P = 0.001). Stratification by ethnicity revealed a statistical association in Asians (OR = 1.389, 95%CI = 1.178-1.638, P < 0.001). There was some evidence of an association between BsmI polymorphism and childhood asthma in the homozygote (OR = 1.462, 95%CI = 1.016-2.105, P = 0.041) and allele models (OR = 1.181, 95%CI = 1.006-1.386, P = 0.042). This association reached significance only in the Caucasian group (OR = 1.236, 95%CI = 1.029-1.485, P = 0.023). For FokI, a statistical association was detected in dominant model (OR = 1.281, 95%CI = 1.055-1.555, P = 0.012); this association was significant in allele model (OR = 1.591, 95%CI = 1.052-2.405, P = 0.028) in Caucasian. CONCLUSION: ApaI polymorphism plays a particular role in childhood asthma in Asians. FokI polymorphism may be connected with pediatric asthma in Caucasian population. And BsmI polymorphism marginally contributes to childhood asthma susceptibility, while there might be no association between TaqI polymorphism and childhood asthma risk. Pediatr Pulmonol. 2017;52:423-429. © 2016 Wiley Periodicals, Inc.

Prevalence of Internet addiction and its association with social support and other related factors among adolescents in China.

A cross-sectional study design was applied amongst a random sample (n = 10158) of Chinese adolescents. Self-completed questionnaires, including demographic characteristics, Internet use situation, Youth Internet Addiction Test, Youth Social Support Rating Scale and Zung Self-rating Depression Scale were utilized to examine the study objectives. Among the study population, the prevalence rate of Internet addiction was 10.4%, with 1038 (10.2%) moderately and 21 (0.2%) severely addicted to the Internet. Results from the multivariate logistic regression analyses suggested that a variety of related factors have significant effects on Internet addiction (parental control, per capita annual household income, academic performance, the access to Internet, online activities). The correlation coefficients showed that Internet addiction was negatively correlated with social support and positively associated with depression. Social support had a significant negative predictive effect on Internet addiction. The mediating effect of depression between social support and Internet addiction was remarkable.

The effect of contraceptive methods on reproductive tract infections risk: a cross-sectional study having a sample of 52,481 women.

OBJECTIVE: The aim of this study was to investigate the association between specific contraceptives use and reproductive tract infections (RTIs). STUDY DESIGN: Participants consisted of 52,481 rural married women of reproductive age identified from a cross-sectional study in Anhui Province of China. The questionnaire, gynecological examination, and laboratory inspection were used to collect data. The subgroup analysis was performed to estimate the effect of the specific contraceptives on the specific RTIs. RESULTS: A total of 49,970 (95.2 %) women used contraceptive methods and 31,390 (59.8 %) women had at least one RTI. Overall, use of intrauterine device (IUD), condom, female sterilisation, rhythm method, and oral contraceptive (OC) were associated with RTIs. In the subgroup analysis, IUD use was a risk factor for endocervicitis, bacterial vaginosis (BV), and trichomoniasis; condom, rhythm method, and OC were associated with endocervicitis; female sterilisation was associated with endocervicitis and trichomoniasis. Moreover, male sterilisation was associated with endocervicitis; withdrawal was a protective factor for endocervicitis and a risk factor for trichomoniasis; subdermal implant was associated with candidiasis and pelvic inflammatory disease (PID). CONCLUSIONS: All the contraceptive methods may lead to the RTIs. A properly assessment for contraceptive methods use is needed for female reproductive health.

The risk and protective factors in the development of childhood social anxiety symptoms among Chinese children.

The aim of this study was to explore the change and associated risk and protective factors of social anxiety symptoms among Chinese children. A 2-year longitudinal study was performed in a general primary and secondary school population in Anhui Province, China including 816 children in grades 3, 4, and 7. Children's social anxiety symptoms were assessed using the Social Anxiety Scales for Children (SASC) at three assessments. The overall prevalence of children's elevated social anxiety symptoms ranged from 15.2% to 16.4% across three assessments. Children's overall mean SASC scores were 5.6 (SD =3.7), 5.3 (SD =3.8), and 5.3 (SD =4.1) at three assessments, respectively, but the difference was not statistically significant. However, children's social anxiety symptom levels and change among different subgroups was not stable across 2-year follow-up. Multivariable logistic regression analysis indicated that age, severe family dysfunction, quality of life, positive coping, negative coping, depressive symptoms and self-esteem were predictive factors for childhood elevated social anxiety symptoms. The findings suggested that the overall social anxiety symptoms showed a relatively stable pattern over time. The identified risk and protective factors may provide scientific evidence for school, family, and health authorities to conduct necessary intervention.

Associations of Angiotensin-Converting Enzyme Insertion/Deletion, Angiotensin II Receptor A1166C, and Endothelial Nitric Oxide Synthase 4b/a Gene Polymorphisms With Pregnancy Hypertensive Disorders: A Meta-Analysis.

There have been numerous studies concerning the associations of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D), angiotensin II receptor 1 (AT1R) gene A1166C, and endothelial nitric oxide synthase (eNOS) gene 4b/a polymorphisms with risk of pregnancy hypertensive disorders (PHDs). However, the results are inconsistent. A total of 83 eligible studies (10,354/18,446 cases/controls) were included in this meta-analysis. Pooled odds ratios with corresponding 95% confidence intervals were used to calculate these associations. The effects of ethnicity and types of PHDs were also considered. Results showed significant associations between the ACE gene polymorphism and PHDs in all of the populations except that in Africa. The associations also existed in AT1R, eNOS gene polymorphism and PHDs in part of the gene models in the overall population. These results indicated the ACE gene polymorphism was associated with an increased risk of PHDs, whereas the eNOS and AT1R gene polymorphism only have increased susceptibility to PHDs in part of the gene models.

Association between apolipoprotein E gene polymorphism and depression.

We performed an updated meta-analysis to obtain a more precise estimation of the relationship between apolipoprotein E (ApoE) gene polymorphism and susceptibility to depression, as previous reports have been inconsistent. Twenty studies with 2286 depression patients and 3845 controls were included. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the association between ApoE gene polymorphism and depression using a random effects model. Results showed a significant association between ApoE gene polymorphism and susceptibility to depression in the overall population (ε2/ε3 genotype versus ε3/ε3: OR 0.76, 95% CI 0.59-0.99). Subgroup analyses indicated an association in the Caucasian population (ε2 allele versus ε3: OR 0.75, 95% CI 0.58-0.97) as well as in late-life depression (LLD) patients (ε3/ε4 genotype versus ε3/ε3: OR 1.34, 95% CI 1.07-1.68, and ε4 allele versus ε3: OR 1.30, 95% CI 1.06-1.59). We concluded that the ε2/ε3 genotype likely provided a protective effect against depression in the overall population and the ε2 allele acted as a protective factor for depression in the Caucasian population while the ε4 allele and ε3/ε4 genotype were associated with an increased risk of depression in the LLD subjects.

Incidence and risk factors of bacterial vaginosis among pregnant women: a prospective study in Maanshan city, Anhui Province, China.

AIM: The aim of this study was to identify the incidence and risk factors of bacterial vaginosis among pregnant women. MATERIAL AND METHODS: Prospective data from a cohort of 668 pregnant women were used to identify potential risk factors for bacterial vaginosis during pregnancy by Cox proportional hazards regression. RESULTS: A total of 204 incident cases of bacterial vaginosis were diagnosed in 274.8 woman-years of follow-up. The bacterial vaginosis incidence rate was 0.74 per 1 woman-year and median prevalence during follow-up was 15.6%. In the adjusted model, changing underwear nearly everyday, miscarriage history, urinary tract infection during follow-up, husbands' education level, and concurrent trichomoniasis and candidiasis remained significantly associated with bacterial vaginosis (adjusted hazard ratio and 95% confidence interval were 1.87 [1.26-2.77]; 2.96 [1.96-4.47]; 2.41 [1.05-5.49]; 0.50 [0.32-0.77]; 1.82 [1.02-3.25]; 1.88 [1.30-2.70], respectively). CONCLUSION: Bacterial vaginosis during pregnancy can be affected by many factors, and some are indirectly acting factors. Further prospective studies that include a larger sample size and more information on the development of bacterial vaginosis are needed.

Children in rural China enjoyed a significant increase in quality of life from 2009 to 2011.

AIM: Little is known about the long-term change in quality of life (QoL) among children in rural China. This study longitudinally examined changes and predictors of QoL among children in one rural county between 2009 and 2011. METHODS: We interviewed 816 children from seven to 16 years of age in 2009 and 2011 using a range of QoL tools. Multivariate forward stepwise linear regression analysis was used to examine the relationships between follow-up QoL and socio-demographic, family environment and psychosocial factors. RESULTS: Overall QoL scores improved significantly from 71.1 ± 14.6 to 72.8 ± 16.3 (p = 0.005). QoL was positively related to annual family income (ß = 0.14, p < 0.001) and baseline QoL (ß = 0.21, p < 0.001) and negatively related to older age (ß = -0.19, p < 0.001), being female (ß = -0.08, p = 0.011), being left in the care of family members by working parents (ß = -0.09, p = 0.004), negative coping styles (ß = -0.10, p = 0.005) and depression (ß = -0.11, p = 0.006). CONCLUSION: Quality of life significantly improved among children in rural China over a two-year period from 2009 to 2011. It was positively related to annual family income and baseline QoL and negatively related to older age, being female, being left in the care of family members by working parents, negative coping styles and depression.

Prevalence of suicide attempts among college students in China: a meta-analysis.

BACKGROUND: Suicide is the leading cause of death among 15-34 year olds in China, but no national data are available on the suicide and suicide attempts rates of college students, a sub-group of youth with 23 million. Several studies have reported the prevalence of suicide attempts among college students, however, no meta-analysis pooling the prevalence of suicide attempts is found. OBJECTIVE AND METHODS: This study aims to estimate the pooled prevalence of suicide attempts among college students in China. The relevant studies up to August 2014 were systematically searched via electronic databases (PubMed-Medline, Embase, Chinese Wanfang database, Chinese National Knowledge Infrastructure and Chinese VIP database). We only selected original articles that either reported the prevalence of suicide attempts or sufficient data for calculating the prevalence. RESULTS: A total of 29 eligible studies, with 88,225 college students, were finally included. The maximum and minimum reported prevalences of suicide attempts among college students in China were 0.4% and 10.5%, respectively. The pooled prevalence of suicide attempts was 2.8% (95%CI: 2.3%-3.3%). Subgroup analyses showed that the pooled estimate of prevalence of life time suicide attempts was 2.7% (95%CI: 2.1%-3.3%), and 12-month suicide attempts was 2.9% (95%CI: 2.0%-3.8%). The prevalence for males was 2.4% (95%CI: 1.8%-3.0%), and for females was 2.7% (95%CI: 1.9%-3.7%). The prevalences among college students in grade 1 through 4 were 2.8% (95%CI: 1.7%-3.8%), 1.8% (95%CI: 1.2%-2.3%), 2.0% (95%CI: 0.8%-3.1%), and 2.9% (95%CI: 0.1%-6.7%), respectively. The prevalences among college students from rural and urban areas were 5.1% (95%CI: 2.8%-7.5%) and 3.7% (95%CI: 1.4%-5.9%), respectively. CONCLUSIONS: 2.8% prevalence of suicide attempts and more than 600,000 suicide attempters among college students indicate that suicide attempt among college students is an important public health problem in China. More attention should be paid to the current situation.

Change and associated factors of self-esteem among children in rural China: A two-year longitudinal study.

Childhood has been targeted as an especially important period for self-esteem formation. The aim of this study is to examine the change and associated factors of self-esteem among children in rural China. A two-year longitudinal study was conducted with a general elementary and secondary school population in Anhui Province, China including 816 children aged between 7 and 16 years. Generalized estimating equation (GEE) was used to examine relationships between low self-esteem and socio-demographic, family environment, and psychosocial factors. On average, self-esteem level among children was increased across three assessments. Multivariable analysis (GEE) showed that low self-esteem in children was clearly associated with male gender (OR = 1.45, 95%CI = 1.12-1.89), moderate and severe family dysfunction (OR = 1.88, 95%CI = 1.40-2.51; OR = 1.88, 95%CI = 1.25-2.83, respectively), quality of life (OR = .97, 95%CI = .96-.98), depression (OR = 1.89, 95%CI = 1.32-2.70), anxiety (OR = 2.05, 95%CI = 1.51-2.77), positive coping styles (OR = .91, 95%CI = .89-.94), and negative coping styles (OR = 1.05, 95%CI = 1.03-1.07). Self-esteem is a dynamic rather than a static construct during childhood. Low self-esteem among children was associated with a number of socio-demographic, family environment, and psychosocial factors. Further studies exploring the pathways and mechanisms by which the effect of these factors impact on self-esteem among children are warranted.