Gut microbiota in preterm infants with late-onset sepsis and pneumonia: a pilot case-control study.

BACKGROUND: Late-onset sepsis (LOS) and pneumonia are common infectious diseases, with high morbidity and mortality in neonates. This study aimed to investigate the differences in the gut microbiota among preterm infants with LOS, or pneumonia, and full-term infants. Furthermore, this study aimed to determine whether there is a correlation between intestinal pathogenic colonization and LOS. METHODS: In a single-center case‒control study, 16 S rRNA gene sequencing technology was used to compare gut microbiota characteristics and differences among the LOS group, pneumonia group, and control group. RESULTS: Our study revealed that the gut microbiota in the control group was more diverse than that in the LOS group and pneumonia group (P < 0.05). No significant differences in diversity were detected between the LOS and pneumonia groups (P > 0.05). Compared with the control group, the abundances of Akkermansia, Escherichia/Shigella, and Enterococcus increased, while the abundances of Bacteroides and Stenotrophomonas decreased in the LOS and pneumonia groups. The pathogenic bacteria in infants with LOS were consistent with the distribution of the main bacteria in the intestinal microbiota. An increase in Escherichia/Shigella abundance may predict a high risk of LOS occurrence, with an area under the curve (AUC) of 0.773. CONCLUSION: Changes in the gut microbiota composition were associated with an increased risk of LOS and pneumonia. The dominant bacteria in the gut microbiota of the LOS group were found to be associated with the causative pathogen of LOS. Moreover, preterm infants exhibiting an elevated abundance of Escherichia/Shigella may be considered potential candidates for predicting the onset of LOS.

Elevated serum myoglobin levels at hospital admission and the risk of early death among patients with hemophagocytic lymphohistiocytosis: evidence from 155 pediatric patients.

Patients with hemophagocytic lymphohistiocytosis (HLH) have high risk of early mortality. The purpose of this study was to test the hypothesis that the elevated level of serum myoglobin among patients with HLH is associated with disease severity and increased risk of mortality. We retrospectively investigated the serum myoglobin levels from 155 pediatric patients diagnosed with HLH in the Hunan Children's Hospital, China. The levels of myoglobin and creatine kinase at hospital admission among non-survivors and survivors were compared. The myoglobin level was dichotomized for the estimation of hazard ratio (HR) for mortality. Patients who died within 7 and 30 days of hospitalization had significantly higher myoglobin levels than did survivors (p < 0.05). The myoglobin level was negatively associated with the days of survival among non-survivors (Spearman correlation coefficient = - 0.29, p = 0.04). An elevated myoglobin level (> 90 ng/mL) was significantly associated with increased mortality (unadjusted HR = 2.66, 95%CI: 1.41, 5.00, p = 0.0024) and persisted after adjusting for age, Epstein-Barr virus infection, admission department, acute kidney injury, myocardial damage, and shock. In conclusion, an elevated serum myoglobin level was associated with increased risk of early death among pediatric patients with HLH, suggesting the potential of myoglobin to be used as a reference indicator for monitoring and managing of HLH.

[Significance and current development status of pediatric palliative care].

Pediatric palliative care refers to the comprehensive physical, mental, and psychological care provided to the children with life-threatening diseases, as well as support for their families, aiming to provide the best quality of life for children and their families. In the face of the large population of children in China, the increasing demand for palliative care services and the insufficient development of related service resources are existential problems in the field of palliative care for children in China. This article reviews the implementation and current development status of pediatric palliative care in China.

Influence of prenatal and early-life exposures on food allergy and eczema in infancy: a birth cohort study.

BACKGROUND: Few prospective birth cohort studies are available on the effects of prenatal and early-life exposures on food allergy and eczema among Chinese children. The aim of this study was to evaluate the influence of prenatal and early-life exposures on food allergy and eczema during the first year of life in a prospective birth cohort study. METHODS: This study was based on a prospective, observational birth cohort of 976 mother-child pairs in three Streets in Changsha, China from January to December 2015. Data on prenatal, early-life exposures and allergic outcomes were obtained from questionnaires collected at birth, and 1, 3, 6, 8, and 12 months of age. Multivariate logistic regression models were performed to estimate the effects of prenatal and early-life exposures on food allergy and eczema. RESULTS: Common risk factors for food allergy and eczema in infancy were parental history of allergy, while moderate eggs consumption (3-4 times/week) during pregnancy was protective for both of them compared with low consumption (≤ 2 times/week). Factors only associated with food allergy were maternal aquatic products consumption during pregnancy, number of older siblings and age of solid food introduction, whereas factors only associated with eczema were maternal milk or milk products consumption during pregnancy, maternal antibiotic exposure during pregnancy, season of birth and antibiotic exposure through medication during the first year of life. CONCLUSION: Our study suggests that factors associated with food allergy and eczema are multifaceted, which involving hereditary, environmental and nutritional exposures. Furthermore, differential factors influence the development of food allergy and eczema in infants.

[Risk factors for delayed breastfeeding initiation based on decision tree model and logistic regression model].

OBJECTIVE: To determine influential factors for delayed breastfeeding initiation.
 Methods: Using questionnaires to collect the data of 950 pregnant women and infants' feeding practices in Changsha, Hunan, logistic regression and decision tree model were used to determine influential factors for delayed breastfeeding initiation.
 Results: Mothers with timely breastfeeding initiation were 594 (62.5%), and those with delayed breastfeeding initiation accounted for 356 (37.5%). Mothers with timely breastfeeding initiation were more likely to use exclusive breastfeeding than those with delayed breastfeeding initiation (P<0.05). Four risk factors were found by logistic regression model and decision tree model, including cesarean delivery, using feeding-bottle before breastfeeding initiation, falling ill, and vomiting during pregnancy. Receiver operating characteristic curve showed no significant difference in the predictive effect of the 2 models (Z=0.142, P=0.889).
 Conclusion: Cesarean delivery, using feeding-bottle before initiation of breastfeeding, and poor physical condition during pregnancy exert negatively effects on breastfeeding initiation. Health workers should help mother to timely initiate breastfeeding and enhance their confidence in exclusive breastfeeding.

Risk factors for postpartum depression among Chinese women: path model analysis.

BACKGROUND: Postpartum depression causes harm to both mothers and infants. The purpose of this study was to find out several potential risk factors, and to identify the intrinsic interrelationships between factors and postpartum depression by constructing a path model. The results of this study may help to control the increasing incidence of maternal postpartum depression. METHODS: The study was based on a sample of mothers from a cross-sectional study which was set up at 4 weeks after a mother had childbirth and was conducted in three streets at Kaifu District of Changsha in Hunan province from January to December 2015. Questionnaires were distributed to subjects who responded to questions concerning factors related to pregnancy, delivery and infants within 4 weeks after childbirth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postpartum depression. Chi-square test was used to detect significant differences between non-postpartum depression group and postpartum depression group. A path model was constructed to explore the interrelationships between variables, and to verify the relationships between variables and postpartum depression. RESULTS: The proportion of maternal postpartum depression was 6.7%. Univariate analysis showed that there were significant differences between non-postpartum depression group and postpartum depression group (all P-values <0.05) on the part of maternal age, parity, frequent exposure to mobile phone during pregnancy, gestational hypertensive disorders, fetus number, premature delivery, birth weight, initiation of breastfeeding, mode of feeding, infant illness within 4 weeks after delivery and infant weight at 4 weeks. Path analysis results showed that the final model could be fitted well with sample data (P = 0.687, CMIN/DF = 0.824, NFI = 0.992, RFI = 0.982, IFI = 1.002, TLI =1.004, CFI = 1.000 and RMSEA < 0.001). Frequent exposure to mobile phone during pregnancy, maternal age and gestational hypertensive disorders had both direct and indirect effects on postpartum depression. Mode of feeding and infant weight at 4 weeks, which was the most total effect on postpartum depression, had only a direct impact on postpartum depression. Fetus number, premature delivery, initiation of breastfeeding and birth weight had only an indirect influence on postpartum depression. CONCLUSION: The findings of this study suggest that constructing a path analysis model could identify potential factors and explore the potential interrelations between factors and postpartum depression. It is an effective way to prevent maternal postpartum depression by taking appropriate intervention measures and carrying out health education for pregnant women.

[Influential factors for postpartum depression based on the structural equation model in Kaifu District in Changsha].

OBJECTIVE: To investigate the current status of the postpartum depression in Kaifu District in Changsha, and to explore the influential factors for postpartum depression.
 Methods: We selected the mothers, who had a delivery and met the inclusion criteria in Changsha during 2015, as the participants and established a prospective birth cohort study. The social demographic characteristics and health-related information for the mothers and their families were collected by using self-made questionnaire. The mothers' depression symptoms after one month postpartum were assessed by the Edinburgh Postnatal Depression Scale. We used the structural equation model to analyze the influential factors for postpartum depression.
 Results: A total of 961 cases were investigated. 82 of them whose scores of EPDS were≥9 points, and the incidence of PPD was 8.2%. The results of structural equation model revealed the influential factors and their correlations with postpartum depression. It has been shown that maternal age, maternal education level, per capita income of family, intention of pregnancy, pregnancy-related complications, mode of conception, mode of delivery, feeding patterns, birth weight, baby gender, and infant illness could exert effects on postpartum depression.
 Conclusion: The incidence of postpartum depression in Kaifu District is at a low level and the structural equation model can be applied to analyze the influential factors and their relations with postpartum depression.

[Risk factors for nausea and vomiting in pregnant women in Changsha].

OBJECTIVE: To explore the risk factors for nausea and vomiting in pregnant women.
 Methods: Using cluster random sampling method and following the exclusion and inclusion criteria, a total of 713 pregnant women from the health service center of 3 street communities in Changsha city district were enrolled. Statistical analysis was used to analyze the relevant influential factors for nausea and vomiting.
 Results: Vomiting incidence in pregnant women was 59.6%. The risk factors for nausea and vomiting were female fetus (OR=1.404, 95% CI 1.035 to 1.905), vaginal bleeding (OR=1.513, 95%CI 1.062 to 2.156) and life stress (OR=1.031, 95% CI 1.009 to 1.054), and the protective factor for nausea and vomiting was the age (OR=0.798, 95% CI 0.661 to 0.964).
 Conclusion: The pregnant vomiting is a result of a combination of multiple factors. Age, female fetus, vaginal bleeding, negative quality of life are the influential factors for vomiting during pregnancy. Prenatal health education should be strengthened for young pregnant women. Suitable maintenance for pregnant woman life should be performed to reduce the amount of negative stimulus.

[Influential factors of iron deficient anemia among infants aged 8 months based on a case-control study].

OBJECTIVE: To study the status and influential factors of iron deficient anemia (IDA) among infants aged 8 months in Changsha City.
 Methods: A case-control study was performed in this research. The case group including 105 8-month-old infants definitely diagnosed as IDA based on standardized blood test. Four-times numbers of age- and genger-matched infants without IDA were selected as a control group. Chi-square test and conditional logistic regression was used to analyze the influential factors for IDA.
 Results: The incidence rate of IDA among infants aged 8 months in Changsha City was 14.7%. The risk factors were as follows: mother with anemia in late pregnancy (OR=3.540, 95% CI 1.898 to 6.601), mixed feeding within 6 months old (OR=1.682, 95% CI 1.099 to 2.574), artificial feeding within 6 months old (OR=4.162, 95% CI 1.343 to 12.896), complementary feeding before 6 months old (OR=1.423, 95% CI 1.022 to 1.982), complementary feeding at or after 7 months old (OR=4.415, 95% CI 2.150 to 9.064), recurrent respiratory tract infections within 8 months old (OR=2.878, 95% CI 1.224 to 6.764), and repeated diarrhea within 8 months old (OR=3.710, 95% CI 1.533 to 8.980).
 Conclusion: There is certain incidence rate of IDA among infants aged 8 months in Changsha City. To prevent the IDA among infants, we should treat mothers' anemia during pregnancy, advocate scientific feeding, encourage complete breastfeeding until 6 months old, add complementary food timely and reasonably, treat infants suffering from respiratory or digestive diseases actively.

[Compilation of a questionnaire on maternal and child health birth cohort study].

OBJECTIVE: To compile a questionnaire on maternal and child health birth cohort study, to provide effective tools for exploring the effect of various exposure factors on pregnancy outcome and children's health, and to track children's growth and development dynamically.
 METHODS: The preliminary questionnaire on maternal and child health birth cohort study was designed after literature research, health information systems analysis and group discussion. The questionnaire was finalized after expert consultation and pre-survey.
 RESULTS: The formal questionnaire on maternal and child health birth cohort study was developed, including maternal health information and children's health information.
 CONCLUSION: The questionnaire can be used for collecting maternal health data and children's health data within 1 year old, and this work is useful for scholars in the study on birth cohort invovling the maternal and child health.

[Influential factors for anemia in pregnancy based on a nested case-control study in Changsha].

OBJECTIVE: To explore the prevalence of anemia during pregnancy and the influential factors in changsha city, and to provide scientific evidence for prevention and intervention of anemia during pregnancy. 
 METHODS: A cluster sampling of 713 mothers, who delivered baby between January 1, 2013 and December 31, 2013 in the three streets of kaifu district of Changsha, was selected to establish a retrospective cohort. The maternal health information during pregnancy was collected within 15 days after the delivery. The influential factors of anemia during pregnancy were analyzed by the method of retrospective nested case-control study and conditional logistic regression.
 RESULTS: The prevalence of anemia during pregnancy in Changsha was 9.96%. The multiple conditional logistic regression results show that high family income (OR=0.632, P=0.020), high education level (OR=0.276, P=0.033), folic acid supplement (OR =0.248, P=0.050), iron supplement (OR=0.272, P<0.001) and eating blood products (OR=0.588, P=0.044) were the beneficial factors for anemia during pregnancy, while multipara (OR=2.917, P=0.003), long duration of menstrual period before pregnancy (OR=1.335, P=0.041), living in new decoration housing (OR=3.690, P=0.045) and tea-drinking (OR=1.365, P=0.094) were the risk factors for anemia during pregnancy. 
 CONCLUSION: The prevalence of anemia during pregnancy in Changsha is below the average levels. The occurrence of anemia during pregnancy is closely related to the women's economic level and nutritional status. Women should strengthen maternal nutrition during pregnancy and bedroom environment monitor, drink little strong tea and improve the nutritional status of iron during pregnancy.

[Impact of pre-pregnancy body mass index on baby's physical growth and nutritional status].

OBJECTIVE: To explore the impact of pre-pregnancy body mass index on baby's physical growth and nutritional status. METHODS: A total of 491 pairs of mother-infant were divided into 3 groups according to mother's pre-pregnancy body mass index (BMI): a pre-pregnancy low BMI group (BMI<18.5 kg/m², n=93), a pre-pregnancy normal BMI group (18.5 kg/m² ≤ BMI<24.0 kg/m², n=326), and a pre-pregnancy high BMI group (BMI ≥ 24.0 kg/m², n=72). Analysis of variance of repeated measurement data and the median percentage methods were used to compare the physical growth and nutritional status of babies in different groups. RESULTS: Baby's weight in the high BMI group were higher than that in the normal BMI and the low BMI group (F=3.958, P=0.020). The incidence of malnutrition in the low BMI group showed a tendency to decline along with the months (χ²=5.611, P=0.018), the incidence of overweight and obesity in the high and the normal BMI groups displayed a tendency to decline along with the months (χ²=18.773, 53.248, all P<0.001). Baby in the low BMI group had higher incidence of malnutrition while baby in the high BMI group had higher incidence of overweight and obesity. CONCLUSION: Pregnancy BMI was correlated with the growth of baby. Too high or too low prepregnancy BMI exerts harmful effect on baby's weight and nutritional status. Medical workers should strengthen the education on women's pre-pregnancy to remind them keeping BMI at normal level.

Association of metals with early postnatal gut microbiota among infants admitted to the neonatal intensive care unit.

The gut microbiota is closely related to infant health. However, the impact of environmental factors on the gut microbiota has not been widely investigated, particularly in vulnerable populations such as infants admitted to the neonatal intensive care unit (NICU). This study investigated the association between exposure to 12 metals and the composition of the gut microbiota in infants admitted to the NICU. Metal concentrations were determined in serum samples obtained from 107 infants admitted to the NICU at Hunan Children's hospital, China. Gut microbiota data were derived from 16S rRNA sequencing using stool samples. Generalized linear regression (GLR) models and Bayesian kernel machine regression (BKMR) analyses were used to estimate the associations between metals and both alpha-diversity indices and bacterial taxa. The GLR models showed that tin correlated negatively with the Shannon index (ß = -0.55, 95% conficence interval [CI]: -0.79, -0.30, PFDR< 0.001) and positively with the Simpson index (ß = 0.26, 95% CI: 0.13, 0.39, PFDR< 0.001). The BKMR analysis yielded similar results, showing that tin had the largest posterior inclusion probability for both the Shannon (0.986) and the Simpson (0.796) indices. Tin, cadmium, mercury, lead, and thallium were associated with changes in one or more taxa at the genus level. The BKMR analysis also revealed a negative correlation between metal mixtures and Clostridium_sensu_stricto, and tin contibuted mostly to the negative correlation. Early postnatal exposure to metals were associated with differences in the microbiome among infants admitted to the NICU. However, as the study was cross-sectional, these relationships must be confirmed in further studies.

Adverse Childhood Experiences, Inflammation, and Depressive Symptoms in Late Life: A Population-Based Study.

OBJECTIVES: This study investigated the association and dose-response relationship between adverse childhood experiences (ACEs) and depressive symptoms in late life and explored the mediating roles of inflammatory markers in the ACEs-depressive symptom association among Chinese older adults. METHODS: This study was conducted using 2014 life history survey data and 2015 follow-up data from the China Health and Retirement Longitudinal Study. Data on ACEs and depression, inflammatory markers of high-sensitivity C-reactive protein (CRP), and white blood cell were collected. The association between ACEs and depressive symptoms was examined using logistic regression, and the mediation effects of inflammatory markers were evaluated. RESULTS: A total of 6,518 individuals over 60 years were included in the analysis. Compared to no ACE exposure, the adjusted odd ratios ranged from 1.377 (95% confidence interval [CI], 1.133-1.673) when participants had been exposed to 2 ACEs to 1.809 (95% CI, 1.451-2.256) when participants were exposed to 4 or more ACEs. A significant dose-response relationship between cumulative ACE scores and depression was observed. Six of the 12 ACE exposures were related to increased odds of depressive symptoms. CRP appeared to partially mediate the ACE-depressive symptom association, and the proportion of the effect of ACEs on depression was 1.17% (P = 0.008). DISCUSSION: A dose-response association exists between ACEs and the prevalence of depressive symptoms among older Chinese adults. CRP partially mediated the ACE-depressive symptom association in late life. Emphasizing interventions targeting individuals with ACE exposure may minimize the burden of late-life depression in China.

The association between urinary phthalate metabolites and serum thyroid function in US adolescents.

The aim was to investigate the association between mixed exposure to phthalates and serum thyroid function among US adolescents. The study used 2007-2008 survey data from the National Health and Nutrition Examination Survey (NHANES). Data on urinary phthalates metabolites and serum thyroid function indicators were collected. The weighted multivariable linear regression models and Bayesian kernel machine regression (BKMR) analyses were used to analyze the relationship between phthalates metabolites and thyroid function. A total of 356 adolescents aged 12-19 years were included in the analysis. Linear regression models showed that mono-(carboxyisoctyl) phthalate (MCOP) was positively correlated with total triiodothyronine (TT3) (ß = 0.045, 95% confidence interval [CI] 0.022, 0.068) and thyroid stimulating hormone (TSH) (ß = 0.1461, 95% CI 0.059, 0.232), while mono-(carboxyisononyl) phthalate (MCNP) was negatively correlated with TSH (ß = - 0.119, 95% CI - 0.196, - 0.042). BKMR analyses showed phthalate metabolites mixtures have significantly positive overall effect on TT3. Exposure to phthalate mixtures might be positively correlated with increased TT3 serum level in US adolescents. The study provided evidence for the association between mixed phthalates exposure and thyroid health in adolescent population.

Association of urine phthalate metabolites levels with kidney function in 1610 US adolescents.

Phthalates are widely used as plasticizer or fragrance ingredients in various consumer products worldwide. However, evidence for the overall effects of mixed exposure to phthalate on kidney function has not been widely investigated. The purpose of this article was to assess the association of urine phthalate metabolite levels and kidney injury parameters in adolescents. We used data from the combined 2007-2016 National Health and Nutrition Examination Survey (NHANES). We fitted weighted linear regressions and Bayesian kernel machine regressions (BKMR) models to explore the association of urinary phthalate metabolites with four parameters of kidney function after adjusting for covariates. Weighted linear regression models showed that MiBP (ß = 8.057; PFDR = 0.016) was significantly positively associated with eGFR and MEP (ß = -0.799; PFDR < 0.001) was significantly negatively correlated with BUN. BKMR analysis showed that the higher the concentration of phthalate metabolite mixture, the higher eGFR in adolescents. Based on the results of these two models, our findings revealed that mixed exposure to phthalates was associated with elevated eGFR in adolescents. However, as the study is cross-sectional, reverse causality is possible, and altered kidney function may impact the concentration of phthalate metabolites in urine.

Association of intestinal microbiota and its metabolite markers with excess weight in Chinese children and adolescents.

OBJECTIVE: The objective of this study was to identify the intestinal microbiota and faecal metabolic biomarkers associated with excess weight in Chinese children and adolescents. METHODS: This cross-sectional study included 163 children aged 6-14 years (including 72 with normal-weight and 91 with overweight/obesity from three Chinese boarding schools). We used 16S rRNA high-throughput sequencing to analyse the diversity and composition of intestinal microbiota. Of these participants, we selected 10 children with normal-weight and 10 with obesity (matched 1:1 for school, sex and age) and measured faecal metabolites using ultra-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS: Alpha diversity was significantly elevated in children with normal-weight compared to overweight/obese. Principle coordinate analysis and permutational multivariate analysis of variance revealed a significant difference in intestinal microbial community structure between the normal-weight and overweight/obese groups. The two groups differed significantly in the relative abundances of Megamonas, Bifidobacterium and Alistipes. In faecal metabolomics analysis, we identified 14 differential metabolites and 2 main differential metabolic pathways associated with obesity. CONCLUSION: This study identified intestinal microbiota and metabolic markers associated with excess weight in Chinese children.

Effect of lead, calcium, iron, zinc, copper and magnesium on anemia in children with BLLs ≥ 100 µg/L.

OBJECTIVE: Adverse effects of lead exposure on children's health have been demonstrated. While studies have examined the relationship between iron status and low-level lead exposure in children with blood lead levels (BLLs) < 100 µg/L, few have investigated the association between blood lead and other trace elements and anemia in children with BLLs ≥ 100 µg/L. This study aimed to assess the levels of lead, iron, copper, zinc, magnesium, and calcium in children aged 0-14 with BLLs≥ 100 µg/L between 2009 and 2021, and to examine the relationship between blood lead, trace elements and anemia. METHODS: A total of 11,541 children with BLLs ≥ 100 µg/L were included in this study. Venous blood samples were collected to measure blood lead levels, hemoglobin levels, and trace element levels. According to the World Health Organization standard, outpatients with hemoglobin levels < 110 g / L were defined as having anemia. RESULTS: The study results found that high BLLs and blood calcium had a negative influence on Hb with odds ratios (95% confidence interval) of 1.411(1.208, 1.649) and 1.219(1.043, 1.424). High blood iron had a positive influence on Hb with odds ratios of 0.421(0.355, 0.499). CONCLUSION: The results suggest that the risk of anemia rose significantly with higher BLLs, blood copper, and blood calcium levels, and decreases considerably with higher blood iron levels.

The concurrence of sexual violence and physical fighting among adolescent suicide ideators and the risk of attempted suicide.

Sexual violence and physical fighting are independent risk factors for suicidal behaviors among adolescents. However, whether the concurrence of these two risk factors increases the risk of suicidal behaviors among ideators, and by how much that risk increases are unknown. This study analyzed data from the 2019 National Youth Risk Behavior Surveys. Students who reported having seriously considered attempting suicide in the past year were included (n = 1755). The associations between physical fighting/sexual violence status and the risk of suicide attempt/plan/attempt requiring medical intervention were estimated. The concurrence of physical fighting and sexual violence substantially increased the relative risk of attempted suicide (adjusted relative risk, adRR = 1.99, 95% CI 1.72, 2.29) and attempted suicide requiring medical intervention (adRR = 4.07, 95% CI 2.84, 5.85; subgroup analyses: among women, adRR = 3.33, 95% CI 2.14, 5.17; among men, adRR = 6.25, 95% CI 3.32, 12.28). Among students who had experienced concurrent physical fighting and sexual violence, more suicide-attempt-associated health-risk behaviors were reported by men (median = 14) than women (median = 12) (p = 0.0023). The concurrence of physical fighting and sexual violence among adolescent suicide ideators was shown to be significantly associated with an increased risk of attempted suicide. A wide variety of health-risk behaviors were shown to cluster with the concurrence of physical fighting and sexual violence. This was especially the case among men, consistent with their higher rate of attempted suicide requiring medical intervention.

Urine Phthalate Levels and Liver Function in US Adolescents: Analyses of NHANES 2007-2016.

Background: Phthalates are non-persistent chemicals with endocrine-disrupting abilities widely used in a variety of consumer products. Evidence for the effects of phthalate exposure on liver function in adolescents is lacking. Methods: Data were analyzed from the combined 2007-2016 National Health and Nutrition Examination Survey (NHANES). Ultimately, a total of 1,650 adolescents aged 12-19 years were selected as the samples. Weighted linear regression was used to investigate the effects of urinary phthalate metabolites on liver function indexes. Results: Weighted Linear regression models showed that MCOP was negatively associated with TBIL (ß = -0.0435, PFDR = 0.007), ΣDEHP (ß = -0.0453, PFDR = 0.003) and MCOP (ß = -0.0379, PFDR = 0.006) were negatively correlated with ALB, while MCPP was positively correlated with ALB (ß = 0.0339, PFDR = 0.024), and MCOP was negatively correlated with TP (ß = -0.0551; PFDR = 0.004). Conclusions: Phthalate metabolites were significantly but weakly associated with changes in liver function indicators among US adolescents. Future work should further examine these relationships.