The Prevalence of Congenital Heart Disease among School-Age Children in China:A Meta-Analysis and Systematic Review

Objectives:To estimate the prevalence of Congenital Heart Disease(CHD)in school-age children,to identify the extent to which altitude affects the prevalence of the disease,and to examine trends in prevalence over time in China.Methods:Seven databases were systematically searched and last retrieved on September 10,2021 for all studies reporting the prevalence of CHD in children after 1970 in China,which were then divided into high and low altitude regions based on 2500 meters above sea level.The random-effected model was used to combine prevalence data and subgroups analysis.The baseline data of all cases and individuals were used for comparison to calculate the odds ratio(OR)for overall and different altitude prevalence.Results:A total of 12,926,083 individuals(aged 3-18 years),with 31,835 cases from 86 studies,were included in the analysis.The pooled CHD prevalence of total children was 4.69[95%confidence interval(CI):4.10 to 5.29]per 1000 children.Overall,temporal trends analysis indicated that the prevalence of CHD in children continuously decreased with time,from 6.19(95%CI:4.50 to 7.88)per 1000 children in 1976-1985 to 3.30(95%CI:2.49;4.38)per 1000 children in 2016-2021.The OR for the prevalence of CHD in children from high and low altitudes with baseline data was 2.84(95%CI:2.48 to 3.27)and 1.31(95%CI:1.13 to 1.53)(χ^(2)=53.89,p<0.01),respectively.The OR of the prevalence of CHD in male children compared to females was 0.60(95%CI:0.53 to 0.68)at high altitudes and 0.79(95%CI:0.71 to 0.89)at low altitudes.Among the seven most common subtypes,patent ductus arteriosus was the most common at high altitudes,while atrial septal defects were the most common at low altitudes.Conclusion:This study provides valuable insights for further disease prevention and etiological exploration.The overall decreasing trend in the prevalence of CHD in children over time may indicate a positive effect of perinatal management and treatment during infancy.

Prevalence and Factors Associated with Iron Deficiency Anemia among School-Age Children in Primary Schools in Burao City, Somaliland, 2020

Background: Anemia is a global public health problem affecting the majority of the population of the world in both developed and developing countries with major consequences on human health as well as social and economic development. It is the world’s second leading cause of disability of the whole global disease burden. It affects 1.62 billion (24.8%) of the population, among them, it is affecting 305 million (25.4%) school-age children (SAC). Objectives: The main objective of this study was to assess the prevalence and factors associated with anemia among school-age children in primary schools in Burao city, Somaliland, 2020. Materials & Methods: A school-based cross-sectional study design was done in four primary schools in Burao, Somaliland. About 285 school-age children in the age group between 6 - 14 years were selected with a respondent rate of 93.4%. Random sampling was used to select schools and systemic random sampling was used to identify children from the selected schools. Socio-demographic data was collected by using a questionnaire & interviews of respondents in addition to anthropometric measurements, hemoglobin measurement, and stool examination. Complete Blood Counting (CBC) was used to determine the mean corpuscular (kor-PUS-kyu-lar) volume (MCV) and hematocrit (HMC) levels to detect hemoglobin status of the children. Data was entered and analyzed using SPSS statistical software for Windows version 21. Anthropometric data was analyzed using ANTHRO Plus. Bivariate logistic regression and multivariable logistic regression were used to identify independent predictors of anemia in school adolescent girls. Statistical significance was set at p < 0.05. Results: A total of 285 school-age children were included in this study. The overall prevalence of anemia was (23.1%) (CI: 18.1%, 28.1%) with the mean and standard deviation of (12.7 ± 1.59). Out of the anemic children, 20.4% were mild and 2.3% and 0.4% of them were moderate and severe, respectively. Children’s from illiterate mothers (AOR = 2.37;95% CI: 1.14, 4.94. P-value = 0.020), consuming organ meat less than once a week (AOR = 2.19;95% CI: 1.05, 4.43. P-value = 0.036) and having parasites in stool (AOR = 5.21;95% CI: 1.10, 24.6. P-value = 0.037) were identified as statistically independent associated factors with prevalence of anemia in school-age children’s from Burao, Somaliland. Conclusion: Prevalence of anemia in Burao city, Somaliland primary schools was a moderate public health problem in the current study area. Nutrition education, iron folic acid supplementation program, deworming, good hygiene, and sanitation are playing an important role in the prevalence of anemia and we recommend to give them more attention from ministry of education and ministry of health in Somaliland.

Visual problems: a review of prevalence studies on visual impairment in school-age children

Childhood visual impairment(VI) have a significant impact on the educational achievement, career choices and social life of affected individual, and in children, is mainly due to either preventable or treatable causes. Reliable data on the prevalence and causes of VI in children will guide the development of a systematic vision screening program for its early detection and successful treatment of possible causes. The purpose of this literature review is to summarize the available data on prevalence and causes of VI in school-age children from various regions globally. A discussion on the major findings highlighting the definition criteria, classifications and limitations for further studies is also presented.

Evidence of increasing risk of schistosomiasis among school-age children in municipality of Calatrava,Province of Negros Occidental,Philippines

Objective:To explore risk of school-age children being infected with schistosomiasis in selected villages in the municipality of Calatrava,province of Negros Occidental,Philippines.Methods:As part of the monitoring and evaluation of the helminth control program in the province of Negros Occidental,parasitological monitoring,through the use microscopy of stool samples processed using Kato-Katz technique,was conducted to describe the baseline and follow-up parasitological status of school-age children in 2010 and 2012.respectively.Seven villages from the municipality of Calatrava were selected as study sites.Results:During baseline assessment,only one case of schistosomiasis was reported from the village of Marcelo.During follow-up assessment,32 cases(6.9%) of schistosomiasis were reported and the prevalence of moderate-heavy intensity infection was 13% in six villages.Among the seven villages included in the follow-up,Minapasuk had the highest prevalence at 14.6%.while San Isidro reported no case of schistosomiasis.Conclusions:Non-endemic villages,which have reported positive cases in school-age children,may need to be assessed for possible cndemicity for schistosomiasis.Transmission of the disease may need to be determined in these villages through active parasitological and malacological surveillance.Other nonendemic villages adjacent to or share river networks with endemic villages in Calatrava may need to be explored for possible introduction of the disease,especially after typhoons and Hooding.Establishing endemicity for schistosomiasis in these villages will help infected and at risk individuals to receive yearly treatment to reduce morbidities caused by this disease.

Effect of dexmedetomidine on the stress reaction caused by sevoflurance anesthesia in school-age children with different personality characteristics

Objective:To observe the effect of dexmedetomidine on the stress reaction caused by sevoflurance anesthesia during the perianesthesia period in school-age children with different personality characteristics.Methods:A total of 160 children who were admitted in our hospital for transumbilical single-port laparoscopic hernia inner ring ligation were included in the study and randomized into dexmedetomidine (D) group and midazolam (M) group. The children were performed with Eysenck Personality Questionnaire before operation (children edition). Children were divided into the emotion group (group I) and stable group (group II). The operation was performed under sevoflurance inhalation anesthesia. Patients in DI and DII groups were given 1 μg/kg DEX, MI and MII groups were given 0.05 mg/kg midazolam, for 15 min. MAP and HR one day before operation (T0), before anesthesia induction (T1), 1 min after pneumoperitoneum establishment (T2), the time after pulling out the laryngeal mask (T3), and the time after shifting from the recovery room (T4) were recorded. A volume of 6 mL venous blood 1 d before operation and 4 h after operation was collected. Blood sugar concentration, cortisol and IL-6 levels were detected.Results:MAP at T1, T2, T3, and T4 in DI and MI groups were significantly elevated when compared with at T0. MAP at T2 and T3 in DII group was significantly elevated when compared with at T0. MAP at T2, T3, and T4 in MII group was significantly elevated when compared with at T0. When compared with DI group, MAP at T1, T2, and T3 in DII group was significantly reduced;MAP at T2, T3, and T4 in MI group was significantly elevated;MAP at T1 in MII group was significantly reduced. When compared with DII group, MAP at T2, T3, and T4 in MI and MII groups was significantly elevated. HR at T1, T2, T3, and T4 was significantly elevated when compared with at T0. When compared with DI group, HR at T1, T2, and T3 in DII group was significantly reduced;HR at each timing point in MI group was significantly elevated;HR at T1 in MII group was significantly reduced, while at T2, T3, and T4 was significantly elevated. When compared with DII group, HR at each timing point in MI group was significantly elevated;HR at T2, T3, and T4 in MII group was significantly elevated. Except for DII group, the blood sugar, cortisol, and IL-6 levels were significantly elevated when compared with before operation. When compared with D1 group, the blood sugar and cortisol levels at T1 in DII group were significantly reduced;the blood sugar, cortisol, and IL-6 levels at T1 in MI and MII groups were significantly elevated. When compared with DII group, the blood sugar, cortisol, and IL-6 levels at T1 in MI and MII groups were significantly elevated.Conclusions:Application of hydrochloric DEX in sevoflurance anesthesia in children can effectively inhibit the excitability of sympathetic nervous system caused by operation, alleviate the stress reaction, and maintain the stability of hemodynamics, which is benefit for the postoperative rehabilitation.

Association between <i>Helicobacter pylori</i>Infection and Iron Deficiency Anemia among School-Age Children in Sohag University Hospital, Upper Egypt

Background: Helicobacter pylori (H. pylori) infection has been suggested as a cause of iron deficiency anemia (IDA) refractory to iron therapy. Objective: The aim of this work was to evaluate the association between H. pylori infection and IDA among school-age children. Subjects and Methods: This was a prospective case-control study conducted for one year starting from March 2015 and included 200 school-age children with IDA and 50 age and sex matched non-anemic controls, attending pediatric outpatient clinic at Sohag university Hospital, Sohag, Upper Egypt. All of participants were subjected to clinical evaluation and the following investigations: CBC, serum iron, total iron binding capacity, serum ferritin and a quantitative detection of H. pylori IgG antibodies. Results: Totally, 72 (36%) children with IDA and 6 (12%) non-anemic controls had positive level for H. pylori specific IgG (P = 0.036). H. pylori IgG antibody titer showed significant positive correlation with age and significant negative correlation with each of Hb level, MCV, HCT and serum ferritin. Age was higher (p H. pylori positive IDA cases in comparison to H. pylori negative IDA cases. Conclusion: The results of this study demonstrate significant association between positive serology for H. pylori infection and IDA in school-age children. Moreover, infection may increase the severity of anemia.

The effects of increased dietary fiber intake on the self-reported quality of life of school-age children

The aim of this community-based, randomized-controlled prospective nutrition intervention study was to assess the impact of serving high-fiber snacks twice a day to a sample of school-age children on their dietary fiber intake and health-related quality of life (HRQOL) scores. Participants (n = 81) were children aged 7-11 years. Children were randomized to receive two high-fiber snacks per day for eight weeks (intervention) or to continue eating their regular snacks (control). At baseline and post-intervention, usual dietary intake data were collected via repeated 24-hour dietary recalls and HRQOL was assessed using the PedsQL? Pediatric Quality of Life Inventory. Statistical analysis to assess significant changes in dietary intake as well as self-reported quality of life was conducted using two-sided student’s t-tests;significance level was set at p < 0.05. Dietary fiber intake increased significantly by 2.41 grams/day in the intervention group. The mean increase in the physical scale score of the PedsQL from baseline to post-intervention was significantly greater for the intervention as compared to control group. This study indicates that providing high-fiber snacks to elementary-school children can effectively increase dietary fiber consumption and may lead to an improved physical quality of life. Further research is needed regarding the impact of nutrition on health-related quality of life.

Sports-Related Concussion in School-Age Children

Viewed through the lens of public health, sports-related concussion or mild traumatic brain injury is an epidemic health problem. This paper commences with a scoping review of sport-related concussion and mild traumatic brain injury considering its historical background, clinical definitions, epidemiology, and pathophysiology and treatment. The second section assesses the complex interplay of intrapersonal and interpersonal, community, and societal factors that influence sport-related concussion and mild traumatic brain injury. The third section concludes with recommendations for policy changes and further research to mitigate the health impact of sports-related concussion in adolescent school-age children. The optimal management of sports-related concussion requires care going beyond the acute injury, and into the school setting to maximize their academic and social outcomes. This is more likely to occur when healthcare and educational systems are optimally coordinated.

Report on Childhood Obesity in China (1) Body Mass Index Reference for Screening Overweight and Obesity in Chinese School-age Children

Purpose To establish and propose a national body mass index (BMI) reference for screening overweight and obesity in Chinese school-age children and adolescents. Methods 2000 CNSSCH (Chinese National Survey on Students Constitution and Health) data, including 216 620 primary and secondary school students aged 7 to 18 years old, were used as a reference population. Compared with those of the NCHS internatioanl reference, three temporary sets of cut-off BMI were proposed by testing different combinations of P8s, P9o, and P95. When physiological and biochemical measures between and among 'obesity','overweight', and 'normal weight' groups were taken into consideration, set Ⅱ was selected to be the most appropriate one.The sex-age-specific curves were then plotted and smoothed by using B-spline method. Results Based on the samples from costal developed metropolis, the BMI curves successfully overcame the shortcomings of lower and level-off tendency of the Chinese total population. Temporary set Ⅱ, composed by cut-offs of P85 for overweight and P95 for obesity, was finally selected by its sensitivity and peculiarity. BMI 24 and 28 were used as cut-offs for overweight and obesity for both males and females aged 18 years old. These cut-offs, consistent with Chinese Adult's Reference, was proposed as the Body mass index reference for screening overweight and obesity in Chinese school-age children and adolescents. Conclusion The new reference clearly showed its superiorty in both prospectivity and actuality. The proposed reference minimized the gaps of the BMI curve between Chinese adolescents and the international reference. Most importantly was that it was consistent with the Eastern Asia ethnic characteristics of body fatness growth. It was therefore proposed by the Working Group on Obesity in China (WGOC) to use it as an nationwide reference for screening overweight and obesity of school-age children and adolescents in China.

Impacts of Types and Degree of Obesity on Non-Alcoholic Fatty Liver Disease and Related Dyslipidemia in Chinese School-Age Children?

Objective To explore the impacts of types and degree of obesity on non‐alcoholic fatty liver disease (NAFLD) and related lipids disturbance in Chinese school‐age children. Methods A total of 1 452 school‐age Children of 7 to 17 years were recruited in Beijing with representative cluster sampling method. Data of anthropometric measurements including weight, height and waist circumference were collected from March to May of 2007. Body mass index(BMI)was calculated. Blood samples were obtained and lipid profiles including triglyceride (TG), total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C) and low‐density lipoprotein cholesterol (LDL‐C) were measured, while glutamate‐pyruvate transaminase (ALT) and glutamic‐oxalacetic transaminase (AST) were determined to evaluate liver function. The liver was also scanned by sonography, and abnormal hepatic sonograms were documented. NAFLD was diagnosed according to the criteria recommended by the Fatty Liver and Alcoholic Liver Disease Study Group under the Chinese Liver Disease Association. Analysis of covariance (ANOVA), Chi‐square test for trend and binary logistic regression analysis were performed. Results The dyslipidemia and ultrasonographic fatty liver deteriorated with the degree of obesity defined either by BMI or waist circumference. Compared with BMI, waist circumference contributed more to the development of dyslipidemia, fatty liver and NAFLD. The highest levels of TG, TC, LDL‐C, and lowest level of HDL‐C were seen in the mixed obese group followed by abdominal obese, peripheral obese and non‐obese ones. Adjusted for gender and age, the odds ratios (ORs) and their 95% confidence intervals of peripheral obesity, abdominal obesity and mixed obesity were 0, 10.93 (0.98‐121.96) and 79.16 (10.95‐572.44) for predicting NAFLD; 12.61 (1.24‐127.78), 19.39 (5.23‐71.85), and 93.21 (29.56‐293.90) for predicting ultrasonographic fatty liver; 1.78 (0.59‐5.44), 3.01 (1.91‐4.77), and 4.64 (3.52‐6.12) for predicting dyslipidemia, respectively compared with the non‐obese control group. The trend of hazards over groups was statistically significant (P<0.01). Conclusion The levels of lipid profile and the prevalence of NAFLD and dyslipidemia increased in parallel with the degree of obesity; As compared with the non‐obese control, the mixed obesity had the strongest association with NAFLD and dyslipidemia, followed by abdominal obesity and peripheral obesity in Chinese school‐age Children.

Report on Childhood Obesity in China (4) Prevalence and Trends of Overweight and Obesity in Chinese Urban School-age Children and Adolescents, 1985-2000

Objective To describe the nationwide prevalence of childhood overweight/obesity, and their group variations and trends over the past 20 years in the Chinese urban population. Methods Data sets of boys and girls at the age of 7-18 years collected from the series of Chinese national surveillance on students' constitution and health (CNSSCH) between 1985 and 2000 were divided into five socioeconomic and demographic groups, while BMI classification reference proposed by Working Group on Obesity in China (WGOC) was used as screening reference to calculate the prevalence and trends of overweight/obesity in these groups. Results In 2000, the prevalence of obesity and overweight in boys aged 7-18 years was 11.3% and 6.5% in Beijing, 13.2% and 4.9% in Shanghai, 9.9% and 4.5% in coastal big cities, and 5.8% and 2.0% in coastal medium/small-sized cities, respectively, while the prevalence of of obesity and overweight in girls of the same age group was 8.2% and 3.7% in Beijing, 7.3% and 2.6% in Shanghai, 5.9% and 2.8% in coastal big cities, and 4.8% and 1.7% in coastal medium/small-sized cities, respectively. The prevalence of obesity was low in most of the inland cities at an early stage of epidemic overweight. The epidemic manifested a gradient distribution in groups, which was closely related to socioeconomic status (SES) of the study population. However, a dramatic and steady increasing trend was witnessed among all sex-age subgroups in the five urban groups, and such a trend was stronger in boys than in girls, and much stronger in children than in adolescents. Conclusion Although China is at an early stage of epidemic obesity by and large, the prevalence of obesity in her urban population, particularly in coastal big cities has reached the average level of developed countries. The increasing trend has been rapid since early 1990s, and the increments in obesity and overweight are exceptionally high. The prospect of epidemic obesity in China is in no way optimistic. Therefore, preventive program should be focused on the improvement of the balance between caloric intake and energy expenditure, and interventions aimed at changing children's life styles.

Mutual Experiences of Japanese Parents and Their Children When Late School-Age Children Engage in Meal-Related Family Routines: A Qualitative Analysis of Parent and Child Dyads

Purpose: The objective of the present study was to identify the type of experiences that parents and their children have with each other when late-school age children take on roles in family routines related to daily meals. Methods: A grounded theory approach was used. The participants were children in the 4th, 5th, and 6th grades of elementary school and their main caregivers. First, 10 parent and child dyads were interviewed using a semi-structured schedule. Next, online group interviews were conducted for 17 parent and child dyads to deductively confirm the categories. Results: The average age of the subjects was 41.9 years for parents and 10.4 years for children in parent-child interviews, and 41.1 years for parents and 9.6 years for children in group interviews. Six categories emerged with nineteen subcategories. Conclusions: Experiences mutually nurtured by parents and their children included experiences in which children used negotiation and conversation skills to consensually engage in family routines related to meals. It also included experiences that socialized the children in family life and fostered good communication. The six categories will be useful for healthcare professionals and school authorities in providing health guidance that addresses health functions of late school-age children and their families.

Waist Circumference Distribution of Chinese School-age Children and Adolescents

Background Waist circumference(WC),a proxy measure of central body fat,is a better predictor than overall body fat for cardiovascular risk factors in both adults and children.WC cutoffs have been established in many countries,but the national WC reference has not been developed in China.Objective To study the distribution of WC in a representative group of Chinese children for establishing Chinese WC cutoff points.Methods Cross-sectional data obtained from 15 mainland provinces and Hong Kong were collected.There were 160 225 children and adolescents aged 7-18 years old in total.The subjects were divided into five regional groups namely costal city,other city,north rural,south rural,and Hong Kong,for analyzing the distribution of WC.Results A large variation in WC distribution was found among the five groups for both sexes.Coastal city group had the highest P85 WC values consistently from the early school ages to 18-year-old compared with other groups.In contrast,south rural group had P85 values consistently lagged behind not only the city groups but also the north rural group.Hong Kong group had a high P85 WC at early ages,but because of the smaller increments of WC during adolescence,the P85 curve was gradually exceeded by the north rural groups.Catch-up trend was found in the two rural groups since the peak of puberty.These disparities were caused by not only socioeconomic and urban-rural factors but also north-south differences.Because of the regional variation of WC,a "gradient" prevalence of central obesity was prospected among these groups.Comparisons of WC distributions between the Chinese and the U.S.A or Netherlands demonstrated the necessary of setting up China's own WC cutoffs.Sex and age-specific percentiles were obtained and smoothed by using LMS method.Conclusion The data obtained from this study could be used to develop national WC cutoff points for Chinese children and adolescents.

Simple anthropometric measurements to predict dyslipidemias in Mexican school-age children: a cross-sectional study

Objective: The purpose of this study was to identify the best predictors of dyslipidemias in Mexican obese children using different anthropometric and body composition measurements. Methods: In an observational, cross-sectional study, 905 children from 5 schools were measured for weight, height, waist and hip circumference, and triceps and subscapular skinfolds. A fasting blood sample was taken from a random sub-sample of 306 children to determine lipid profile. Abnormal total cholesterol, LDL, HDL, triglycerides, total cholesterol to HDL ratio, and LDL to HDL ratio, were determined. Logistic regressions and ROC analysis were carried out to determine the best anthropometric predictors of these risk factors. Results: Prevalence of elevated total cholesterol, triglycerides and LDL cholesterol was 14%, 56% and 58%, respectively. In logistic regressions, BMI and triceps skinfold had the highest odds ratios to predict elevated total cholesterol (1.05, 95%CI: 0.97 - 1.14;1.07, 1.01 - 1.13, respectively), triglycerides (1.19, 1.11 - 1.27;1.12, 1.08 - 1.17, respectively), LDL cholesterol (1.11, 1.04 - 1.18;1.09, 1.05 - 1.14, respectively), total cholesterol to HDL ratio (1.06, 1.00-1.14;1.07,1.03-1.12, respectively) and LDL to HDL ratio risk (1.08,1.01-1.15;1.07, 1.03-1.12, respectively). After BMI and triceps skinfold, subscapular skinfold also predicted dyslipidemias, except for low HDL;both skinfolds had a narrower odds ratio confidence interval than BMI. In ROC analysis, subscapular skinfold was the best predictor of elevated triglycerides with an AUC ≥ 0.7. Conclusion: Anthropometric measurements are not strongly associated with dyslipidemias in Mexican children. However, since triceps and subscapular skinfolds were better predictors than other anthropometry measures, they may be a simple way to predict dyslipidemias in Mexican children.

Corneal Biomechanical Properties and Associated Factors in School-age Children

Purpose: To study and analyze the correlation among corneal biomechanical properties and associated factors including central corneal thickness (CCT), corneal curvature (CT), and intraocular pressure (IOP) in school-age children. Methods:A cross sectional investigation was conducted. An ocular response analyzer was utilized to assess the corneal biomechanical properties,such as corneal hysteresis and corneal resistance factors, in children of school age. Multivariate regression analysis was used to investigate the relationship between corneal biomechanical properties and other ocular parameters including CCT, corneal curvature (k1 and k2), and IOP. The right eyes of all subjects were selected for statistical analysis. Results: A total of 571 children were enrolled: 303 male and 268 female,with an average age of 10.47 ±1.0 years. The mean value of corneal hysteresis was 10.98 ±1.78 mmHg, corneal resistance factor was 11.46±1.69 mmHg,and CCT was 556.01±28.97 μm. Conclusion:The feasibility of corneal biomechanical detection in school age children was validated. This study provides fundamental data on corneal biomechanical properties in school-age children and associated factors. (Eye Science 2013; 28:34-39)

Effect of artificial natural light on the development of myopia among primary school-age children in China:a three-year longitudinal study

AIM:To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children.METHODS:This is a prospective,randomized control,intervention study.A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study.The whole randomization method was adopted to include classes as a group according to 1:1 randomized control.Classrooms in the control group were illuminated by usual light,and classrooms in the intervention group were illuminated by artificial natural light.All students received uncorrected visual acuity and best-corrected visual acuity measurement,non-cycloplegic autorefraction,ocular biometric examination,slit lamp and strabismus examination.Three-year follow-up,the students underwent same procedures.Myopia was defined as spherical equivalent refraction≤-0.50 D and uncorrected visual acuity<20/20.RESULTS:There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y.The three-year cumulative incidence rate of myopia was 26.4%(207 incident cases among 784 eligible participants at baseline)in the control group and 21.2%(164 incident cases among 774 eligible participants at baseline)in the intervention group[difference of 5.2%(95%CI,3.7%to 10.1%);P=0.035].There was also a significant difference in the three-year change in spherical equivalent refraction for the control group(-0.81 D)compared with the intervention group[-0.63 D;difference of 0.18 D(95%CI,0.08 to 0.28 D);P<0.001].Elongation of axial length was significantly different between in the control group(0.77 mm)and the intervention group[0.72 mm;difference of 0.05 mm(95%CI,0.01 to 0.09 mm);P=0.003].CONCLUSION:Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

The SACT Template:A Human Brain Diffusion Tensor Template for School-age Children

School-age children are in a specific development stage corresponding to juvenility,when the white matter of the brain experiences ongoing maturation.Dffusion-weighted magnetic resonance imaging(DWI),especially diffusion tensor imaging(DTI),is extensively used to characterize the maturation by assessing white matter properties in vivo.In the analysis of DWI data,spatial normalization is crucial for conducting inter-subject analyses or linking the individual space with the reference space.Using tensor-based registration with an appropriate diffusion tensor template presents high accuracy regarding spatial normalization.However,there is a lack of a standardized diffusion tensor template dedicated to school-age children with ongoing brain development.Here,we established the school-age children diffusion tensor(SACT)template by optimizing tensor reorientation on high-quality DTI data from a large sample of cognitively normal participants aged 6-12 years.With an age-balanced design,the SACT template represented the entire age range well by showing high similarity to the age-specific templates.Compared with the tensor template of adults,the SACT template revealed significantly higher spatial normalization accuracy and inter-subject coherence upon evaluation of subjects in two different datasets of schoolage children.A practical application regarding the age associations with the normalized DTI-derived data was conducted to further compare the SACT template and the adult template.Although similar spatial patterns were found,the SACT template showed significant effects on the distributions of the statistical results,which may be related to the performance of spatial normalization.Looking forward,the SACT template could contribute to future studies of white matter development in both healthy and clinical populations.The SACT template is publicly available now(tp://igshare com/aricles/dataseu'SACT_.template/14071283).

Survey and clinical considerations of gender identity in lower primary school children

BACKGROUND Gender consciousness directly affects the development of gender identity,which is a continuous and lifelong process.Meanwhile,hospitalization is a part of many children's lives and has an impact on their gender development.AIM To investigate the current situation of gender identity in lower primary school children by conducting a survey of 202 hospitalized children in the lower grades and to provide a theoretical basis and foundation for the cultivation of gender identity and medical treatment of children based on the results.This study aims to inspire clinical medical staff to scientifically and reasonably arrange hospital wards for lower primary school children and pay attention to gender protection during the medical treatment process and to help children shape a unified and clear gender identity,which will enable them to better integrate into society and promote their personality development.METHODS The gender consciousness scale for elementary and middle school students was RESULTS Gender identity was already present in lower primary school children.The children's gender roles and gender equality consciousness were strong,exceeding the critical value,but their gender characteristics,gender identity,and gender ideal consciousness were weak.Children aged 6 had the weakest gender identity,and girls had significantly stronger gender identity than boys.CONCLUSION Gender identity is already present in lower primary school children,providing a basis and inspiration for the cultivation of gender identity and medical treatment of lower primary school children.Clinical medical staff should be aware of and understand these results and should scientifically and reasonably arrange hospital wards for lower primary school children.

Improving school physical education to increase physical activity and promote healthy growth of Chinese school-aged children Time for action

Throughout its more than 5000-year history,China has a long tradition of encouraging active engagement in physical and sport activities.1,2This enduring tradition,however,has been facing some major headwinds as China continues to experience demographic and environmental changes related to aging,urbanization,and lifestyle shifts.3-5Mounting evidence indicates increasing levels of sedentary behaviors。

Physical activity among Chinese school-aged children:National prevalence estimates from the 2016 Physical Activity and Fitness in China The Youth Study

Purpose: This study was to present national estimates of participating in moderate-to-vigorous physical activity(MVPA) and adherence to the recommendations of 60 min/day of MVPA among Chinese school-aged children and to assess demographic differences in MVPA.Methods: Cross-sectional analyses of data from the 2016 Physical Activity and Fitness in China—The Youth Study. Participants were 90,712 primary, junior middle, and junior high school children(boy: 47%; girl: 53%), recruited from 1204 rural and urban schools across 32 administrative provinces and regions in the Mainland of China. Main outcomes were(a) average MVPA minutes per day in the previous 7 days by self-reports and(b) percentage meeting MVPA recommendations.Results: Average MVPA time was 45.4 min/day, with boys having more MVPA(47.2 min/day) than girls(43.7 min/day) overall and across the 3 school grade categories. About 30% of participants met MVPA recommendations, with a higher percentage of boys(32%) than girls(28%) overall and across the 3 grades categories. Urban school children outperformed rural children in terms of MVPA time. Overall, boys were more likely to meet MVPA recommendations(adjusted odds ratio(a OR) = 1.19, 95% confidence interval(CI): 1.16–1.22) compared with girls; children in higher grades(junior middle(a OR = 0.92, 95%CI: 0.87–0.98) and junior high(a OR = 0.59, 95%CI: 0.53–0.66)) were less likely to meet recommendations compared with primary school children. The odds of meeting recommendations did not differ between urban and rural children(p = 0.07),but urban boys were found to be more likely to meet recommendations compared with rural boys(a OR = 1.14, 95%CI: 1.06–1.19).Conclusion: Overall, the average MVPA minutes per day among Chinese school-aged children is low, and less than one-third of them meet MVPA recommendations. These results were most evident among junior middle and junior high school children and those living rural areas.