UNASSIGNED: To explore the association between VPA and weight status in adolescents.
UNASSIGNED: The 2017/2018 Health Behavior in School-aged Children survey (HBSC) targeted children and adolescents aged 11, 13 and 15. A systematic multistage stratified cluster randomized sampling method was used in each participating country. The 2017/2018 survey enrolled over 240,951 adolescents across 45 countries and regions. Frequency of VPA, weight status and confounding factors were collected using a self-reported questionnaire.
UNASSIGNED: Compared to daily VPA, less frequent VPA was linked to higher odds of obesity. For example, those who participating in VPA for 4-6 times a week (OR = 1.10, 95% CI = 1.06-1.13), 2-3 times a week (OR = 1.21, 95% CI = 1.17-1.25), or once a week (OR = 1.21, 95% CI = 1.16-1.25) all have higher odds of abnormal weight status. For boys, the frequency of 4-6 times a week (OR = 1.09, 95% CI = 1.04-1.13), 2-3 times a week (OR = 1.22, 95% CI = 1.17-1.27), or once a week (OR = 1.25, 95% CI = 1.19-1.32) were associated with higher odds of abnormal weight status. For girls, those who participating in VPA 4-6 times a week (OR = 1.11, 95% CI = 1.06-1.16), 2-3 times a week (OR = 1.20, 95% CI = 1.14-1.25), or once a week (OR = 1.17, 95% CI = 1.11-1.23) all have higher odds of abnormal weight status (i.e., overweight or obesity).
UNASSIGNED: This population-based study suggests that infrequent VPA participation is associated with unhealthy weight status in adolescents compared to their physically active counterparts. Additionally, this association remains consistent in both boys and girls.

OBJECTIVE: To understand preoperative experiences and information needs of Chinese school-aged children undergoing elective surgery to design standardized preoperative education programs to alleviate preoperative anxiety.
METHODS: Semi-structured interviews combined with drawing, writing, and telling techniques were conducted in 12 children. The paintings were interpreted alongside children\'s verbal expressions. All data were analyzed using thematic analysis.
RESULTS: Three themes emerged: Origins of Surgical Knowledge: Proximity-based knowledge, media exposure, past personal medical experiences, ward-mate interactions, healthcare staff education; Pre-Surgery Experiences: Anticipation of pain, post-op sensations and impact on life, fantasizing about the operation, being aware of risks, demonstrating psychological resilience, being curious about anesthesia experience, enjoying a break; Preoperative Informational Needs: 55 identified.
CONCLUSIONS: Lack of standardized preoperative education creates a gap between children\'s knowledge and actual surgical experiences. Developing preoperative education tailored to individualized informational needs and developmental level helps fill their gaps, alleviate preoperative anxiety and improve health outcomes.

Numerous studies have consistently demonstrated the presence of the approximate number system (ANS) throughout development. Research has also revealed that visual cues may influence the ANS acuity, which may change with age. However, most studies have drawn conclusions based on performance differences between incongruent and congruent trials, which may be confounded by an individual\'s ability to inhibit interference. Therefore, to examine the developmental changes of the impact of visual cues on ANS acuity, we utilized congruent trials with varying visual cues. Our sample comprised Chinese children from grade one to grade five. We manipulated the salience of numerical cues (numerical ratio) and visual cues (dot size) in a non-symbolic numerosity comparison task. The results revealed a discernible leap in development from first to third grade and first to fifth grade; however, this upward trajectory did not persist into the transition from third to fifth grade, where no appreciable advancement was observed. Moreover, we observed different effects of visual cues on the dot-comparison task depending on the numerical cues and age. Specifically, visual cues (i.e., dot size) only facilitated ANS acuity in older school-aged children when numerical cues were weakened. The results indicate the presence of two distinct magnitude representational systems-one for the numerical dimension and another for the non-numerical dimension-during development.

The present study aims to validate the 40-item and the brief 17-item Washoe County School District Social-Emotional Competency Assessment (WCSD-SECA), a self-report measure of social-emotional competencies, among Chinese school-aged children residing in Hong Kong. A total of 349 children (M = 9.86 years, SD = 1.22; 45.82% girls) and their parents (77.84% mothers) completed a set of questionnaires independently. The factor structure of both versions of the WCSD-SECA was assessed via confirmatory factor analyses. Structural equation models were then conducted to examine the predictive validity of the WCSD-SECA. The findings indicated that both the 40-item and the 17-item versions of the WCSD-SECA fit the data adequately. Both versions were also associated with self-reported positive and negative affect and parent-reported internalizing problems and externalizing problems. Additionally, social-emotional competencies as measured by the 40-item version were significantly associated with parent-reported prosocial behavior, whereas those as measured by the 17-item version were associated with prosocial behavior with a marginal significance. The findings demonstrated an adequate factor structure and predictive validity of the full version and the brief version of the WCSD-SECA in assessing social-emotional competencies. Hence, they serve as a useful tool for researchers, educators, and mental health practitioners to evaluate school-aged children\'s social-emotional competencies in the Chinese context.

The median urinary iodine concentration (UIC) of school-aged children has been commonly used as a surrogate to assess iodine status of a population including pregnant women. However, pregnant women have higher iodine requirements than children due to increased production of thyroid hormones. The aim of the study was to evaluate the iodine status of pregnant women and children as well as their household salt iodine concentration (SIC) in Quzhou, Zhejiang Province, China. Eligible pregnant women and children from all six counties of Quzhou in 2021 were recruited into the study. They were asked to complete a socio-demographic questionnaire and provide both a spot urine and a household table salt sample for the determination of UIC and SIC. A total of 629 pregnant women (mean age and gestation weeks of 29.6 years and 21.6 weeks, respectively) and 1273 school-aged children (mean age of 9 years and 49.8% of them were females) were included in the study. The overall median UIC of pregnant women and children in our sample was 127 (82, 193) μg/L and 222 (147, 327) μg/L, respectively, indicating sufficient iodine status in children but a risk of mild-to-moderate iodine deficiency in pregnant women. Distribution of iodine nutrition in children varied significantly according to their sex and age (P < 0.05). The rate of adequately household iodised salt samples (18-33 mg/kg) provided by pregnant women and children was 92.4% and 90.6%, respectively. In conclusion, our results indicated a risk of insufficient iodine status in pregnant population of China, but iodine sufficiency in school-aged children. Our data also suggested that median UIC of children may not be used as a surrogate to assess iodine status in pregnant women.

BACKGROUND: We aimed to examine the associations between depressive symptoms and physical activity parameters (e.g., intensity, frequency, and duration) among Chinese school-aged children.
METHODS: Participants in this study were extracted from the Tongji Mental Health Cohort Study. The baseline survey was conducted in June 2020 involving 2588 school-aged children from two primary schools in Hubei Province, China. A total of 2435 children were followed up successfully in December 2020. The Children\'s Depression Inventory Short Form (CDI-S) was applied to evaluate depressive symptoms among school-aged children. The Physical Activity Rating Scale-3 (PARS-3) was adopted to estimate children\'s physical activity parameters including the intensity, frequency, and duration. Generalized estimation equation models were used to explore the longitudinal associations between physical activity and depressive symptoms among school-aged children.
RESULTS: Engaging in moderate levels of physical activity (OR, 0.800; 95%CI, 0.692-0.924) or high levels of physical activity (OR, 0.808; 95%CI, 0.689-0.947) in the baseline survey was associated with a reduced risk of developing depressive symptoms in the follow-up survey compared with children engaging in low levels of physical activity. Stratified analyses revealed that the associations between physical activity and depressive symptoms exhibited a significant correlation among boys and children in the older age group (11-12 years). Our findings showed that engaging in physical activity more than once a week, with each session lasting 20 min or longer, was related to significant reductions in depressive symptoms by 43.8% and 22.3%, respectively.
CONCLUSIONS: Self-reported physical activity is positively associated with improved mental health among Chinese school-aged children, especially when considering parameters such as frequency and duration. The association between vigorous-intensity physical activity and depressive symptoms in children should be cautiously interpreted. Future research should continue to explore the effects of vigorous-intensity physical activity on depressive symptoms in children.

OBJECTIVE: To analyze the distribution of refractive status in school-age children with different corneal curvatures (CC) and the correlation between CC and refractive status.
METHODS: A total of 2214 school-aged children of grade 4 in Hangzhou who were screened for school myopia were included. Uncorrected distance visual acuity (UCDVA), non-cycloplegic refraction, axial length (AL), horizontal and vertical corneal curvature (K1, K2) were measured and spherical equivalent (SE), corneal curvature radius (CCR) and axial length/corneal radius of curvature ratio (AL/CR) were calculated. UCDVA<5.0 and SE≤-0.50 D were classified as school-screening myopia. According to the different CCRs, the patients were divided into the lower corneal curvature (LCC) group (CCR≥7.92) and the higher corneal curvature (HCC) group (CCR<7.92). Each group was further divided into the normal AL subgroup and the long AL subgroup. The refractive parameters were compared to identify any differences between the two groups.
RESULTS: Both SE and AL were greater in the LCC group (P=0.013, P<0.001). The prevalence of myopia was 38% in the LCC group and 44% in the HCC group (P<0.001). The proportion of children without screening myopia was higher in the LCC group (62%) than in the HCC group (56%). Among these children without screening myopia, the proportion of long AL in the LCC group (24%) was significantly higher than that in the HCC group (0.012%; P<0.001). The change of SE in the LCC group was less affected by the increase of AL than that in the HCC group.
CONCLUSIONS: School-aged children in the LCC group have a lower incidence of screening myopia and longer AL. Low CC can mask SE reduction and AL growth to some extent, and the change of AL growth change more in children with low CC than high CC. Before the onset of myopia, its growth rate is even faster than that after the onset of myopia.

Obesity is strongly associated with disturbances of vitamin D (VD) metabolites in the animal models. However, the related epidemiological evidence is still controversial, especially the different degrees of obesity children. Hence, in this present representative case-control study, 106 obesity school-age children aged 7-12 years were included and divided into different subgroups as degree I (the age- and sex-specific BMI≥95th percentile, n=45), II (BMI ≥120% percentile, n=34) and III (BMI ≥140% percentile, n=27) obesity groups across the ranges of body mass index (BMI). While the age- and sex-matched subjects without obesity were as the control group. Notably, it was significantly different of body composition, anthropological and clinical characteristics among the above four subgroups with the dose-response relationships (P<.05). Moreover, comparing with the control group, the serum VD concentrations were higher, VD metabolites like 25(OH)D, 25(OH)D3 and 1,25(OH)2D, and related hydroxylases as CYP27A1, CYP2R1 and CYP27B1 were lower in the degree I, II, and III obesity subgroups (P<.05), which were more disorder with the anthropological and clinical characteristics as the obesity was worsen in a BMI-independent manner (P<.05). However, there was a significant increase of CYP27B1 in the degree III obesity group than those in the degree I and II obesity subgroups. Furthermore, the methylation patterns on the genome-wide (Methylation/Hydroxymethylation) and VD metabolism genes (CYP27A1, CYP2R1 and CYP27B1) were negatively correlated with the worse obesity and their related expressions (P<.05). In summary, these results indicated that obesity could affect the homeostasis of VD metabolism related genes such as CYP27A1, CYP2R1, CYP27B1 and etc through abnormal DNA methylation, resulting in the disorders of VD related metabolites to decrease VD bio-availability with the BMI-independent manner. In turn, the lower levels of VD metabolites would affect the liver function to exacerbate the progression of obesity, as the Degree II and III obesity subgroups.

BACKGROUND: The long-term sequelae of Coronavirus disease 2019 (COVID-19) in children are unclear. We investigated COVID-19 symptoms in school-aged children to determine their impact on patients and their families.
METHODS: This cross-sectional study, conducted on February 25-28, 2023, selected a representative kindergarten and 9-year school from Shenzhen, China. There were randomly two classes each for the 12 grades from kindergarten to junior high school. The school-aged children were aged 3-16 years. Literate parents completed an online questionnaire related to their children\'s COVID-19 symptoms since December 1, 2022. Descriptive statistics were computed as necessary. Univariate and multivariable linear regression analyses were performed, and variables with a p-value < 0.05 were considered to have a significant association with the subjective feeling scores for COVID-19 infection.
RESULTS: We included 936 school-aged children, with a COVID-19 infection rate of 68.5%. The prevalence of LC 28 (illness with symptoms lasting for 28 days) was 3.4%. During acute infection, the median number of the 641 children\'s symptoms was 3.0 (IQR: 1.0-5.0) and the median score of subjective feelings was 15.0 (IQR: 11.0-24.5). The top three symptoms were fever, cough/expectoration, and rhinobyon. Age of 13-16 years (adjusted beta: 3.60, 95% CI: 0.32-6.88) and comorbidities (adjusted beta: 3.47, 95% CI: 1.20-5.73) were independently associated with higher subjective feelings (p < 0.05). The top three characteristics associated with LC 28 were alopecia (33.3%, 5/15), cognitive dysfunction (29.2%, 7/24), and emotional problem (28.6%, 6/21).
CONCLUSIONS: Children with COVID-19 have a short duration of symptoms and milder symptoms, so they can self-medicate to minimize hospital crowding. Children with basic diseases require prompt attention. Although LC 28 is uncommon in children, mental and psychological problems after COVID-19 recovery should not be ignored.

OBJECTIVE: To illustrate the changes of iodized salt usage, goiter rate of school-aged children and median urinary iodine concentration (MUIC) of school-aged children in Chongqing for the last 21 years. This study aims to estimate the variational provincial status of iodine nutrition and provide scientific evidence for fine-tuning and adaptation of the current program.
METHODS: Different number of families and school children aged 8-10 years from Chongqing during 1997-2018 participated in the study. UIC and iodine content in table salt were measured. Thyroid volumes of students were examined and goiter prevalence was calculated across years.
RESULTS: The median iodine content of table salt was negatively associated with years(r = -0.727, P < 0.01). The MUIC were decreased annually (ranged between 200 and 300 μg/L) and was negatively associated with year(r = -0.831, P < 0.01). Goiter of school-aged children in Chongqing was decreased from the highest rate of 23.58% in 1999 to 1.62% in 2018(Cochran-Armitage Trend Test: χ2=-30.695, P < 0.01). Thyroid volume were negatively associated with years(r = -0.962, P < 0.01) and had a positive relationship with MUIC 1997-2018 (r = 0.862, P < 0.01).
CONCLUSIONS: The consumption of adequately iodized salt can eliminate Iodine deficiency disorders (IDD) in children, but possible excessive iodine intake from salt could result in high urinary iodine excretion and even goiter. A systematic, well-designed and continual program monitoring is essential to ensure the adequacy of iodine fortification levels and to regularly change the iodine concentration in household table salt.