Adolescent idiopathic scoliosis (AIS) is becoming increasingly common in clinical settings, imposing a heavy burden on the family and society. At present, few treatments are available with fair effects for AIS, and there is a lack of unified and effective treatment schemes for AIS.

To explore the effect of Schroth therapy with bonesetting massage in AIS.

Forty adolescent AIS patients treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to December 2020 were selected, and equally randomly divided into treatment group and control group, 20 cases in each group. Both groups received bone setting massage once a week, and the treatment group additionally received Schroth therapy, 90 minutes per time, 3 times per week. The treatment for both groups lasted for 6 months. Pre- and post-treatment Cobb angle and angle of trunk rotation (ATR) as well as clinical efficacy were compared between the two groups.

The Cobb angle after treatment was smaller than that before treatment in both groups (P<0.05). And the treatment group had a smaller post-treatment Cobb angle than the control group (P<0.05). ATR decreased after treatment in both groups (P<0.05), and it decreased more obviously in the treatment group (P<0.05). The response rate for either control group or treatment group was 95.0% (19/20) but the marked response rate was higher in the treatment group〔85.0% (17/20) vs. 30.0% (6/20) 〕 (P<0.001) .

Compared with bonesetting massage alone, Schroth therapy with bonesetting massage had better effect on improving the Cobb angle and ATR in AIS patients, so the combination therapy is recommended for clinical use.

In 2019, the National Health Commission issued the Capacity Standards for Community Health Service Center (2018 version), which proposed that the 56 common disease species should be offered diagnosis and treatment services by CHSC, but it did not specify the common disease species of children in the community, which to some extent affects the assessment and construction of CHSC capacity in the community.

To investigate and analyze the common childhood disease species and their characteristics in community health services, in order to provide a reference basis for further community child health service capacity building.

In April 2020, a convenience sampling method was adopted to select community health service agencies in 11 different level cities in China as the sample unit. A self-designed questionnaire was administered to cover the subject's basic condition, the common childhood disease conditions suitable for diagnosis and treatment in the community, and their sequencing. Filled out online voluntarily anonymously by child health service personnel at the sample institution, 3 090 cases were successfully investigated. Respondents ranked the common degree of children's related disorders from low to high, assigning 1 to 5 points to each of the top 5 common childhood disorders, which is, assigning 5 points to ranked 1, 1 point to ranked 5, and 0 points to unselected, calculating a total and sorting by total score.

The top 5 disease categories for children in the community were acute upper respiratory infection, diarrhea, bronchitis, pneumonia, and eczema. Of the top 10 ranked community common childhood disorders, 3 were respiratory, 3 were facial and dermatologic, 2 were infectious, and 1 each was a digestive and growth and development related disorder. The top 5 common childhood diseases ranked by different regions, different levels of cities and different posts were consistent, but the ranking order was different, but there were differences in the 6th-10th disease species and order.

The current coverage of common childhood diseases in community health services is high. There is regional, urban, and post heterogeneity in common childhood disease species in communities. Construction of community child health service capacity should be oriented to improve the capacity of diagnosis and treatment service of common childhood diseases in the community, and fully consider the disease species variability in different regions, cities, and posts.

The right to health of children has been a general concern of the society. The rate of systematic health management for children is a core indicator effectively reflecting the monitoring and management of children's physical growth and psycho-behavioral development. Most of the studies on systematic health management for children use an empirical design, mainly focusing on explorations of management models, while few have made in-depth analysis of the national status from temporal and geographical perspectives.

To analyze the temporal changes and regional differences in terms of the rate of systematic health management of children under three years old from 2010 to 2019, providing valuable evidence for the consolidation and improvement of the health management level in this group, and for promoting health level in children.

In November 2021, data about health management of children under three years old in China during 2011—2020 were extracted from 10 volumes of China Health Statistics Yearbook published annually from 2011 to 2020. A descriptive analysis was used to conduct temporal and geographical analysis of the systematic health management for children.

As a whole, the national health management rate for children under three years old showed a continuous upward trend increased from 81.5% in 2010 to 91.9% in 2019, with a 12.8% increase. The annual rate of systematic health management of the children during the period was greater than 90.0% in Beijing, Inner Mongolia Autonomous Region, Liaoning Province, Shanghai, Jiangsu Province, Zhejiang Province, Shandong Province, Guangdong Province and Shaanxi Province, but was relatively low in the Tibet Autonomous Region (71.9% in 2019) , indicating that there was still a certain gap between the local level and policy goals in this region. The analysis from temporal changes and regional differences as well as regional perspective revealed the following findings: the rate of systematic health management for children under three years during 2010—2019 was higher than the national level in 13 (41.9%) out of 31 regions in China, lower than the national level in 7 regions (22.6%) , and moved around the national level in 11 regions (35.5%) . The systematic health management rate of children under 3 years old varied greatly between regions during 2010—2012, but the inter-regional differences gradually narrowed after 2015. The rate of systematic health management for children under 3 years old was the highest in northeast China, followed by eastern China, western China and central China. In 2019, there was still large differences in the rate of systematic health management for these children among regions in western China.

China has achieved remarkable results in systematic health management for children under 3 years old. More attention should be given to the regions in western China, especially the Tibet Autonomous Region during the improvement of the management for these children. To further improve and consolidate the health management level of children, it is suggested to make efforts to improve the equity and accessibility of essential medical services, narrow the inter-regional differences between health resource allocation and public health services, learn and apply relevant good management methods from advanced regions, make full use of big data and internet techniques, and strengthen the construction of community pediatric health management team.

Helicobacter pylori is difficult to remove naturally in children after being infected with it. Due to differences in sample size and features, design and setting, there is little consistency between studies on epidemiology of Helicobacter pylori infection and its affecting factors in children from China, a country with high prevalence of Helicobacter pylori. Therefore, a comprehensive and objective understanding of the prevalence and risk factors of Helicobacter pylori infection among Chinese children is of great significance for the prevention of Helicobacter pylori infection in this group.

To systematically review the prevalence and risk factors of Helicobacter pylori infection among Chinese children.

In June 2021, We searched for studies on Helicobacter pylori infection and its risk factors among Chinese children in databases of PubMed, EmBase, the Cochrane Library, CNKI, CQVIP and Wanfang Data from inception to June 2021. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Meta-analysis was performed using R 4.1.0.

Thirty-seven articles were included with a total sample size of 40 786 cases, of whom 11 267 were infected with Helicobacter pylori. Meta-analysis showed that the overall prevalence of Helicobacter pylori infection was 30.31%〔95%CI= (25.72%, 35.10%) 〕. Subgroup analysis showed that the prevalence of Helicobacter pylori infection significantly varied by geographical region of participants, the year of the publication of the article, and Helicobacter pylori detection method (P<0.05) . With the city economic decline, the prevalence of Helicobacter pylori infection in children was on the rise (χ²_trend=465.955, P<0.001) . Univariate meta-regression results showed that the city economic level had a significant impact on the prevalence of Helicobacter pylori infection in children (P<0.05) . Meta-analysis further indicated that poor living conditions〔OR (95%CI) =1.47 (1.09, 2.00) 〕, history of premastication〔OR (95%CI) =2.88 (1.80, 4.60) 〕, children〔OR (95%CI) =1.56 (1.01, 2.43) 〕or family members〔OR (95%CI) =2.23 (1.68, 2.98) 〕with gastrointestinal symptoms, gnawing fingers or toys〔OR (95%CI) =3.64 (2.10, 6.32) 〕, and use of shared bathroom utensils〔OR (95%CI) =2.54 (2.54, 5.73) 〕 were all risk factors for Helicobacter pylori infection in children. In contrast, living in urban areas〔OR (95%CI) =0.63 (0.56, 0.71) 〕and washing hands frequently〔OR (95%CI) =0.36 (0.18, 0.69) 〕were associated with decreased risk of Helicobacter pylori infection. In addition, the prevalence of Helicobacter pylori infection increased with the age of the children (χ²_trend=416.923, P<0.001) .

The overall prevalence of Helicobacter pylori infection among Chinese children is high, which may be higher in children living in rural and economically lagging areas, and with poor hygiene habits of individuals or family members. Strengthening Helicobacter pylori screening in children in rural areas and the education of associated risk factors will help to effectively prevent Helicobacter pylori infection in children.

There are less studies on sleep disturbance and limited effective screening and assessment scales for sleep disturbance in Chinese preschoolers.

To assess the reliability and validity of the Chinese version of Sleep Disturbance Scale for Children (SDSC-C) in Chinese preschoolers, providing evidence for expanding the application of SDSC in preschoolers.

By use of convenience sampling, preschool children (3-5 years old) were selected as survey participants for testing the psychometrics of the draft of the SDSC-C from one urban community and one rural community in each of five cities (Fuzhou, Quanzhou, Longyan, Sanming and Nanping) of Fujian Province from June to November 2021 with the assistance of the Fujian Family Planning Association Network, and their parents were selected as their agents to complete the questionnaire survey. Then its items were modified, screened and evaluated by an expert group, after that, the draft was developed into a formal version consisting of six domains and 23 items. The reliability and validity of the scale were assessed by item analysis, reliability analysis, validity analysis, exploratory factor analysis, and confirmatory factor analysis.

The survey obtained a response rate of 92.04% (370/402) . The high-score group〔n=106, ranked the top 27% in terms of total score of SDSC-C (≥49 points) 〕and low-score group〔n=113, ranked the bottom 27% in terms of total score of SDSC-C (≤37 points) 〕divided by critical ratio method had significant differences in the score of each item of the SDSC-C (P<0.05) . The Cronbach's α of the scale was 0.86, with 0.87 of estimating interrater agreement. The I-CVI for each item was >0.78, with kappa values were > 0.74. The S-CVI/UA was 0.87 and S-CVI/Ave was 0.98. For SDSC-C , KMO= 0.85, results of Bartlett's test of sphericity were χ²=3 013.30, P<0.001. By principal component analysis, 7 factors with an engivalue >1 were extracted, explaining 65.125% of the total variance. However, a six-factor solution (i.e. six types of sleep disorder) based on parent-reported sleep disorder symptoms in our study indicated the factor loading of items ranged from 0.34-0.85, which could explain 60.539% of the total variance. The confirmatory factor analysis showed the values of fitting indicator as follows: χ²/DF=2.66, CFI=0.84, TLI=0.81, SRMR=0.08, and RMSEA=0.08.

This study revealed that the SDSC-C is a valid and reliable scale that can provide a comprehensive and detailed assessment of sleep disturbances in Chinese preschool children, which is beneficial to clinicians for early screening and assessment of sleep-related problems in preschool children.

Noninvasive prenatal screening is more effective in screening for fetal aneuploidy than does traditional serological screening. We attempted to analyze the real-world data about the positive predictive value (PPV) for chromosome aneuploidy, and chromosome copy number variation (CNV) obtained by noninvasive prenatal testing (NIPT) , and to explore the pregnancy outcome for fetuses with sex chromosome aneuploidies and chromosome microdeletion or microduplication determined by pregnant women.

To assess the clinical value of karyotype analysis and chromosomal microarray analysis (CMA) of the testing results of NIPT.

Five-hundred and twenty-eight pregnant women who were found with a fetus at high risk of chromosome aneuploidy, and CNV by NIPT were selected from Department of Reproductive and Genetic Medicine, Hebei General Hospital, from January 1, 2014 to December 31, 2018. Amniocentesis or umbilical vein puncture was performed in them to obtain fetal cells for a definite prenatal diagnosis using karyotype analysis and CMA. All delivered cases were followed up by telephone within one year after childbirth to understand the pregnancy outcome.

Prenatal diagnosis analysis revealed that 447 fetuses were at high risk of chromosome aneuploidy. And PPVs for the risk of trisomy 21, trisomy 18, trisomy 13, sex chromosome aneuploidies, and other chromosome aneuploidy were 82.86% (174/210) , 51.52% (34/66) , 12.50% (4/32) , 50.82% (62/122) , and 5.88% (1/17) , respectively. Another 81 fetuses were at high risk of CNVs. CMA suggested that copy number variations were found in 28 cases (PPV 34.57%) , and the proportion with a clear pathogenic significance reached 24.69% (20/81) . Among the subjects under 35 years and 35 years or older, the proportions of abnormal results confirmed by prenatal diagnosis were 48.51% (147/303) and 70.22% (158/225) , respectively, showing statistically significant difference (χ²=24.938, P<0.05) . Out of the 62 pregnant women diagnosed with fetal sex chromosome abnormality, 13 (20.97%) continued with the pregnancy. Eight cases were reported no clear significance in CMA, among them one case was lost to follow-up, other seven cases chose to continue pregnancy. Among the seven infants, five were born healthy and developed normally, one girl had six fingers in both hands and the remaining one's situation was unknown.

The real-world data regarding PPVs for chromosomal aneuploidies and CNVs by NIPT, and follow-up of pregnancy outcome obtained by us, provide a reliable basis for clinical genetic counseling and treatment. It is recommended to perform karyotype analysis and CMA for a pregnant woman with a fetus with suspected chromosomal abnormality (extra or missing chromosomes, chromosome microdeletion, or microduplication) suggested by NIPT, to identify chromosome inversion, balanced translocation, low proportion chimerism and some morphological abnormalities, so as to improve the detection rate of fetal chromosome abnormalities.

Helicobacter pylori (H. pylori) infection induced precancerous lesions of gastric mucosa mostly in adulthood. However, it is debatable whether these pathological changes could also occur in children.

To investigate the relationship between H. pylori infection and precancerous lesions of gastric mucosa in children hospitalized due to upper gastrointestinal symptoms in central plain area of China.

A total of 1 015 children under the age of 18 years old were enrolled. These children attended the People's Hospital of Zhengzhou University for upper gastrointestinal symptoms such as abdominal pain, bloating, nausea, vomiting, hiccups, and acid reflux from August 2018 to July 2021. All children underwent gastroscopy, from which gastric mucosal biopsy tissues were taken for rapid urease test and histopathological examination. The clinical and pathological data of the patients were collected retrospectively. The children were divided into infected and uninfected groups according to H. pylori infection status. The age, sex, endoscopic diagnosis, and H. pylori infection rate were compared between children in infected and uninfected groups. The incidence of precancerous lesions of gastric mucosa, inflammatory activity and the degree of inflammatory cell infiltration were compared between infected and uninfected groups, meanwhile these tests were also compared in children of different age groups.

Among the 1 015 children, 854 (84.14%) were infected with H. pylori and 161 (15.86%) were not infected. H. pylori-infected children were significantly older than those of non-infected subjects (P<0.05). Endoscopy examination revealed that the proportion of chronic superficial gastritis in H. pylori- infected group was significantly higher than that in uninfected group, while nodular gastritis was more common in H. pylori-uninfected patients (P<0.05). Among the enrolled children, 54 were 1-4 years old, 199 were 5-8 years old, 435 were 9-12 years old, and 327 were 13-18 years old. H. pylori infection rate in groups of 5-8, 9-12 and 13-18 year-old children was significantly higher than that in group of 1-4 year-old children; and the infection rate in groups of 9-12 and 13-18 year-old children was also significantly higher than that in group of 5-8 year-old children (P<0.05). Among H. pylori-infected patients, 37 out of 854 children had precancerous lesions of gastric mucosa (with incidence rate of 4.33%), of which 17 patients had atrophy, 11 patients had intestinal metaplasia and 9 patients had dysplasia, and only one of the 161 H. pylori-uninfected patients (0.62%) had atrophic gastritis. The incidence of precancerous lesions of gastric mucosa in H. pylori-infected patients were significantly more than those uninfected patients (χ²=5.178, P=0.023). The level of active inflammation and inflammatory cell infiltration of gastric mucosa in H. pylori-infected children were higher than that in non-infected children (P<0.05). In groups of 5-8, 9-12 and 13-18 year-old children, the prevalence of active inflammation and neutrophil granulocyte infiltration in gastric mucosa were significantly higher than that in uninfected patients (P<0.05). In H. pylori-infected patients, children in groups of 9-12 and 13-18 years old showed more severe lymphocyte infiltration over the uninfected patients (P<0.05) .

In children, gastric mucosal precancerous lesions occur in 4.33% of H. pylori-infected patients in central China, this include atrophic gastritis, intestinal metaplasia and dysplasia; the data revealed an obvious critical issue requiring future investigation and intervention for this group of population.

Scoliosis is a common abnormal curvature of the spine. Patients with mild scoliosis are usually treated with outpatient physiotherapy, but satisfactory efficacy is associated with appropriate treatment time and frequency. The efficacy of offline physiotherapy may be affected by limited medical resources and patients' treatment time and geographical location. Remote rehabilitation may save patients' treatment time and increase the geographical accessibility of physiotherapy, making the therapy more simple and convenient.

To explore the efficacy of remote rehabilitation combined with outpatient treatment in mild adolescent idiopathic scoliosis (AIS) .

Fifty-eight eligible mild AIS patients were selected from Department of Rehabilitation Medicine, Tianjin Hospital from September 2020 to September 2021, and divided into three groups according to patients and their parents' selection of treatment: online group (n=18), combined group (n=20) and offline group (n=20). The online group received WeChat- and Tencent Video-based physiotherapeutic scoliosis specific exercise (PSSE), the combined group received both outpatient and WeChat- and Tencent Video-based PSSE treatment, and the offline group received outpatient PSSE treatment. Data of three groups were collected, including the main curve Cobb angle, coronal balance (CB), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, sagittal vertical axis (SVA), angle of axial trunk rotation (ATR), parietal vertebra rotation (Raimondi), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), muscle activation rate (MAR) on both sides of paraspinal vertebrae, root mean square ratio (RMSR) of paraspinal muscles on both sides of paraspinal vertebrae, and the score of SRS-22 before and after treatment.

The main curve Cobb angle, TK, SVA, ATR, Raimondi, SS, MAR on paraspinal vertebrae, RMSR on the concave side of the parietal vertebra and SRS-22 self-image and mental health domain scores were significantly different from those before treatment in all groups (P<0.05). Specifically, the combined group was superior to the other two groups in improved ATR and treatment satisfaction. The combined group had significantly improved main curve Cobb angle after treatment than the online group. The improvement of the concave MAR in either the combined group or offline group was significantly better than that in the online group (P<0.05) .

In mild AIS patients, remote rehabilitation combined with outpatient treatment could effectively slow down the progression of AIS curve, improve sagittal abnormality of spine, abnormal posture and vertebral rotation, increase the activation rate of paraspinal muscles on the concave side of paraspinal vertebra and improve the balance of paraspinal muscles on both sides of paraspinal vertebrae. Moreover, the combined therapy also improved the quality of life.

The prevalence of health problems in Chinese children and adolescents is high. The mention of myopia, obesity, caries, scoliosis and other health problems in adolescents in the Healthy China 2030 Initiative Indicates that these problems have become the national concerns. The establishment of a long-term, standardized disease screening and management mode by the community health center (CHC) in combination with schools in service coverage areas of the CHC will provide a new idea for strengthening the health management of children and adolescents by the CHC.

To perform posture assessment and vision screening in full-time students receiving the nine-year compulsory education in schools in the service coverage area of Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area using a CHC-school-based approach, to identify problems in disease screening and management for children and adolescents, to analyze the practice and advantages of CHC-school-based disease screening and management, and to develop a CHC-school-based health management model for children and adolescents.

This study was conducted from May to November 2021. Cluster sampling was used to select grades 1-9 full-time students (n=11 318) in 225 classes of 6 primary schools and 3 middle schools in the areas covered with health services delivered by the Chaohe Community Health Center of Zhengzhou Economic-Technological Development Area. All of them received posture assessment and vision screening.

Among the participants, 6 260 were male and 5 058 were female; 7 979 were pupils, and 3 339 were junior high school students. The prevalence of abnormal posture was 41.34% (4 679/11 318) . With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, and toe valgus increased, while that of knee hyperextension, flat feet and pes valgus decreased (P<0.05) . The prevalence of 1, 2, 3 and 4 or more abnormal postures was 29.13% (3 297/11 318) , 8.60% (973/11 318) , 3.01% (341/11 318) , and 0.60% (68/11 318) , respectively. Male students had higher prevalence of thoracic kyphosis, scoliosis, flat feet and toe valgus, and lower prevalence of knee hyperextension, X-shaped legs, O-shaped legs and foot valgus than female students (P<0.05) . The prevalence of abnormal vision was 74.99% (8 486/11 318) . The prevalence of myopia, hyperopia, and astigmatism was 41.75% (4 725/11 318) , 26.14% (2 959/11 318) , and 7.09% (802/11 318) , respectively. With the increase of grade, the prevalence of myopia increased and that of hyperopia decreased (P<0.05) .

At present, the abnormal posture rate of children and adolescents in Zhengzhou is about 40%, and the myopia rate exceeds 40%. With the increase of grade, the prevalence of uneven shoulders, thoracic kyphosis, scoliosis, O-shaped legs, toe valgus and the prevalence of myopia increased, but there is a lack of effective and normal screening and health management systems. As the hospital-school approach could improve the effectiveness and normalization of the health screening and management for children and adolescents, so this approach is recommended to be used in further improvement of the top-level design and efficacy assessment of health management in children and adolescents. In addition to CHC school-based management, the health management of children and adolescents also involves the efforts of themselves and their families, which is equally important as the former two.

The prevalence of allergic diseases is rapidly increasing among the global population, affecting 10%-40% of people worldwide. Allergic diseases often begin in childhood. So far, data for analyzing the trends in the incidence of pediatric allergic diseases in China over the past decade are scant. This study aims to provide an epidemiological support for the prevention and management of pediatric allergic diseases in China by mining electronic medical record data from a single-center institution.

To analyze the annual proportion and trend of outpatient visits for allergic diseases among children aged 0-18 years in the Beijing Children's Hospital, Capital Medical University from 2014 to 2021.

A retrospective analysis of outpatient electronic medical records from the hospital information system of Beijing Children's Hospital, Capital Medical University from 2014 to 2021 was conducted to examine the annual proportional composition and changes in the trend changes of allergic diseases. The gender- and age-based proportions of different allergic diseases including eczema, urticaria, allergic rhinitis, bronchial asthma, allergic cough, allergic conjunctivitis, food allergies, drug allergies, pollen allergy, and anaphylaxis were calculated. The trend of changes in the proportion of allergic diseases with stable annual composition ranking in the top 10 was further analyzed.

From 2014 to 2021, there were a total of 1 231 890 outpatient visits for pediatric allergic diseases in our center. After excluding missing data, a total of 1 231 863 eligible cases were included, involving 727 082 (59.0%) boys and 504 781 (41.0%) girls. The majority of children visited for allergic diseases were under the age of 3 years (46.9%). Non-IgE mediated allergic diseases, such as henoch-schoenlein purpura, bronchitis, and respiratory tract infections were excluded, and the remaining 1 208 265 cases included in the disease spectrum analysis. From 2016 to 2021, the proportion of outpatient visits for pediatric allergic diseases in Beijing Children's Hospital, Capital Medical University showed an upward trend. From 2014 to 2017, the top 5 allergic diseases visited in the outpatient department were eczema, urticaria, allergic rhinitis, bronchial asthma, and allergic cough. From 2018 to 2021, allergic rhinitis, eczema, urticaria, allergic conjunctivitis, and bronchial asthma ranked the top 5. The trend analysis for an annual proportion of pediatric allergic diseases showed that the ratios of allergic rhinitis, allergic conjunctivitis, and food allergies among all allergic diseases from 2014 to 2021 showed an increasing trend, with peak ratios of 45.4%, 11.1% and 2.8%, respectively. The ratios of urticaria, eczema, and bronchial asthma showed a decreasing trend, with peak ratios of 46.5%, 24.9% and 11.3%, respectively.

From 2016 to 2021, the proportion of outpatient visits for pediatric allergic diseases in Beijing Children's Hospital, Capital Medical University showed an upward trend. Between 2014 and 2021, the annual proportions of allergic rhinitis, allergic conjunctivitis, and food allergies exhibited an increasing trend, while the annual proportions of eczema, urticaria, and bronchial asthma demonstrated a decreasing trend.

Exploring the factors influencing healthy lifestyle in adolescents is beneficial to promoting the physical and mental health of adolescents, which is an important initiative to promote the achievement of the goals of Healthy China. Moreover, it is also an important means to achieve the goals of health poverty alleviation and targeted poverty alleviation projects in both left-behind and non-left-behind rural adolescents.

To investigate the longitudinal effect of cumulative ecological risk on healthy lifestyle and the mediating effect of future time perspective between them in rural left-behind and non-left-behind adolescents.

Rural left-behind and non-left-behind adolescents from 24 classes in 12 schools in Shijiazhuang, Hebei Province were selected from October 2020 to October 2021. Three surveys (the first, second and third were on cumulative ecological risk, future time perspective and healthy lifestyle, respectively) were conducted with them, and had 1 135, 1 102 and 1 053 responders, respectively. Person correlation analysis was used to analyze the correlation between cumulative ecological risk, future time perspective and healthy lifestyle. Structural equation model was used for mediation analysis, and Bootstrap sampling method was used to further assess the mediating effect of future time perspective.

Finally, 1 053 cases who effectively responded to each of the three surveys were included for analysis, including 335 left-behind adolescents (31.81%) and 718 non-left-behind adolescents (68.19%) . The scores of annual cumulative ecological risk (October 2020) , future time perspective (April 2021) and healthy lifestyle (October 2021) were (2.78±1.45) , (53.40±13.80) and (150.72±24.67) , respectively for left-behind responders, and were (2.34±1.24) , (59.21±8.46) and (159.07±14.43) , respectively for non-left-behind responders. Correlation analysis showed that cumulative ecological risk was negatively correlated with both future time perspective and healthy lifestyle (P<0.05) , and future time perspective was negatively correlated with healthy lifestyle (P<0.05) . Forced regression indicated that the healthy lifestyle was inversely and longitudinally influenced by cumulative ecological risk in rural left-behind adolescents (β=-0.31, P<0.01) , showing a trend of sharp and positively accelerated decline. The healthy lifestyle was also inversely and longitudinally influenced by cumulative ecological risk in non-left-behind adolescents (β=-0.22, P<0.01) , demonstrating a relatively liner trend of mild decline. Mediating analysis using Bootstrap sampling revealed that future time perspective played a mediating role in the longitudinal effect produced by cumulative ecological risk on the healthy lifestyle in both rural left-behind and non-left-behind adolescents (P<0.01) .

The cumulative ecological risk may be a longitudinal predictor of the healthy lifestyle in left-behind and non-left-behind adolescents, and its predictive value was higher in the latter. Future time perspective was a mediator in the relationship between cumulative ecological risk and healthy lifestyle in both left-behind and non-left-behind adolescents.

It is hard to make an early and accurate diagnosis of developmental delay (DD) /mental retardation (MR) in children due to complex etiology, diverse and heterogeneous clinical manifestations of the disease. There are few large-sample analyses of the clinical and genetic test data of these children in China.

To perform an analysis of genetic test results of children with DD/MR, providing evidence for genetic diagnosis, treatment plan formulation and prognosis assessment in such children.

Ninety-three children with DD/MR of unknown origin were selected from Department of Rehabilitation, Kunming Children's Hospital from September 2017 to September 2021. Whole-exome sequencing (WES) was performed to explore pathogenic gene mutations associated with clinical manifestations. Copy number variation (CNV) detection was conducted to examine the characteristics of pathogenic CNVs. The detection of gene mutations was analyzed.

The DD/MR in the children was mainly manifested by motor or global DD, or MR, and with a developmental level falling behind normal developmental milestones. Seventy-four cases (79.6%) were detected with genetic variants, and the detection rate was 79.6%, among whom 40 (43.0%) with pathogenic gene mutations, 13 (14.0%) with gene CNVs, and 21 (22.6%) with mutations of uncertain significance. The genetic test results involved more than 50 pathogenic genes in total. The most prevalent disease caused by gene mutation was spinal muscular atrophy caused by mutations in the SMN1 gene (10.0%, 4/40), followed by Bethlem myopathy-1 caused by mutations in the COL6A2 gene (7.5%, 3/40) and Joubert syndrome-21 caused by mutations in CSPP1 (5.0%, 2/40) .

Pathative gene mutations and gene copy number variants may be main causes of DD/MR. SMN1, COL6A2, and CSPP1 are common mutated genes in DD/MR patients. WES combined with CNV detection may greatly contribute to the exploration of the etiology of DD/MR, especially for DD/MR manifested by atypical phenotypes and clinical manifestations.

Dyspepsia (namely, the functional dyspepsia) in children, is a common pediatric disease that has a high recurrence rate. Severe dyspepsia will affect the nutritional intake of children, and may further impair their physical development and even mental health.

To systematically review the effectiveness and safety of Changyanning Granules in the treatment of dyspepsia in children.

We searched databases of CNKI, WanFang Data, CQVIP, and SinoMed for randomized controlled trials (RCTs) in Chinese and searched databases of PubMed, The Cochrane Libarary, EMBase, Web of Science for relevant RCTs in English from inception to May 2021. Regarding children with dyspepsia treated by Changyanning Granules or Changyanning Granules in combination with routine western treatment〔Live Combined Bifidobacterium and Lactobacillus Tablets (LCBLT) or Motilium Tablets (MT) 〕 (experimental group) compared with those treated with Xiaoer Xishi Pian (a Chinese patent medicine) or routine western treatment (LCBLT or MT) regardless of dosage, administration route and duration of treatment. We used response rate as the primary outcome indicator, and incidence of adverse reactions and clinical symptoms disappearing time as secondary outcome indicators. We used the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1) and RevMan 5.3 for conducting the meta-analysis.

Six RCTs were included, involving 1 150 cases (575 in the experimental group and 575 in the control group) . Meta-analysis showed that Changyanning Granules were superior to Xiaoer Xishi Pian in terms of overall response rate〔RR=1.57, 95%CI (1.27, 1.94) , P<0.000 1〕 with lower incidence of adverse reactions〔RR=0.18, 95%CI (0.09, 0.37) , P<0.000 01〕. Compared with LCBLT or MT, Changyanning Granules with LCBLT or MT produced higher overall response rate〔RR=1.60, 95%CI (1.13, 2.26) , P=0.008〕, and shortened the clinical symptom disappearing time (P<0.05) , but showed no significant difference in the incidence of adverse reactions (P>0.05) .

For children with dyspepsia, available evidence has demonstrated that using Changyanning Granules alone, or in combination with LCBLT or MT, could improve the overall response rate, shorten the clinical symptoms disappearing time with relatively low incidence of adverse reactions. However, due to low quality of included RCTs, our conclusion needs to be further verified by RCTs meeting the international standards with a large sample size, and rigorous design.

Functional constipation (FC) is highly prevalent with complex associated factors in children, posing great health risk to the affected children. So far, the results of studies on the prevalence of FC and its influencing factors vary widely, and those focusing on FC in urban children in China are relatively few.

The purpose was to investigate the prevalence and influencing factors of FC in children in urban communities, so as to provide data support for establishing a database of FC in children in the community and for carrying out standardized, multidisciplinary and continuous management of FC in children in the community.

Children aged 6 to 48 months who were registered as recipients of health services delivered by Yuetan Community Health Center, Beijing were selected from the Beijing Maternal and Child Healthcare Information System (Phase 2) during the period from April to July 2021. A questionnaire designed by our research group was used to survey the primary guardians of the included children, focusing on questions related to defecation habits prepared according to the RomeⅣ criteria for FC in the Childhood Functional Gastrointestinal Disorders: Neonate/Toddler issued in 2016, and factors possibly influencing FC including history of allergies, family history of constipation, mode of delivery, feeding practices, appetite, eating habits, daily water intake, frequency of physical activity, and family parenting practices. In total, 1 458 guardians attended the survey, and children of the 1 264 (86.69%) guardians who handed in responsive questionnaires were finally included for analysis.

The overall prevalence of FC was 9.89% (125/1 264) . Specifically, the prevalence of FC in age groups of 6 to 12, 13 to 36, and 37 to 48 months was 10.39% (16/154) , 8.75% (69/789) , and 12.46% (40/321) , respectively, demonstrating no significant difference in FC prevalence by age group (P>0.05) . The results of multivariate Logistic regression analysis showed that allergy history and feeding practices were influential factors for FC in 6-12-month-old children (P<0.05) , allergy history, feeding practices and parenting style were influential factors for FC in 13-36-month-old children (P<0.05) , and allergy history and parenting style were influential factors for FC in 37-48-month-old children (P<0.05) .

The prevalence of FC in 6-48-month-old children in urban communities is high, which is associated with multiple preventable and controllable factors, suggesting that the prevention of FC in this age group of children should be carried out in accordance with individual factors, family relationship, and social environment.

The association of adverse childhood experiences (ACEs) with chronic disease prevalence among middle-aged and elderly people has become a research hot spot, but the association between ACEs and self-rated health in older people is still unclear, and relevant studies in Chinese population are especially rare.

To explore self-rated health in Chinese elderly people, and its association with ACEs.

The study was conducted in October 2021. Data about ACEs and self-rated health were acquired by applying from the 2014 and 2018 waves of CHARLS conducted by Peking University, involving 7 579 older people (≥ 60 years old) . The ACEs were stratified into three groups by the times of ACEs events (10 kinds in total) : high-risk (4 or more) , low-risk (1-3) , and reference (zero) . The self-rated health was divided into three levels: good, fair and poor. Ordinal logistic regression was used to analyze the correlation of self-rated health with the number and types of ACEs events.

Among the participants, the prevalence of good, fair and poor self-rated health was 22.06% (1 672/7 579) , 59.03% (4 474/7 579) , and 18.91% (1 433/7 579) , respectively, and the prevalence of experiencing ≥4, 1-3 and no ACEs events was 25.36% (1 922/7 579) , 69.71% (5 283/7 579) , and 4.93% (374/7 579) , respectively. The self-rated health differed significantly by age, gender, place of living, and types of ACEs (parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, bullying) (P<0.05) . The self-rated health also differed significantly across the three groups stratified by the number of ACEs events (P<0.05) . Univariate ordinal logistic regression analysis indicated that the probability of a worse self-rated health increased by a factor of 1.358〔95%CI (1.110, 1.663) 〕in those with 1-3 ACEs events, and increased by a factor of 2.151 in those with 4 or more ACEs events compared with those with no ACEs events (P<0.05) . The ordinal Logistic regression analysis indicated that results showed that parental divorce, parental violence, parental depression, parental disability, living in an unsafe neighborhood, childhood loneliness, childhood famishment, and bullying were associated a worse self-rated health (P<0.05) . The statistical results remained unchanged after adjusting for age, gender and place of living.

The self-rated health status in Chinese older people was generally fair. To improve the self-rated health to promote healthy aging in this population, interventions could be provided for them targeting reducing the negative influence caused by parental divorce, parental violence, parental depression and disability, living in an unsafe neighborhood, childhood loneliness, and childhood famishment.

At present, almost all the definitions of hypertension in pediatric hypertension guidelines issued by countries and organizations are based on blood pressure percentile of 95% (P₉₅). However, a large number of research data have shown that high normal blood pressure has a higher risk of progression to hypertension and cause similar target organ damage as hypertension. The review summarized the classification methods of blood pressure of children and adolescents in different countries and organizations, the prevalence of hypertension and high normal blood pressure, the rate of progression from high normal blood pressure to hypertension, and target organ damage caused by high normal blood pressure in children and adolescents, emphasizing that pediatricians should pay greater attention to the definition of high normal blood pressure and hypertension for children and adolescents.

Pneumonia in children poses a serious disease burden globally, and pneumococcal conjugate vaccination is the most direct and effective preventive measure against pneumococcal disease, while there is a lack of information on the coverage of 13-valent pneumococcal conjugate vaccine (PCV13) in children.

To analyze the vaccination rate of PCV13 in children born from 2017 to 2022 in Jiangsu Province, find the difference and reasons under different circumstances, and provide reference on improvement of PCV13 vaccination rate for future.

Through the Jiangsu provincial vaccination management information system, the basic information and vaccination information of PCV13 (as of 2023-12-31) were collected, including the date of birth, gender, household registration attributes, date of vaccination, and the number of doses of vaccination and other basic information, and the data were descriptive analyzed.

There were 4 537 123 children registered in the Jiangsu provincial vaccination management information system from 2017 to 2022, of which 784 220 children were vaccinated with 2 406 974 doses of PCV13, with a vaccination rate of 17.28%. In Jiangsu Province, there were 697 698 children given the first dose of vaccination, of which 82 503 (11.83%) were given the first dose at <2 months of age, 511 273 (73.28%) at 2-6 months of age, 26 106 (3.74%) at 7-11 months of age, 38 530 (5.52%) at 12-24 months of age, and 39 286 (5.63%) at 2-5 years of age. The rate of 1, 2, 3, and 4 doses of vaccination was higher among resident children (16.11%, 14.71%, 13.43%, and 11.50%) than among migrant children (13.87%, 12.70%, 11.42%, and 9.52%) (P<0.05). In terms of regional distribution, the vaccination rate of each dose was in the order of South Jiangsu, Central Jiangsu and North Jiangsu from high to low, and the difference was statistically significant (P<0.05). In terms of gender, there was no statistically significant difference in the rates of the first dose and the second doses of vaccination between boys and girls (P>0.05) ; but the rates of the 3rd and 4th doses of vaccination were lower in boys than in girls (P<0.05). Among children born in 2017-2022, the rate of 1, 2, 3, and 4 doses of vaccination increased with the year of birth (P<0.05). The proportion of children aged 2-6 months who received the first dose of PCV13 was the highest among children of different household registration, gender, year of birth and region, and significant differences were also observed in the ages at the first vaccination of the children from various household registration, of both genders, with various regions, and in various years of birth (P<0.05) .

The vaccination rate of PCV13 among children in Jiangsu Province is 17.28%, which is at a relatively low level. The age of the first dose of vaccination is the highest in the age of 2-6 months, and the vaccination rate of each dose increases with the year of birth, so in order to improve the coverage level of PCV13 in the target population, it is recommended that PCV13 be included in the National Immunization Program.

In China, a rational healthcare seeking pattern in children has not yet taken shape amid the active promotion of the implementation of hierarchical medical system, one major cause of which may be inadequate implementation of first contact in primary care settings in children due to poor service capability for children of these institutions. Therefore, it is of great practical significance and application value to analyze the influencing factors of children's intention to seek healthcare in primary healthcare institutions.

To investigate children's intention to seek healthcare in primary healthcare settings and associated determinants, offering insights into the development of a sound and rational healthcare-seeking pattern in children.

Two surveys were conducted during March to July, 2021 using a questionnaire developed based on the Anderson's Behavioral Model of Health Services Use (containing three aspects: demographics of children and their guardians, children's opinions on hospital selection for treatment and associated factors, and intention to seek healthcare in primary care. One survey was offline, with children aged 0-14 years as participants accidental sampled from people in two grade A tertiary general hospitals, three community health centers, and other public places (such as public parks and squares) in Guangzhou's urban areas, and the other one was online, with a purposive sample of age-matched children included in a WeChat group as participants. For collecting information more appropriately, the questionnaire was completed by the children's guardians. Univariate and multivariate ordinal regression were used to identify factors associated with children's intention to seek healthcare in primary care.

Altogether, the results of questionnaires effectively answered by the guardians of 501 children were used for analysis. The prevalence of intending to seek healthcare in primary care in the children was 36.53% (183/501). The prevalence of primarily choosing a primary healthcare setting for initial treatment of common diseases was 26.3% (132/501), which were mainly owing to shorter distance between home and the hospital (83.3%, 110/132), shorter waiting time for treatment (40.9%, 54/132) and having a pediatric or general practice clinic (36.4%, 48/132). Multivariate Logistic regression analysis indicated that the level of intention to seek healthcare in primary care in children was increased if the nearest hospital was a primary hospital instead of a secondary or tertiary hospital〔OR (95%CI) =1.514 (1.060, 2.166) 〕. Visiting a primary hospital at least four times in the last year was associated with a higher level of intention to seek healthcare in primary care in children compared with visiting a primary hospital zero times〔OR (95%CI) =0.248 (0.111, 0.557) 〕. A higher level of intention to seek healthcare in primary care in children was associated with parents' high level of satisfaction with primary care services instead of parents' fair level of satisfaction with primary care services〔OR (95%CI) =0.348 (0.236, 0.515) ] or parents' dissatisfaction with primary care services〔OR (95%CI) =0.086 (0.043, 0.173) 〕.

In general, the children in Guangzhou mainly seek healthcare in nearby hospitals, and the their level of intention to seek healthcare in a primary hospital could be improved greatly. To improve their satisfaction with primary care services and intention to seek healthcare in primary care settings, it is suggested to further deepen the theoretical research and practical exploration regarding hierarchical diagnosis and treatment, strengthen the cooperation between primary and higher level hospitals for balancing the distribution of pediatric medical resources among hospitals, and to improve the pediatric service capabilities of primary hospitals via improving the software and hardware configuration of these hospitals.

Myopia is an important cause of visual impairment and has become a public health problem all over the world. In China, myopia has a high incidence rate and age of onset of which is becoming younger. There is no clinical method to reverse myopia in children. Therefore, it is important to standardize the screening for ametropia to realize early detection and intervention of myopia. As a primary care institution, a community health center may accurately understand the prevalence of myopia in teenagers in its service coverage area. So giving full play to the role of community health center has important practical significance for the containment of myopia in children and adolescents.

To explore the feasibility of community-based prevention and control of myopia in school-age children.

A cohort study was conducted. The information about visual acuity and refractive status of students in a primary school in Beijing's Chaoyang District from September 2019 to September 2021 were collected for statistical analysis, among which four groups of data in September 2019, September 2020, March 2021 and September 2021 were finally included according to the inclusion and exclusion criteria, with a total of 5 558 records. Then, based on the data, an electronic students' refractive database was established, with uncorrected visual acuity, corrected visual acuity, refractive status (power of a spherical lens, power of a cylindrical lens, axis) , prevalence of wearing glasses or orthokeratology incorporated. The warning levels of vision screening were set to be 0, 1, 2 and 3 from low to high. The visual change, visual warning level, spherical equivalent (SE) of students were compared by grade. The visual changes and warning level evolution at different times were compared at the individual level. Corresponding interventions were implemented for different warning levels, and the intervention results were analyzed and discussed.

There were statistically significant differences in uncorrected distance visual acuity (UDVA) among students by grade (F=100.413, P<0.05) . The UDVA differed significantly in male or female students (F=47.168, 53.042, P<0.05) . Compared with the lower grade students (grades 1 and 2) , middle and higher grade students (grades 3, 4, 5 and 6) had lower UDVA (P<0.003) . The UDVA decreased with the increase in grade in male and female students, and the decline in female students was faster. The composition of the warning levels of myopia risk assessed based on the UDVA in male and female students in all grades was similar, mainly composed of 0, 1, and 3 levels. With the increase in grade, the number of low warning level (level 0) gradually decreased, while that of high warning level (level 3) gradually increased. The SE in students differed obviously by grade (F=474.728, P<0.05) . The SE also differed much in male or female students (F=121.704, 123.807, P<0.05) . With the increase of grade, SE tended to be negative, and the difference in SE between left and right eyes was statistically significant (t=-4.67, P<0.05) . The negative trend of SE for the right eye was more remarkable, suggesting that the warning level of the right eye was higher, and the right eye was more prone to myopia. The follow-up of three consecutive years for assessing individual visual changes revealed that the results of four UDVA screening differed significantly in all students and female students (F=8.727, 10.221, P<0.05) . The UDVA result screened in March 2021 for all students decreased significantly compared with that screened in September 2019 or September 2020 (P<0.008) , so did the UDVA result screened in September 2021 (P<0.008) . During the evolution of warning level, higher warning level was associated with lower possibility of returning to the low warning level, and the possibility of progressing to a higher warning level increased with the growth of warning level.

The visual acuity and refractive status of students in this primary school in Beijing's Chaoyang District were not optimistic. With the increase in grade, the UDVA decreased and the number of high warning level gradually increased. To actively contain myopia in school-age children, it is suggested to establish a community-based vision screening and warning mechanism, and to promote the containing of myopia by home-school-community collaboration efforts.

Birth weight is closely related to individual health. Low birth weight is a high-risk factor for early neonatal death. Macrosomia is associated with higher risk of maternal and infant complications and various chronic diseases in adulthood. Therefore, it is very important to identify the influencing factors of neonatal birth weight.

To investigate the relationship between maternal intestinal flora and neonatal birth weight.

Participants were 516 singleton mothers and their babies〔24 with low birth weight (LW group) , 479 with normal birth weight (NW group) and 13 with macrosomia (OW group) 〕 delivered at term in Guangzhou Women and Children's Medical Center from January to September 2017. Maternal intestinal flora and clinical laboratory test parameters were collected, and the composition and diversity of intestinal flora were analyzed using QIIME. LEfSe analysis was used to compare the relative abundance of intestinal flora at the genus level of the mothers of three groups of babies to identify the flora with significant intergroup differences. MaAslin was used to assess associations of maternal laboratory test parameters and microbial genera. The Boruta was used to build models for predicting three types of neonatal birth weight using maternal laboratory test parameters and intestinal flora OTUs, to assess the association of maternal intestinal floras and neonatal birth weight.

The analysis of maternal intestinal floras showed that the abundance of Firmicutes was the highest at the phylum level, and Faecalibacterium was significantly enriched at the genus level. There were no significant differences in Simpson's Diversity Index and Shannon Diversity Index at the phylum level across the maternal intestinal floras of three groups of babies (P>0.05) . LEfSe analysis found that compared with intestinal flora of mothers of LW group, the intestinal flora of mothers of NW group showed significantly enriched Streptococcus and Roseburia (P<0.05) , and significantly reduced abundance of Bacillaceae, Raphanus, Methanosphaera, Barnesiella and Paraprevotella (P<0.05) , while the intestinal flora of mothers of OW group demonstrated significantly enriched Closrtidiaceae and Alistipes as well as significantly reduced abundance of Barnesiella (P<0.05) . Compared with intestinal flora of mothers of NW group, the intestinal flora of mothers of OW group indicated significantly enriched Megamonas, Coprococcus, Veillonellaceae, cc-115, Closrtidiaceae and Alistipes, and significantly reduced abundance of Blautia and Eggerthella (P<0.05) . The area under ROC curve (AUC value) based on laboratory test parameter OTUs model and intestinal flora OTUs model was 0.62 and 0.77, respectively, in discriminating LW from NW, and was 0.65, and 0.78 respectively, in discriminating OW from NW.

Neonatal birth weight varied by the features of maternal intestinal floras. The OTUs model based on maternal intestinal flora could distinguish the neonatal birth weight. Maternal intestinal flora may be a good predictor of neonatal birth weight.

Neonatal necrotizing enterocolitis (NEC) adversely affects the long-term neurodevelopmental outcomes of preterm infants. However, few studies concerning the risk factors for neurodevelopmental outcomes in preterm infants with NEC have been conducted.

To investigate the risk factors for adverse neurodevelopmental outcomes of NEC in preterm infants.

Preterm infants diagnosed with stageⅡ toⅢ NEC in Department of Neonatology, the Third Affiliated Hospital of Zhengzhou University from January 2019 to June 2020 were included. General conditions and neonatal complications of the infants, as well as pregnancy-related complications of the mothers were obtained. All infants were followed up to a corrected age of 12 months, at which the neurodevelopmental outcome was evaluated by the Bayley Scales of Infant Development Ⅲ (BSID-Ⅲ) , and in accordance with the evaluation results, the infants were divided into a normal group and an adverse neurodevelopment outcome group. Multivariate Logistic regression analysis was performed to investigate the risk factors for adverse neurodevelopmental outcomes.

Of the 236 infants included, 23 died, and 13 were lost to follow up, the other 200 cases who completed the follow-up were finally included for analysis, including 21 (10.5%) with neurodevelopmental disorders (adverse neurodevelopmental outcome group) , and 179 (89.5%) with normal neurodevelopmental outcome (normal group) . Compared with infants with normal neurodevelopmental outcome, those with neurodevelopmental disorders had lower mean birth weight, and higher incidence of sepsis, intestinal perforation, and short bowel syndrome (P<0.05) . Univariate analysis revealed that, compared to infants with normal neurodevelopmental outcome, those with neurodevelopmental disorders had lower mean birth weight, and higher incidence of sepsis, bowel perforation and short bowel syndrome (P<0.05) . Multivariate Logistic regression analysis indicated that birth weight <1 000 g〔OR=4.603, 95%CI (1.220, 17.365) , P=0.024〕, sepsis〔OR=4.401, 95%CI (1.191, 16.262) , P=0.026〕and bowel perforation〔OR=5.239, 95%CI (1.522, 18.029) , P=0.009〕were independently associated with increased risk factor of adverse neurodevelopmental outcomes.

Birth weight less than 1 000 g, sepsis and bowel perforation may be risk factors for adverse neurodevelopmental outcomes in preterm infants with NEC, which should be significantly valued by newborn pediatricians for the prevention or early identification of NEC, thereby reducing the rate of NEC-caused disabilities.

Aspartate aminotransferase (AST) /alanine aminotransferase (ALT) is a novel indicator to evaluate the prognosis of acute critical illness in recent years. At present, AST/ALT has only been reported to evaluate the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults, while HLH in children has not been studied.

To explore the relationship between AST/ALT and clinical characteristics and its prognostic significance in children with HLH, so as to provide a theoretical basis for early clinical recognition and diagnosis of HLH in children.

A total of 128 hospitalized children diagnosed with HLH in the Affiliated Hospital of Zunyi Medical University from January 2013 to May 2022 were selected as the research objects, and the baseline data of children were collected through the electronic medical record system. The children were divided into the T1 group (AST/ALT≤1.57, n=43), T2 group (1.57<AST/ALT<3.22, n=42), and T3 group (AST/ALT≥3.22, n=43) according to the AST/ALT quantiles, and followed up by outpatient review and telephone follow-up once every 6 months from the time of discharge to 2022-06-01, with the termination event of death or loss of follow-up. Spearman rank correlation analysis was used to explore the correlation between AST/ALT and laboratory test results. The receiver operating characteristic (ROC) curve of laboratory indicators for predicting death in children with HLHwas plotted, the area under ROC curve (AUC) and optimal cut-off value were calculated. Kaplan-Meier method was used to plot survival curves to analyze the effect of different AST/ALT groupings on overall survival, and Log-rank test was used for comparison. Cox proportional risk model was used to explore the influencing factors of death in children with HLH.

There were statistically significant differences in gender, PICU admission, treatment methods, incidence of respiratory failure and shock among the 3 groups (P<0.05). Lactate dehydrogenase, creatine kinase isoenzyme, serum ferritin and activated partial thromboplastin time in the T3 group were higher than those in the T1 and T2 groups, while the levels of albumin and fibrinogen in the T3 group were lower than those in the T1 and T2 groups (P<0.05). Na⁺ level in the T2 and T3 groups was lower than that in the T1 group, while C-reactive protein level was higher than that in the T1 group (P<0.05). Correlation analysis showed that AST/ALT was positively correlated with absolute neutrophil count (r_s=0.182, P=0.040), C-reactive protein (r_s=0.419, P<0.001), total bilirubin (r_s=0.182, P=0.040), creatine kinase isoenzyme (r_s=0.310, P<0.001), lactate dehydrogenase (r_s=0.474, P<0.001), activated partial thromboplastin time (r_s=0.316, P<0.001), serum ferritin (r_s=0.311, P<0.001), and negatively correlated with albumin (r_s=-0.352, P<0.001), fibrinogen (r_s=-0.179, P=0.043), Ca²⁺ (r_s=-0.259, P=0.003), Na⁺ (r_s=-0.244, P=0.006). ROC curve results showed that the AUCs of C-reactive protein, lactate dehydrogenase, activated partial thromboplastin time, serum ferritin and fibrinogen were 0.560〔95%CI (0.451, 0.669) 〕, 0.666〔95%CI (0.560, 0.772) 〕, 0.605〔95%CI (0.499, 0.710) 〕, 0.724〔95%CI (0.626, 0.822) 〕, 0.648〔95%CI (0.551, 0.745) 〕 and 0.715〔95%CI (0.624, 0.807) 〕, respectively, with the optimal cutoff values of 82.08 mg/L, 40.5 U/L, 927.5 U/L, 53.95 s, 1 897 μg/L, and 1.45 g/L, respectively. The mortality rate in the T1, T2 and T3 groups was 14.0% (6/43), 33.3% (14/42) and 44.2% (19/43), respectively, with statistically significant differences (χ²=9.518, P=0.009). Multivariate Cox proportional hazard regression analysis showed that shock〔HR=4.24, 95%CI (2.09, 8.61), P<0.001〕, activated partial thromboplastin time ≥53.95 s〔HR=2.44, 95%CI (1.24, 4.81), P=0.010〕and serum ferritin ≥1 897 μg/L〔HR=3.05, 95%CI (1.02, 9.09), P=0.046〕were the risk factors for death in children.

HLH patients in children with higher AST/ALT have higher incidence of poor prognosis, shorter overall survival, and worse prognosis.

As the main providers of essential pediatric services, the capabilities of community general practitioners (GPs) in managing pediatric patients may directly reflects the overall status of pediatric care services in primary care settings. In China, there are great regional differences in the supply and demand of pediatric services, and the capabilities of primary care settings are unsatisfactory in providing pediatric services. The current encounters and influencing factors of GPs with pediatric patients in suburban districts are worthy of attention.

To understand the status and associated factors of clinical encounters of GPs with pediatric patients in a suburban district of Beijing, providing a reference for the development of tiered diagnosis and treatment of pediatric diseases.

In June 2021, purposive sampling was used to recruit GPs who participated in a training named "Beijing Miyun District Medical Consortium Construction & General Practitioners' Comprehensive Capability Improvement Project" to attend a semi-structured group interview for understanding the status of clinical encounters of GPs with pediatric patients and related influencing factors. The interview results were recorded, and transcribed, then coded using NVivo 12, and analyzed using thematic analysis.

Nineteen GPs (5 men and 14 women) in the age range of 24-51 years〔average age of (33.2±7.6) years〕, attended the interview, 18 of whom had a bachelor degree; 9 had a title of attending physician; 1 had participated in the standardized general practice residency program; 8 had participated in the "3+2" assistant general practitioners training program; 8 had participated in the standardized training before making a career change into general practice. The average years of them working a GP was 1-18 years〔 (6.3±4.8) years on average〕. Four themes emerged from the analysis: (1) Both the numbers of pediatric patients and illnesses encountered by suburban GPs were less than those encountered by their urban counterparts, and pediatric patients encountered by suburban GPs aged greater than or equal to 3 years. (2) Suburban GPs generally had a low level of self-confidence in treating pediatric patients. (3) The major factors negatively affected suburban GPs encountering pediatric patients include the pediatric patient's parents with a lower level of trust in their GP, inadequate capabilities of GPs in managing pediatric patients, high risk of managing pediatric patients, underperformance of nurses, inadequate available pediatric medicines and equipments for laboratory tests in the community, and lack of a clear referral system. (4) The major facilitators for suburban GPs to encounter pediatric patients include managing pediatric patients in the community by pediatricians, and increasing pediatric medicines and equipments for laboratory tests.

The encounters of suburban GPs with pediatric patients in primary care were unsatisfactory due to many problems and challenges. To improve the situation, it is suggested to improve the capabilities of suburban GPs in managing pediatric patients by trainings, the collaboration between GPs and pediatricians, and the tiered system for the diagnosis and treatment of pediatric diseases.

Stubbornly high pregnancy prevalence in adolescent females worldwide, results in numerous adverse pregnancy outcomes, causing wide public concern. Thereby, it is pressing to study the pregnancy characteristics, adverse pregnancy outcomes and associated factors in adolescent primiparous females.

To examine adverse pregnancy outcomes and related factors in adolescent primiparous females via comparing pregnancy outcomes of them with those of emerging and early adult females.

Primiparous females (n=12 222, <35 year old) with ≥28 weeks of gestation were recruited from Ningbo Women and Children's Hospital during 2019—2020, including 210 aged 13-19 (adolescent group) , 1 729 aged 20-24 (adult group 1) , and 10 283 aged 25-34 (adult group 2) . Data were collected for maternal demographics, pregnancy complications, comorbidities, delivery course and adverse fetal outcomes. The associations of age, marital status, education background, rural or urban living, income, body mass index (BMI) with adverse maternal and fetal outcomes were analyzed.

Adolescent primiparas had higher proportions of individuals with unmarried status, junior high school or lower education level, rural living, and an unstable income, as well as less mean prenatal care visits than the other two groups (P<0.05) . Moreover, adolescent primiparas also had higher rates of placental abruption, maternal anemia, vaginal delivery, perineal laceration, premature labor, (very) low-birth-weight infant, and stillbirth (P<0.05) . Multivariate Logistic regression analysis demonstrated that in adolescent primiparas, 13-24 years, unmarried and BMI<18.5 kg/m² were associated with lower risk of gestational diabetes (P<0.05) ; gravida≥3 and BMI≥28 kg/m² were risk factors for gestational diabetes (P<0.05) ; 13-24 years, unmarried, unstable income and BMI≥28 kg/m² were risk factors for vaginitis (P<0.05) ; 13-19 year-old, unmarried, junior high school or lower education level and unstable income were risk factors for placental abruption (P<0.05) ; gravida≥3 was the risk factor for placenta previa (P<0.05) ; 13-24 years, unmarried, junior high school or lower education level, rural living and unstable income were risk factors for maternal anemia (P<0.05) ; BMI≥28.0 kg/m² was associated with lower risk of maternal anemia (P<0.05) . Further analysis showed that 13-24 years, unmarried, junior high school or lower education level, rural living and BMI<18.5 kg/m², were associated with higher possibility of having vaginal delivery (P<0.05) , whereas gravida≥3 was associated with higher possibility of having cesarean section (P<0.05) . Aged 13-19 years, unmarried, junior high school or lower education level, unstable income, gravida≥3, and BMI<18.5 kg/m² or ≥28.0 kg/m² were risk factors for premature labor (P<0.05) . Aged 13-19 year-old, unmarried, junior high school or lower education level, rural living, unstable income, gravida≥3, and BMI<18.5 kg/m² were risk factors for (very) low-birth-weight infants (P<0.05) . 20-24 year-old was associated with lower risk of fetal distress (P<0.05) . 13-19 year-old and unmarried were risk factors for stillbirth (P<0.05) . 13-24 years, junior high school or lower education level, rural living, unstable income, and gravida≥3 were risk factors for neonatal asphyxia (P<0.05) .

Adolescent primiparous females were featured by high rates of having unmarried status, rural living, an unstable income, low education level, fewer prenatal care visits, and adverse pregnancy outcomes. Younger age, unmarried, poor socioeconomic status, higher number of pregnancies, and excessive low or high BMI were risk factors for adverse pregnancy outcomes in this group. Healthcare specialists should schedule prenatal examinations for these people based on the high risk factors accordingly. And government at all levels and affiliated adolescent institutions should offer appropriate social and economic support for teenage mothers to reduce adverse pregnancy outcomes.