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Assessing diet quality has been challenging, and the associations of diet quality and daily free sugar intake with depressive and/or anxiety symptoms have shown inconsistency. A total of 1749 students aged 12–16 years were recruited using stratified random cluster sampling across three cities in China. The overall Global Dietary Recommendations (GDR) score, a novel indicator of diet quality, was constructed using the low-burden Diet Quality Questionnaire. Free sugar intake, including from beverages and foods, was measured using the Food Frequency Questionnaire. Daily free sugar intake was divided into low, medium, and high categories based on the latest version of the dietary guidelines for Chinese residents. Binomial and multinominal logistic regression analyses were used to examine the associations of the overall GDR score and daily free sugar intake categories or different sources of free sugar intake with depressive and/or anxiety symptoms. The overall GDR score was negatively associated with depressive symptoms (adjusted odds ratio[aOR] = 0.92, 95%CI: 0.87–0.98) and anxiety symptoms (0.95, 0.90–0.99), particularly with comorbid depression and anxiety (0.90, 0.84–0.97). Conversely, daily free sugar intake was positively associated with symptoms of depression and/or anxiety, the multiple aOR for symptoms depression or anxiety were significantly increased with higher daily free sugar intake (all P trend < 0.05). Both free sugar from beverages and from foods were positively associated with depressive and/or anxiety symptoms. These associations were consistent between males and females. Cross-sectional design and self-reported symptoms. Diet quality was negatively associated with symptoms of depression or anxiety, especially with comorbid symptoms among adolescents. Daily free sugar intake, regardless of its sources, was positively associated with symptoms of depression and/or anxiety. • This study examined the associations of diet quality and daily free sugar intake with depressive and/or anxiety symptoms. • This study also examined the association of different sources of free sugar intake with depressive and/or anxiety symptoms. • The overall GDR score, a novel indicator of diet quality, was constructed by the low-burden Diet Quality Questionnaire. • Free sugar including from eight beverages and six foods were evaluated. [ABSTRACT FROM AUTHOR]

Background: Both internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, however, the association between IA and NSSI was not well understood. We aimed to investigate the association between IA and NSSI within a cohort study, and explore the mediated effect of depressive symptoms and the moderating effect of social support in the association. Methods: A total of 1530 adolescents aged 11–14 years who completed both the baseline (T1) and 14-month follow-up (T2) survey of the Chinese Adolescent Health Growth Cohort were included for the current analysis. IA, NSSI, depressive symptoms and social support were measured at T1; depressive symptoms and NSSI were measured again at T2. Structural equation models were employed to estimate the mediated effect of depressive symptoms and the moderating effect of social support in the association between IA and NSSI at T2. Results: IA was independently associated with an increased risk of NSSI at T2, with the total effect of 0.113 (95%CI 0.055–0.174). Depressive symptoms mediated the association between IA and NSSI at T2, and social support moderated the indirect but not the direct effect of IA on NSSI at T2. Sex differences were found on the mediated effect of depressive symptoms and the moderated mediation effect of social support. Conclusions: Interventions that target adolescents' NSSI who also struggle with IA may need to focus on reducing depressive symptoms and elevating social support. [ABSTRACT FROM AUTHOR]

Sponge City, as a new concept in urban stormwater management, utilizes on-site or local hydrologic processes for runoff control and therefore is highly dependent on the geographical location (soil type) and site-specific climatic conditions. Field studies are valuable because of the insufficient quantity of field performance data in low-impact development (LID)-related research. Rain gardens are recommended for LID to manage stormwater. A rain garden was designed as a pilot project in Nanchang city, which is one of the typical red soil areas in southern China. Red soil is usually not conducive to runoff infiltration due to its low organic carbon, strong acidity and low permeability rainfall characteristics, but the permeability of the filter media layer is an important parameter in LID design. The construction depth of the rainwater garden was 600 mm, and 30% sand, 10% compost and 60% laterite were used as combined matrix; the permeability coefficient of medium layer was 1.48 × 10−5 m·s−1. Rainfall runoff control and pollutant removal efficiencies were studied based on the on-site conditions. The analysis of almost 2 years of field data showed that volume capture ratio of annual rainfall was 78.9%, the mean load removal of TSS, NH3-N, TP, TN, COD and NO3-N were 92.5%, 85.3%, 82.9%, 80.5%, 79.8% and 77.5%, respectively, which could meet the technical guidelines for sponge city construction in Nanchang. The research results could provide a basis for sponge city design in low organic carbon and low permeability areas. [ABSTRACT FROM AUTHOR]

The seasonal and spatial variation in the phytoplankton community structure and the environmental variables were investigated in December (the dry season) 2016 and July (the rainy season) 2017 in the Jinjiang River Estuary, China. We identified a total of 138 species of phytoplankton, which were mainly Chlorophyta, Bacillariophyta, and Cryptophyta in the dry season; however, in the rainy season, only Bacillariophyta were found. In the Jinjiang River Estuary, the species evenness and the biodiversity index were higher in the rainy season and that the species diversity was higher in the dry season. Redundancy analysis (RDA) revealed that the dominant species were statistically related to many of the environmental variables, including the water temperature (WT), pH, salinity (Sal), dissolved oxygen (DO), total phosphorus (TP), and total nitrogen (TN). Among the variables, the Sal, DO, TP, and TN had a significant influence on the dominant species distribution, and the WT and pH also affected the dominant species distribution to some extent. [ABSTRACT FROM AUTHOR]

Association of greenness surrounding school with aggression among adolescents was not well understood. This study aimed to investigate the associations of greenness surrounding school with adolescents' total and sub-types of aggression and explore potential mediators underlying these associations. A multi-site study of 15,301 adolescents aged 11–20 years were recruited through a multistage, random cluster sampling across 5 representative provinces in mainland China. Satellite-derived Normalized Difference Vegetation Index (NDVI) values within circular buffers of 100 m, 500 m, and 1000 m surrounding school were used to indicate the adolescents' greenness exposure. We used the Chinese version of Buss and Warren's Aggression Questionnaire to assess total and sub-types of aggression. Daily concentrations of PM 2.5, and NO 2 were obtained from the China High Air Pollutants datasets. Per IQR increment of NDVI 100 m and 500 m surrounding school was associated with lower odds of total aggression; odds ratio [OR] with 95% CI was 0.958 (0.926–0.990) for the 100 m buffer and 0.963 (0.932–0.996) for the 500 m buffer, respectively. Similar associations can be observed in two sub-types of aggression, including verbal (NDVI 100 m: 0.960 (0.925–0.995); NDVI500m: 0.964 (0.930–0.999)) and indirect aggression (NDVI 100 m: 0.956 (0.924–0.990); NDVI500m: 0.953 (0.921–0.986)). There were no sex and age differences in the associations of school surrounding greenness with aggression, except that the beneficial associations of greenness exposure with total aggression (0.933(0.895–0.975) vs.1.005(0.956–1.056)), physical aggression (0.971(0.925–1.019) vs.1.098(1.043–1.156)), and hostility (0.942(0.901–0.986) vs.1.016(0.965–1.069)) were greater among participants aged ≥16 years than those aged<16 years. PM 2.5 (proportion mediated estimates: 0.21; 95% CI: 0.08, 0.94) and NO 2 (−0.78, 95% CI: −3.22, −0.37) mediated the association of NDVI 500 m surrounding school with total aggression. Our data indicated that exposure to greenness in school surroundings was associated with reduced aggression, particularly in verbal and indirect aggression. The presence of PM 2.5 and NO 2 partially mediated these associations. • School surrounding greenness was associated with reduced aggression in adolescents. • School surrounding greenness linked with aggression was not differed by age and sex. • PM 2.5 and NO 2 mediate the association of school surrounding greenness with aggression. [ABSTRACT FROM AUTHOR]

Background: Transition to enteral feeding is difficult for very low-birth-weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes.Method: Data on feeding practices and short-term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non-GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates.Results: Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8-33 days), weight gain (5.0-14.6 g/kg/day), ∆z-scores (-0.54 to -1.64), incidence of NEC (1%-13%), and mortality (1%-18%). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P < .001) than non-GD units, but NEC incidence and mortality were similar.Conclusion: Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant- and hospital-related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to make non-Chinese readers better informed about the current safety situation of acupuncture in China. Methods: Four (4) major Chinese comprehensive databases were searched: Chinese Journal Full-text Database (1949-2010), China Biomedical Literature Database (1978-2010), Chinese Technology Journal Database (1989-2010), and Wanfang (1998-2010). Case reports of adverse events related to acupuncture therapy were included. Literature reviews, case-control study, translations, duplicate literatures in various databases, and duplicate published articles with duplicate data were excluded. Results: One hundred and sixty-seven (167) articles were included with 1038 cases, among which 35 patients died. The most frequent adverse events were syncope (468 cases), pneumothorax (307 cases), and subarachnoid hemorrhage (64 cases). Conclusions: Acupuncture-related adverse events were mainly caused by mental tension of the patient, improper operation by the doctor, and incompleteness of sterilization. Most of them can be avoided by standardizing teaching and clinical practices. Making the corresponding safety standards can greatly lower the risk of adverse events and protect patient safety to the greatest extent. [ABSTRACT FROM AUTHOR]

Introduction: Previous evidence whether diuretics are suitable for patients with hypertension and diabetes seems to be inconsistent. Angiotensin-receptor blockers have been reported to have additional cardiovascular benefits beyond blood-pressure lowering effects and recommended to be beneficial for patients with hypertension and diabetes by guidelines. Hypothesis: Telmisartan-based regimen was more effective than diuretic-based treatment on reducing cardiovascular events in patients with hypertension and diabetes. Methods: As part of the Chinese Hypertension Intervention Efficacy Study (CHIEF) conducted in 180 clinical centers in China, in a randomized, open-label, blinded-endpoint trial, high-risk hypertensive patients with diabetes were assigned to receive treatment with either amlodipine plus telmisartan (N=1580) or amlodipine plus co-amilozide (N=1539). The primary outcome was the composite of nonfatal stroke, nonfatal myocardial infarction or death from cardiovascular causes. Results: The median follow-up was 41 months. No between-group difference was observed in mean blood pressure reduction, with a fall from baseline of 26.4/14.2 mmHg in telmisartan-based group and 26.1/14.0 mmHg in diuretic-based group. However, fewer primary endpoint events occurred in the diuretic-based group than telmisartan-based group (58 vs. 93), representing a relative risk reduction of 36.4% (hazard ratio [HR], 0.64, 95% confidence interval [CI], 0.46 to 0.88; p=0.007). There were trends toward reducing all stroke (HR, 0.70; p=0.08) and all myocardial infarction (HR, 0.54; p=0.10) in diuretic-based group. Conclusions: With a similar blood-pressure reduction, the diuretic-based regimen was more efficacious in reducing cardiovascular morbidity and mortality than the telmisartan-based combination among hypertensive patients with diabetes. Our findings suggested that diuretics could be suitable medication for patients with hypertension and diabetes and that lowering blood pressure could reverse the long-term negative impacts of diabetes induced by diuretics on cardiovascular events. (ClinicalTrials.gov number, NCT01011660.) [ABSTRACT FROM AUTHOR]

Introduction: Whether antihypertensive agents have more cardiovascular benefits in obese patients than normal-weight patients has inconsistent findings. Previous trials have shown that diuretic-based regimens seem to confer better cardiovascular protection in obese patients than in patients with normal weight. Hypothesis: Diuretic-based treatment was more efficacious than nondiuretic-based therapy on reducing cardiovascular events in hypertensive patients with high body mass index. Methods: In the Chinese Hypertension Intervention Efficacy Study (CHIEF), a randomized, open-label, blinded-endpoint trial, hypertensive patients with high risk for cardiovascular events from 180 clinical centers in China were assigned to receive treatment with either amlodipine plus telmisartan or amlodipine plus co-amilozide. On the basis of body mass index (BMI), patients were divided into normal weight (BMI<24, n=3287), overweight (≥24 to <28, n=6365) or obese (≥28,n=3858) categories. With adjustment for age, sex, diabetes, previous cardiovascular disease or chronic kidney disease, we compared the rates for the primary outcome of nonfatal stroke, nonfatal myocardial infarction or cardiovascular death. Results: In patients allocated in diuretic-based group, there was a nonsignificant trend toward reducing the primary endpoint for obese patients compared with patients with normal weight (Hazard ratio, 0.83; p=0.40). In patients allocated telmisartan-based treatment, there was a nonsignificant trend toward increasing the primary endpoint for obese patients compared with patients with normal weight (Hazard ratio, 1.27; p=0.24). In patients of normal weight, the primary event rates were similar in diuretic-based and telmisartan-based groups (Hazard ratio, 1.04; p=0.84), but the rates were significantly reduced with amlodipine and co-amilozide in overweight patients (Hazard ratio, 0.72; p=0.03) and similarly in obese patients (Hazard ratio, 0.68; p=0.06). Conclusions: Diuretic-based regimen was superior to telmisartan-based treatment on reducing cardiovascular morbidity and mortality in patients with high BMI. (ClinicalTrials.gov number, NCT01011660) [ABSTRACT FROM AUTHOR]

Objectives: In this study, we describe the patterns of antibiotic prescription for neonates based on World Health Organization's (WHO) Essential Medicines List Access, Watch, and Reserve (AWaRe), and the Management of Antibiotic Classification (MAC) Guidelines in China., Methods: One-day point-prevalence surveys (PPS) on antimicrobial prescriptions were conducted on behalf of hospitalized neonates in China from September 1 and November 30, annually from 2017 to 2019., Results: Data was collected for a total of 2674 neonatal patients from 15 hospitals in 9 provinces across China of which 1520 were newborns who received at least one antibiotic agent. A total of 1943 antibiotic prescriptions were included in the analysis. The most commonly prescribed antibiotic was meropenem (11.8%). The most common reason for prescribing antibiotic to neonates was pneumonia (44.2%). There were 419 (21.6%), 1343 (69.1%) and 6 (0.3%) antibiotic prescriptions in the Access, Watch and Reserve groups, respectively. According to MAC Guidelines in China, there were 1090 (56.1%) antibiotic agents in the Restricted and 414 (21.3%) in the Special group., Conclusion: Broad-spectrum antibiotics included in the Watch and Special groups were likely to be overused in Chinese neonates., (© 2024. The Author(s).)

Importance: In China, parental labor migration often leaves children behind and is potentially adversely associated with children's health. However, the association between parental migration and aggression among their offspring remains largely underexplored., Objective: To investigate the associations of parental labor migration with total and subtypes of aggression among their offspring as well as potential sex differences therein., Design, Setting, and Participants: This cross-sectional study was conducted from February to October 2015 among students aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from December 1, 2022, to August 1, 2023., Exposures: Parental migration, including migration status (yes or no), pattern (father, mother, or both), and the child's age at the initial parent-child separation., Main Outcomes and Measures: Total and subtypes of aggression (including physical aggression [PA], verbal aggression [VA], indirect aggression [IA], anger, and hostility) were measured using the Chinese version of the Buss-Warren Aggression Questionnaire. Binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of parental migration by total and subtypes of aggression., Results: A total of 15 301 participants (7900 [51.6%] male and 7401 [48.4%] female) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of these participants, 5961 (39.0%) experienced parental migration; 2451 (16.0%) met the criteria for total aggression, 2407 (15.7%) for PA, 2283 (14.9%) for VA, 2899 (18.9%) for IA, 2307 (15.1%) for anger, and 2564 (16.8%) for hostility. Parental migration was associated with total aggression (aOR, 1.11; 95% CI, 1.01-1.22); no significant association between parental migration and subtypes of aggression was found except for PA (aOR, 1.14; 95% CI, 1.03-1.25). Compared with children whose parents did not migrate, the aORs for total aggression and PA for participants whose father migrated were 1.12 (95% CI, 1.01-1.28) and 1.15 (95% CI, 1.03-1.29), respectively; for participants with both parents having migrated, the aORs were 1.16 (95% CI, 1.02-1.31) and 1.12 (95% CI, 1.04-1.24), respectively. Compared with children whose parents did not migrate, children who experienced initial separation from 1 or both parents at adolescence had an aOR for total aggression of 1.20 (95% CI, 1.04-1.36), children who experienced initial separation from 1 or both parents at school age or adolescence had an aOR for PA of 1.15 (95% CI, 1.01-1.32) and 1.26 (95% CI, 1.04-1.51), respectively. No sex differences were found in these associations., Conclusions and Relevance: In this cross-sectional study of Chinese children and adolescents, we found that parental migration, mainly of the father or both parents or an initial separation at adolescence or school age from 1 or both parents, was associated with higher odds of total aggression and PA among offspring. These associations were similar between male and female participants.

Background: Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants., Methods: A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23-37 weeks' gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes., Results: A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28-32 weeks' gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54-25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed., Conclusions: Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28-32 weeks' gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

Microplastics have received widespread attention as an emerging contaminant, but limited information was available during wetland restoration. The occurrence and characteristics of microplastics and their interaction with heavy metals in surface sediments from the Jinjiang Estuarine restored mangrove wetland were investigated. The abundance of microplastics ranged from 490 ± 127.3 to 1170 ± 99.0 items/500 g dry sediment, and the restored regions were much higher than mudflats, indicating mangrove restoration promoted its accumulation. Polyethylene terephthalate (PET), polyethylene (PE) and polypropylene (PP) were the main materials of microplastics after Raman spectroscopy identification. SEM-EDS images illustrated the mechanical erosion and chemical weathering on microplastics' surface, and Cr, Zn, Pb, and Cd were observed in elemental composition. The contents of Cr, Ni, Cu, Zn, Pb, As, and Cd accumulated in microplastics were not correlated with their total concentrations in sediments except for Hg, indicating that they might not be derived from sediments., (Copyright © 2020. Published by Elsevier Ltd.)

To explore the risk factors of thrombosis in patients with JAK2 V617F -mutated myeloproliferative neoplasms (MPNs), a cohort of 1537 Chinese patients with JAK2 V617F -mutated MPN was retrospectively analyzed. The Kaplan-Meier method and multivariate Cox analysis were used to study the risk factors of thrombosis in patients with JAK2 V617F -mutated MPN. Among the 1537 MPN patients, 931, 468, and 138 had polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), respectively. The median follow-up time was 7 years (range 1-47), and 12.8% of patients (197/1537) died during this period. A total of 16.8% (259/1399) of PV and ET patients had secondary myelofibrosis, and 2.5% (38/1537) of patients developed acute myeloid leukemia (AML). Thrombotic events occurred in 43.9% (675/1537) of patients, among which 91.4% (617/675) were arterial thrombosis and 16.6% (112/675) were venous thrombosis. The number of thrombotic events in PV, ET, and PMF patients was 439 (47.2%), 197 (42.1%) and 39 (28.2%), respectively. The multivariate analysis indicated that age ≥60 years old, HCT ≥48%, at least one cardiovascular risk factor, a history of thrombosis, and JAK2 V617F allele burden (V617F%) ≥50% are risk factors for thrombosis in JAK2 V617F -mutated MPN. According to the results of the multivariate analysis, a risk model of thrombosis was established and comprised low-risk (0 points), intermediate-risk (1 points) and high-risk (≥2 points) groups, among which the incidence of thrombosis was 9.1%, 33.7% and 72.9%. For elderly patients with JAK2 V617F -mutated MPN and a history of thrombosis, reducing the V617F%, controlling HCT and preventing cardiovascular risk factors are necessary measures to prevent thrombosis., (© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

To understand how planting patterns influence As and Cd in soils, the pollution grade release risk and fractions of As and Cd in soils from Jinjiang Estuary wetland were investigated. The geoaccumulation index ( I geo ) and risk assessment code (RAC) were used to identify pollution grades and reveal the potential ecological risk of trace metals, respectively. The results showed that the ratios of the acid soluble fraction of Cd in the mangrove area (∼65%) were larger than that of the control group (∼31%). The residual fraction of As in the mangrove area (∼74%) was also larger than that of the control group (∼66%). Therefore, the planting of vegetation increased the mobility of Cd and decreased the mobility of As. Variance analysis showed that the total concentrations and fraction of As and Cd significantly differed among various vegetation types and planting densities. Thus, planting patterns might influence the transformation of trace metal fractions in soil, influencing the total concentrations of As and Cd. Furthermore, mangrove reforestation improved the pollution levels of As and Cd and increased the potential release risk of Cd. The study advances current knowledge on the importance of restoring wetland vegetation, providing suggestions on feasible planting patterns.