Objective: To investigate the sleep characteristics of children aged 3-12 years old in Shanghai, and to provide a reference for improving pediatric sleep health. Methods: From April to June 2019, 16 542 children aged 3-12 years old were randomly selected from 31 kindergartens and 17 primary schods in Shanghai, and a cross sectional epidemiological survey was conducted using multi stage cluster sampling. The Children s Sleep Habits Questionnaire (CSHQ) was used to evaluate sleep characteristics. Results: The bedtime routine of children in Shanghai was (21:27±00:36) and (21:46±00:46) on weekdays and weekends, respectively. Corresponding wake up times were (6:52±00:28) and (7:47±00:48), total sleep duration was (9.05±1.07) and (9.52±1.17)h, and the prevalence of inadequate sleep was 81.0% and 55.4%. The average score of sleep problems was (51.56±8.04), and the prevalence of disturbed sleep was 93.5%. With advancing age, the total sleep time of children in Shanghai decreased, and the difference in weekend weekday sleep patterns increased. Furthermore, two major sleep problems were observed, namely, short sleep duration and daytime sleepiness, which became increasingly more prominent. Girls usually went to bed later on weekdays and woke up later on weekends, and a greater difference in weekend weekday sleep patterns was observed. Moreover, psychological problems such as sleep anxiety were more serious among girls. Conclusion At present, children in Shanghai have insufficient sleep time and late bedtimes. Large differences in weekend weekday sleep patterns were observed, and various sleep problems were identified. Sleep related anxiety and differences in weekend weekday sleep patterns were particularly high among girls.

Objective: To investigate the effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction. Methods: From May 2013 to September 2014, a total of 3 474 pregnant women who took their first antenatal care and willing to undergo their prenatal care and delivery in Ma 'anshan Maternity and Child Care Centers were recruited in the cohort study. Excluding subjects without weight data before delivery (n=54), pregnancy termination (n=162), twins live births (n=39), without fetal birth weight data (n=7), 3 212 maternal-singleton pairs were enrolled for the final data analysis. Demographic information of pregnant woman, pregnancy history, disease history, height and weight were collected. In the 24^th-28^th, 32^nd-36^th gestational week and childbirth, three follow-up visits were undertaken to collect data of pregnancy weight, pregnancy vomiting, gestational hypertension, gestational diabetes mellitus, newborn gender and birth weight. χ² test was used to compare the detection rate of fetal growth restriction in different groups. Multivariate unconditional logistic regression model and spreadsheet were used to analyze the independent and interaction effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction. Results: The incidence of fetal growth restriction was 9.7%(311/3 212). The incidence of fetal growth restriction in pre-pregnancy underweight group was 14.9% (90/603), higher than that in normal pre-pregnancy weight group (8.7% (194/2 226)) (χ²=24.37, P<0.001). The incidence of fetal growth restriction in inadequate increase of gestational weight group was 17.9% (50/279), higher than the appropriate increase of weight group (11.8% (110/932)) (χ²=36.89, P<0.001). Multivariate unconditional logistic regression analysis showed that compared with normal pre-pregnancy weight group, pre-pregnancy underweightwas a risk factor for fetal growth restriction, with RR (95%CI) at 1.76 (1.34-2.32); Compared with the appropriate increase of gestational weight group, inadequate weight increase during pregnancy was a risk factor for fetal growth restriction, with the RR (95%CI) at 1.70 (1.17-2.48). No additive model interaction [relative excess risk of interaction, attributable proportions of interaction, the synergy index and their 95%CI were 0.75 (-2.14-3.63), 0.21 (-0.43-0.86) and 1.43 (0.45-4.53), respectively] or multiplication model interaction (RR (95%CI): 1.00 (0.44-2.29)) existed between pre-pregnancy underweight and inadequate increase of gestational weight on fetal growth restriction. Conclusion Pre-pregnancy underweight and inadequate increase of gestational weight would increase the risk of fetal growth restriction without interaction.

Objective: To examine the prevalence of allergic diseases in schoolaged children from Shanghai and to explore related factors so as to produce epidemiological data regarding allergic diseases in children. Methods: Multistage cluster sampling was used to carry out the study in Shanghai from April to June 2019. A total of 10 686 children aged 7-12 years from 17 primary schools participated in the survey. The International Study of Asthma and Allergies in Childhood (ISAAC)Scale was used to evaluate allergic diseases. Multivariate Logistic regression analysis was performed to analyze the related factors. Results: The overall prevalence of allergic diseases among schoolaged children in Shanghai was 47.0%. A higher prevalence was observed among boys (50.4% vs 43.3% in girls, χ2=54.44, P<0.01). Common allergic diseases included asthma (13.9%), allergic rhinitis (18.2%), and atopic dermatitis (34.3%). The Logistic regression analysis showed that the common risk factors of asthma, allergic rhinitis and atopic dermatitis included the following:male gender (OR=1.52,1.44,1.22); mother has a bachelors degree or above (OR=1.26,1.77,1.84); family history of allergic diseases (OR=2.87,4.24,2.57); only child (OR=1.16,1.28,1.22); curtain cleaning frequency <1 time/month (OR=1.41,1.79,1.77); room not cleaned daily (OR=1.14,1.18,1.20); and dust exposure frequency ≥1 time/month (OR=1.45,1.56,1.42), all P<0.05. These three types of allergic diseases were also associated with unique risk factors that dependent on socialenvironmentalbehavioral factors. Conclusion Compared with previous data, the prevalence of allergic diseases among schoolaged children in Shanghai increased significantly in 2019. The related influencing factors involve multiple variables including demographics, environmental exposure and behavior, which warrant further exploration.

Objective: To explore the association between exclusive breastfeeding and sleep onset delay among school aged children, and to provide a reference for promoting childhood sleep health. Methods: A total of 10 686 children aged 7-12 years old were recruited from 17 primary schools in Shanghai using the multi stage sampling method from April to June 2019. The duration of sleep onset delay and exclusive breastfeeding were identified using the Children s Sleep Habits Questionnaire and a self designed questionnaire, respectively. The association between the duration of exclusive breastfeeding and the score and the risk of sleep onset delay were estimated using linear regression and a Logistic regression model, respectively. Results: After adjusting for confounding factors, compared with never exclusive breastfeeding, the score of sleep onset delay decreased by 0.07, 0.08 and 0.05 in cases that involved exclusive breastfeeding for less than 3 months, 3-6 months and more than 6 months, respectively; and the odds of sleep onset delay decreased by 39.0%(OR=0.61, 95%CI=0.47-0.79), 41.1%(OR=0.59, 95%CI=0.47-0.75) and 21.1%(OR=0.79, 95%CI=0.65-0.96), respectively. Similar findings were observed in analyses stratified by gender, although the association was stronger among boys. Moreover, administration of probiotics or yogurt only improved sleep onset delay in those who were exclusively breastfed for no more than 6 months. Conclusion Longer durations of exclusive breastfeeding were associated with a lower risk of sleep onset delay among school aged children. However, exclusive breastfeeding for over 6 months diminished the protective effect that was otherwise observed on sleep onset delay.

OBJECTIVETo examine the effect of parents' occupational and life exposure during six months before pregnancy on executive function of preschool children.

METHODSPregnant women involved in the study came from the Ma'anshan Birth Cohort Study,a part of the China-Anhui Birth Cohort Study. Between October 2008 and October 2010, pregnant women who accepted pregnancy care in four municipal medical and health institutions in Ma'anshan city were recruited as study objects. A total of 5,084 pregnant women and 4,669 singleton live births entered in this cohort. Between April 2014 and April 2015, a total of 3,803 pre-school children were followed up. Finally, except 32 preschool children did not have EF evaluation result, there were 3,771 children included in this study. By using self-designed " Maternal health handbook", we researched parents' general demographic characteristics, and life and occupational exposure during six months before pregnancy. To research preschool children's executive function, we used the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Univariate and multivariate statistical method was used to analyze the association of parents' life and occupational exposure during six months before pregnancy and preschool children's EF.

RESULTS3,771 preschool children's detected rate of inhibitory self-control index (ISCI), flexibility index (FI), emergent metacognition index (EMI) and global executive composite (GEC) dysplasia were 4.8% (182), 2.3% (88), 16.5% (623) and 8.6% (324) respectively. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.86, 95% CI: 1.36-2.54), whose maternal were exposed to pesticides were the risk of ISCI dysplasia(OR=3.60, 95% CI: 1.45-8.95). During six months before pregnancy, children whose maternal were exposed to pesticides (OR=6.72, 95% CI: 2.50-18.07) and whose father were exposed to occupational lead (OR=2.10, 95% CI: 1.25-3.54) were the risk of FI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.42, 95%CI: 1.18-1.71) and whose father were exposed to occupational lead (OR=1.30, 95%CI: 1.02-1.65) were the risk of EMI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment (OR=1.58, 95% CI: 1.24-2.01) and whose maternal were exposed to pesticides (OR=2.39, 95% CI: 1.02-5.58) were the risk of GEC dysplasia.

CONCLUSIONThe development of executive function is worse among preschool children whose parents live in noise environment, mother exposed to pesticides, and father exposed to occupational lead during six months before pregnancy.

Child ; Child, Preschool ; China ; Cohort Studies ; Environmental Exposure ; adverse effects ; Executive Function ; Family Characteristics ; Female ; Humans ; Lead ; adverse effects ; Male ; Occupational Exposure ; adverse effects ; Parents ; Pesticides ; adverse effects ; Pregnancy ; Prenatal Exposure Delayed Effects ; epidemiology ; psychology

OBJECTIVETo investigate the related influencing factors of preschool children's emotional and behavioral problems in early life and explore the associations between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children.

METHODSBased on the Ma'anshan Birth Cohort Study of the China-Anhui Birth Cohort Study (C-ABCS), women were recruited at their first clinical visit between October 2008 and October 2010 in four municipal medical and health institutions of Ma'anshan City, a total of 5 084 pregnant women and 4 669 singletons live births were included in the birth cohort. Women completed measures of depressive (Self-Rating Anxiety scale) and anxious (Center for Epidemiologic Studies Depression) symptoms in pregnancy. By the age of 3-6 follow-up, 3 653 children were followed with completed information between April 2014 and April 2015, strengths and difficulties questionnaires were used to assessed offspring emotional and behavioral problems. Logistics regression was used to investigate the relationship between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children.

RESULTSThe detected rates of emotional symptoms, conduct problems, hyperactivity and peer problems in preschool children were 6.3% (229/3 653), 7.5% (274/3 653), 7.6% (278/3 653) and 2.8% (103/3 653), while 7.6% (277/3 653) for total difficulties, 10.9%(398/3 653) for prosocial behavior and 27.4%(981/3 557) for impact respectively. Prevalence of anxiety and depression in the first trimester was 2.7%(100/3 653) and 4.7%(171/3 653) respectively, and in the second trimester was 2.0%(66/3 375) and 3.6%(122/3 375) respectively. After we controlled the confoundings of gestation age, place of residence, family income, maternal education, paternal education, premature birth and folic acid supplement before pregnancy, multinomial logistic regression analysis showed that the risk of children's emotional symptoms in maternal anxiety in both first-trimester and second-trimester group was higher than the group of no depression and anxiety symptoms, and OR(95%CI) was 5.90(2.00-17.48). Compared with whose mother no depression in both first-trimester and second-trimester, the risk of children's emotional symptoms in maternal depression in both first-trimester and second-trimester group was higher, and OR(95% CI) was 3.07 (1.30-7.28). And the risk of children's total difficulties of maternal anxiety in second-trimester was 2.27 (95%CI: 1.10-4.71) times of no anxiety in second-trimester. While the risk of children's total difficulties of maternal depression in second-trimester was 2.20 (95%CI: 1.24-3.93) times of no depression in second-trimester. Maternal emotional symptoms were not significant associations with conduct problems, hyperactivity, peer problems and prosocial behaviors (P> 0.05).

CONCLUSIONThere was a negative impact of maternal anxiety and depression symptoms during pregnancy on emotional and behavioral problems in preschool children. These findings highlight the need for additional clinical and research attention to both maternal depression and anxiety in pregnancy, which may be helpful to reduce the incidence of children's emotional and behavioral problems and act as an important measure in prevention.

Anxiety ; epidemiology ; Child ; Child, Preschool ; China ; Cohort Studies ; Depression ; epidemiology ; Female ; Humans ; Logistic Models ; Mothers ; psychology ; Pregnancy ; Prevalence ; Problem Behavior ; psychology ; Surveys and Questionnaires

OBJECTIVETo explore the effects of hyperbaric oxygen preconditioning (HBOP) on human stress responses during acute exposure to high altitude and the possible mechanism.

METHODSEight male subjects were treated with HBOP for 3, 5, and 7 days, followed by acute exposure to hypoxia simulating an altitude of 4,000 m. Subjects at rest were divided into sea-level control group, simulated high-altitude group, and 5-day HBOP intervention group, while subjects after physical load were divided into sea-level control group, simulated high-altitude group, 3-day HBOP intervention group, and 7-day HBOP intervention group. The physical load test was performed for each subject before and after HBOP, and the plasma levels of dopamine (DA), epinephrine (E), norepinephrine (NE), and adrenocorticotropic hormone (ACTH) were determined before and after exercise. The physical load test was performed by stepping up on to a 30 cm-high stepping stool at a rate of 25/min for 5 minutes, which was a type of moderate physical exercise. The stepping rate and timing were controlled by a metronome.

RESULTSThe levels of DA, E, NE, and ACTH at rest and after physical load were significantly higher in subjects acutely exposed to high altitude than in the sea-level control groups (all P<0.05). Moreover, the levels of DA, E, NE, and ACTH at rest were significantly higher after acute exposure to high altitude in the 5-day HBOP intervention group than in the simulated high-altitude group (all P<0.01). Except for the ACTH level in the 3-day HBOP intervention group, the levels of DA, E, NE, and ACTH after physical load were significantly higher after acute exposure to high altitude in the 3-day and 7-day HBOP intervention groups than in the simulated high-altitude group (all P<0.01).

CONCLUSIONHBOP can elevate the plasma expression of DA, E, NE, and ACTH, and then speed up the establishment of a new balance of homeostasis to adapt to the acute hypoxia at high altitude.

Adrenocorticotropic Hormone ; blood ; Altitude ; Dopamine ; blood ; Epinephrine ; blood ; Exercise ; Homeostasis ; Humans ; Hyperbaric Oxygenation ; Hypoxia ; blood ; Male ; Norepinephrine ; blood ; Rest ; Stress, Physiological

Objective To explore the association of adverse childhood events with early puberty timing and possible gender differences.Methods Data was gathered through questionnaires,physical and secondary sexual characteristics,examination with breast stage in girls and testicular volume in boys measured under informed consent among children in grade 3 to grade 5 from a largescale primary school.Information regarding adverse childhood experiences (ACEs),time of screening and physical activity was included in the questionnaire.Age limits on secondary sexual characteristics for defining early puberty established under the "China Puberty Research Collaboration Project" were used to classify early puberty timing.Body mass index was calculated and used to classify both overweight and obesity,in each gender.Results Among the 1 744 children aged 8.2-12.2 years old (957 boys),the prevalence rates of early puberty timing among boys and girls were 7.5％ and 14.6％,respectively,with gender differences (x2＝ 11.671,P＜ 0.001).Boys who reported having experienced serious adverse family events and girls with physical abuse were more likely to develop early puberty.Results from multivariate logistic regression analysis showed that family life events were associated with a higher risk of early puberty timing in boys (odds ratio:2.531,95％ CI:1.276-5.020) while experience related to physical abuse appeared a risk factor of early puberty timing in girls (odds ratio:2.453,95％CI:1.588-3.788).Conclusion Physical abuse and adverse family life events seemed to be associated with early puberty timing,suggesting further longitudinal study should be carried out to understand the nature of these findings and gender differences.

OBJECTIVETo understand the association between the blood glucose levels of pregnant women in second trimester detected by 75 gram oral glucose tolerance test (OGTT) and the birth weight of neonates.

METHODSDemographic information collection and OGTT were conducted for 3 081 pregnant women at ≤14 gestational weeks and 24-28 gestational weeks respectively. Multiple logistic regression analysis was done to identify the factors associated with the birth weight and the risks of large for gestational age (LGA) in three levels (FPG, OGTT-1 h and OGTT-2 h) of OGTT percentile group, multiple linear regression analysis was used to evaluate the relationships between maternal glucose levels and neonate birth weight.

RESULTSPre-pregnancy obesity (24.0 kg/m2≤BMI<28.0 kg/m2) (OR=1.4, 95%CI:1.0-2.0, P=0.029) and gestational diabetes mellitus (OR=2.4,95% CI: 1.8-3.2, P<0.001) were the risk factors. Pre-pregnancy underweight (BMI<18.5 kg/m2) (OR=1.6, 95%CI: 1.2-2.2, P=0.003), preeclampsia (OR=4.0, 95%CI: 1.9-8.4, P<0.001) increased the risk for small for gestational age (SGA). Multiple linear regression analysis showed neonate birth weight was positive correlated with maternal glucose levels (β were 91.99, 33.60, 32.00, respectively, P<0.001). Percentile groups of each OGTT level was linearly positive associated with increased mean value of neonate birth weight, and so with the risk of LGA.

CONCLUSIONSThere were positive correlations between maternal glucose levels and neonate birth weight. The risk of LGA increased with the maternal glucose levels, but there was no statistical association between SGA and maternal glucose levels. FPG level is one of the predictors of LGA. Active surveillance and control of maternal glucose level can effectively reduce the risk of LGA.

Birth Weight ; Blood Glucose ; analysis ; Cohort Studies ; Diabetes, Gestational ; Female ; Glucose Tolerance Test ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Logistic Models ; Obesity ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, Second ; blood ; Risk Factors ; Thinness