ObjectiveTo establish pediatric serum CysC reference intervals based on the children's hospital laboratory data in Zhejiang Province and analyse the effects of CysClevels on age and gender. MethodsCysC was one of tests of a routine biochemical screening panel employed for most outpatients and inpatients in the children's hospital, and 8 127 subjects (4 264 boys and 3 863 girls) were selected from 13 567 subjects from laboratory information system according to the exclusion criterion with seriously systemic diseases, cardiovascular diseases, kidney diseases, elevated values of creatinine, urea or ALT for which 1.5-fold upper limit, serum samples with hemolysis, icterus or lipid turbidity, same patients with non-first-time CysC results and living addresses which were not in Zhejiang. The serum CysC was determined by transmission turbidimetry on Roche DPP modular automatic biochemical analyzer. SPSS 17.0 software and EXCEL 2003 were employed for statistical analysis in this study. Results The serum CysC concentration was a Gaussian distribution after log transformation. The mean Log-transformated CysC lg (CysC) concentration of boys in five age groups ( ＜ 1 month, 1 to 3 months, 4 to 11 months, 1 to 2 years and 2 to 16 years) were 0. 224,0. 170,0. 112,0. 061, -0. 011 (mg/L,lg) respectively, and the mean Log-transformated CysC lg(CysC) concentration of girls in five age groups were 0. 222, 0. 164, 0. 089, 0. 057,-0. 010 ( mmg/L, lg) respectively, and no statistically significant differences between Ig( CysC ) and gender in five age groups were found ( t values were 0. 174, 0. 362, 0. 445,- 1. 464 and - 0. 093, respectively,and corresponding P values all were greater than 0. 05 ). The mean lg ( CysC ) concentrations in five age groups were 0. 222,0. 166,0. 100,0. 059, - 0. 010 ( mmg/L, lg), and significant differences between Lg ( CysC ) and ages by Analysis of Variance were observed ( F = 309. 785 and P = 0 in between-groups totally,P = 0 in any two groups). Serum CysC levels were highest in the age of ＜ 1 month, then declined to the age of 2 years and kept stable in the age of 2 to 16 years. The serum CysC reference intervals for children were as follows:0. 95 -2. 92 mg/L in the age of ＜ 1 month, 0. 81 -2.67 mg/L in the age of 1 to 3 months, 0. 65 -2.45 mg/L in the age of 4 tol2 months, 0. 56 -2. 35 mg/L in the age of 1 year and 0. 45 -2. 13 mg/L in the age of 2 to 16 years. ConclusionsThere is no significant effect on pediatric CysC levels with gender but close correlated with age below 2 years old. It is necessary to establish appropriate age-related reference intervals of serum CysC for efficiently evaluating renal function in local children.

Objective: To investigate the general situation of sleep duration, sleep quality and related risk factors among primary students in Shanghai and to provide evidence for the prevention and control of students sleep health. Methods: By using stratified cluster random sampling method, 3 410 students from 16 primary schools in four urban areas and four suburb areas of Shanghai were selected to conduct sleep health questionnaire survey and physical examination Chi square test was used for group comparison while binary Logistic regression was used to assess possible factors related with sleep quality. Results: The detection rate of sleep insufficiency (<10 h) among students was 93.0%. The detection rate of poor sleep quality was 66.8% with 67.1% in girls and 66.6% in boys. The top three sleep problems were daytime sleepiness(80.9%), irregular sleep duration (74.1%) and sleep anxiety(59.5%). Multivariate Logistic regression analysis showed that everyday moderate-intensity physical activity (OR=1.51, 95%CI=1.04-2.21) and daily walking activity (more than 10 minutes)(OR=1.27, 95%CI=1.08-1.50) were risk factors of poor sleep quality(P<0.05). Conclusion In Shanghai, the prevalence of sleep insufficiency and poor sleep quality among primary students are high. Sleep health was associated with moderate physical activity and walking activity. Increasing the duration of moderate physical activity and daily walking activity is the very important measures in prevention and control of the sleep problems.

Objective: To investigate the establishment of health care institutions and the staffing primary and secondary school health care in Shanghai, and to understand the capacity building needs of health care personnel. Methods: A survey was conducted on all primary and secondary schools in Shanghai from April to August in 2020. The content of the questionnaire covers the establishment of health care institutions, the staffing of school health care centers and the capacity building need of health care personnel. Chi square test was used to compare the difference of the health care institutions setting and staffing by schools and areas. Results: In 2020, there were 1 847 primary and secondary schools in Shanghai (including branches schools). About 51.4% of primary and secondary schools in Shanghai were equipped with school health care personnel in the ratio of the number of students at least 600∶1 , and the staffing compliance rate of urban schools (59.3%) was higher than that of suburban schools (47.3%)( χ 2=24.27, P <0.01). All school health care personnel believed that there are currently few opportunities for capacity buliding services from health facilities. Conclusion School health care institutions in Shanghai are well equipped, but the staffing shortage is substantial, with strong need for capacity building.

Objective: To investigate incidence of traffic injury and its associated factors among secondary school students in Shanghai, so as to provide scientific basis for intervention. Methods: Using the method of multi stage stratified random cluster sampling, an on-the-spot anonymous questionnaire survey was conducted among 19 629 adolescents from 16 districts in Shanghai from May to June 2021. The multivariate Logistic regression was used to analyze possible associated factors. Results: The rate of road traffic injuries among secondary school students in Shanghai was 0.74%, the highest reporting rate among secondary vocational school students (1.35%), followed by junior high school students (0.72%), and the lowest reporting rate of road traffic injuries among senior high school students (0.55%), with statistically significant differences ( χ 2=13.39, P <0.01). The results of multivariate Logistic regression analysis showed that the junior high school ( OR =0.56, 95% CI =0.35-0.89) or senior high school ( OR = 0.40 , 95% CI =0.24-0.68) and residential school ( OR =0.39, 95% CI =0.18-0.88) were protective factors of road traffic injuries( P <0.05). Male ( OR =1.65, 95% CI =1.14-2.37), unaware of seat belt ( OR =6.38, 95% CI =2.81-14.50), had a cycling chase/fight ( OR =2.33, 95% CI =1.39-3.90), music or phone calls on a bicycle ( OR =2.54, 95% CI =1.72-3.75) were positively correlated with road traffic injury( P <0.05). Conclusions The road traffic injury among secondary school students in Shanghai is related to many factors, and traffic hazards are common among students in all school sections. Targeted measures should be taken to strengthen traffic safety knowledge education and intervention in healthy behaviors among adolescents, in order to reduce the incidence of road traffic injury.

Objective: To assess the changes of students’ hand washing behaviors after implementing comprehensive interventions, and to provide the reference for hand-washing promotion among students. Methods: The implementation of comprehensive intervention projects had been carried out in three aspects: hardware transformation, system establishment, health management and health education. A randomized controlled trial method was used to select each one primary and secondary school in 2016 from 17 districts in Shanghai, and 17 intervention schools and 17 control schools were taken as object. Non-participant observation was used for students’ hand washing behaviors for 4 times during May, 2016 to May, 2017. Descriptive analysis and chi square test were used to analyze the data. Results: Compared with the control group, the hand washing rate of the intervention group was lower than that of the control group at baseline. The intervention group has got a higher rate than that of the control group in the evaluation of 1, the assessment 2 and the assessment 3 after intervention. The difference was statistically significant(χ2=7.70, 24.23, 38.88, 21.71, P<0.05). Compared with the control group, the hand washing rate of the intervention group after class was lower than that of the control group. After the intervention, the rate of the intervention group was higher than that of the control group in the evaluation 1, the assessment 2 and the assessment 3 after the intervention. The difference was statistically significant (χ2=8.52, 33.79, 54.64, 13.99, P<0.05). Compared with the control group, there was no difference between the baseline intervention group and the control group before meals. The intervention group after intervention was higher than the control group in the evaluation of 1, evaluation 2 and evaluation 3. The difference was statistically significant (χ2=45.01, 42.19, 27.82, P<0.05). Conclusion After comprehensive intervention, the effect was significant under different temperature conditions, and the effect of intervention lasted for one year.

Objective: To understand the influencing factors and family burden of bicycle injury among middle school students in Shanghai for bicycle injury prevention. Methods: Based on 1∶2 matched case-control design, students who were injured when cycling were selected from Shanghai student injury case reporting system during Sept. 2017 to Dec. 2018 as the case group. The same-sex control was selected from the same grade in the same school with the case. A total of 61 cases and 122 control were selected. Self-reported questionnaires were conducted by parents of children. Univariate and multivariate logistic regression were used to analyze the influencing factors of bicycle injury. Results: Poor eyesight (OR=2.27, 95%CI=1.02-5.07), lots of intersections near the residence (OR=2.00, 95%CI=1.00-3.98), and lots of cyclists near the residence (OR=2.15, 95%CI=1.06-4.36) were positively correlated with bicycle injuries among middle school students. About 34.43% and 8.20% of parents reckon bicycle injuries had a moderate impact on family economic, daily activities and recreational activities. Among the students with bicycle injury, 70.49% of the students were absent from school because of illness, and 36.07% of their parents missed work because of illness. The average absence time for school and working were 10.79 days and 3.03 days respectively. The total economic loss caused by the lack of work was 84 950 yuan, with an average of 1 393 yuan. Conclusion Bicycle injury of middle school students in Shanghai causes certain family burden. Poor eyesight, lots of intersections near the residence, lots of cyclists near the residence are positively correlated with bicycle injuries among middle school students.

Objective: To evaluate the effects of physical activity interventions based on social ecology model, and to explore promising approach for increasing physical activity of students in large cities. Methods: A quasi-experimental design with parallel control was implemented. Students from grade 4 in 20 primary schools in 3 districts of Shanghai were recruited. Based on social ecology model, physical activity interventions were carried out in three levels: personal, social-and physical environment. The interventions lasted for 6 months. Questionnaires, physical examinations and physical fitness tests were carried out. Rank sum test, chi-square test and logistic stepwise regression was used to analyze the intervention effects. Results: In the intervention group, the proportion of students who favored physical activity increased from 47.9% to 50.7%. Time spent in moderate to vigorous intensity physical activity (MVPA) increased from 64 min/d to 70 min/d, mainly during the weekend. The interventions showed significant effects, especially for girls. In the intervention group, the proportion of students spent 1 h/d in MVPA increased from 53.7% to 57.7%(χ2=4.95, P<0.05). Multivariate analysis showed that after intervention, the proportion of students spent more than 1 h/d in MVPA in the intervention group was higher than that in the control group (OR=1.22, 95%CI=1.02-1.48, P=0.03). Conclusion Physical activity interventions based on social ecology model can increase uptake of physical activity among school students.

Objective: To establish a risk assessment index system for epidemic infectious diseases in primary and secondary schools, for early warning and prevention of school infectious diseases accurately and timely. Methods: Through literature review, the indicators pool was established by consulting relevant experts and referring to practical experience. Then two rounds of expert consultation using the Delphi method were conducted(13 experts of round 1, and 20 experts of round 2). The concentration of expert opinions (the average, the percentage of full marks) and the coordination of expert opinions (the coefficient of variation, the coordination coefficient W ) were calculated and analyzed. The coordination coefficient W was obtained by nonparametric Kendall s W test of multiple samples. According to the experts feedback, necessary addition, reduction and modification of the indicators were carried out to determine the evaluation index system, and the analytic hierarchy process (AHP) was used to calculate the weight of each indicator. Results: The expert authority coefficients of the two rounds of consultation were 0.89 and 0.88, respectively, and the form recovery rate was 100%. The range of the variation coefficient of each three level indicator was 0.07-0.31 and 0.06-0.19, and the coordination coefficient W was 0.25 and 0.47, respectively, indicating that the consistency and credibility of expert opinions were good. Finally, the risk assessment index system of infectious diseases in primary and secondary schools was established, which was composed of 5 first level indexes, 23 second level indexes and 86 third level indexes. The AHP was used to calculate the intra level weight of the index. The variation coefficient of five first level indicators of school health management and security system, school health personnel facilities, health monitoring and cognition level, severity and coping measures were 0.09, 0.06, 0.08, 0.12 and 0.06 , respectively, and the weight coefficients were 20.42%, 21.19%, 19.87%, 17.45% and 21.08%, respectively. Conclusion The risk assessment index system of school infectious diseases is applicable to primary and secondary schools. The initiative, coordination and authority of experts in this system are all high. It is of practical guiding significance for the early warning of infectious diseases in primary and secondary schools.

Objective: To investigate the relationship between body fat percentage (BF%) and high blood pressure among adolescents in Shanghai, and to provide basis for early prevention and intervention of cardcovascular diseases. Methods: By using stratified cluster sampling method, a total of 5 148 adolescent students in 16 schools from 16 districts of Shanghai were selected. Questionnaire survey and physical examination were performed. The bioelectrical impedance analysis (BIA) was used to measure body fat percentage. National Blood Pressure Reference for Chinese Han Children was used to define high blood pressure. And T test, chi-square test and Logistici regression were used to assess the relation between BF% with high blood pressure. Results: The prevalence of high blood pressure in 5 148 junior middle school students in Shanghai was 10.98%, with girls (13.13%) higher than boys (8.99%)(χ 2=22.48, P<0.01). The average total body fat percentage of male students was (20.90±10.73)%, which decreased with age (linear trend variance is 10.04, P<0.01). The average total body fat percentage of girls was (25.14±8.03)%, which increased with age (linear trend variance is 69.23, P<0.01). After adjusted for age, diet, exercise and other influencing factors, the prevalence of hypertension showed an increasing trend with the increase of body fat percentage for both boys and girls. The risk of high blood pressure in boys with BF%≥P 90 was 12.43 times higher than that in boys with BF%

Conclusion There was a positive correlation between body fat percentage and high blood pressure in adolescents. The prevalence of high blood pressure increased with the increase of body fat percentage, which was more obvious in boys.

Objective: To explore the relationship between myopia and nutritional status among upper elementary students in Shanghai. Methods: A stratified cluster sampling method was used to select 5 576 fourth and fifth grade students from 16 districts in Shanghai, vision test, physical examination and questionnaire survey were administered. Two level multivariate Logistic regression and mixed linear models were used to analyze the relationship between myopia, spherical equivalent (SE) and nutritional status. Results: The detection rates of overweight and obesity were 17.0%(949) and 18.7%(1 042), respectively. There was a statistical difference in the proportion of the nutritional status in boys and girls( χ 2=210.94, P <0.01), with overweight and obesity in boys higher than those of girls. The overweight boys were more likely to have myopia (univariate analysis: OR=1.23, P =0.04; multivariate analysis: OR=1.21, P =0.06) than the normal weight boy. Overweight students tended to had more negative refractive than those with normal weight in both boys and girls(multivariate analysis, boys: β =-0.19, girls: β=-0.24, P <0.05). Myopia risk and refractive power in obese students showed no statistical difference with normal weight students( P >0.05). Conclusion Overweight students have lower SE than the normal weight among upper elementary students of Shanghai, more researches are needed to confirm this finding and to provide theoretical bases for myopia prevention and control.