1.China - Africa cooperation for tropical diseases control: current status and future priorities
Shenning LU ; Kun YANG ; Yingjun QIAN ; Duoquan WANG ; Shan LÜ ; Xiaonong ZHOU
Chinese Journal of Schistosomiasis Control 2026;38(1):1-7
Tropical diseases, the transmission of which is affected by multiple natural and social factors, pose a great challenge to global public health, notably in African countries. During the past several decades, China and African countries have continuously collaborated for the control of neglected tropical diseases and malaria, which has become an important part of global South-to-South cooperation and global health governance. This article reviews the history of China-Africa cooperation for tropical diseases control, summarizes the experiences and achievements over the past decade, analyzes the current challenges in the coopera tion, and proposes future recommendations. The China-Africa cooperation has achieved significant progress in the control of tropical diseases, such as malaria, schistosomiasis, and filariasis, and established a China-Africa cooperation network for tropical diseases control. Through the "Three-Step" strategy of China-Africa cooperation, the effectiveness of China's integrated control strategies has been validated in Africa, and the application of China's tropical disease control technologies has been promoted in African disease-epidemic countries. Currently, China-Africa collaboration, however, still experiences multiple realistic challenges, such as insufficient resources, difficulty in technology transfer, and weak primary healthcare systems. In the future, both sides are recommended to further strengthen policy coordination, deepen technological cooperation, innovate cooperation models, aiming to continuously promote the high-quality development of China-Africa cooperation for tropical diseases control.
2.Application of action observation therapy in stroke rehabilitation from 2016 to 2025: a bibliometric analysis
Cheng HUANG ; Yangyi SHEN ; Biying LU ; Tong LIU ; Yue LIU
Chinese Journal of Rehabilitation Theory and Practice 2026;32(4):399-410
ObjectiveTo analyze the application trends and research hotspots of action observation therapy (AOT) in the field of stroke rehabilitation over the past decade. MethodsLiteratures on AOT in stroke rehabilitation published from January, 2016 to December, 2025 were retrieved from the Web of Science Core Collection database. CiteSpace 6.4.R1 was used for visual analysis. ResultsA total of 463 articles were included. The annual publication volume showed a fluctuating upward trend. The country with the highest number of publications was China, the most productive institution was Chang Gung University and Consiglio Nazionale delle Ricerche, and the most prolific author was Avanzini Pietro. Mirror neuron system, motor imagery, upper limb and facilitation were identified as high-frequency keywords and bursting words. ConclusionIn the past decade, the number of publications on AOT in stroke rehabilitation has generally increased. Researches are focusing on the synergy of sensory-closed-loop multimodal technologies, reconstruction of fine upper limb function and neural facilitation mechanisms.
3.Mechanisms of Shenqi Wenfei Prescription in Intervening in Chronic Obstructive Pulmonary Disease in Rats Based on ROS/TXNIP/NLRP3 Signaling Pathway
Di WU ; Mengyao SHI ; Lu ZHANG ; Tong LIU ; Jiabing TONG ; Cheng YANG ; Zegeng LI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):78-87
ObjectiveTo investigate the effects and underlying mechanisms of Shenqi Wenfei prescription (SQWF) on chronic obstructive pulmonary disease (COPD). MethodsA rat model of COPD with lung Qi deficiency was established using lipopolysaccharide (LPS) combined with cigarette smoke. Forty-eight SD rats were randomly divided into a blank group, a model group, low-, medium-, and high-dose SQWF groups (2.835, 5.67, 11.34 g·kg-1), and a Yupingfeng group (1.35 g·kg-1). Drug administration began on day 29 after modeling and continued for 2 weeks. The general condition of the rats was observed, and the lung function in each group was assessed. Hematoxylin-eosin (HE) staining was used to observe pathological changes in lung tissue. The proportion of inflammatory cells in bronchoalveolar lavage fluid (BALF) was measured. Apoptosis in lung tissue was examined by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. The release level of lactate dehydrogenase (LDH) in BALF was detected by a microplate assay. Reactive oxygen species (ROS) levels in lung tissue were detected using fluorescent probes. The levels of malondialdehyde (MDA), total superoxide dismutase (SOD), and reduced glutathione (GSH) in BALF were measured by biochemical methods. Ultrastructural changes in lung cells were observed via transmission electron microscopy. Double immunofluorescence staining was performed to detect the expression of thioredoxin-interacting protein (TXNIP) and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) in lung tissue. Western blot analysis was used to detect the protein expression of TXNIP, NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), cysteinyl aspartate-specific protease-1 (Caspase-1), Caspase-1 p20, gasdermin D (GSDMD), GSDMD N-terminal active fragment (GSDMD-N), interleukin-1β (IL-1β), and IL-18 in lung tissue. Serum IL-1β and IL-18 levels were measured by ELISA. ResultsCompared with the blank group, the model group showed lassitude, fatigue, tachypnea, and audible phlegm sounds, and lung function significantly declined (P0.01). Pulmonary emphysema and inflammatory cell infiltration were obvious. The level of inflammatory cells in BALF increased significantly (P0.05). The number of TUNEL-positive cells increased (P0.01). Levels of LDH, ROS, and MDA in BALF increased significantly (P0.01), while GSH and SOD activities decreased significantly (P0.01). Lung tissue cells showed irregular morphology, swollen mitochondria, disrupted cell membranes, and abundant vesicles, i.e., pyroptotic bodies. Protein levels of TXNIP, NLRP3, ASC, Caspase-1, Caspase-1 p20, GSDMD, GSDMD-N, IL-1β, and IL-18 in lung tissue were significantly elevated (P0.01), and serum IL-1β and IL-18 levels also increased significantly (P0.01). Compared with the model group, each medication group showed alleviation of qi deficiency symptoms and improved lung function (P0.01). Pulmonary emphysema and inflammatory cell infiltration were reduced. Inflammatory cell levels decreased (P0.05). The number of TUNEL-positive cells decreased significantly (P0.01). Levels of LDH, ROS, and MDA decreased significantly (P0.05), while GSH and SOD activities significantly increased (P0.01). Morphological and structural damage in lung tissue was improved to varying degrees. Protein levels of TXNIP, NLRP3, ASC, Caspase-1, Caspase-1 p20, GSDMD, GSDMD-N, IL-1β, and IL-18 in lung tissue significantly decreased (P0.01), and serum IL-1β and IL-18 levels also decreased significantly (P0.05). ConclusionSQWF can improve lung function and alleviate inflammatory responses in COPD rats. Its mechanism may be related to regulating the ROS/TXNIP/NLRP3 pathway and inhibiting pyroptosis.
4.Mechanisms of Shenqi Wenfei Prescription in Intervening in Chronic Obstructive Pulmonary Disease in Rats Based on ROS/TXNIP/NLRP3 Signaling Pathway
Di WU ; Mengyao SHI ; Lu ZHANG ; Tong LIU ; Jiabing TONG ; Cheng YANG ; Zegeng LI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(3):78-87
ObjectiveTo investigate the effects and underlying mechanisms of Shenqi Wenfei prescription (SQWF) on chronic obstructive pulmonary disease (COPD). MethodsA rat model of COPD with lung Qi deficiency was established using lipopolysaccharide (LPS) combined with cigarette smoke. Forty-eight SD rats were randomly divided into a blank group, a model group, low-, medium-, and high-dose SQWF groups (2.835, 5.67, 11.34 g·kg-1), and a Yupingfeng group (1.35 g·kg-1). Drug administration began on day 29 after modeling and continued for 2 weeks. The general condition of the rats was observed, and the lung function in each group was assessed. Hematoxylin-eosin (HE) staining was used to observe pathological changes in lung tissue. The proportion of inflammatory cells in bronchoalveolar lavage fluid (BALF) was measured. Apoptosis in lung tissue was examined by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. The release level of lactate dehydrogenase (LDH) in BALF was detected by a microplate assay. Reactive oxygen species (ROS) levels in lung tissue were detected using fluorescent probes. The levels of malondialdehyde (MDA), total superoxide dismutase (SOD), and reduced glutathione (GSH) in BALF were measured by biochemical methods. Ultrastructural changes in lung cells were observed via transmission electron microscopy. Double immunofluorescence staining was performed to detect the expression of thioredoxin-interacting protein (TXNIP) and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) in lung tissue. Western blot analysis was used to detect the protein expression of TXNIP, NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), cysteinyl aspartate-specific protease-1 (Caspase-1), Caspase-1 p20, gasdermin D (GSDMD), GSDMD N-terminal active fragment (GSDMD-N), interleukin-1β (IL-1β), and IL-18 in lung tissue. Serum IL-1β and IL-18 levels were measured by ELISA. ResultsCompared with the blank group, the model group showed lassitude, fatigue, tachypnea, and audible phlegm sounds, and lung function significantly declined (P0.01). Pulmonary emphysema and inflammatory cell infiltration were obvious. The level of inflammatory cells in BALF increased significantly (P0.05). The number of TUNEL-positive cells increased (P0.01). Levels of LDH, ROS, and MDA in BALF increased significantly (P0.01), while GSH and SOD activities decreased significantly (P0.01). Lung tissue cells showed irregular morphology, swollen mitochondria, disrupted cell membranes, and abundant vesicles, i.e., pyroptotic bodies. Protein levels of TXNIP, NLRP3, ASC, Caspase-1, Caspase-1 p20, GSDMD, GSDMD-N, IL-1β, and IL-18 in lung tissue were significantly elevated (P0.01), and serum IL-1β and IL-18 levels also increased significantly (P0.01). Compared with the model group, each medication group showed alleviation of qi deficiency symptoms and improved lung function (P0.01). Pulmonary emphysema and inflammatory cell infiltration were reduced. Inflammatory cell levels decreased (P0.05). The number of TUNEL-positive cells decreased significantly (P0.01). Levels of LDH, ROS, and MDA decreased significantly (P0.05), while GSH and SOD activities significantly increased (P0.01). Morphological and structural damage in lung tissue was improved to varying degrees. Protein levels of TXNIP, NLRP3, ASC, Caspase-1, Caspase-1 p20, GSDMD, GSDMD-N, IL-1β, and IL-18 in lung tissue significantly decreased (P0.01), and serum IL-1β and IL-18 levels also decreased significantly (P0.05). ConclusionSQWF can improve lung function and alleviate inflammatory responses in COPD rats. Its mechanism may be related to regulating the ROS/TXNIP/NLRP3 pathway and inhibiting pyroptosis.
5.Development and evaluation of classification system for drug-related problems in China
Shuang ZOU ; Tingting LU ; Lei BAO ; Yun LIAO ; Ling LI ; Ping ZHANG
China Pharmacy 2026;37(3):371-376
OBJECTIVE To establish a Chinese drug-related problem (DRP) classification system applicable to pharmacist-led pharmaceutical care in China, providing pharmacists with an effective and practical tool for pharmaceutical care. METHODS A multi-stage process was employed to construct the DRP classification system, including literature review and analysis, comparison of existing classification systems, refinement of classification items and framework development, two rounds of standard case validation, expert discussion, and system revision. The Fleiss′ kappa test was used to calculate the consistency coefficient κ, assessing the reliability of pharmacists participating in evaluating the classification system. An electronic questionnaire comprising six items was employed to evaluate the system’s applicability. RESULTS The constructed Chinese DRP classification system comprised six sections [problem(including potential problems), DRP evaluation, cause (including possible causes of potential problems), intervention, acceptance of intervention and DRP status], with 24 primary codes and 96 secondary codes. In the first round of case validation, κ values exceeded 0.4 for all sections except “intervention” and “DRP status”. In the second round, κ values exceeded 0.4 for all sections. In the applicability evaluation of the classification system, positive ratings (“strongly agree” or “agree”) exceeded 85% for all items. Specifically, positive ratings for“the classification system can provide appropriate category selection”,“ the classification system is comprehensive”,“ the classification system is convenient to use” and “the classification system is highly satisfactory” exceeded 92%. CONCLUSIONS The Chinese DRP classification system developed demonstrates both high reliability and applicability, providing an effective and practical classification tool for pharmacists in China to conduct pharmaceutical care.
6.A Review of Methods for Establishing and Evaluating Animal Models of Stroke
Yunrong YANG ; Wenyu WU ; Yue TAN ; Guofeng YAN ; Yao LI ; Jin LU
Laboratory Animal and Comparative Medicine 2026;46(1):94-106
Stroke is one of the leading causes of disability and mortality worldwide. Research into its mechanisms and the development of therapeutic strategies heavily rely on animal models that accurately replicate the pathological features of human disease. An ideal animal model for stroke should not only reproduce the neurological deficits and pathological changes observed in clinical patients but also demonstrate good reproducibility and translational value. This review focuses on the preparation and evaluation methods of ischemic stroke animal models. Firstly, it elaborates on the selection criteria, advantages, and disadvantages of experimental animals, including rodents (rats, mice) and non-rodents (non-human primates, miniature pigs, rabbits, zebrafish). Secondly, it provides a detailed overview of the modeling principles, key procedures, and application scopes for ischemic stroke models and hemorrhagic stroke models. Furthermore, the review summarizes advances in the applications of emerging technologies—including gene editing [e.g., clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) gene editing], multimodal imaging (e.g., two-photon microscopy, photoacoustic imaging), artificial intelligence, optogenetics, 3D bioprinting, organoid models, and multi-omics–in model optimization, precise assessment, and mechanistic investigation. Finally, based on a systematic analysis of relevant domestic and international literature from 2019 to 2024, this review discusses model selection strategies based on research objectives, a multidimensional evaluation system encompassing behavioral, imaging, and molecular pathological assessments, and envisions future directions involving technological integration to achieve model precision and individualization. This article aims to provide a comprehensive methodological reference to help researchers select appropriate animal models of stroke according to specific scientific questions.
7.Mechanisms of Liuwei Buqi Prescription in Regulating Macrophage Efferocytosis for Treatment of Lung-kidney Qi Deficiency Syndrome in COPD Based on Nrf2/MARCO Signaling Pathway
Jiankang JIANG ; Hui WANG ; Lu ZHANG ; Zegeng LI ; Jiabing TONG ; Fan WU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):222-229
ObjectiveTo investigate the mechanisms by which Liuwei Buqi prescription (LWBQ) regulates alveolar macrophage efferocytosis and improves inflammatory responses in rats with chronic obstructive pulmonary disease (COPD) characterized by lung-kidney Qi deficiency based on the nuclear factor erythroid 2-related factor 2 (Nrf2)/macrophage receptor with collagenous structure (MARCO) pathway. MethodsSuccessfully modeled rats were randomly divided into a model group, low-dose LWBQ group (LWBQ-L, 2.25 g·kg-1·d-1), medium-dose LWBQ group (LWBQ-M, 4.5 g·kg-1·d-1), high-dose LWBQ group (LWBQ-H, 9 g·kg-1·d-1), and aminophylline group (AMIN, 50 mg·kg-1·d-1), with 8 rats in each group. Another 8 healthy rats were included as the blank group. Except for the blank group, rats in the remaining groups were subjected to smoke exposure combined with forced swimming, intratracheal lipopolysaccharide (LPS) instillation, and subcutaneous hydrocortisone injection to establish a COPD model with lung-kidney Qi deficiency. After successful modeling, rats were administered different doses of LWBQ or AMIN by gavage. Body weight, fur condition, and oral secretions were observed. Pulmonary function was measured using an animal lung function analyzer. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression levels of interferon-γ (IFN-γ), interleukin-6 (IL-6), interleukin-1 (IL-1), and tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid (BALF) and serum (SER). Hematoxylin-eosin (HE) staining was used to examine pathological changes in lung tissue. Giemsa staining was performed to detect eosinophils, basophils, and neutrophils in BALF. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) was used to detect apoptosis in lung tissue. Western blot and real-time polymerase chain reaction (Real-time PCR) were employed to determine the protein and mRNA expression levels of efferocytosis-related proteins growth arrest-specific gene 6 (GAS6), milk fat globule-epidermal growth factor 8 (MFG-E8), and pathway-related proteins Nrf2 and MARCO in lung tissue. ResultsCompared with the blank group, the model group showed reduced food intake, nasal and oral secretions with sputum, and decreased body weight (P<0.01), decreased peak expiratory flow (PEF) (P<0.01), increased forced vital capacity (FVC) (P<0.01), and decreased forced expiratory volume in 0.3 s/forced vital capacity [FEV0.3/FVC (%)] (P<0.01). The expression levels of IFN-γ, IL-6, IL-1, and TNF-α in BALF and SER were increased (P<0.01). Lung tissue exhibited structural destruction, hyperplasia, inflammatory exudation, increased apoptotic cells, and increased mean optical density (P<0.01). The protein and mRNA expression levels of GAS6, MFG-E8, and MARCO, as well as Nrf2 mRNA expression, were increased (P<0.01). Compared with the model group, the LWBQ groups showed increased food intake, reduced nasal and oral secretions with sputum, and increased body weight (P<0.05, P<0.01). PEF was increased (P<0.01). FVC was increased in rats treated with low- and medium-dose LWBQ (P<0.01), and FEV0.3/FVC (%) was increased in rats treated with medium- and high-dose LWBQ (P<0.05, P<0.01). The expression levels of IFN-γ, IL-6, IL-1, and TNF-α in BALF and SER were decreased (P<0.01). Lung tissue structure was relatively intact, with improvement in hyperplasia and inflammatory exudation. The number of apoptotic cells in lung tissue was reduced, and mean optical density was decreased (P<0.05, P<0.01). The protein and mRNA expression levels of efferocytosis-related proteins GAS6 and MFG-E8 and pathway-related proteins Nrf2 and MARCO were increased (P<0.01). ConclusionLWBQ can alleviate pulmonary and systemic inflammation, improve lung function, and reduce lung tissue damage in rats with COPD characterized by lung-kidney Qi deficiency. The mechanism may be related to enhancement of alveolar macrophage efferocytosis through regulation of the Nrf2/MARCO pathway.
8.Mechanism of Fresh Cutting of Traditional Chinese Medicine: Discussion on Integration of Traditional Wisdom and Modern Technology
Wenjie BAO ; Lingyun ZHONG ; Wenhua WU ; Congmin LIU ; Zixin CHEN ; Xingmei LU ; Hengli TONG ; Yi HUANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):282-290
Fresh-cut processing constitutes a pivotal technique in the origin processing of Chinese medicinal materials, with a long history documented in multiple materia medica. In recent years, it has garnered national policy support for its ability to prevent component loss and low processing efficiency associated with traditional drying-before-cutting methods. As of August 2025, 26 provinces and municipalities nationwide have cumulatively published 789 species for fresh-cut processing. Among these, 78 were included in the 2025 edition of the Pharmacopoeia of the People's Republic of China. However, the practice continues to face common challenges and difficulties, including ambiguous scientific understanding, fragmented standards, limited quality control approaches, and poor process stability. Based on this, this paper synthesises years of research findings to systematically elucidate the core mechanisms of fresh-cut processing. These encompass alterations to herbal tissue structure during cutting, post-processing changes in constituents, and physiological-biochemical processes such as plant stress responses and shifts in endogenous enzyme activity. It also summarises influencing factors, including inherent herbal properties, cutting timing and methods, and environmental conditions like temperature, humidity, and microbial presence. Based on this overview of fresh-cutting mechanisms, subsequent research should advance in four directions:Clarifying the scientific principles of fresh-cutting, overcoming technical bottlenecks, upgrading intelligent equipment, and establishing quality standards and evaluation systems. This study provides a theoretical foundation and scientific basis for future research on fresh-cutting in traditional Chinese medicine(TCM), promoting its deeper practical application within the industry and contributing to the high-quality development of TCM industry and the modernization of TCM.
9.Analysis of depressive symptoms and predictive factors in children and adolescents in Inner Mongolia Autonomous Region
Guiwei CHEN ; Lu TONG ; Ziyu LI ; Xiaojuan GAO ; Ruiqi WANG ; Xiaolu ZHANG ; Le LIU ; Yinxia BAI
Sichuan Mental Health 2026;39(1):83-88
BackgroundIn recent years, the incidence of depression among adolescents has been increasing steadily, posing a serious threat to their physical and mental health and even leading to severe consequences such as self-harm and suicide. At the same time, the detection rate of subclinical depression symptoms among adolescents is even higher. Although these symptoms do not meet the clinical diagnostic criteria, they have significantly affected their quality of life, and their persistence over time may further develop into depression. Therefore, in-depth exploration of adolescent depression symptoms and the predictive factors holds significant practical significance and research value. However, up to now, no large-scale investigation and research on depression symptoms among children and adolescents has been conducted in Inner Mongolia Autonomous Region. ObjectiveTo understand the prevalence of depressive symptoms among children and adolescents in Inner Mongolia Autonomous Region, in order to provide references for formulating scientific and effective prevention strategies and intervention measures. MethodsBy using the cluster stratified random sampling method, 6 281 students from the third grade of primary school to the second grade of high school in 12 leagues and cities of Inner Mongolia Autonomous Region were selected in March 2024. A self-designed questionnaire and the Self-rating Depression Scale (SDS) were used for on-site investigation. ResultsA total of 6 058 (96.45%) children and adolescents completed the valid questionnaire survey, and 2 728 cases (45.03%) were found to have depressive symptoms. There were statistically significant differences in the detection rates of depressive symptoms among children and adolescents of different genders, ages, whether they were only children, different family types, family monthly income, parents' educational levels, and whether the mother was employed (χ2=33.769, 40.618, 48.593, 29.972, 142.648, 195.999, 168.190, 5.445, P<0.05 or 0.01).The results of the Logistic regression analysis showed that for children and adolescents, being female, aged between 12 and 16, over 16 years old, not being an only child, living in a reconstituted family, having a monthly family income of less than 5 000 yuan, and having parents with an education level of primary school or below were predictors of depressive symptoms (OR=1.241, 1.427, 1.273, 1.177, 1.549, 1.278, 1.462, 1.417, 1.514, 1.929, 1.660, 1.528, P<0.05 or 0.01). ConclusionThe detection rate of depressive symptoms among children and adolescents in Inner Mongolia Autonomous Region is relatively high. Factors that may predict depressive symptoms in children and adolescents include female gender, ages between 12 and 16, ages over 16 years old, non-only children, families with a restructured structure, monthly family income of less than 5 000 yuan, and parents with an education level of primary school or below. [Funded by Science and Technology Planning Project of the Inner Mongolia Autonomous Region (number, 2022YFSH0119)]
10.Longitudinal cohort study on pubertal development trajectories of testicular and breast development among children
Chinese Journal of School Health 2026;47(3):408-412
Objective:
To characterize longitudinal trajectories of testicular development in boys and breast development in girls, so as to provide reference data for understanding patterns of pubertal sexual maturation.
Methods:
Based on the Shanghai Pudong New Area Cohort Study on Growth, Development and Health in Children and Adolescents, a baseline survey was conducted in 2020 using a mult stage cluster random sampling method. A total of 2 184 children who completed all follow ups during the primary school period from 13 elementary schools in Pudong New Area,Shanghai,with annual follow ups during 2021-2025. Testicular volume and Tanner stage of breast development were assessed by professional physicians using standardized visual inspection and palpation. The age distribution of testicular volume and breast development was fitted by using cumulative link mixed models and Turnbull s nonparametric maximum likelihood estimation method.
Results:
Median ages for testicular volumes of 2, 3, 4 and 5 mL in boys were 7.07, 9.24, 10.29, and 11.57 years old, respectively. Median ages for Tanner breast stages Ⅱ, Ⅲ, Ⅳ, and Ⅴ in girls were 8.55 , 10.17, 11.18, and 13.78 years old, respectively. Based on overweight and obesity, stratified analysis showed that earlier pubertal onset among overweight/obesity children, and the key milestones for pubertal initiation were testicular volume reaching 4 mL in boys and breast Tanner II in girls for 10.29, 10.83; 8.18, 9.00 years.
Conclusion
Overweight and obesity are associated with earlier pubertal initiation,but there are certain gender and developmental stage specific patterns.


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