Objective: To analyze the association between altitudes and nutritional status of children and adolescents, and to explore the moderating effects of dietary behaviors and physical activity, so as to provide a scientific basis for developing lifestyle interventions tailored to local conditions. Methods: From September to November 2023, physical examinations and questionnaire surveys were conducted among children and adolescents aged 7-17 in two autonomous regions, Inner Mongolia and Xizang, with a final sample of 156 511 participants by the stratified cluster random sampling method. Height and weight were measured to calculate body mass index (BMI). Sociodemographic characteristics, dietary behaviors, and physical activity were collected via questionnaires, while the altitude of each participant s school was obtained using Amap. Logistic regression was performed to examine the relationship between altitudes and nutritional status. Interaction terms and stratified analyses were applied to assess the moderating effects of dietary behaviors and physical activity. Restricted cubic spline (RCS) were used for visualization. Results: In 2023, the prevalence of wasting and overweight/obesity among children and adolescents in Xizang were 9.7% and 9.0%, respectively, compared to 2.9% and 22.0% in Inner Mongolia. Logistic regression analysis results showed that for every 1 km increase in altitude, the risk of wasting increased, while the risk of overweight/obesity decreased ( OR =1.43, 0.19, both P <0.05). The results of the stratified analysis showed that compared to those living at altitudes <1 km, children and adolescents with healthy diets showed no significant association between altitudes (1-<2 and 2-<3 km) and wasting ( OR =1.22, 0.75, both P >0.05), whereas significant associations were observed at 3-<4 and ≥4 km altitudes ( OR =2.25, 2.89, both P <0.05). In contrast, unhealthy dietary groups showed statistically significant associations across altitudes ( OR =1.18-4.04, all P <0.05), consistent with RCS results. No moderating effects were observed for physical activity on the altitude wasting association or for dietary behaviors and physical activity combined on the altitude overweight/obesity association ( P interaction =0.63, 0.10, 0.53). Conclusion Healthy dietary behaviors play a critical role in improving the nutritional status of children and adolescents and reducing regional disparities, providing a scientific foundation for public health policy formulation and implementation.

In view of the problem of slow development of intensive care medicine in Xizang, the research team made full use of the national partner assistance to Xizang, gathered resources across all cities in Xizang, and formed a national academic platform for critical care medicine in plateau areas. Adhering to the academic orientation with hemodynamics as the main topic, critical care ultrasound as the bedside dynamic monitoring and evaluation method, and blood flow-oxygen flow resuscitation as the core connotation, we have achieved the goals of improving the critical care talent echelon throughout Xizang, driving the overall progress of intensive care medicine in Xizang, making a figure in China, and focusing on training of top-notch talents.

Objective: To understand campus bullying in colleges and middle schools in Tibet, and to analyze related influencing factors, so as to provide reliable basis and reference for formulating targeted intervention measures. Methods: A stratified cluster sampling method was used to investigate the status and influencing factors of being bullied by questionnaire among 3 875 college and middle school students in Ngari, Qamdo, Lhasa, Nagqu and Xigaze of Tibet, from September to November 2019. Chi-square test and Logistic regression method were used for data analysis. Results: The report rate of campus bullying among college and middle school students in Tibet was 5.50%; 4.35% for girls and 6.76% for boys；8.81% for college students, 1.64% for senior high school students and 5.94% for junior high school students. The results of multivariate Logistic regression analysis showed that smoking ( OR =1.71), Internet addiction ( OR =3.82), depression ( OR =3.84), obesity ( OR =2.02), single parent family ( OR = 1.67 ) and reorganized family ( OR =3.74) were positively correlated with campus bullying ( P <0.05). Girls ( OR =0.66) and senior high school ( OR =0.28) were negatively correlated with campus bullying ( P <0.05). Conclusion Campus bullying is related to campus environment, family type, behaviors and life styles, etc. Efforts should be committed to build a caring campus culture and a good family moral education environment, in order to reduce the incidence of campus bullying and associated adverse effects.

Objective: To monitor and evaluate the nutritional improvement of primary and middle school students in rural Tibet from 2015 to 2017, and to provide a reference for local nutritional policy. Methods: From 2015 to 2017, 10% of the primary and middle schools in 45 counties implementing the rural nutrition improvement plan in Tibet were selected to carry out nutrition monitoring assessment. The monitoring indicators included growth retardation, emaciation, overweight and obesity, and the percentage comparison was analyzed by chi-square test. Results: A total of 56 674 aged 6-16 students were monitored from 2015 to 2017, and the wasting rate was 11.62%, 9.08% and 8.39%, respectively.Growth retardation rate was 10.27%, 11.87% and 8.99%.The overweight rate was 5.17%, 6.78% and 7.04%.Obesity rate 2.49%, 2.70%, 5.65%. The wasting rate and growth delay rate of rural students in Tibet decreased year by year, while overweight rate and obesity rate increased year by year. The difference between wasting and growth delay prevalence in three years was statistically significant (χ2=122.40, 81.96, P<0.01).The difference between overweight and obesity prevalence within three years also had statistical significance (χ2=665.88,320.74, P<0.01).The emaciation rate of boys and girls monitored from 2015 to 2017 was 11.85% and 7.60, respectively. Growth retardation was 10.71% and 7.70%.The overweight rate was 6.59% and 6.00%.The obesity rate was 3.41%, 3.50%, the wasting rate difference between male and female in three years has statistical significance (χ2=290.25, P<0.01);The growth delay rate difference was statistically significant (χ2=153.63, P<0.01);The difference of overweight rate was statistically significant (χ2=8.33, P<0.01);There was no statistically significant difference in the obesity prevalence(χ2=0.34, P>0.05), since the emaciation rate, growth delay rate and overweight rate of male students were higher than that of female students. From 2015 to 2017, there were statistically significant differences in weight loss, growth delay, overweight and obesity prevalence among students aged 6-16 years old(P<0.05). With the growth of age, the weight loss rate and growth delay rate increased year by year, while the overweight rate and obesity rate decreased with the growth of age. Conclusion The malnutrition (wasting and growth retardation) of Tibetan rural primary and secondary school students has been improved obviously through the nutrition improvement plan, but the excess nutrition is also increasing.