Objective: To analyze the prevalence trends of different types of elevated blood pressure and their association with nutritional status among primary and secondary school students in Inner Mongolia from 2019 to 2024, providing references for targeted prevention strategies. Methods: From September 2019 to 2024, a stratified random cluster sampling method was used to select 12 primary and secondary schools from each league city in Inner Mongolia Autonomous Region. A total of 177 108, 137 758, 190 182, 180 084 , 188 056, 180 351 primary and secondary school students (excluding grades one to three of primary school) were included for physical examination. The correlation between their nutritional status and high blood pressure was analyzed based on the basic situation of 129 821 primary and secondary school students who completed a questionnaire survey at the same time in 2024. Statistical analysis was conducted using a Chi-square test and multiple Logistic regression model. Results: From 2019 to 2024, the detection rates of elevated blood pressure were 13.60%, 13.68%, 17.60%, 17.24%, 14.77% and 15.96%, respectively. The rates for isolated systolic hypertension were 4.24%, 5.83%, 7.26%, 7.19%, 6.24% and 6.93%; isolated diastolic hypertension rates were 6.38%, 4.99%, 6.23 %, 6.41%, 5.39% and 5.66%; and combined systolic and diastolic hypertension rates were 2.97%, 2.86%, 4.11%, 3.65%, 3.14 % and 3.36%. Multivariate Logistic regression analysis showed that girls, junior high school, senior high school, overweight, and obesity were positively associated with elevated blood pressure risk ( OR =1.27, 1.25, 1.32, 1.66, 3.07, all P <0.05); conversely, county residence, Mongolian ethnicity, and other ethnicities showed negative associations ( OR =0.90, 0.93, 0.90, all P <0.05). Conclusions Overweight and obesity among children and adolescents are closely related to various types of elevated blood pressure. Prevention strategies should prioritize effectively controlling weight issues among children and adolescents, thereby effectively reducing the incidence of elevated blood pressure.

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.

Objective: To understand the current status of malnutrition, depressive symptoms, and their coexistence among middle school students, so as to provide references for exploring the "comorbidity-common cause-common prevention" model for these conditions. Methods: In September 2023, a stratified random cluster sampling method was adopted to select 88 594 students from junior high schools, regular high schools, and vocational high schools in 12 leagues/cities (covering 103 banners/counties) of Inner Mongolia Autonomous Region. Physical examinations were conducted to collect data on malnutrition, and the Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms. The Chi-square test and multivariate linear stepwise regression analysis were employed to analyze the related factors of malnutrition, depressive symptoms, and their coexistence. Results: In 2023, the detection rates of malnutrition, depressive symptoms, and their coexistence among middle school students in Inner Mongolia were 4.60%, 21.85%, and 0.90%, respectively. There were statistically significant differences in the detection rates of malnutrition, depressive symptoms, and their coexistence among middle school students of different genders, monitoring sites (except for malnutrition), and school stages ( χ 2=4.95-817.39, all P <0.05). The results of the multivariate Logistic regression analysis showed that high school students，drink sugar sweetened beverages ≥1 time per day and those with Internet addiction had higher risk of coexisting malnutrition and depressive symptoms [ OR (95% CI )=1.38 (1.04-1.83), 1.46 (1.20-1.78), 2.28 (1.90-2.74), respectively, all P <0.05 ]. The risk of coexistence was lower among female students, those who ate fresh fruits at least once a day, those who engaged in moderate-to-vigorous physical activity for ≥1 time/day, those who engaged in moderate-to-vigorous physical activity for ≥1 hour/day on ≥5 days/week, those who did not use cough syrup without therapeutic need, those who did not use sedative hypnotic drugs without medical advice, and non-drinking students [ OR (95% CI )=0.84 (0.73-0.98), 0.77 (0.66-0.89), 0.82 (0.68-0.98), 0.66 (0.53- 0.80 ), 0.57 (0.41-0.78), 0.63 (0.53-0.72), respectively, all P <0.05]. Conclusions The occurrence of undernutrition, depressive symptoms, and their coexistence among middle school students in Inner Mongolia can t be ignored. Schools, the government and society should implement a strategy aimed at concurrent prevention of multiple conditions through comprehensive interventions.

Objective: To analyse the correlation between unhealthy lifestyles and anxiety symptoms among high school students in Inner Mongolia Region, so as to provide a scientific basis for the prevention of anxiety symptoms among high school students. Methods: From September to November 2023, 35 362 high school students were selected by stratified cluster random sampling method from 12 cities (103 counties) in Inner Mongolia Region, and the survey was conducted by using the questionnaire on student health status and influencing factors. The χ2 test and multivariate Logistic regression analyses were used to determine the influencing factors of anxiety symptoms. Results: The total number of students with anxiety symptoms was 2 747, and the detection rate of anxiety symptoms was 7.77%. The results of multivariate Logistic regression analyses showed that female students, father having higher education background, never eating breakfast, being overweight and obese, sleeping <8 h/d, being scolded by parents in the past 30 days, and depressive symptoms were positively correlated with the anxiety symptoms of the high school students (OR=1.31, 1.23, 1.53, 1.14, 1.22, 1.51,28.92); nonsmoking, having no alcohol consumption, no Internet addiction and no use of sedatives without doctors permission were all negatively correlated with anxiety symptoms of high school students (OR=0.84, 0.73, 0.57,0.40) (P<0.05). Conclusions Anxiety symptoms of high school students are closely related to unhealthy lifestyle. Measures should be taken to improve unhealthy lifestyle, so as to reduce the occurrence of anxiety symptoms in high school students.

Objective: To analyse associated factors of campus bullying in schools, and to construct a nomogram model to predict the risk of campus bullying, so as to provide a theoretical basis for campus bullying prevention and control. Methods: In September 2023, 89 117 middle and high school students were selected by stratified cluster random sampling method within 12 cities (103 counties) in Inner Mongolia, and were surveyed with self administered questionnaire. Among them, there were 62 381 participants in the training set and 26 736 participants in the testing set. Statistical analysis was conducted using χ 2 test and multiple Logistic regression, and a nomogram model was drawn for predicting campus bullying. Results: The prevalence of campus bullying was 3.49%. Living in a suburban county, living in an unstable family, not the only child, having a father with a college degree or above, sometimes or never eating breakfast, being overweight or obese, living on campus, being scolded by parents in the past 30 days, smoking, Internet addiction, experiencing depression, anxiety symptoms, recreational soluble solvents use, cough medicine abuse, nonprescribed use of sedatives were all positively correlated with campus bullying ( OR =1.18, 1.40, 1.12, 1.33, 1.13, 1.72 , 1.12, 1.17, 1.82, 1.32, 1.83, 3.92, 2.40, 2.25, 1.51, 1.63, P <0.01).There were a negative correlation between high school students, female students, and the number of physical education classes per week (2-3, ≥4) with campus bullying ( OR =0.67, 0.58, 0.72, 0.83, P <0.01). The prediction model of campus bullying risk was established by nomogram model. The area under curve (AUC) was 0.82, and the calibration curve showed that the predicted value was close to the actual value. Conclusions Bullying among middle and high school students are related to family intimacy, poor daily behaviour and psychological factors. Targets of bullying intervention in schools should be identified, and preventive and control measures against bullying in secondary schools should be formulated, so as to reduce the occurrence of campus bullying.

Objective: To explore the current situation of Internet addiction among junior high school students in Inner Mongolia and its associated factors, so as to provide a theoretical basis for the prevention and control of Internet addiction among junior high school students. Methods: In September 2023, 53 755 junior high school students were selected by stratified cluster random sampling method from all the flag counties in Inner Mongolia, and questionnaires were administered according to the "Monitoring and Intervention Program of Common Diseases and Health Influencing Factors of Students, by using the Internet Addiction Inventory and Generalized Anxiety Disorder Scale-7 Item. The Chi test and multiple Logistic regression analysis were used to explore related factors and draw nomograms. Results: The reported rate of Internet addiction among junior high school students in Inner Mongolia was 2.15%. The results of multivariate Logistic regression analyses showed that students were more likely to be in higher grades (grade eight: OR =1.54; grade nine: OR =1.64), being scolded by their parents ( OR =1.06), living in the school ( OR =2.28), being bullied in the school ( OR =1.91), anxiety symptoms ( OR =3.15), and substance abuse (smoking: OR =2.56; drinking alcohol: OR =2.29; inhaling soluble solvents for pleasure: OR =2.17; using cough suppressant except for coughing: OR =1.50; using sedatives without doctor s permission: OR =1.34) were positively correlated with Internet addiction among junior high school students in Inner Mongolia ( P <0.05). The area under the curve was 0.819, and the calibration curve showed that the predicted values were basically consistent with the measured values. Conclusions Internet addiction among junior high school students in Inner Mongolia is related to students living environment and substance abuse behavior. Attention should be paid to the living environment of junior high school students and strengthen the preventive education of substance abuse in order to reduce the occurrence of Internet addiction among junior high school students.

Objective:To investigate the risk factors and cumulative risk of myopia in children and adolescents, providing a basis for identifying cumulative risk factors in preventing and controlling myopia.Methods:Baseline data from the mental and physical health cohort of children and adolescents established in Inner Mongolia Autonomous Region were used. A stratified random cluster sampling method was adopted to select 138 974 students from fourth to twelfth grade as participants. Distance visual exams, refractive assessments, and questionnaires were conducted on the included students. Logistic regression analysis was used to evaluate each risk factor's impact on myopia's prevalence. The number of risk factors was summed to form a cumulative risk score, and logistic regression analysis was conducted to examine the association between the cumulative risk score and the prevalence of myopia. Additionally, the association between the cumulative risk score of myopic students and their degree of refractivity was analyzed using a generalized estimating equation.Results:The study found a high prevalence of myopia among children and adolescents at baseline (70.2%). Girls exhibited a higher prevalence (74.8%) than boys (65.6%), urban areas (74.3%) surpassed suburban ones (68.6%), and the incidence was greater in high schools (80.3%) compared to middle schools (75.3%), which, in turn, was higher than in elementary schools (57.7%) (all P<0.05). Analysis of risk factors revealed that children and adolescents experiencing improper reading and writing distances ( OR=1.10, 95% CI: 1.07-1.13), excessive homework ( OR=1.09, 95% CI: 1.06-1.12), insufficient sleep ( OR=1.10, 95% CI: 1.07-1.13), having myopic father ( OR=1.98, 95% CI: 1.91-2.05), having myopic mother ( OR=2.04, 95% CI: 1.97-2.10), or using classroom chairs not matched to their height faced ( OR=1.04, 95% CI: 1.01-1.07) increased myopia risks. Additionally, the prevalence and significant odds ratio of myopia increased with the increase in cumulative risk score, with every additional unit of cumulative risk score increasing the right eye's refractive error by -0.10 D. Conclusion:The presence of multiple factors and their comprehensive score increases the prevalence of myopia in children and adolescents.

Objective:To evaluate the efficacy and safety of Xiao′er Huangjin Zhike Granules in the treatment of cough caused by acute bronchitis in children, which is defined in TCM terms as a syndrome of phlegm-heat obstructing the lung.Methods:This was a block-randomized, double-blind, placebo-controlled, multicenter clinical trial.From January 2022 to September 2023, 359 children aged 3 to 7 years old diagnosed as acute bronchitis (lung-obstructing phlegm-heat syndrome) were enrolled from 21 participating hospitals and randomly assigned to the experimental group and placebo group in a 3︰1 ratio, and respectively treated with Xiao′er Huangjin Zhike Granules and its matching placebo.Cough resolution/general resolution rate after 7 days of treatment was used as the primary efficacy outcome for both groups.Results:(1)On the seventh day of treatment, the rate of cough disappearance/basically disappearance in the experimental group and placebo group were 73.95% and 57.61% retrospectively, which had statistically significance ( P=0.001).(2)After 7 days of treatment, the median duration of cough disappearance/basic disappearance were 5 days and 6 days in the two groups , with a statistically significant difference ( P=0.006).The area under the curve of cough symptom severity time was 7.20 ± 3.79 in the experimental group and 8.20±4.42 in the placebo group.The difference between the two groups was statistically significant ( P=0.039).(3) After 7 days of treatment, the difference between TCM syndrome score and baseline was -16.0 (-20.0, -15.0) points in the experimental group and -15.0 (-18.0, -12.0) points in the placebo group, with significant difference between the two groups ( P=0.004).In the experimental group, the clinical control rate, the markedly effective rate, the effective rate and the ineffective rate were 49.04%, 28.35%, 16.48% and 6.13% severally; and in the placebo group, the clinical control rate, the markedly effective rate, the effective rate and the ineffective rate were 38.04%, 26.09%, 29.35%, and 6.52% separately, which had statistically significant ( P=0.014).(4) There was no significant difference in the incidence of adverse events or adverse reactions during the trial between both groups.Moreover, while adverse reactions in the form of vomiting and diarrhea were occasionally reported, no serious drug-related adverse event or adverse reaction was reported.(5)The tested drug provided good treatment compliance, showing no statistically significant difference from the placebo in terms of compliance rate. Conclusions:Based on the above findings, it can be concluded that Xiao′er Huangjin Zhike Granules provides good safety, efficacy, and treatment compliance in the treatment of cough caused by acute bronchitis, and lung-obstructing phlegm-heat syndrome, in children.

Abstract In recent years, child and adolescent health problems such as myopia, obesity, and mental health have attracted the attention of society as a whole and have become important public health issues. Considering high prevalence in each of the major health problems among children and adolescents in China, current high prevalence of co morbidities of these health problems needs further attention. Shared behavioral and environmental risk and protective factors make it possible to improve the co morbidities among children and adolescents through the same interventions. It is urgent to explore the Co morbidity，Shared Etiology，and Shared Prevention mechanism of common diseases of children and adolescents in China, and to explore standardized programs and processes for the implementation of comorbidity intervention for children and adolescents across varied scenarios including families, schools, communities and medical institutions, so as to improve the health level of children and adolescents.

Objective: To analyze the prevalence trend of scoliosis among myopic students in Inner Mongolia Autonomous Region during 2019-2022, to explore the common etiology of myopia and scoliosis co-morbidities, so as to provide a reference for the development of relevant measures. Methods: The method of stratified random cluster sampling was used to select 181 533, 141 552 , 200 987, 190 918 primary and secondary school students from 12 leagues(103 banners) in Inner Mongolia Atuonomous Region in September each year from 2019 to 2022. And scoliosis screening, vision examination and questionnaire survey were conducted among students in the included studies. The χ 2 test was used to analyze the data, and the binary multivariate Logistic regression model was used to screen the influencing factors of scoliosis and myopia co-morbidities. Results: From 2019 to 2022, the myopia rate of primary and secondary school students in Inner Mongolia Autonomous Region was 55.55%-59.72%, scoliosis rate was 1.56 %-2.81% and the rates of scoliosis and myopia co-morbidities were 1.14%-1.95%, and the difference between different years was statistically significant ( χ 2=595.01, 775.56, 461.84, P < 0.05 ). In 2022, the co-morbidity rate was higher in girls than in boys(1.32% vs 0.97%), the rate of urban areas was higher than that of rural areas(2.57% vs 0.62%), the rate of students in vocational high school and high school was higher than that in junior high school and primary school (3.82%,2.47% vs 1.70%,0.42%), the rate of over developed areas was higher than that of poor areas (1.21% vs 0.99%)( χ 2=52.19, 1 269.82, 1 361.52, 17.29, P < 0.05 ). Logistic regression analysis showed that at least 1 h of moderate and high intensity exercise every day on weekends, the number of physical education classes per week was more than 3 sessions, the height of desks and chairs was adjusted according to height, resting outdoors, limiting screen time, and strictly requiring standing and sitting posture were the negative correlated with scoliosis and myopia, and the OR value was 0.65-0.90, reading books or electronic screens while participating in cram classes, walking or riding in the car were positively correlated with comorbid scoliosis and myopia, and the OR values were 1.27 and 1.13 ( P < 0.05), respectively. Conclusion Behavioral habits severely affect scoliosis and myopic of students. Prevention and control of scoliosis and myopia co-morbidity should start with students behavioral habits, early screening and early intervention.