Objective: To analyze the association between drinking behaviors and anxiety symptoms, with the mediating role of insomnia symptoms among college freshmen, so as to provide a reference basis for reducing the occurrence of anxiety symptoms in college freshmen. Methods: From October to December 2021, 31 856 freshmen were selected by the purposive sampling method in 22 colleges across 11 provinces (Fujian, Jiangsu, Guangdong, Henan, Anhui, Hubei, Shanxi, Jiangxi, Shaanxi, Yunnan, Chongqing) in China. The Semi quantitative Food Frequency Questionnaire was used to investigate college freshmen drinking behaviors. The Depression Anxiety Stress Scale 21 and the Insomnia Severity Index were used to assess anxiety symptoms and insomnia symptoms in college freshmen. The generalized linear model was employed to analyze the association between drinking behaviors and anxiety symptoms in college freshmen, and the structural equation modeling was used to assess the mediating effect of insomnia symptoms on the association. Results: The detection rate of anxiety symptoms among college freshmen was 28.2%, the detection rates of the mild, moderate, severe and extremely severe were 6.6%, 15.9%, 3.2% and 2.6%, respectively. While 23.6% of college freshmen reported drinking in the past month, the rates were 39.8% among boys and 15.9% among girls. After adjusting for demographic variables (ethnicity, education, major, etc.) and confounding variables (self evaluation of learning burden, number of close friends, screen time, etc.), the results of generalized linear model analysis showed that beer consumption was associated with anxiety symptoms in college freshmen( β =0.09, 95% CI =0.04-0.14), girls( β =0.14, 95% CI =0.07-0.21) and those aged 19-20 years ( β =0.12, 95% CI =0.05-0.19)(all P <0.05). Red wine consumption was associated with anxiety symptoms in male students ( β =0.13, 95% CI =0.02-0.24, P <0.05). Alcohol and beer consumption were associated with insomnia in college freshmen[ β (95% CI ) =0.22(0.08-0.36),0.31(0.23-0.39),both P <0.01]. Insomnia symptoms partially mediated the association between drinking behaviors and anxiety symptoms among college freshmen with a mediating effect value of 0.05, accounting for 50.49% of the total effect. Conclusions Insomnia symptoms partially mediates the association between drinking behaviors and anxiety symptoms in college freshmen. Measures should be taken to simultaneously intervene in the drinking behaviors and insomnia symptoms of college freshmen to prevent the occurrence of their anxiety symptoms.

Objective: To understand the association between beverage and snack intake and insufficient serum 25 hydroxyvitamin D [25(OH)D] among primary and secondary school students, so as to provide a scientific basis for targeted intervention measures. Methods: From October to December 2021, a stratified random sampling method was used to select 2 477 primary and secondary school students aged 8 to 15 years old from 9 counties in Yunnan Province implemented the Nutrition Improvement Plan for Rural Compulsory Education Students. The intake of beverages and snacks was investigated using the Rural Student Nutrition Monitoring Questionnaire from Chinese Center for Disease Control and Prevention. The snack intake intensity was calculated and classified into no intake, extremely low, low, medium, and high intensity. Serum 25(OH)D levels were measured in the laboratory, and levels <20 ng/mL were defined as insufficient. Chi square tests, LASSO regression, random forest and binary Logistic regression were used to analyze the association between 20 types of beverages and snacks and serum 25(OH)D insufficiency. Results: Insufficient serum 25(OH)D was detected in 564 boys (45.9%) and 855 girls (68.5%), with a total of 1 419 cases (57.3%). Binary Logistic regression results showed that extremely low intake intensity of carbonated beverages ( OR =1.51), plant protein beverages ( OR =1.61), and milk tea beverages ( OR =1.39) increased the risk of insufficient serum 25(OH)D, while protective factors were fruits and vegetables ( OR =0.77) and pure milk and yogurt ( OR =0.74) (all P <0.05). Subgroup analysis showed that extremely low intake intensity of carbonated beverages, milk containing beverages, tea beverages, fruit and vegetable juices, and plant protein beverages increased the risk of insufficient serum 25(OH)D in girls ( OR =2.22, 1.72, 1.67, 1.74, 1.92), and high intake intensity increased the risk of insufficient serum 25(OH)D in boys ( OR =1.73, 1.48, 1.52, 1.49, 1.97) (all P <0.05). Extremely low intake intensity of carbonated beverages, plant protein beverages, and milk tea beverages in junior high school students ( OR =1.92, 2.54, 1.68) and low intake intensity in primary school students ( OR =1.40, 1.33, 1.45) increased the risk of insufficient serum 25(OH)D (all P <0.05). Conclusions Frequent intake of beverages and highly processed snacks increases the risk of insufficient serum 25(OH)D in primary and secondary school students, while natural foods such as fruits, vegetables, pure milk and yogurt can reduce the risk. Girls and junior high school students are more susceptible to these effects.

Objective To summarize the best evidence for diaphragm rehabilitation in mechanically ven-tilated ICU patients with ventilator-associated diaphragm dysfunction based on evidence-based methods.Meth-ods A systematic search was conducted across guideline websites,professional associations,and Chinese/English databases for evidence regarding diaphragm rehabilitation in mechanically ventilated ICU patients.The search timeframe spanned from database inception to December 31,2024.Two researchers independently per-formed quality assessment and synthesized the evidence.Results Twenty articles were included:2 clinical de-cisions,1 guideline,2 evidence summaries,3 systematic reviews,7 randomized controlled trials(RCT),and 5 expert consensuses/opinions.Twenty-seven pieces of evidence were formed across 6 themes:rehabilitation team,rehabilitation assessment,rehabilitation interventions,outcome evaluation,precautions,and education/training.Conclusion This study summarizes the best evidence for diaphragm rehabilitation in ICU mechani-cally ventilated patients.Healthcare professionals should implement diaphragm rehabilitation by integrating this evidence with specific clinical contexts to improve patient outcomes and enhance nursing quality.

Diaphragmatic dysfunction often occurs in ICU patients with prolonged mechanical ventilation, which seriously affects patients′prognosis. This article reviewed the progress of rehabilitation treatment of diaphragmatic dysfunction in ICU patients with mechanical ventilation, focused on the concept and assessment of diaphragm rehabilitation, the current status, evaluation indexes, emphasized the importance of nurses, analyzed the dilemmas and countermeasures in the application, which aimed to provide a reference for the promotion of diaphragm rehabilitation in clinical practice.

Diaphragmatic dysfunction often occurs in ICU patients with prolonged mechanical ventilation, which seriously affects patients′prognosis. This article reviewed the progress of rehabilitation treatment of diaphragmatic dysfunction in ICU patients with mechanical ventilation, focused on the concept and assessment of diaphragm rehabilitation, the current status, evaluation indexes, emphasized the importance of nurses, analyzed the dilemmas and countermeasures in the application, which aimed to provide a reference for the promotion of diaphragm rehabilitation in clinical practice.

Objective To analyze the secular trends and geographic disparities of all-cause mortality among Chinese adolescents aged 10-24 years over the period of 1953-2010.Methods Data were extracted from the Chinese National Census in 1953-2010.We calculated the all-cause mortality and annualized rates of the changes.Using the provincial gross domestic product (GDP) per capita as an indicator of regional socio-economic development level,we calculated the Wagstaff normal concentration indices for adolescent mortality.Results Over the period of 1953-2010,the general patterns of Chinese adolescent mortality appeared higher in males than those in females,higher in the 20-24-year-old than those in the 15-19 year-old and in the 10-14 year-old groups,higher in adolescents from the western than those in the eastern regions.The mortality of adolescents decreased from 554.6/100 000 in 1953-1964 to 55.7/100 000 in 2010 in males and decreased from 488.4/100 000 to 26.7/100 000 in females,respectively.The percentage of decrease for females (94.5％) was higher than that for males (90.0％).In 1981-2010,the highest annualized rate of decline for males was seen in Beijing (4.4％),with the lowest seen in Qinghai (0.1％).For girls,Hubei showed the highest annualized rate of decline (6.4％) while Qinghai the lowest (0.8％).Provinces that with higher mortality tended to have lower annualized rate of decline.The concentration indices for boys were-0.07 (95％ CI:-0.11--0.03),-0.13 (95 ％ CI:-0.18--0.08),and-0.16 (95 ％ CI:-0.22--0.10) in 1990,2000,and 2010,respectively,and were-0.07 (95％CI:-0.13--0.02),-0.18 (95％CI:-0.24--0.12),and-0.18 (95％CI:-0.26--0.09) respectively in girls.The indices among 1990,2000,and 2010 did not show statistically significantly differences,both for boys and girls (P＞0.05).Conclusions Over the half century,the mortality of Chinese adolescents showed dramatic decreasing trend.However,in terms of death rates,gender and geographic disparities were consistently seen in the adolescents.

Objective:To compare the probability of physical activity (PA) time ≥1 hour at school and influencing factors in students in China between 2010 and 2014.Methods:We used the data of 2010 and 2014 Chinese National Survey on Students’ Constitution and Health (CNSSCH). The surveys covered the Han students aged 9-22 years and Tibetan students aged 9-18 years (Tibet). The participants were primary school students (9-12 years old), junior high school students (13-15 years old), senior high school students (16-18 years old) and college students (19-22 years old). The probability of PA time ≥1 hour at school was compared using χ2 tests between 2010 and 2014 survey years. Log-binomial Regression was used to estimate the relative risk ( RR) for the probability of PA time ≥1 hour at school in different age groups. Results:The overall probability of PA time ≥1 hour at school in students aged 9-22 years was 20.5 % in 2010, and 23.8 % in 2014. The difference between 2010 and 2014 was significant ( P<0.001). On the whole, the probability of PA time ≥1 hour at school increased in the eastern, central and western areas in 2014 compared with 2010 ( P<0.05), and the increase range was highest in eastern area, followed by western area and central area ( P<0.05). The probability of PA time of 1 hour at school in all age groups increased in 2014 compared with 2010 ( P<0.05). The increase in the probability of PA time ≥1 hour at school was larger in primary school students than that in high school students and college students ( P<0.05). The probability of PA time ≥1 hour at school increased in all age groups in three areas, except in junior and senior high school students in the central area where the probability of PA time ≥1 hour at school decreased. The probability of PA time ≥1 hour at school in primary and junior/senior high school students in the eastern area had the greatest increase, but in college students it had the smallest increase in the three areas. From 2010 to 2014, the changes in the probability of PA time ≥1 hour at school in students in different provinces were quite different, especially in primary school students. The probability of PA time ≥1 hour at school in four age groups increased in only three provinces. With the probability of PA time ≥1 hour at school in primary school students as the reference, the RR in junior high students had no significant change between 2010 and 2014. The RR in senior high school increased from 0.34 (0.33-0.35) in 2010 to 0.36 (0.36-0.37) in 2014, and the RR in college students increased from 0.33 (0.32-0.34) in 2010 to 0.43 (0.42-0.44) in 2014. Conclusions:The probability of PA time ≥1 hour at school in all age groups increased in 2014 compared with 2010, but there were great differences among provinces. The findings of our study suggests that although the national policy played a certain role, the provinces should take specific measures to improve the probability of PA time ≥1 hour at school in students according to their own conditions. In addition, more attention should be paid to PA of older students.

Objective: To examine the relation between physical fitness and frequency of having breakfast among Chinese Han college students so as to provide proper intervention and theoretical basis for improving college students’ physical fitness. Methods: The data from 2014 Chinese National Survey on Students’ Constitution and Health (CNSSCH) was used. The data of 47 172 Han students were calculated, the chi-square test wasused to compare the differences of the physical fitness passing rate in different subgroups of college students. The Log-binomial model was established to assess the relation between physical fitness and breakfast consumption. Results: The unqualified rate of physical fitness was 22.8%. Boys(24.7%), urban students (25.7%), and those who exercised less than one hour per day (23.3%) had lower physical fitness passing rates than girls(20.9%), rural students (19.9%) and those who exercised more than one hour per day (20.3%)respectively(χ2=101.38, 223.33, 32.20,P<0.01). The unqualified rate of physical fitness increased by age. The unqualified rate of physical fitness in eastern, central and western regions was 21.2%, 21.7% and 25.1% respectively. The unqualified rate of physical fitness for those with normal nutritional status (18.2%) was significantly lower than those who were underweight (26.0%) or overweight/obese(42.6%)(χ2=1 660.50, P<0.01). In this study, 53.2% of college students had breakfast every day,unqualified rate of physical fitness was higher among students with less regular consumption of breakfast(χ2=393.50, P<0.01). The Log-binomial model showed that the college students who had 3-5 breakfasts(PR=1.16, 95%CI=1.11-1.20), 1-2 breakfasts(PR=1.34, 95%CI=1.28-1.40), never had breakfast (PR=1.43, 95%CI=1.32-1.53) per week had higher physical fitness failure rates than those who had breakfast every day. Conclusion There is a significant association between physical fitness and breakfast consumption among college students. Developing the good habit of having breakfast is not only the component of healthy lifestyle but also an indispensable part to the improvement of college students’ physical fitness.

Objective: To describe the subnational disparity of anemia among Chinese Han students aged 7-14 years, and to provide a reference for making intervention measures to improve anemia among Chinese children. Methods: A total of 71 115 Chinese Han students aged 7-14 years were selected from the project ‘2014 Chinese National Survey on Students’ Constitution and Health'. Anemia and its severity were defined according to the diagnosis criteria of World Health Organization (WHO). The rank sum test was used to compare anemia distribution of different subgroups. Logistic regression models were established to analyze the influencing factors of anemia and moderate-to-severe anemia. Results: In the 71 115 students with measured hemoglobin concentrations in the 2014 CNSSCH, the overall prevalence rate of anemia was 8.9%, with 5.8% to be mild anemia and 3.1% to be moderate-to-severe anemia. For boys aged 7-14 years, the hemoglobin concentration increased with age; Boys aged 7 years had the highest anemia prevalence (9.8%) and moderate-to-severe anemia prevalence(4.4%). For girls aged 7-12 years, the hemoglobin concentration increased with age, but the concentration decreased a little when girls reached 14 years of age; 14-year-old girls had the highest prevalence of anemia(13.3%), and 7-year-old girls had the highest prevalence of moderate-to-severe anemia(4.8%). The highest prevalence rates of anemia were found in Hainan (24.1%) and Gansu(19.6%), while the lowest was in Beijing(2.0%). Logistic regression models revealed that, for children aged 7 and 9 years, when comparing to those lived in urban areas, living in rural areas appeared to be a risk factor for anemia (OR=1.34) and moderate-to-severe anemia(OR=1.48); when comparing to living in cities of upper socio-economic status, living in cities of intermediate socio-economic status appeared to be a risk factor for anemia (OR=1.43) and moderate-to-severe anemia(OR=1.41), and living in cities of lower socio-economic status also appeared to be a risk factor for anemia (OR=1.26) and moderate-to-severe anemia(OR=1.35). For students aged 12 and 14 years, girls were at higher risks for anemia and moderate-to-severe anemic(OR=2.41，2.20). Conclusion The overall prevalence of anemia was low in Chinese school-aged children, but substantial subnational disparity and subgroup disparity exists. Our data called for setting up context-specific measures, such as deworming and iron supplementation, to deal with child anemia. Intervention programs need to be implemented among adolescent girls and those with relatively low socioeconomic status.

Objective: To compare the prevalence of growth retardation in students aged 7-18 years from 26 minority ethnic groups in China and provides reference evidence to promote the growth and improve the health status of students in minority ethnic groups. Methods: The body height data of students aged 7-18 years in 26 minority ethnic groups in 2014 Chinese National Surveys on Students’ Constitution and Health were used for the analysis and comparison. Growth retardation was defined according to the school-aged child and adolescent malnutrition screening standard (WS/T 456-2014). Results: In 2014, the average body heights of school boys and school girls aged 18 years in 26 ethnic minority groups were (168.3±6.8) cm and (156.2±5.9) cm respectively. The overall growth retardation prevalence rate of school boys and school girls in 26 ethnic groups were 5.4% and 5.1%, respectively. The growth retardation prevalence rate was highest in students of Shui ethnic group (24.5% for boys and 23.0% for girls), and lowest in students of Hui ethnic group (0.1% for boys and 0.3% for girls). The growth retardation prevalence rates in 9 ethnic minority groups were higher than the average level, in these 9 ethnic groups, the differences in prevalence rates of boys of Buyi ethnic group, girls of Lisu ethnic group and girls of Hani ethnic group had no significance among four age groups. Growth retardation in students of Sala ethnic group was mainly observed in age group 7-9 years, but in others ethnic group, for example, Wa ethnic, it was mainly observed in older age group. The students in minority ethnic groups in southwestern China had the highest growth retardation prevalence rate (8.1%), significantly higher than that in northern China (0.8%) (OR=10.6, 95%CI: 7.8-14.4). The overall growth retardation prevalence rate between 7 and 17 years old was negatively correlated with the body height of 18 years old (boys: r=-0.811, P<0.001; girls: r=-0.715, P<0.001). Conclusions In 2014, the differences in body height among students aged 18 years in 26 minority ethnic groups in China were significant. In general, the first five minority ethnic groups with high detection rate of growth retardation in boys were Shui, Wa, Buyi, Yao and Yi, and the five minority ethnic groups with high detection rate of growth retardation in girls were Shui, Yao, Buyi, Wa and Miao. The detection rate of growth retardation was highest in students of minority ethnic groups in southwestern China. Nutritional interventions and healthy education should be carried out in minority ethnic groups and areas with high growth retardation prevalence rate to promote the growth of the students.