Objective: To explore the role of outdoor activity in the relationship between infancy responsive caregiving trajectories and early childhood development, so as to provide a theoretical basis for the promotion of early child development. Methods: The study participants were drawn from the Shanghai Maternal-Child Pairs Cohort and 4 723 mother-child pairs who completed responsive caregiving questionnaires at 2, 6 and 12 months old were included. Questionnaires were used to assess children s responsive caregiving and average daily hours of outdoor activity at 2 years of age. The Age-Stage Questionnaire, Third Edition (ASQ-3) was used to evaluate children s development problems at 2-5 years old. Group based trajectory model was applied to fit infancy responsive caregiving trajectory. Modified Poisson regression was used to analyze associations between different responsive caregiving trajectory groups and child development, and moderating effects were tested for hours of outdoor activity. Results: Infancy responsive caregiving trajectories were categorized into general group ( n =3 871), declining group( n =160), and fluctuating group( n =646). After adjusting for confounding factors, such as parents educational level, annual household income, maternal progestation body mass index,maternal tobacco exposure during pregnancy,maternal anxiety and depression during pregnancy, maternal age at delivery,maternal gestational age,maternal mode of delivery, children s gender,children s birth weight, and duration of breastfeeding, the results of modified Poission regression analysis showed that compared with the general group, children at the age of 2 in declining and fluctuating group had increased risks of suspected developmental delays in communication, gross motor, fine motor, problem solving, and personal-social scales ( OR =1.41,1.31,1.35,1.23,1.21；1.07,1.08,1.08,1.09,1.06);but children only had increased risk of suspected developmental delays in communication of declining group ( OR =1.08), personal-social scales of fluctuating group ( OR =1.06) at 3-5 years of age ( P <0.05). At lower levels of outdoor activity, children in fluctuating group had reduced scores in communication ( β =-1.41), fine motor ( β =-2.34), problem solving ( β =-1.11) and personal-social scales ( β =-1.99) as compared to general group; and children in declining group had reduced scores in gross motor ( β =-4.78)( P <0.05). While at higher levels of outdoor activity, no differences were found between children in fluctuating, declining groups and those in general group in scores of different scales ( P >0.05). Conclusion Prolonged outdoor activity attenuates the adverse effects of declining and fluctuating trajectories of infancy responsive caregiving on early childhood development.

Objective: To understand 24 h physical activity levels of children aged 8-9 years in Pudong New Area and to explore its association with metabolic syndrome, so as to provide scientific basis for children s participation in physical activities and reducing the risk of metabolic syndrome. Methods: A stratified cluster random sampling method was adopted to select 13 schools in Pudong New Area, Shanghai. A total of 2 013 primary school students aged 8-9 years old were included as the research subjects. During September 2021 to December 2022, Actigraph GT3X accelerometer, height measuring gauge, electronic sphygmomanometer and waist circumference tape was used to measure physical activity, height, blood pressure and waist circumference, respectively. A total of 5 mL of venous blood was collected from students, and the levels of triglycerides (TG), highdensity lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) were detected, and online questionnaires were conducted. The ttest and oneway ANOVA were employed to compare the differences in 24 h physical activity levels among children with different characteristics. Multivariate Logistic regression was used to analyze the association between the 24 h physical activity levels and metabolic syndrome as well as its components. Results: Among primary school students, the average daily time of moderate to vigorous physical activity (MVPA) was (34.25±13.49)min, the attainment rate was 1.59%. The average daily sleep (SLP) time was (538.27±28.53) min, attainment rate was 1.89%. The detection rates of metabolic syndrome, abdominal obesity (AO), elevated blood pressure (BP), elevated TG, low HDL-C, and elevated FPG were 2.48%, 34.53%, 10.38%, 10.73%, 1.24% and 0.70%, respectively. Multivariate Logistic regression analysis showed that, for every 10minute increase in sedentary behavior (SB) time, the risks of AO, elevated BP, and elevated TG increased by 2% ( OR=1.02, 95%CI =1.01-1.04), 5% ( OR=1.05, 95%CI =1.01-1.08), and 6% ( OR= 1.06, 95%CI =1.02-1.11), respectively ( P <0.05). For every 10minute increase in MVPA time, the risk of metabolic syndrome decreased by 27% ( OR=0.73, 95%CI=0.57-0.93, P <0.05). For every 10 minute increase in SLP time, the risks of AO, elevated BP, and metabolic syndrome decreased by 16% ( OR=0.84, 95%CI =0.80-0.88), 9% ( OR=0.91, 95%CI =0.82- 0.99 ), and 15% ( OR=0.85, 95%CI =0.77-0.94), respectively （P <0.05). Conclusions The time of MVPA and SLP are seriously insufficient among children aged 8-9 years in Pudong New Area. There is an association between physical activity levels and metabolic syndrome as well as its components. Increasing the time of MVPA and SLP is of great significance for maintaining a relatively low risk of metabolic syndrome in children.

Objective: To analyze the trajectory of dietary behaviors among middle school students in Jiading District, Shanghai, from 2021 to 2023, and longitudinally verify their association with anxiety and depression symptoms, aiming to provide scientific evidence for promoting the mental health of adolescents. Methods: The data were sourced from the National Monitoring and Intervention Project on Common Diseases and Health Impact Factors of students in Jiading District, Shanghai. A total of 1 217 middle school students who participated in at least two surveys from 2021 to 2023 were selected as the research objects, and group-based trajectory model was constructed to identify their dietary behavior scores trajectories. Modified Poisson regression was used to investigate the impact of dietary behavior scores trajectories on anxiety and depression, while Logistic regression was employed to explore the association between trajectories and changes in depression score levels. Results: The dietary behavior scores trajectories of middle school students were divided into three groups: Persistent Healthy Dietary Behavior (9.5%), Persistent Relatively Unhealthy Dietary Behavior (85.0%), and Persistent Very Unhealthy Dietary Behavior (5.5%). Students who perceived their academic performance as poor and whose parents had a cultural level of high school or below had a significantly lower proportion in the Persistent Healthy Dietary Behavior group compared to students with other characteristics ( χ 2=12.87, 8.69, 6.50, P <0.05). Compared with the Persistent Healthy Dietary Behavior group, the risk of anxiety symptoms in middle school students in the Persistent Very Unhealthy Dietary Behavior group was significantly increased ( aRR=3.04, 95%CI =1.15-8.02); Persistent Relatively Unhealthy Dietary Behavior and Persistent Very Unhealthy Dietary Behavior increased the risk of depressive symptoms ( aRR = 1.80 , 2.45, respectively), and were positively correlated with the increase in depression scores ( aOR =1.70, 2.24) ( P <0.05). Conclusions The dietary behavior of middle school students have not changed significantly in the past three years, with persistent unhealthy dietary behavior being the most common. Unhealthy dietary behaviors are positively correlated with the risk of anxiety and depressive symptoms and an increase in depression scores.

ObjectiveTo analyze the impact of maternal postpartum depression (PPD) at 2 months postpartum on caregiving for infants aged2 to 24 months, and to provide a scientific basis for future maternal and infant healthcare services. MethodsBased on the Shanghai Maternal-Child Pairs Cohort, 1 060 mother-child pairs were selected from those fully participating in follow-up visits at 2, 6, 12, and 24 months postpartum. Pregnancy and childbirth-related information was collected using standardized questionnaire surveys and hospital obstetric and maternity records. The Edinburgh postpartum depression scale was used to assess the maternal postpartum depressive symptoms at 2 months postpartum. At 2, 6, 12, and 24 months postpartum, questionnaire survey was used to evaluate the maternal responsiveness in caregiving and the provision of early learning opportunities for infants. Scores for responsive caregiving and early learning opportunities at 2, 6, 12, and 24 months were grouped based on the 25th percentile (P₂₅) of total scores. The mixed-effects model was used to analyze the longitudinal impact of maternal postpartum depression at 2 months on the caregiving of 2 to 24-month-old infants. ResultsThe longitudinal results from the mixed-effects model did not show an impact of maternal PPD on infant responsive caregiving within 12 months and early learning opportunities within24 months. However, cross-sectional analysis revealed that, compared to the non-PPD group, the risk of low responsive caregiving at 2 months in the PPD group was 93% higher (OR=1.931, 95%CI: 1.113‒3.364, P=0.019). The risks for low provision of early learning opportunities at2 months and 24 months increased by 59% (OR=1.589, 95%CI: 1.082‒2.324, P=0.017) and 60% (OR=1.598, 95%CI:1.120‒2.279, P=0.010), respectively. ConclusionMaternal postpartum depression increases the risk of low responsive caregiving at 2 months, but its long-term effects warrant further research.

Objective: To investigate the current status of refractive errors and insufficient hyperopia reserve in preschool children aged 3-6 years in Hefei and to analyze influencing factors, so as to provide a scientific basis for formulating targeted myopia prevention policies and comprehensive interventions. Methods: In May 2022, a stratified cluster random sampling method was used to select 897 preschool children from 8 kindergartens across four districts (Baohe, Yaohai, Shushan, and Economic and Technological Development Zone) in Hefei, and Children’s Visual Health related Behavior Assessment Scale was used to collect personal information and environmental factors. Pre and post cycloplegic refraction tests were conducted to assess insufficient hyperopic reserve and refractive development levels. Group comparisons were conducted using 2 test, t-test or analysis of variance. Multivariate regression analysis was performed to identify key factors influencing hyperopic reserve, axial length and spherical equivalent in preschool children. Results: The detection rates of refractive errors among preschool children were 6.8% for hyperopia, 1.6% for myopia, and 11.1% for astigmatism. Notably, the prevalence of myopia was significantly higher in boys (2.3%) than in girls (0.7%) ( χ 2=3.88, P <0.05). Additionally, 8.8% of the children exhibited insufficient hyperopic reserve. The results of multiple regression analysis showed that preschool children with high myopia in the father, high myopia in the mother, longer daily duration of near work, and longer daily electronic product use time had increased risks of axial growth ( β =0.12, 0.09, 0.15, 0.11), SE reduction ( β =-0.10, -0.07, -0.18, -0.13), and insufficient hyperopic reserve ( OR=1.87, 2.22, 1.40, 1.28) (P <0.05). While, preschool children with longer sleep time and daily outdoor activity duration had lower risks of axial growth ( β =-0.11, -0.10 ), SE reduction ( β =0.39, 0.51), and insufficient hyperopia reserve ( OR =0.54, 0.51) in preschool children ( P <0.05). Conclusions The rates of refractive errors and insufficient hyperopia reserve in preschool children in Hefei are relatively low, which are influenced by many factors. Parents, kindergartens and relevant departments should implement early vision monitoring and intervention for preschool children, and cultivate their scientific eye use habits.

Objective: To analyze the epidemiological characteristics and changing trends of non suicidal self injury (NSSI) behaviors among middle school students in Jiading District of Shanghai, from 2015 to 2023, so as to provide a basis for the development of NSSI prevention and control measures among students. Methods: Using a stratified cluster random sampling method, a total of five times for Shanghai Adolescent Health Risk Behavior Surveys were conducted for every two years in Jiading District of Shanghai from 2015 to 2023. A total of 5 231 middle school students from junior high schools and senior high schools were selected for questionnaire surveys. Intergroup comparisons were performed using the x 2 test or the χ 2 trend test, and the JointPoint 5.0 software was used to analyze the changing trends, with the annual percent change (APC) used for evaluation. A binary Logistic regression model was employed to analyze the related factors of NSSI behavior among middle school students. Results: In 2023, the reported NSSI rate among middle school students in Jiading District was 14.2%. The rate was significantly higher among junior high school students (17.1%) than that among senior high school students (11.1%), and higher among females (19.2%) than that among males (10.0%) ( χ 2=10.04, 23.21, both P <0.01). From 2015 to 2023, the overall reported NSSI rate showed an increasing trend, rising from 8.6% in 2015 to 14.2% in 2023 ( χ 2 trend =22.25), with an APC of 6.64% ( t =3.49), and the APC for girls was 9.79 % ( t =3.20) (all P <0.05). Among students reporting NSSI, the proportion experiencing ≥6 episodes increased from 10.8% in 2015 to 19.2% in 2023 ( χ 2 trend =6.57, P <0.05). Multivariate Logistic regression analysis indicated that girls, junior high school students, those with insomnia, depressive emotion and drinkers had higher risks of NSSI, compared to boys, senior high school students, those without insomnia, non depressive emotion students and non drinkers ( OR =1.71, 1.96, 3.44, 4.76, 1.77, all P < 0.05 ). Conclusions The reported rate of NSSI among middle school students in Jiading District of Shanghai, increased annually from 2015 to 2023, and the proportion of repeated NSSI also showed an upward trend. Early intervention measures targeting middle school students, especially junior high school students and females, should be implemented to prevent and control its occurrence and development.

ObjectiveTo understand the visual environment sanitation in primary and secondary school classrooms in Minhang District， Shanghai， and to investigate the factors affecting the decline in students’ visual acuity. MethodsIn 2020， among all the primary and secondary schools in Minhang District， according to different types of classroom structures， levels， orientations， unilateral lighting， and bilateral lighting， a total of 20 231 students from 674 classrooms in primary and secondary schools were selected through stratified cluster sampling. Each monitored classroom was regarded as a research unit， and the naked eye vision of students was tested using a standard logarithmic vision chart during the 2020 and 2021 academic years. The change in average visual acuity between the two measurements was taken as the dependent variable， and the visual environment indices were considered as independent variables. The relationship between classroom visual environment indices and the decline in students’ naked eye vision was analyzed. ResultsThe qualification rates for per capita classroom area， window to floor area ratio， average illuminance of the blackboard， uniformity of blackboard illuminance， average illuminance of the desks， uniformity of desk illuminance， lighting coefficient of classroom， blackboard reflection ratio， back wall reflection ratio， and distance between lamps and desks were 79.53%， 88.58%， 46.74%， 70.33%，64.69%， 80.86%， 71.81%， 20.30%， 1.63%， and 97.53%， respectively. The average naked eye vision of primary and secondary school students in the 2020 academic year was 4.75±0.37 （right eye） and 4.76±0.37 （left eye）， while in the 2021 academic year， it was 4.70±0.39 （right eye） and 4.71±0.38 （left eye）. There was a significant decrease in the naked eye vision of primary and secondary school students in the 2021 academic year compared to that of 2020 （P<0.05）. Univariate linear regression analysis showed a significant correlation between grade， average illuminance of the blackboard， average illuminance of the desks， uniformity of desk illuminance， lighting coefficient， and distance between lamps and desks， and the decline of students’ naked eye vision within one academic year （P<0.05）. After adjusting for grade， multiple linear regression analysis revealed a significant correlation between the average illuminance of the blackboard， uniformity of desk illuminance， lighting coefficient， and distance between lamps and desks， and the decline of students’ naked eye vision within one academic year （P<0.05）. Higher average illuminance of the blackboard， uniformity of desk illuminance， lighting coefficient， and distance between lamps and desks were protective factors for naked eye vision. ConclusionThe visual environment of primary and secondary school classrooms in Minhang District is a matter of concern. Average illuminance of the blackboard， uniformity of desk illuminance， lighting coefficient， and distance between lamps and desks are related to the degree of visual impairment in students over a year.

Objective:To explore the effect of timely induction intervention on postpartum urination in primipara during vaginal delivery, so as to provide the evidence for preventing the occurrence of postpartum urinary retention and relieving the pain of primipara.Methods:This study adopted a randomized controlled trial design, and selected 400 cases of primipara who were hospitalized for vaginal delivery in the Obstetric Department of Dalian Women and Children's Medical Group Sports New Town Hospital from June 2021 to September 2022 as the study objects by convenience sampling method. They were divided into the intervention group and the control group with 200 cases each by random number table method, and the control group received routine postpartum care. Instruct active urination within 6 hours after delivery. The intervention received timely induction urination intervention. The general condition and bladder urine volume of the women in the intervention group were evaluated at 2, 4, 6 h after delivery, respectively, and personalized guidance was implemented, including the frequency of massage of the bottom of the uterus, the control of water intake, the selection of methods and timing of inducing urination, etc., and routine postpartum care was given when the women completed their first urination and had no complaints of discomfort. The first urination time, first urination volume, first bladder irritation during the first urination and the incidence of postpartum urinary retention in different periods were compared between the two groups.Results:The patients in the control group were (29.60 ± 3.20) years old, while the patients in the intervention group were (28.81 ± 3.42) years old. The first urination time in the intervention group was (6.89 ± 2.18) h, which was shorter than that in the control group (9.11 ± 3.86) h, and the difference was statistically significant ( t=-2.49, P<0.01). The first urination volume in the intervention group was (322.36 ± 120.15) ml, which was higher than that in the control group (262.93 ± 105.68) ml, and the difference was statistically significant ( t=3.39, P<0.05). The incidence of the first bladder irritation in the intervention group was 22.0%(44/200), which was lower than that in the control group 33.5%(67/200), and the difference was statistically significant ( χ2=6.60, P<0.05). The incidence of postpartum urinary retention within 24 h in the intervention group was 5.5%(11/200), which was lower than that in the control group 11.5%(23/200), and the difference was statistically significant ( χ2=4.63, P<0.05). The incidence of postpartum urinary retention within 1 week in the intervention group was 9.5%(19/200), which was lower than that in the control group 16.5%(33/200), and the difference was statistically significant ( χ2=4.33, P<0.05). There was no significant difference in the incidence of postpartum urinary retention within 24 to 72 h between the two groups ( P>0.05). Conclusions:Timely induction intervention can reduce the incidence of postpartum urinary retention, shorten the time of first urination, increase the volume of first urination and improve the comfort of first urination, which is worthy of clinical application.

The construction of healthy schools is one of the key measures to implement the Outline of the Healthy China 2030 Plan. The establishment and implementation of the Guidelines for Healthy Primary and Secondary School Evaluation （Guidelines） is helpful for the large-scale promotion and standardization of healthy school construction by government departments in Shanghai and other major cities in China， thereby more students benefited from the Healthy China Initiative. The Guidelines integrate the efforts of multiple departments related to school health， based on internationally recognized content and strategies for health-promoting schools. They aim to foster students’ health development by combining the basic requirements for school health with priority projects for health promotion. Healthy school evaluation indicators and standardized requirements suitable for the current socio-economic development level of Shanghai have been developed， aligning with international concepts of health-promoting schools. They also reflect a high starting point and high level of investment and development in school health in Shanghai over the past decade. The Guidelines provide recommendations on the basic requirements， organization guarantees and management， social and culture environment， health promotion education， health services， and connection between school and communities， and families， of healthy school evaluation for primary and secondary schools. This paper aims to interpret the compilation process and main content of the Guidelines.

Objective: To investigate the association of parental knowledge and skills in myopia prevention and control with healthy eye behavior in primary school children, so as to provide a basis for accurate family education. Methods: A total of 4 979 students in grades 1-5 from eight elementary schools in Pudong New Area were sampled between October and December in 2022 by using a stratified cluster sampling method. A self administered questionnaire was used to assess healthy eye behavior in primary school children and parental knowledge and skills in myopia prevention and control. The Chi squared test, independent samples t-test and Logistic regression were used to analyse the association between parental knowledge and skills in myopia prevention and control and healthy eye behaviour in primary school children. Results: Parents of primary school children with a high level of knowledge and skills in myopia prevention and control were 50.97% and 56.36%, respectively. The knowlegde entry scores for parents of lower and middle elementary school students were higher than those of parents of upper primary students with respect to their understanding, on the main causes of myopia in their children, the correct knowledge of myopia prevention and control, the role of family members in helping each other to manage and treat myopia in their children and the parents responsibility to teach their children to use their eyes correctly and scientifically (3.05±1.21, 2.97±1.20; 5.92±0.68, 5.83±0.86; 4.46±0.88, 4.40±0.93; 3.88±1.04, 3.72±1.07); all differences were statistically significant (t=2.04, 3.39, 2.00, 4.87, P<0.05). The differences in the scores of parents of primary school children in different grades for all items were statistically significant (t=2.93-7.31, P<0.05) in the skill entries. Parental knowledge levels were poor for items of full scores that assessed the following: knowing the main causes of their childrens myopia, awareness of the correct knowledge of myopia prevention and control measures, awareness of Comprehensive Prevention and Control Strategy for Children and Adolescents with Myopia, and concerning that their childrens future education and employment will be affected by myopia, understanding the responsibility of parents for guiding children to use their eyes scientifically and correctly, with 12.71%, 22.90%, 19.30%, 21.83% and 22.47% respectively. Parental skills were poor for items of full scores that assessed the following:reminding their children to rest their eyes when doing homework, reading or writing, deliberately avoiding mobile phone use when spending time with their children, the number of times which taking children to the hospital for refractive screening in the past year, and giving their children extra learning tasks, with 33.26%, 15.12%, 9.00% and 5.36% respectively. Compared to parental knowledge in myopia prevention and control, parental skills had a more pronounced effect on the four dimensions of healthy eye behavior (reading and writing, screen time, outdoor activities, and sleep duration) among students in different grades (OR=1.41-3.37, P<0.05). Conclusions Parental knowledge and skills in myopia prevention and control are still insafficient, associated with healthy eye behavior in primary school children. There is a need to strengthen accurate health education for parents on the prevention and control of myopia, to cultivate healthy eye behaviour among primary school students and reduce the incidence of myopia among them.