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Objectives To investigate oral hygiene behaviours and their correlates among Chinese adolescents. Materials and Methods This cross-sectional study recruited 118,601 subjects aged 12-15 years from the National Oral Health Survey using multistage cluster sampling. Questionnaire data were used for descriptive and multivariate analyses. Results A total of 32.6% of subjects brushed their teeth twice daily, 7.4% used fluoridated toothpaste, 3.9% cleaned their teeth twice daily with fluoridated toothpaste, and 9.7% used dental floss. Multivariable logistic regression showed that the probability of good oral hygiene practices (twice-a-day tooth brushing with fluoridated toothpaste) was higher among these groups: females (AOR: 1.141; 95%CI: 1.072-1.214), 15-year-olds (AOR: 1.786; 95%CI: 1.634-1.952), from urban areas (AOR: 1.389; 95%CI: 1.288-1.497), without siblings (AOR: 1.351; 95%CI: 1.259-1.450), with an educated father (AOR: 1. 605; 95%CI: 1.442-1.788) and mother (AOR: 1.706; 95%CI: 1.530-1.903), having dental visit experiences (AOR: 1.702; 95%CI: 1.589-1.823), rating one’s oral health as good (AOR: 2.341; 95%CI: 2.083-2.631), having fluoride knowledge (AOR: 4.345; 95%CI: 4.034-4.678) and having a positive attitude towards regular dental care (AOR: 1.589; 95%CI: 1.460-1.729). Conclusion The oral hygiene behaviours of Chinese adolescents were undesirable. Good oral hygiene practices are significantly associated with sociodemographic factors, fluoride knowledge, and attitudes towards regular dental care. Clinical Relevance Professionals, parents and adolescents should pay attention to adolescents' oral hygiene behaviours. It should be emphasized that twice-a-day tooth brushing with fluoridated toothpaste is essential when designing the content of oral health education and when counselling adolescents.

Background To analyze the potential cost savings in dental care associated with increased sugar-free gum (SFG) use among Chinese teenagers and adults. Methods The amount of SFG chewed per year and decayed, missing and filled teeth (DMFT) was collected from a cross-sectional survey to create a dose–response curve assumption. A cost analysis of dental restoration costs was carried out. A budget impact analysis was performed to model the decrease in DMFT and the subsequent cost savings for dental care. Three different scenarios for the increase in the number of SFG were calculated. Results The average cost savings per person in the Chinese population due to increasing SFG use ranged from 45.95 RMB (6.94 USD) per year to 67.41 RMB (10.19 USD) per year. It was estimated that 21.51–31.55 billion RMB (3.25–4.77 billion USD) could be saved annually if all SFG chewers among Chinese teenagers and adults chewed SFG regularly. Conclusion This study suggests that dental care costs could be significantly reduced if SFG use increased in the Chinese population.

Background Polygenic risk score (PRS) is a method of revealing multiple genes effect. The study of PRS and childhood trauma (CT) and resilience on adolescent depressive symptoms are fewer reported, especially the functional mechanism of resilience among them. Methods 718 Chinese adolescents aged 10-14 years were surveyed including CT, resilience, depressive symptoms, and phenotype data in three years of the cohort study. PRS was calculated by the weighted accumulation effects of alleles on depressive symptoms. Their relationships were analyzed by the mediation and moderation models. Results PRS and CT were risk factors for depressive symptoms. Interaction (PRS × CT) on depressive symptoms had no statistical significance. Resilience acted as the protective mediator from CT (emotional abuse, emotional neglect, physical neglect) to depressive symptoms and moderator from CT (emotional abuse) to depressive symptoms. Limitations The sample size was a little small so that the inference were drawn prudently. Except gene data, other were collected by self-reported questionnaire instruments which inevitably brought recall bias. Conclusions PRS and CT could have adverse impact on depressive symptoms, resilience could alleviate these risk effects as a moderator and a mediator. The findings have important implications for prevention and intervention in adolescent depressive symptoms.

Background Neglect and physical abuse may be typical risk factors for aggressive behavior in adolescents. However, findings on their specific effects and sex differences are still unclear. This study aimed to examine the specific effects of neglect and physical abuse on adolescent aggressive behaviors and to further explore the potential sex-specific effect. Methods A multicenter school-based survey was conducted in rural China. A total of 15,957 students aged 11–20 years completed self-report questionnaires to record aggressive behaviors, neglect and physical abuse, and other related information. Participants were grouped into those who experienced none, one of, or both neglect and physical abuse for statistical analyses. Results Of the participants, 37.0% experienced both neglect and physical abuse, 30.0% experienced neglect only, and 9.8% experienced physical abuse only. Higher risk for physical aggression (OR=1.24, 95% CI=1.06–1.45), and lower risk for verbal aggression (OR=0.83, 95% CI=0.72–0.94) and hostility (OR=0.81, 95% CI=0.69–0.94) were found in the physical abuse only group as compared to the neglect only group. No sex difference was found between neglect or physical abuse and general aggressive behaviors (P>0.05), except that females were more likely to exert physical aggression than males when exposed to neglect and physical abuse (P Limitations Cross-sectional design, retrospective self-report data, and not including other maltreatment subtypes. Conclusions Neglect and physical abuse may each have distinct sensitivity for different subtypes of aggression. Targeted treatment for diverse aggressive symptoms is suggested, and strategies to prevent both neglect and physical abuse across gender would yield comprehensive benefits.

Previous gene-environment studies on depression have examined the interaction between FKBP5 gene and childhood trauma, but the results are inconsistent and few studies have focused on Asian adolescents. Psychological resilience may explain for the inconsistency. We examined the interaction between FKBP5 gene and childhood trauma on depressive symptoms in Chinese adolescents, and firstly explored the moderating role of resilience in the relationship.This study comprised 942 participants (448 males, 47.6%) randomly recruited from four senior schools in Wuhan, Hubei of China. Depressive symptoms, childhood trauma, and resilience were respectively evaluated by the Center for Epidemiological Studies Depression Scale (CES-D), the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-RISC). Three potentially functional FKBP5 polymorphisms were selected for genotyping.Participants carrying minor alleles of FKBP5 polymorphisms (rs3800373, rs1360780, and rs4713916) and a haplotype derived from these variants displayed higher CES-D scores when exposed to childhood physical abuse after adjusting for demographic characteristics and resilience (all P 0.01). The three-way interactions of FKBP5 SNPs, physical abuse, and resilience on depressive symptoms all yielded statistical significance after adjusting for demographic characteristics (β = -0.282 to -0.236; all P 0.001).Cross-sectional design, self- reported measurements and limited genotyped FKBP5 polymorphisms.FKBP5 variants in combination with childhood physical abuse may increase more pronounced depressive symptoms among Chinese adolescents, while resilience plays a moderating role in the associations. Future research to examine the exact mechanism of resilience in these associations is needed.

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Previous studies have reported that Internet addiction (IA) is an important predictor of aggression. However, little is known whether aggression is a risk factor of IA. This study aims to explore whether IA can predict total and sub-types of aggression, whether aggression also can predict IA, and the potential sex difference.A total of 15,977 adolescents aged 12 to 18 were recruited though a stratified cluster sampling across five representative provinces in mainland of China. Young's Internet Addiction Test (IAT) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure IA and aggression, respectively.The prevalence of IA and total aggression was 16.8 % and 25.0 %, respectively. Binary logistic regression analysis indicated that IAT score was significantly associated with total and five sub-types of aggression (P 0.001). However, scores of physical aggression, hostility, and indirect aggression were positively associated with IA (P 0.001), while verbal aggression and anger were not significant (P 0.05). Moreover, the interaction of sex and IA was significant for aggression. Specifically, females with IA had higher risks of anger and indirect aggression but had lower risks of physical and verbal aggression compared to males with IA.Cross-sectional design, self-reported information, and only Chinese rural adolescents.IA is a strong risk factor of total and five sub-types of aggression, while not all sub-types of aggression are predictors of IA. Prevention programs for adolescents' IA and aggression should consider different aggression sub-types and sex.

Key Points Question Is the labor migration of parents in China associated with nonsuicidal self-injury (NSSI) or suicidality among children, adolescents, and young adults who were left behind, and are there sex differences in any association? Findings In this cross-sectional study in China of 15 312 participants, labor migration of the father or of both parents was associated with 1 to 4 (but not ≥5) episodes of NSSI in 1 year and with suicidality among offspring, whereas differential associations by sex were minimal. In addition, higher odds of experiencing 1 to 4 episodes of NSSI were found for offspring who were initially separated from 1 or both parents at preschool age. Meaning These findings suggest that interventions to address NSSI should consider potential associations with parental migration., Importance The labor migration of parents in China often leaves children behind, which may be adversely associated with children’s health. However, few studies have assessed the association of parental migration with nonsuicidal self-injury (NSSI) or with suicidality among their offspring. Objective To examine the associations of parental labor migration with NSSI and with suicidality as well as potential differential associations by sex among offspring left behind. Design, Setting, and Participants This nationwide cross-sectional study was conducted from February to October 2015 among individuals aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from November 1, 2020, to March 1, 2021. Exposures Parental labor migration, including parental migration status (yes vs no), migration pattern (father, mother, or both), and the child’s age at the initial parent-child separation. Main Outcomes and Measures Less frequent (1-4 episodes) NSSI, more frequent (≥5 episodes) NSSI, suicidal ideation, and suicide attempt in the past year were measured using validated questionnaires. Multinomial or binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of the associations between parental migration and NSSI, suicidal ideation, or suicide attempt. Potential covariates (demographic, family-level, and psychological characteristics) were adjusted for in 3 sequential models. Results A total of 15 312 participants (7904 male [51.6%] and 7408 female [48.4%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of those participants, 5963 (23.3%) experienced parental migration. The 12-month prevalence of less frequent NSSI was 17.2% (2635 of 15 312), the 12-month prevalence of more frequent NSSI was 11.6% (1783 of 15 312), the 12-month prevalence of suicidal ideation was 15.2% (2335 of 15 312), and the 12-month prevalence of suicide attempt was 3.5% (535 of 15 312). Parental migration was associated with less frequent NSSI (adjusted odds ratio [aOR], 1.13; 95% CI, 1.03-1.24); no significant association of parental migration with more frequent NSSI (aOR, 1.01; 95% CI, 0.90-1.13), suicidal ideation (aOR, 1.00; 95% CI, 0.90-1.10), or suicide attempt (aOR, 1.09; 95% CI, 0.90-1.33) was identified. Compared with children whose parents did not migrate, the aOR for less frequent NSSI for participants whose father migrated was 1.18 (95% CI, 1.06-1.31), and the aOR for less frequent NSSI for participants having both parents migrate was 1.12 (95% CI, 1.01-1.28). Compared with children whose parents did not migrate, participants who experienced initial separation from 1 or both parents at preschool age had an aOR for less frequent NSSI of 1.16 (95% CI, 1.03-1.31). No sex disparities were found in these associations except for participants who experienced initial separation from 1 or both migrant parents at preschool age, for which the aOR for more frequent NSSI was higher among male (aOR, 1.27; 95% CI, 1.04-1.55) than female (aOR, 0.96; 95% CI, 0.77-1.19) participants. Conclusions and Relevance This cross-sectional study found that parental migration, mainly of the father or of both parents, or an initial separation of children at preschool age from 1 or both parents who migrated was associated with higher odds of experiencing 1 to 4 NSSI episodes in 1 year among offspring. Overall, the associations of parental migration with NSSI and suicidality were similar between male and female participants., This cross-sectional study examines whether migration of 1 or both parents is associated with risk of nonsuicidal self-injury or suicidality and whether the risk differs by sex among the children, adolescents, and young adult offspring left behind in China.

Aggressive behavior is a highly prevalent and serious public health problem among adolescents. However, the etiology and pathogenesis of aggressive behavior remain unclear. Childhood maltreatment is an acknowledged factor for aggressive behavior. SIRT1 is closely related to the occurrence and development of psychiatric disorders. We aimed to reveal the interactive effect between SIRT1 and childhood maltreatment on aggressive behavior among Chinese adolescents.Aggressive behavior and childhood maltreatment were evaluated by the Buss and Warren's Aggression Questionnaire (BWAQ) and short form Childhood Trauma Questionnaire (CTQ-SF), respectively. This study comprised 436 aggression cases and 435 controls. Four SIRT1 tagSNPs were selected for genotyping. Interaction between SIRT1 and childhood maltreatment was estimated by logistic regression models.Individuals carrying SIRT1 rs4746720 minor allele and TAAC haplotype derived from SIRT1 variants was associated with reduced aggression risk when childhood maltreatment occurred (all P 0.01). An antagonistic additive interaction between SIRT1 rs4746720 and childhood maltreatment on aggressive behavior (S = 0.421; 95%CI: 0.234 to 0.758) was further testified. No main effect of the SIRT1 SNPs or the haplotype block was observed (all P 0.05).Since participants were only males, our findings were unable to be directly extended to females. Cross-sectional design, self-reported measurements and limited sample size were adopted.This study provides the first evidence of SIRT1 × childhood maltreatment interaction on aggressive behavior in male adolescents. The minor allele of SIRT1 rs4746720 presents a protective effect on combination with childhood maltreatment on the risk of aggressive behavior.

Aims The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA. Methods A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations. Results During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively. Conclusions CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.

Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression.A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively.During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively.Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment.CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.

IntroductionAssociations of pre-pregnancy impaired fasting glucose (IFG) and body mass index (BMI) with large for gestational age (LGA) and preterm birth (PTB) have been poorly understood. We aimed to investigate the associations of maternal BMI, separately and together with pre-pregnancy IFG, with LGA and PTB in Chinese population. We also aimed to quantify these associations by maternal age.Research design and methodsThis was a retrospective cohort study of women from the National Free Preconception Health Examination Project with singleton birth from 121 counties/districts in 21 cities of Guangdong Province, China, from January 1, 2013 to December 31, 2017. Women were included if they did not have pre-existing chronic diseases (diabetes, hypertension, etc). Participants were divided into eight groups according to their BMI (underweight (BMI 2), normal weight (18.5–23.9 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥28.0 kg/m2)) and pre-pregnancy fasting glucose status (normoglycemia (fasting glucose concentration ResultsWe included 634 030 women. The incidences of LGA, severe LGA, PTB and early PTB for the study population were 7.1%, 2.5%, 5.1% and 1.1%, respectively. Compared with normal weight mothers with normoglycemia, overweight and obese mothers irrespective of IFG had a higher risk of LGA (eg, obesity with IFG aIRR 1.85 (1.60–2.14)) and severe LGA (eg, obesity with IFG 2.19 (1.73–2.79)). The associations of BMI and pre-pregnancy fasting glucose status with LGA were similar found among women of all age groups. Underweight with normoglycemia had 6.0% higher risk of PTB (1.06 (1.03–1.09)) and 8.0% higher risk of early PTB (1.08 (1.02–1.17)), underweight with IFG had 14.0% higher risk of PTB (1.14 (1.02–1.27)), and obese mothers with IFG had 45.0% higher risk of PTB (1.45 (1.18–1.78)). The associations of BMI and pre-pregnancy fasting glucose status with PTB differed by maternal age.ConclusionOverweight and obesity regardless of IFG were associated with an increased risk of LGA, and these associations were similarly observed among mothers of all age groups. Underweight regardless of IFG, and obesity with IFG were associated with an increased risk of PTB, but the associations differed by maternal age. Findings from this study may have implications for risk assessment and counselling before pregnancy.

Bullying victimization is a robust predictor of mental distress among lesbian/gay, bisexual, and questioning (LGBQ) adolescents. However, few research accounted bullying victimization within the context of both sibling and peer relationships.To examine the effect of sibling and peer bullying victimization on depression and anxiety between heterosexual adolescents and LGBQ adolescents.This was a cross-sectional study with a random sample of 3062 Chinese senior high school students (56.0% female) aged 14 to 18. Related information was collected through a self-reported questionnaire. The associations were examined via a set of logistic regression analysis.Of the participants, 12.5% were victims of sibling bullying only, 10.1% reported peer victimization only, and 4.7% were involved in both sibling and peer victimization. Compared to heterosexuals, LGBQ adolescents had increased risks of sibling victimization only, peer victimization only, and both sibling and peer victimization. The prevalence of major depression and generalized anxiety disorder were 24.9% and 18.7% respectively. Bullying victimization and sexual orientation were independently associated with depression and anxiety. Furthermore, the stratified analysis indicated that sibling victimization only was significantly associated with depression and anxiety for heterosexual adolescents, while the associations were not significant for LGBQ adolescents.Sexual orientation and bullying victimization are predictive factors of depression and anxiety. In particular, bullying victimization shows the different effects on depression and anxiety between heterosexual and LGBQ adolescents. Anti-bullying intervention could take distinct strategies based on different sexual orientation to reduce risks of adolescents' mental health problems.

Background The 2019 novel coronavirus disease (COVID-19) emerges in China, which spreads rapidly and becomes a public health emergency of international concern. Chinese government has promptly taken quarantine measures to block the transmission of the COVID-19, which may cause deleterious consequences on everyone’s behaviors and psychological health. Few studies have examined the associations between behavioral and mental health in different endemic areas. This study aimed to describe screen time (ST), physical activity (PA), and depressive symptoms, as well as their associations among Chinese college students according to different epidemic areas. Methods The study design is cross-sectional using online survey, from 4 to 12 February 2020, 14,789 college students accomplished this online study, participants who did not complete the questionnaire were excluded, and finally this study included 11,787 college students from China. Results The average age of participants was 20.51 ± 1.88 years. 57.1% of the college students were male. In total, 25.9% of college students reported depression symptoms. ST > 4 h/day was positively correlated with depressive symptoms (β = 0.48, 95%CI 0.37–0.59). COVID-19ST > 1 h/day was positively correlated with depressive symptoms (β = 0.54, 95%CI 0.43–0.65), compared with COVID-19ST ≤ 0.5 h/day. Compared with PA ≥ 3 day/week, PA < 3 day/week was positively associated with depression symptoms (β = 0.01, 95%CI 0.008–0.012). Compared with low ST and high PA, there was an interaction association between high ST and low PA on depression (β = 0.31, 95%CI 0.26–0.36). Compared with low COVID-19ST and high PA, there was an interaction association between high COVID-19ST and low PA on depression (β = 0.37, 95%CI 0.32–0.43). There were also current residence areas differences. Conclusions Our findings identified that high ST or low PA was positively associated with depressive symptoms independently, and there was also an interactive effect between ST and PA on depressive symptoms.

Background: Recurrence remains one of the key reasons of relapse after the radical radiation for locally advanced nasopharyngeal carcinoma (NPC). Here, the multiple molecular and clinical variables integrated decision tree algorithms were designed to predict individual recurrence patterns (with VS without recurrence) for locally advanced NPC. Methods: A total of 136 locally advanced NPC patients retrieved from a randomized controlled phase III trial, were included. For each patient, the expression levels of 33 clinicopathological biomarkers in tumor specimen, 3 Epstein-Barr virus related serological antibody titer and 5 clinicopathological variables, were detected and collected to construct the decision tree algorithm. The expression level of 33 clinicopathological biomarkers in tumor specimen was evaluated by immunohistochemistry staining. Results: Three algorithm classifiers, augmented by the adaptive boosting algorithm for variable selection and classification, were designed to predict individual recurrence pattern. The classifiers were trained in the training subset and further tested using a 10-fold cross-validation scheme in the validation subset. In total, 13 molecules expression level in tumor specimen, including AKT1, Aurora-A, Bax, Bcl-2, N-Cadherin, CENP-H, HIF-1α, LMP-1, C-Met, MMP-2, MMP-9, Pontin and Stathmin, and N stage were selected to construct three 10-fold cross-validation decision tree classifiers. These classifiers showed high predictive sensitivity (87.2-93.3%), specificity (69.0-100.0%), and overall accuracy (84.5-95.2%) to predict recurrence pattern individually. Multivariate analyses confirmed the decision tree classifier was an independent prognostic factor to predict individual recurrence (algorithm 1: hazard ration (HR) 0.07, 95% confidence interval (CI) 0.03-0.16, P < 0.01; algorithm 2: HR 0.13, 95% CI 0.04-0.44, P < 0.01; algorithm 3: HR 0.13, 95% CI 0.03-0.68, P = 0.02). Conclusion: Multiple molecular and clinicopathological variables integrated decision tree algorithms may individually predict the recurrence pattern for locally advanced NPC. This decision tree algorism provides a potential tool to select patients with high recurrence risk for intensive follow-up, and to diagnose recurrence at an earlier stage for salvage treatment in the NPC endemic region.

The ultrastable metal electrodes that can withstand the mechanical deformations of the soft substrates are always essential for the development of flexible supercapacitors. However, the metal electrode physically deposited on the flexible substrate is rigid and delaminated, and the contact interface is easily degraded under the mechanical cycling. The highly flexible and conductive composites with the intermixed metal–polymer structure as electrodes are key to solving the contact problem. In this work, a universal and facile method for flexible micro-supercapacitors (MSCs) with combination of nickel electroless plating (EN) and reduced graphene oxide (rGO) electrodeposition was presented. The so-called surface exchange and ion exchange (SMIE) technique has been employed to prepare the seed layer, and the electroless plating was conducted to deposit the Ni–P layer. The rGO-coated (GC) layer was then electrodeposited onto the Ni–P layer to form an EN/GC composite structure. EN/GC electrodes with symmetric i...

Background: Bullying tends to peak during adolescence, and it is an important risk factor of self-harm and suicide. However, research on the specific effect of different sub-types of bullying is limited.Objective: The purpose of this study is to examine the associations between four common forms of bullying (verbal, physical, relational, and cyber) and self-harm, suicidal ideation (SI), and suicide attempts (SA).Method: This was a cross-sectional study of a sample including 4,241 Chinese students (55.8% boys) aged 11 to 18 years. Bullying involvement, self-harm, SI, and SA were measured via The Juvenile Campus Violence Questionnaire (JCVQ). The association was examined through multinomial logistic regression analysis, adjusted for demographic characteristics and psychological distress.Results: Bullying victimization and perpetration were reported by 18.0 and 10.7% of participants. The prevalence of self-harm, SI, and SA were 11.8, 11.8, and 7.1%, respectively. Relational bullying victimization and perpetration were significantly associated with SI only, SI plus self-harm, and SA. Physical bullying victimization and perpetration were risk factors of self-harm only and SA. Verbal victimization was significantly associated with SI only. Cyber perpetration was a risk factor of SA.Conclusions: The findings highlight the different effects of sub-types of bullying on self-harm and suicidal risk. Anti-bullying intervention and suicide prevention efforts should be prior to adolescents who are involved in physical and relational bullying.

Objective/background School closure and home quarantine has been implemented worldwide during the coronavirus disease 2019 (COVID-19) outbreak. The study aims to assess the associations of circadian rhythm abnormalities (CRA) during the COVID-19 outbreak with mental health in Chinese undergraduates. Methods A nationwide cross-sectional university-based survey was conducted from 4th February to 12th, 2020. Based on different geographical locations and purposive sampling approach, 19 universities from 16 provinces or municipalities in the mainland of China were selected. A total of 14,789 participants were recruited by using multistage stratified random sampling. The data of CRA were collected by self-reported questionnaires consist of four items involved rest–activity cycle, diet rhythm, wake up rhythm and sleep rhythm. The Patient Health Questionnaire and the Generalized Anxiety Disorder were applied to evaluate the symptoms of depression and anxiety. Chi-square test and ordinal logistic regression models were used to describe the distributions and associations of CRA and mental health. Results A total of 11,787 students [female: 6731(57.1%)] aged 15–26 years old (M = 20.45, SD = 1.76) were analyzed (response rate: 79.7%). The results showed the percentage of CRA were 17.5–28.7%. The prevalence of depression and anxiety were significantly higher in students with single CRA. Students who reported the coexistence of four CRA were more likely to be with the symptoms of depression (OR: 4.43, 95% CI: 3.91–5.03) and anxiety (OR: 3.11, 95% CI: 2.70–3.60). Dose–response relationships were found between multiple CRA and mental problems. Conclusion Circadian rhythm abnormalities are positively associated with mental health among university studies. Mental health care is needed for college students during the COVID-19 epidemic period.

BACKGROUND Problematic internet use (PIU) is a growing public health and social issue among adolescents, however, its prevalence in rural adolescents remains to be investigated. Adverse life experiences (ALEs) and resilience have been reported to be important influence factors of PIU, but little is known about the interaction effects of ALEs and resilience on PIU, or gender differences in these effects. OBJECTIVE This study aimed to provide the first prevalence report of PIU in Chinese rural adolescents based on a nationwide sample, and to examine the association among ALEs, resilience and PIU, as well as the gender difference within these relationships. METHODS A school-based survey was conducted in rural areas from five provinces in China in 2014-2015. A total of 15950 students aged 11-22 years finished a complete self-report questionnaire, including demographic characteristics, measurements of PIU, stressful life events, child neglect and maltreatment, and resilience. ALEs were defined as having experienced stressful life events and/or child neglect and maltreatment. Univariate and multivariable logistic regression analyses were used. RESULTS There were 2734 adolescents assessed with PIU in our sample, with a prevalence rate of 17.1%. Multiple adjusted odds ratios for PIU was significantly increased with higher ALEs scores (5-6: OR=1.28, 95% CI=1.11-1.48; 7-8: OR=1.66, 95% CI=1.43-1.92) and significantly decreased with higher resilience level (Mild: OR=0.83, 95% CI=0.74-0.93; Moderate: OR=0.68, 95% CI=0.60-0.77; High: OR=0.59; 95% CI=0.52-0.67). Moderate resilience had significantly protective effect on PIU in adolescents with high ALEs scores (OR=0.63, 95% CI=0.41-0.97). A significant interaction effect was found between ALEs and resilience on PIU only in girls (P=0.021) but not in boys (P=0.081), however, this gender difference showed no significance (P=0.305). CONCLUSIONS This study suggests a relative high prevalence of PIU among Chinese rural adolescents. More ALEs and lower resilience are associated with higher risk for PIU, and resilience can moderate the association between ALEs and PIU. Strategies combining ALEs prevention and resilience promotion both in girls and boys would yield better to decrease PIU problems in adolescents.

BACKGROUND Since the COVID-19 outbreak was first reported, considerable attention has been drawn to mental health problems among college students. OBJECTIVE We aimed to estimate the prevalence of anxiety and depressive symptoms among college students in different geographical areas of China during the early stage of the COVID-19 outbreak. METHODS A nationwide cross-sectional survey was conducted among Chinese college students of 16 provinces or municipalities from February 4 to 12, 2020. A web-based survey was adopted to collect information from these college students, including demographics, perceived risk of infection, attitudes toward the epidemic and its control, and mental health status. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale, and depressive symptoms were assessed using the Patient Health Questionnaire. Chi-square test was used to compare the percentage of perceived risk of infection and attitude toward COVID-19 among college students in different geographic locations. Binary logistic models were used to identify associations between geographic locations and mental health problems after controlling for covariates. RESULTS A total of 11,787 participants were analyzed in this study (response rate: 79.7%). The prevalence of anxiety and depressive symptoms among college students was 17.8% (95% CI 17.1%-18.5%) and 25.9% (95% CI 25.1%-26.7%), respectively. After controlling for covariates, current residence area in Wuhan city was found to have a positive association with anxiety symptoms (odds ratio [OR] 1.37, 95% CI 1.11-1.68) and depressive symptoms (OR 1.32, 95% CI 1.09-1.59). Similarly, college location in Wuhan city was found to have a positive association with anxiety symptoms (OR 1.20, 95% CI 1.07-1.35) and depressive symptoms (OR 1.22, 95% CI 1.10-1.36). History of residence in or travel to Wuhan city in the past month was also positively associated with anxiety symptoms (OR 1.62, 95% CI 1.46-1.80) and depressive symptoms (OR 1.48, 95% CI 1.35-1.63). Furthermore, the perceived risk of COVID-19 was higher among students whose college location and current residence area were in Wuhan city, and it was positively associated with anxiety and depressive symptoms. CONCLUSIONS During the COVID-19 pandemic, mental health problems among Chinese college students were widespread and geographically diverse. Our study results provide further insight for policymakers to develop targeted intervention strategies.

Background: During the coronavirus disease (COVID-19) pandemic, harsh social distancing measures were taken in China to contain viral spread. We examined their impact on the lives of medical students. Methods: A nation-wide cross-sectional survey of college students was conducted from 4&ndash, 12 February 2020. We enrolled medical students studying public health in Beijing and Wuhan to assess their COVID-19 awareness and to evaluate their mental health status/behaviors using a self-administered questionnaire. We used the Patient Generalized Anxiety Disorder-7 and Health Questionnaire-9 to measure anxiety disorders and depression. We used multivariable logistic regression and path analysis to assess the associations between covariates and anxiety disorder/depression. Results: Of 933 students, 898 (96.2%) reported wearing masks frequently when going out, 723 (77.5%) reported daily handwashing with soap, 676 (72.5%) washed hands immediately after arriving home, and 914 (98.0%) reported staying home as much as possible. Prevalence of anxiety disorder was 17.1% and depression was 25.3%. Multivariable logistic regression showed anxiety to be associated with graduate student status (odds ratio (aOR) = 2.0, 95% confidence interval (CI): 1.2&ndash, 3.5), negative thoughts or actions (aOR = 1.6, 95% CI: 1.4&ndash, 1.7), and feeling depressed (aOR = 6.8, 95% CI: 4.0&ndash, 11.7). Beijing students were significantly less likely to have anxiety than those in the Wuhan epicenter (aOR = 0.9, 95% CI: 0.8&ndash, 1.0), but depression did not differ. Depression was associated with female students (aOR = 2.0, 95% CI: 1.2&ndash, 3.3), negative thoughts or actions (aOR = 1.7, 95% CI: 1.5&ndash, 1.9), and anxiety disorder (aOR = 5.8, 95% CI: 3.4&ndash, 9.9). Path analysis validated these same predictors. Conclusions: Despite medical students&rsquo, knowledge of disease control and prevention, their lives were greatly affected by social distancing, especially in the Wuhan epicenter. Even well-informed students needed psychological support during these extraordinarily stressful times.