The norm of the Physical Activity afterschool Questionnaire for Preschooler (P-PAQ) in urban areas of China / 中国学校卫生

Objective@#To establish the norm of the Physical Activity afterschool Questionnaire for Preschooler(P-PAQ) in urban areas of China, so as to provide a basis for graded guidance from the family perspective and to improve children s physical activity levels.@*Methods@#From October 2020 to January 2021, 6 267 children aged 3-6 years old were recruited from 40 kindergartens in eight cities across six major administrative regions by stratified cluster sampling, and the P-PAQ initially developed by the researchers of this study were completed by the primary caregivers. The questionnaire was administered to collect data relating to the amount of physical activity undertaken by the preschoolers, and the norm was determined by quartiles. Data relating to parental concepts of sports and parental behavior were assessed by calculating mean scores in order to establish the norm.@*Results@#Among preschoolers in urban areas, the M(P 25 ，P 75 ) of total physical activity time (min/day), moderate-to-vigorous physical activity time (min/day), outdoor time (min/day) and screen time (min/day) on school days outside kindergarten and on weekends were 84 (54,120), 22 (8,40), 12 (0,24) and 18 (6,30), and 170 (115,240), 60 (30,95), 90 (35,120) and 30 (20,60), respectively. When the score of parents sports concept and behavior (total score of 40) were≥34, 29-<34, 24-<29, <24, it was defined as four levels about above medium, medium, lower medium and lower, respectively. And for two dimensions，when the score of parental sports concept were ≥19, 17-<19, 15-<17, <15，and the score of parental behaviors were ≥16, 12-<16, 8-<12, <8, it was defined as four levels about upper medium, medium, lower medium and lower, respectively.@*Conclusion@#The norm of extracurricular activities among preschool children in Chinese cities has good representativeness and appropriate threshold values, which could provide a valuable reference for early assessment, as well as guidance in relation to out-of-school physical activity behaviors among children aged 3-6 years old.

A dietary and nutritional status survey among young children in five big cities of China.

BACKGROUND AND OBJECTIVES: To investigate the dietary patterns and nutritional status of young children living in urban environments in China. METHODS AND STUDY DESIGN: A cross-sectional study was conducted of 750 children aged 6 - 35 months living in 5 large cities in China. The survey methodology included a physical exami-nation, blood hemoglobin measurements and a 24 hour dietary recall questionnaire Results: The educational lev-el of participant mothers was high (79% had attended college or university or higher), which may not be fully representative across all areas of urban China. Overall anthropometric nutritional status indicators were within acceptable ranges based on national recommendations, and there was no evidence of severe micronutrient defi-ciencies. However, we identified three significant nutritional issues that warrant attention: 1.) Later than optimal introduction and low-intake of animal-based iron-containing foods into the diet, and a need for greater inclusion of vitamin B-1 rich foods among 12-35 month old children. 2.) Presence of significant rates of anemia in 6-11 and 12-23 month old children. 3.) An increased risk of overweight/obesity. CONCLUSIONS: Since food availability and affordability are no longer major issues in the well developed parts of urban China, achieving further im-provements in the diet and nutrition of young children in these environments is likely require more specific edu-cation to parents and other significant carers such as grandparents. The relatively high educational level and so-cio-economic status of the population group is likely to facilitate the uptake of such measures in this population group.

National survey showed that Chinese city children under two years of age had similar feeding patterns to developed countries.

AIM: This 2015 study was a part of the National Growth Survey of Children under seven years of age, which has been carried out in nine Chinese cities every 10 years since 1975. Our aim was to assess children's feeding practices and nutritional supplements. METHODS: This was a cross-sectional survey of 89 006 healthy children aged one to 24 months. All data were collected by face-to-face interviews during child health visits, using a questionnaire. RESULTS: The exclusive breastfeeding rate was 53% in infants under six months of age, and the continued breastfeeding rate was 51% among infants who were 10-12 months and 5% when they were 21-24 months. Infants were weaned at a mean of 9.3 months in urban areas and 9.4 months in suburban areas. Cereals were provided as complementary food at a mean age of five months, eggs at six months, meat at eight and a half months and bean products at over 12 months. The most common nutritional supplements given to the children were vitamins A and D and calcium. CONCLUSION: The feeding practices of Chinese city children were similar to those in developed countries, but strategies are needed to promote more rational consumption of nutritional supplements.

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel.

BACKGROUND: The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. METHODS: An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer-reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health). RESULTS: The Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs - through engagement with planning, implementation (including the full use of community-level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence-based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached. CONCLUSIONS: Stronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence-based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detection and treatment of HIV/AIDS, tuberculosis, malaria, hypertension, and other chronic diseases. Continued strengthening of CBPHC programs based on rigorous ongoing operations research and evaluation will be required, and this evidence will be needed to guide national and international policies and programs.

The 5th national survey on the physical growth and development of children in the nine cities of China: Anthropometric measurements of Chinese children under 7 years in 2015.

OBJECTIVES: To describe the physical growth of healthy children under 7 years in China based on the latest national survey and provide more data for revising growth reference and monitoring the impact of social development on children's health and growth. METHODS: In the cross-sectional survey, 161,774 healthy children under 7 years were selected by multistage stratified cluster sampling method in nine cities of China. According to the geographical location, the nine cities were divided into northern, central and southern regions, and each city included urban and suburban areas. Anthropometric measurements were obtained on the spots and other related information was collected with questionnaires. RESULTS: There were slight urban-suburban difference and obvious regional difference in anthropometric measurements in China. Comparison with the 4th NSPGDC in 2005, measurements increased 0.1-1.1 kg in weight, 0.5-1.8 cm in height in urban areas (except children under 3 years) and 0.1-2.5 kg in weight, 0.2-3.8 cm in height in suburban areas. The urban-suburban difference of those measurements became smaller than 10 years ago, but their regional difference persistently exist. Chinese children were 0.36 SD in weight, 0.43 SD in height in urban areas and 0.30 SD in weight, 0.30 SD in height in suburban areas higher than WHO standards. CONCLUSIONS: Physical growth of children under 7 years old was undergoing a slowly positive secular trend during the latest decade in more economically developed regions of China. Urban-suburban difference of those measurements became smaller, while their regional difference persistently exist. Chinese healthy children under 7 years in nine cities was taller and heavier than WHO standards.

Surveillance of childhood blood lead levels in 11 cities of China.

BACKGROUND: Exposure to lead can be deleterious to children's health. Surveillance for blood lead levels (BLLs) is reported every year in the USA and some other countries. However, such reports are lacking in China which has the world's largest population of children. In this study, we provided the latest nationally representative data on BLLs among Chinese children living in cities, described the change in BLLs since 2004, and explored the risk factors for elevated BLLs (EBLLs) among children. METHODS: We studied 12 693 children aged 0-6 years in 2004 and 11 255 children aged 0-6 years in 2010. We evaluated the average BLLs and the prevalence of EBLLs, and a multivariate logistic regression model was used to estimate predictors of EBLLs. RESULTS: The geometric mean BLLs of children aged 0-6 years dropped by 16% (from 46.38 ± 2.10 µg/L in 2004 to 38.95 ± 1.83 µg/L in 2010), while the prevalence of EBLLs dropped by 87% (from 9.78% in 2004 to 1.32% in 2010). In a multivariate analysis, the following factors were associated with EBLLs: (1) children being cared for at home or at a boarding nursery (compared to children being cared for in a day nursery), (2) children having fathers with a lower education level, and (3) children often eating popcorn and chewing fingernails or sucking fingers were associated with EBLLs. CONCLUSIONS: The results of this study demonstrated a substantial decline in BLLs from 2004 to 2010 among Chinese children 0-6 years living in cities. However, these levels were higher than levels in countries, such as the USA, Canada, Japan and Sweden. These data demonstrate that Chinese children's lead exposure remains a public health problem that requires additional effort and resources.

Evaluating the efficacy of the AAP "pediatrics in disaster" course: the Chinese experience.

OBJECTIVE: "Pediatrics in Disasters" (PEDS) is a course designed by the American Academy of Pediatrics to provide disaster preparedness and response training to pediatricians worldwide. China has managed to sustain the course and adapt its content for local needs. China has also experienced several natural disasters since the course's inception, providing an opportunity to evaluate the impact of courses that took place in Beijing and Sichuan, in 2008-2010. METHODS: We used pretesting/post-testing, participant surveys, and in-depth interviews to evaluate whether the course imparted cognitive knowledge, was perceived as useful, and fostered participation in relief efforts and disaster preparedness planning. RESULTS: In Beijing and Sichuan, post-test scores were 16 percent higher than pretest scores. On immediate postcourse surveys, 86 percent of Beijing and Sichuan respondents rated the course as very good or excellent. On 6-month surveys, participants identified emotional impact of disasters, planning/triage, and nutrition as the three most useful course modules. Twelve of 75 (16 percent) of Beijing respondents reported direct involvement in disaster response activities following the course; eight of 12 were first-time responders. Participant interviews revealed a need for more training in providing nutritional and psychological support to disaster victims and to train a more diverse group of individuals in disaster response. CONCLUSIONS: PEDS imparts cognitive knowledge and is highly valued by course participants. Emotional impact of disasters, planning/triage, and nutrition modules were perceived as the most relevant modules. Future versions of the course should include additional emphasis on emotional care for disaster victims and should be extended to a broader audience.

Physical growth of children in urban, suburban and rural mainland China: a study of 20 years change.

OBJECTIVE: To describe secular trends on physical growth of children in China during the year of 1985-2005 and to analyze the urban-suburban-rural difference and its change. METHODS: The measurements of height, weight and chest circumference obtained from two serial national cross-sectional surveys for children aged 0 to 7 years in China were used to analyze the secular trends, and the growth differences among urban, suburban and rural children were compared. RESULTS: The average weight and height for both boys and girls from urban, suburban and rural areas have significantly increased in most age groups during the past 20 years; The average chest circumference increased slightly, ranging from 0.0 to 2.0 cm. From 1985 to 2005, the urban-suburban difference in height had become smaller, and that in weight showed similar trend for children under 3 years old but became larger after 3 years old; the suburban-rural difference both in height and weight became larger after 6 months old. The increment per decade in height was the greatest in the suburban group while the greatest increment in weight was the urban group. CONCLUSION: Positive secular trends were observed among urban, suburban and rural areas in Chinese children under 7 years old during the 1980s and the 2000s, reflecting a rapid socio-economic development in China.

Secular trends in height and weight for healthy Han children aged 0-7 years in China, 1975-2005.

OBJECTIVES: To report the secular growth changes of Chinese children aged 0-7 years between 1975 and 2005. METHODS: Height and weight measurements obtained from four consecutive national surveys were used to analyze the secular trends. Urban-rural difference and regional difference in growth were compared, respectively. RESULTS: A rapid positive secular trend was observed in China over the last three decades, increased by 5.3 and 5.0 cm in height for urban boys and girls at age 6-7 years, respectively. Urban-rural height difference has continuously reduced, but weight difference has gradually widened after 3-years old which results from the excessive weight increase of urban children, 2.68 kg for rural boys aged 6-7 years but 3.26 kg for urban during the 30 years. Clear regional differences in growth are not narrowing over time. Generally, the growth level in eastern China is higher than central-western, successively higher than southern. CONCLUSIONS: The rapid positive secular trends will still continue with the rapid socio-economic development in China. Urban-rural height difference will further narrow. Currently no sufficient evidence indicates that growth difference in inter-city has reduced. Weight increases rapidly for urban children, which does not match with height.

[Physical growth trend of Chinese children under 7 years old, in 1975 - 2005].

OBJECTIVE: To analyze the physical growth changes in Chinese children aged from 0 to 7 years old during the past 30 years. METHODS: Four national physical growth surveys of the children under 7 years old were undertaken in the same urban and suburban areas of nine main cities in China from 1975 to 2005. The nine cities were Beijing, Harbin and Xi'an in the northern part; Shanghai, Nanjing and Wuhan in the central part; Guangzhou, Fuzhou and Kunming in the southern part of China. Random cluster sampling method was used. The children aged from 0 to 7 years old were classified into 22 groups by age. The sample size was ranged from 150 to 200 persons for each sex-age group in each area (urban/rural) of each city. Totally, 158 400, 152 874, 157 362 and 138 775 healthy children were examined in 1975, 1985, 1995 and 2005 respectively. The data of weight, height, chest and head circumference obtained from these surveys were analyzed. RESULTS: Average weight and height in most of the age groups for both boys and girls from urban and suburban rural areas has been significantly improved during the past 30 years, the average increments of weight were 0.76 kg to 1.14 kg in 12 - 15 months group and 2.58 kg to 3.26 kg in 6 - 7 years group; and the average increments of height were 2.7 cm to 3.8 cm in 12 - 15 months group and 5.0 cm to 7.6 cm in 6 - 7 years group. Chest circumference did not show an increase in infants younger than 4 months and increased slightly after 4 months. The average increments of head circumference were 0.1 cm to 1.0 cm. From 1975 to 2005, the increments of weight and height per 10 years was in an increasing trend, e.g. weight increments of 5 - 6 years old were 0.58 kg, 1.02 kg and 1.67 kg and the height increments were 1.5 cm, 2.0 cm and 2.6 cm for every 10 years. The urban-rural difference in height has become smaller, the height difference in 6 - 7 years group for boys was decreased from 4.9 cm in 1975 to 2.6 cm in 2005. The weight has become smaller in children under 3 years old but becoming greater after 3 years, such as the difference increased from 1.14 kg in 1975 to 1.72 kg in 2005 for boys aged 6 - 7 years old. The regional difference also showed a decreasing trend. CONCLUSION: The physical growth of Chinese children had been much improved during the past 30 years and the secular trend should be still continuing at an accelerated growth stage. The urban-rural difference and regional difference in weight and height had become smaller.

Severe acute respiratory syndrome, Beijing, 2003.

The largest outbreak of severe acute respiratory syndrome (SARS) struck Beijing in spring 2003. Multiple importations of SARS to Beijing initiated transmission in several healthcare facilities. Beijing's outbreak began March 5; by late April, daily hospital admissions for SARS exceeded 100 for several days; 2,521 cases of probable SARS occurred. Attack rates were highest in those 20-39 years of age; 1% of cases occurred in children <10 years. The case-fatality rate was highest among patients >65 years (27.7% vs. 4.8% for those 20-64 years, p < 0.001). Healthcare workers accounted for 16% of probable cases. The proportion of case-patients without known contact to a SARS patient increased significantly in May. Implementation of early detection, isolation, contact tracing, quarantine, triage of case-patients to designated SARS hospitals, and community mobilization ended the outbreak.

Risk factors for SARS among persons without known contact with SARS patients, Beijing, China.

Most cases of severe acute respiratory syndrome (SARS) have occurred in close contacts of SARS patients. However, in Beijing, a large proportion of SARS cases occurred in persons without such contact. We conducted a case-control study in Beijing that compared exposures of 94 unlinked, probable SARS patients with those of 281 community-based controls matched for age group and sex. Case-patients were more likely than controls to have chronic medical conditions or to have visited fever clinics (clinics at which possible SARS patients were separated from other patients), eaten outside the home, or taken taxis frequently. The use of masks was strongly protective. Among 31 case-patients for whom convalescent-phase (>21 days) sera were available, 26% had immunoglobulin G to SARS-associated coronavirus. Our finding that clinical SARS was associated with visits to fever clinics supports Beijing's strategy of closing clinics with poor infection-control measures. Our finding that mask use lowered the risk for disease supports the community's use of this strategy.

Superspreading SARS events, Beijing, 2003.

Superspreading events were pivotal in the global spread of severe acute respiratory syndrome (SARS). We investigated superspreading in one transmission chain early in Beijing's epidemic. Superspreading was defined as transmission of SARS to at least eight contacts. An index patient with onset of SARS 2 months after hospital admission was the source of four generations of transmission to 76 case-patients, including 12 healthcare workers and several hospital visitors. Four (5%) case circumstances met the superspreading definition. Superspreading appeared to be associated with older age (mean 56 vs. 44 years), case fatality (75% vs. 16%, p = 0.02, Fisher exact test), number of close contacts (36 vs. 0.37) and attack rate among close contacts (43% vs. 18.5%, p < 0.025). Delayed recognition of SARS in a hospitalized patient permitted transmission to patients, visitors, and healthcare workers. Older age and number of contacts merit investigation in future studies of superspreading.

Evaluation of control measures implemented in the severe acute respiratory syndrome outbreak in Beijing, 2003.

CONTEXT: Beijing, China, experienced the world's largest outbreak of severe acute respiratory syndrome (SARS) beginning in March 2003, with the outbreak resolving rapidly, within 6 weeks of its peak in late April. Little is known about the control measures implemented during this outbreak. OBJECTIVE: To describe and evaluate the measures undertaken to control the SARS outbreak. DESIGN, SETTING, AND PARTICIPANTS: Data were reviewed from standardized surveillance forms from SARS cases (2521 probable cases) and their close contacts observed in Beijing between March 5, 2003, and May 29, 2003. Procedures implemented by health authorities were investigated through review of official documents and discussions with public health officials. MAIN OUTCOME MEASURES: Timeline of major control measures; number of cases and quarantined close contacts and attack rates, with changes in infection control measures, management, and triage of suspected cases; and time lag between illness onset and hospitalization with information dissemination. RESULTS: Health care worker training in use of personal protective equipment and management of patients with SARS and establishing fever clinics and designated SARS wards in hospitals predated the steepest decline in cases. During the outbreak, 30 178 persons were quarantined. Among 2195 quarantined close contacts in 5 districts, the attack rate was 6.3% (95% confidence interval [CI], 5.3%-7.3%), with a range of 15.4% (95% CI, 11.5%-19.2%) among spouses to 0.36% (95% CI, 0%-0.77%) among work and school contacts. The attack rate among quarantined household members increased with age from 5.0% (95% CI, 0%-10.5%) in children younger than 10 years to 27.6% (95% CI, 18.2%-37.0%) in adults aged 60 to 69 years. Among almost 14 million people screened for fever at the airport, train stations, and roadside checkpoints, only 12 were found to have probable SARS. The national and municipal governments held 13 press conferences about SARS. The time lag between illness onset and hospitalization decreased from a median of 5 to 6 days on or before April 20, 2003, the day the outbreak was announced to the public, to 2 days after April 20 (P<.001). CONCLUSIONS: The rapid resolution of the SARS outbreak was multifactorial, involving improvements in management and triage in hospitals and communities of patients with suspected SARS and the dissemination of information to health care workers and the public.