The association between prenatal bisphenol F exposure and infant neurodevelopment: The mediating role of placental estradiol.

BACKGROUND: There are limited population studies on the neurodevelopmental effects of bisphenol F (BPF), a substitute for bisphenol A. Furthermore, the role of placental estradiol as a potential mediator linking these two factors remains unclear. OBJECTIVE: To examine the association between maternal prenatal BPF exposure and infant neurodevelopment in a prospective cohort study and to explore the mediating effects of placental estradiol between BPF exposure and neurodevelopment in a nested case-control study. METHODS: The prospective cohort study included 1077 mother-neonate pairs from the Wuhu city cohort study in China. Maternal BPF was determined using the liquid/liquid extraction and Ultra-performance liquid chromatography tandem mass spectrometry method. Children's neurodevelopment was assessed at ages 3, 6, and 12 months using Ages and Stages Questionnaires. The nested case-control study included 150 neurodevelopmental delay cases and 150 healthy controls. Placental estradiol levels were measured using enzyme-linked immunosorbent assay kits. Generalized estimating equation models and robust Poisson regression models were used to examine the associations between BPF exposure and children's neurodevelopment. In the nested case-control study, causal mediation analysis was conducted to assess the role of placental estradiol as a mediator in multivariate models. RESULTS: In the prospective cohort study, the pregnancy-average BPF concentration was positively associated with developmental delays in gross-motor, fine-motor, and problem-solving ( ORtotal ASQ: 1.14(1.05, 1.25), ORgross-motor: 1.22(1.10, 1.36), ORfine-motor: 1.19(1.07, 1.31), ORproblem-solving: 1.11(1.01, 1.23)). After sex-stratified analyses, pregnancy-average BPF concentration was associated with an increased risk of neurodevelopmental delays in the gross-motor (ORgross-motor:1.30(1.12, 1.51)) and fine-motor (ORfine-motor: 1.22(1.06, 1.40)) domains in boys. In the nested case-control study, placental estradiol mediated 16.6% (95%CI: 4.4%, 35.0%) of the effects of prenatal BPF exposure on developmental delay. CONCLUSIONS: Our study supports an inverse relationship between prenatal BPF exposure and child neurodevelopment in infancy, particularly in boys. Decreased placental estradiol may be an underlying biological pathway linking prenatal BPF exposure to neurodevelopmental delay in offspring.

Application of Complete Decongestive Therapy in Patients with Secondary Bilateral Lower Limb Lymphedema after Comprehensive Treatment of Gynecological Malignant Tumor.

Objective: The purpose of this study is to investigate the effect of complete decongestive therapy (CDT), based on fluoroscopy-guided manual lymph drainage (FG-MLD), combined with intermittent pneumatic compression (IPC) on patients with secondary bilateral lower limb lymphedema after comprehensive treatment for gynecological malignant tumors. Methods: After comprehensive treatment for gynecological malignant tumors, 18 patients suffering from bilateral lower limb lymphedema were evaluated and treated by specialist nurses (with the qualification of lymphedema therapists). The treatment course included manual drainage, IPC, bandaging, functional exercise, and skincare etc., which are performed once a day for a total of 18 times. Results: After performing the treatment 18 times, a significant reduction is observed in the patient's bilateral lower limb circumference, extracellular water (ECW) content, and lower limb segment ECW ratio. Moreover, the 50-kHz bioelectrical impedance and quality of life (QoL) scores are found to be significantly higher than before treatment (all p < 0.05). Subjective symptoms also improve significantly (p < 0.05), except for local swelling (p = 0.289 > 0.05). Conclusions: CDT based on FG-MLD, combined with IPC, effectively relieves secondary bilateral lower limb lymphedema after comprehensive treatment of gynecological malignant tumors. It also improves subjective symptoms and patients' QoL, thus deserving clinical reference and promotion.

Association of Early Parent-Child Separation With Multidomain Implications in Adolescence and Emerging Adulthood: A Prospective Cohort Study in China.

PURPOSE: The aim of the study was to explore the long-term impacts of parent-child separation on a broad set of health and well-being indicators during adolescence and emerging adulthood. METHODS: Participants were from the China Family Panel Studies, a national representative prospective cohort, and 2710 adolescents aged 7-15 years recruited from 25 provinces after an 8-year follow-up were eventually included in this study. We examined the association of prolonged parent-child separation with educational, social, emotional, and health-related outcomes by comparing participants with experience of prolonged parent-child separation and their counterparts staying with parents. RESULTS: Participants who experienced prolonged parent-child separation in childhood were more likely to have lower educational attainment (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.03, 2.76; p = .04), depression (OR: 2.63, 95% CI: 1.28, 5.41; p = .008), marriage or cohabitation (OR: 2.79, 95% CI: 1.40, 5.57; p = .004), and ever-smoke (OR: 3.39, 95% CI: 1.95, 5.91; p < .001). Prolonged parent-child separation was also associated with a 0.64-year loss in educational attainment, 2.99- and 2.39-unit decreases in math and word test score, as well as 2.08 kg/m2 decreases in body mass index. DISCUSSION: This nationally representative study indicates that prevention efforts that reduce exposure to parent-child separation in childhood could substantially reduce the lifetime prevalence of educational, emotional, behavioral, and cognitive problems in the general population.

Childhood separation from parents with cognitive and psychopathological outcomes in adolescence.

To examine the effects of childhood parent-child separation with varying duration and form on later cognitive performance and psychopathological problems over a 6-year period, we use data from the China Family Panel Study (CFPS), which is an ongoing, prospective nationally representative study across 25 provinces in China. Of the 4033 children aged 4-10 years followed in 2012, 3522 children with complete data on separation from fathers and mothers were included. In 2018, 2560 participants were followed and interviewed to assess cognitive performance, behavioral problems as well as depressive symptoms at age 10-16 years. A total of 3522 children (mean [SD] age at baseline, 6.9 [2.0] years) were included. About 17.9% and 13.3% had separated from father and mother over 11 months or more in the year prior to the survey. Prolonged separation from parents was associated with lower scores in vocabulary (maternal: adjusted ß = -1.64, P = 0.002; paternal: adjusted ß = -1.58, P < 0.001) and mathematics performance (maternal: adjusted ß = -1.10, P = 0.009; paternal: adjusted ß = -0.94, P = 0.004) over a 6-year period. Prolonged maternal separation was associated with 0.34-point higher internalizing behaviors (P < 0.001) and 0.21-point higher externalizing behaviors (P = 0.009), as well as 0.89-point higher depressive symptoms (P = 0.018), while prolonged paternal separation was associated with 0.23-point higher internalizing behaviors (P = 0.005) and 0.76-point higher depressive symptoms (P = 0.011). The finding demonstrates substantial negative impacts of childhood paternal and maternal separations on cognitive and mental well-being during adolescence, which might be dependent on the "stress-dose" (duration of separation) and urban-rural residence. RESEARCH HIGHLIGHTS: Prolonged parent-child separation is independently associated with cognitive impairment and psychopathological problems during adolescence. The adverse effects of childhood separation on cognition and psychopathology varied by separation duration and separation forms. Age- and residence-specific associations between parent-child separation with cognition and psychopathology are observed.

Intergenerational continuity of parent-child separation among mother-offspring dyads: Implication for child cognitive development in rural China.

The labor migration in China often leads to parent-child separation. Research to date has primarily focused on understanding mental and cognitive outcomes for children exposed to parent-child separation, with little consideration for the cumulative effects of intergenerational continuity of parent-child separation. A total of 2729 children between the ages of 4 and 6, along with one parent (primarily mothers, 86.2%) and/or one primary caregiver (if the child is separated from both parents), were recruited in the rural area of Anhui Province, China. A unique subsample of children (n = 249) with persistent experience of parent-child separation or whose mother reported being left behind by her parents during early childhood were enrolled for cognitive assessment. A total of 239 age-, gender- and residence-matched children without any parent-child separation experience were selected as the control group. Child cognitive performance was examined with the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth edition (WPPSI-IV). The association between intergenerational continuity of parent-child separation and child cognition was described using multivariate OLS regression models. Compared to mother-offspring dyads without any history of parent-child separation, girls (n = 236/450, 52.4%) who experienced the intergenerational continuity of parent-child separation showed a significant decrease of 5.73 points (95% CI: -9.83, -1.62; p = 0.006) on full-scale intelligence quotient (FSIQ) and a decrease of 5.71 points (95% CI: -9.80, 1.63; p = 0.006) on verbal comprehension index. No similar result was observed in boys. The cumulative effects of parent-child separation among mother-offspring dyads on child cognitive development highlight the need for effective early intervention to break the intergenerational cycle of disadvantage. Sex differences and possible epigenetic mechanisms underlying the intergenerational effects of parent-child separation warrant further investigation.

Sex-specific association of exposure to bedroom light at night with general and abdominal adiposity in young adults.

Experimental animal studies and limited epidemiologic evidence among elder population suggest that exposure to light at night (LAN) may be obesogenic. Nevertheless, little is known about the possible impact of bedroom LAN exposure on subsequent adiposity and the distribution pattern of the accumulated fat, especially in younger population. Here, we estimated longitudinal associations of objectively assessed bedroom LAN exposure with general and abdominal adiposity among young adults. We measured 2-night bedroom LAN exposure using a portable illuminometer in a cohort of young adults (n = 482). Body composition using multifrequency bioelectrical impedance analysis was evaluated at baseline and 1-year follow-up visit. Significant increases in fat mass (2.4 kg, P = 0.015 in male; 1.9 kg, P < 0.001 in female), visceral fat area (10.7 cm2, P < 0.001 in male; 5.0 cm2, P = 0.01 in female), waist circumference (3.8 cm, P = 0.039 in male; 2.5 cm, P = 0.047 in female) and percentage of body fat (3.6%, P = 0.002 in male; 3.0%, P = 0.001 in female) were observed among individuals with bedroom LAN higher than 5 lx. Compared to the lowest quartile group of bedroom LAN exposure, the highest quartile group was associated with an increase of 0.64 kg/m2 in BMI (95% CI: 0.18-1.09 kg/m2; P = 0.006) and 1.22 kg increase in fat mass (95% CI: 0.10-2.34 kg; P = 0.025) among female participants, and 10.58 cm2 in visceral fat area (95% CI: 4.85-16.31 cm2; P = 0.001) and 2.59 cm in waist circumference (95% CI: 0.37-4.81 cm; P = 0.023) among male participants. In this cohort of Chinese young adults, significant associations were observed between bedroom LAN exposure and adiposity in a sex- and fat depot-specific fashion. Further intervention and longitudinal studies could help elucidate the actual effects and develop sex-specific strategies against lifetime obesity and related metabolic disorders.

Joint trajectories of life style indicators and their links to psychopathological outcomes in the adolescence.

BACKGROUND: Rapid socio-economic development makes China a unique laboratory for examining how lifestyle changes affect adolescent mental health. This study aims to identify joint trajectories of modifiable lifestyle indicators during pubertal transition and its associations with psychopathological outcomes. METHODS: A cohort of 1974 children aged 7-9 years were recruited in Anhui Province, China during March 2013. The assessment of lifestyle behaviors (screen time, physical activity, sleep duration and beverage intake) and depressive symptoms were conducted from Wave 1 to Wave 4 (2018). Suicide ideation, non-suicidal self-harm (NSSI) and alcohol use were self-reported at Wave 4. Longitudinal trajectories of lifestyle patterns were defined using group-based multi-trajectory models in 2019. RESULTS: Four lifestyle trajectories were identified: persistent healthy (39.9%), suboptimal healthy (25.3%), unhealthy mitigation (17.2%), and persistent unhealthy (17.7%). Compared with persistent healthy group, the risk of subsequent suicide ideation [odds ratio (OR): 2.86, 95%CI: 2.15-3.81], depressive symptoms (OR: 2.16, 95%CI: 1.39-3.35), alcohol use (OR: 2.53, 95%CI: 1.78-3.61) and non-suicidal self-harm (OR: 1.35, 95%CI: 1.09-1.67) was significantly higher in persistent unhealthy group. CONCLUSIONS: This study provided convincing evidence that unhealthy lifestyle trajectory during adolescence is associated with more than two-fold elevated odds for multiple domains of psychopathological outcomes over 5 years.

Inflammatory burden in adolescents with prolonged parent-child separation.

BACKGROUND: Prolonged parent-child separation is associated with a broad array of poor developmental outcomes. A potential pathway may be through changes in inflammatory processes. However, relatively little is known about the relationship between parent-child separation pattern (timing and duration) and inflammatory burden. The aim of this study was to investigate whether parent-child separation since birth is associated with inflammatory burden in adolescents. METHODS: A total of 574 adolescents (mean age 12.07 years, SD: 0.62) were enrolled from rural areas of Chizhou, Anhui Province, China. Parent-child separation was reported mainly by primary caregivers, and other adverse childhood adversities (ACEs) were derived from adolescents semi-structured interview or questionnaire. Blood samples were collected from venepuncture for C-reactive protein (CRP) as well as soluble urokinase plasminogen activator receptor (suPAR). RESULTS: Nearly 40% (232/574) participants experienced parent-child separation, among which more than 1 of 4 persistently separated from both parents since birth. Both CRP and suPAR levels were significantly higher among adolescents persistently separated from both parents, compared with those who did not separate from both parents (CRP: 1.75 vs. 1.36 mg/L, P < 0.001; suPAR: 2.85 ng/mL vs. 2.55 ng/mL, P < 0.001). After adjusted for demographic covariates, body mass index, ACEs as well as parental characteristics, persistent parent-child separation was associated with elevated suPAR (B = 0.30; 95% CI, 0.12-0.48) and CRP (B = 1.34; 95% CI, 1.02-1.75). No similar associations were observed between inflammatory burden with current or early childhood parent-child separation groups. Adolescents who exposed to persistent parent-child separation were more likely to have elevated suPAR levels even if they did not have elevated CRP levels (aOR, 4.26, 95% CI, 1.23-14.80; P = 0.022). CONCLUSION: Elevated inflammatory burden observed in persistent parent-child separation adolescents highlights the need to support children and adolescents undergoing separation from both parents in order to minimize the long-term impact on disease vulnerability.

Sleep quality in preschool children in three provinces along the middle and lower reaches of the Yangtze River / 中国学校卫生

Objective@#To analyze the detection rate of sleep problems such as sleep delay and deficiency in preschool children in the middle and lower reaches of the Yangtze River in China,and to provide the reference for the standard of sleeping mode among preschool students.@*Methods@#From October to November 2017, a questionnaire survey was conducted among 27 200 preschool children in 11 cities in Hubei, Anhui and Jiangsu provinces in the middle and lower reaches of the Yangtze River in China. Epidemiology of sleep delays, deficiencies and sleep patterns in preschool children was described.@*Results@#The detection rate of sleep problems in preschool children in the middle and lower reaches of the Yangtze River was 15.3%. Taking the length of sleep and bedtime as the main analysis points, it was found that the average sleeping time point of each age group was 21:31, and the detection rate of bedtime delay was 86.5%. The average length of sleep was (10.60±1.12) hours. The detection rate of sleep deprivation in preschool children was 15.7%. Sleep delay was positively correlated with girls, age increase and parents’ higher educational level (P<0.05), and negatively correlated with living in the city, non-only child and bedroom without TV (P<0.01) .The detection rate of sleep deprivation was positively correlated with children of high age group (4yearold group：OR=1.32，95%CI=1.19-1.46；5-year-old group：OR=2.10，95%CI=1.91-2.32；6-year-old group：OR=2.47，95%CI=2.20-2.77)(P<0.01), and negatively correlated with no TV in bedroom (OR=0.91，95%CI=0.84-0.98) and no light in sleep (OR=0.87，95%CI=0.78-0.97)(P<0.05).@*Conclusion@#Preschool children sleep delay and sleep deprivation and other sleep problems are more prominent, affected by family environment and other factors.

[A prospective study on the current status of repeated injuries and its risk factors in middle school and college students].

OBJECTIVE: To examine the epidemiological features and relative risk factors of repeated injuries among middle, high and college students in Ma'anshan city of Anhui province. METHODS: A prospective study on repeated injuries for 1-year follow-up period was carried out among 1494 students from 3 middle schools or colleges. Risk factors for repeated injuries were analyzed with multivariate logistic regression model. RESULTS: 799 students suffered 1639 episodes of injuries, with an incidence rate of 53.48%. The repeated group consisted of 200 students who suffered 854 injuries, accounted for 52.10% among the total injuries. RESULTS: from Multi-normal logistic regression analysis showed that male, number of family members of 4 or over, extraversion of character trait, and upper quartile of self-rating anxiety symptoms were the risk factors for the occurrence of repeated injuries. Moderate or well-of family income, mothers with senior high school education, and upper quartile of self-rating depression symptoms were protective factors for repeated injuries. CONCLUSION: Socio-demographic factors and emotional status may predict the occurrence of repeated injuries that called for further study.

[Influence of retrospective time period on reliability of epidemiological survey to injuries].

OBJECTIVE: To analyze the influence of different recall time periods on epidemiological survey of injuries among children and adolescents. METHODS: A study on injuries for 12 months follow-up period was actively surveyed among 4523 pupils selected by cluster sampling from 12 kindergartens, 1 elementary school, 1 junior high school, 1 senior high school and 1 college in Maanshan city in November, 2007 to November, 2008. Injury events were actively surveyed by school doctors or class health workers simultaneously. Participants were divided into three groups, the first group including self-reported injuries by 3-months interval, the second group with self-recalled injuries by 6-months interval and the third group with self-reported injuries in the past 12 months. Validity and reliability of injuries between surveillance injuries and retrospective injuries were compared. RESULTS: The overall rate of injury events was 74.2% and injury events and rate was higher in boys than that in girls (P < 0.01), In total, 6350 injury events were registered for the survey. Compare with surveillance findings, the injury rate declined 0.02% and the number of injuries had a 19 person/time reduction from the retrospective injuries by 3-months interval. The injury rate declined 0.02% and number of injuries reduced 58 person/times from the survey of retrospective injuries by 6-month interval. The rate of injuries declined 8.8% and frequencies had a 505 reduction from data of self-reported injuries in the past 12 months. The largest declines were found for the 3 to 6 year-old age group and for minor injuries. CONCLUSION: The 12-month recall period on underestimate injury rates was compared to the 3-month recall periods and 6-month recall periods. Recall periods of 6 months were recommended to be used in injury survey in children and adolescents.