This study aimed to determine the levels of health-related behaviours (physical activity, screen exposure and sleep status) among Chinese students from primary, secondary and high schools during the pandemic of COVID-19, as well as their changes compared with their status before the pandemic. A cross-sectional online survey of 10,933 students was conducted among 10 schools in Guangzhou, China, between 8th and 15th March, 2020. After getting the informed consent from student’s caregivers, an online questionnaire was designed and used to obtain time spending on health-related behaviours during the pandemic of COVID-19, as well as the changes compared with 3 months before the pandemic, which was completed by students themselves or their caregivers. Students were stratified by regions (urban, suburban, exurban), gender (boys and girls), and grades (lower grades of primary school, higher grades of primary schools, secondary schools and high schools). Data were expressed as number and percentages and Chi-square test was used to analyse difference between groups. Overall, the response rate of questionnaire was 95.3% (10,416/10,933). The median age of included students was 13.0 (10.0, 16.0) years and 50.1% (n = 5,219) were boys. 41.4%, 53.6% and 53.7% of total students reported less than 15 min per day in light, moderate and vigorous activities and 58.7% (n = 6,113) reported decreased participation in physical activity compared with the time before pandemic. Over 5 h of screen time spending on online study was reported by 44.6% (n = 4,649) of respondents, particular among high school students (81.0%). 76.9% of students reported increased screen time compared with the time before pandemic. Inadequate sleep was identified among 38.5% of students and the proportion was highest in high school students (56.9%). Our study indicated that, during the COVID-19 pandemic, the school closure exerted tremendous negative effects on school-aged children’s health habits, including less physical activity, longer screen exposure and irregular sleeping pattern.

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ObjectivesTo quantify the burden and variation trends of cancers in children under 5 years at the global, regional, and national levels from 1990 to 2019.MethodsEpidemiological data for children under 5 years who were diagnosed with any one childhood cancer were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2019. The outcomes were the absolute numbers and rates of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for different types of cancer.ResultsIn 2019, 8,774,979.1 incident cases (95% uncertainty interval [UI]: 6,243,599.2 to11,737,568.5) and 8,956,583.8 (6,446,323.9 to 12,364,520.8) prevalent cases of cancer in children under 5 years were identified worldwide; these cancers resulted in 44,451.6 (36,198.7 to 53,905.9) deaths and 3,918,014.8 (3,196,454.9 to 4,751,304.2) DALYs. From 1990 to 2019, although the numbers of incident and prevalent cases only decreased by −4.6% (−7.0 to −2.2) and −8.3% (−12.6 to −3.4), respectively, the numbers of deaths and DALYs clearly declined by −47.8% (−60.7 to −26.4) and −47.7% (−60.7 to −26.2), respectively. In 2019, the middle sociodemographic index (SDI) regions had the highest incidence and prevalence, whereas the low SDI regions had the most mortality and DALYs. Although all of the SDI regions displayed a steady drop in deaths and DALYs between 1990 and 2019, the low-middle and low SDI regions showed increasing trends of incidence and prevalence. Leukemia remained the most common cancer globally in 2019. From 1990 to 2019, the burdens of leukemia, liver cancer, and Hodgkin's lymphoma declined, whereas the incidence and prevalence of other cancers grew, particularly testicular cancer.ConclusionsThe global childhood cancer burden in young children has been steadily decreasing over the past three decades. However, the burdens and other characteristics have varied across different regions and types of cancers. This highlights the need to reorient current treatment strategies and establish effective prevention methods to reduce the global burden of childhood cancer.

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ObjectivesNon-alcoholic fatty liver disease (NAFLD) greatly affects cardiovascular disease, but evidence on the associations between NAFLD and markers of aortic calcification is limited. We aim to evaluate the association between NAFLD and aortic calcification in a cohort of Chinese adults using propensity score-matching (PSM) analysis.MethodsThis prospective cohort study involved adults who underwent health-screening examinations from 2009 to 2016. NAFLD was diagnosed by abdominal ultrasonography at baseline, and aortic calcification was identified using a VCT LightSpeed 64 scanner. Analyses included Cox proportional-hazards regression analysis and PSM with predefined covariates (age, gender, marital and smoking status, and use of lipid-lowering drugs) to achieve a 1:1 balanced cohort.ResultsOf the 6,047 eligible participants, 2,729 (45.13%) were diagnosed with NAFLD at baseline, with a median age of 49.0 years [interquartile range, 44.0–55.0]. We selected 2,339 pairs of participants with and without NAFLD at baseline for the PSM subpopulation. Compared with those without NAFLD, patients with NAFLD were at a higher risk of developing aortic calcification during follow-up; significant results were observed before and after matching, with the full-adjusted hazard ratios and corresponding 95% confidence intervals being 1.19 (1.02–1.38) and 1.18 (1.01–1.38), respectively (both p < 0.05). In subgroup analyses, no interaction was detected according to age, gender, smoking status, body mass index, total cholesterol, low-density lipoprotein cholesterol, use of lipid-lowering drugs, hypertension, or type 2 diabetes.ConclusionsNAFLD may be independently associated with aortic calcification. Further studies are warranted to elucidate the possible underlying mechanisms.

Purpose: The main objective of the study was to translate, validate, and compare the Chinese ORTO scales (ORTO-15 and ORTO-R). The secondary objective was to assess factors that may be related with risk of orthorexia nervosa (ON). Methods: Two cross-sectional surveys were conducted on March-to-June 2021 for ORTO-15) and April 2022 (ORTO-R). ORTO questionnaires were translated into Chinese using the forward–backward–forward method. Exploratory factor analysis, discriminant validity and confirmatory factor analysis (CFA) were used to examine the construct validity of the assessment questionnaires. The internal consistency was assessed by using the Cronbach alpha coefficient and the test-retest reliability. Multivariate linear regression analysis was used to explore potential impact factors related with ON scores. Results: Totally, 1289 and1084 eligible participants were included for the study of ORTO-15 and ORTO-R, with the mean age of 20.9±2.0 years and 21.0±2.3 years. The internal consistency of Chinese ORTO-15 scale and ORTO-R scale were both satisfactory (α=0.79, ICC=0.79; α=0.77, ICC=0.82). A two-factor solution of ORTO-R was characterized by acceptable goodness-of-fit, whereas the three-factor solution of ORTO-15 showed relatively poor fit. Multivariate linear regression indicated that physical activities and mental disorders were positively associated with ON risk assessed by both ORTO-R and ORTO-15. Conclusion: The Chinese ORTO-R scale were a more reliable tool to screen for ON tendencies than the Chinese version of ORTO-15. Mental disorders and physical activities might be associated with the increased ON risk.Level of evidence Level V (descriptive cross-sectional study).

Purpose: The main objective of the study was to translate, validate, and compare the Chinese ORTO scales (ORTO-15 and ORTO-R). The secondary objective was to assess factors that may be related with risk of orthorexia nervosa (ON). Methods: Two cross-sectional surveys were conducted on March-to-June 2021 for ORTO-15) and April 2022 (ORTO-R). ORTO questionnaires were translated into Chinese using the forward-backward-forward method. Exploratory factor analysis, discriminant validity and con rmatory factor analysis (CFA) were used to examine the construct validity of the assessment questionnaires. The internal consistency was assessed by using the Cronbach alpha coe cient and the test-retest reliability. Multivariate linear regression analysis was used to explore potential impact factors related with ON scores.Results: Totally, 1289 and1084 eligible participants were included for the study of ORTO-15 and ORTO-R, with the mean age of 20.9±2.0 years and 21.0±2.3 years. The internal consistency of Chinese ORTO-15 scale and ORTO-R scale were both satisfactory (α=0.79, ICC=0.79; α=0.77, ICC=0.82). A two-factor solution of ORTO-R was characterized by acceptable goodness-of-t, whereas the three-factor solution of ORTO-15 showed relatively poor t. Multivariate linear regression indicated that physical activities and mental disorders were positively associated with ON risk assessed by both ORTO-R and ORTO-15. Conclusion:The Chinese ORTO-R scale were a more reliable tool to screen for ON tendencies than the Chinese version of ORTO-15. Mental disorders and physical activities might be associated with the increased ON risk.Level of evidence Level V (descriptive cross-sectional study).