In this cross-sectional study of 540,667 adult hospitalized patients with COVID-19, 94.9% had at least 1 underlying medical condition. Hypertension and disorders of lipid metabolism were the most frequent, whereas obesity, diabetes with complication, anxiety disorders, and the total number of conditions were the strongest risk factors for severe COVID-19 illness. What are the implications for public health practice?Preventing COVID-19 in populations with these underlying conditions and multiple conditions should remain a public health priority, with targeted mitigation efforts and ensuring high uptake of vaccine, when available, in these individuals and their close contacts.

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BackgroundSedentary behaviours (television, video and computer) are related to health outcomes independent of physical activity. Few studies have examined trends and correlates of sedentary behaviours among youth in developing nations. The current study is to examine temporal trends in sedentary behaviours and recent correlates of screen use in Chinese children during a period of economic transition.MethodsSecondary analysis of China Health and Nutrition Surveys. Cross-sectional data on sedentary behaviours including screen use among children aged 6-18 years from four surveys in 1997 (n = 2,469), 2000 (n = 1,838), 2004 (n = 1,382) and 2006 (n = 1,128). Temporal trends in screen use by socio-demographic characteristics were examined. The correlates of spending more than 2 hours per day on screen time in the most recent survey data (2006, n = 986) were analysed using survey logistic regression analysis.ResultsDaily screen time significantly increased in each subgroup by age, sex and urban/rural residence, with the largest increase for urban boys aged 13-18 years from 0.5 hours to 1.7 hours, and for rural boys aged 6-12 years from 0.7 hours to 1.7 hours (p < 0.0001). Daily time in both homework and extracurricular cultural activity increased significantly from 2000 to 2004 but was stable from 2004 to 2006. Boys (OR: 1.41, 95%CI: 1.09 -1.82), having a TV in the bedroom (OR: 1.86, 95%CI: 1.15 - 3.01), having access to internet at home (OR: 1.93, 95%CI: 1.12 - 3.31) or at internet cafés (OR: 2.01, 95%CI: 1.21 - 3.34), or often watching TV with parents (OR: 2.27, 95%CI: 1.37 - 3.74) were all associated with being more likely to be high screen users (≥ 2 hours/day). While children aged 13-18 years (OR: 0.67, 95%CI: 0.46-0.97) were less likely to be high screen users. Children whose parents often have rules on their TV viewing (OR: 0.64, 95%CI: 0.37 - 1.10) were slightly but not significantly less likely to be high screen users.ConclusionThis study confirms sedentary behaviour has increased over the last decade in Chinese children. Efforts to ensure Chinese youth meet screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time and to set limits on their child's screen time.

BackgroundEfforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component.MethodsFirst, completed home-, community-, and school-based trials involving minority or low-income children aged 2–17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information.ResultsOur final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size.ConclusionsVariable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted.

The purpose of the present study was to evaluate the effect of the Happy 10 programme on the promotion of physical activity, physical growth and development of primary school students, and on obesity control and prevention. Two similar primary schools from one district of Beijing, China were selected, one as an intervention school and the other as a control school. A Happy 10 programme was implemented at least once every school day in the intervention school for two semesters, whereas no intervention was adopted in the control school. The information on energy expenditure and duration of physical activity was collected by a validated 7-day physical activity questionnaire. Height and weight were measured by the trained investigators following standardized procedure. Energy expenditure and intensity of each Happy 10 session were measured by a physical activity monitor. The average energy expenditure and duration of total physical activity per day among students in the intervention school increased significantly from 15.0 to 18.2 kcal kg(-1) and 2.8 to 3.3 h, respectively, whereas the figures significantly decreased in the control school. There was a significant difference in change of weight and body mass index between girls in the intervention and control school (2.4 kg vs. 4.6 kg; 0.47 kg m(-2) vs. 0.66 kg m(-2)). The prevalence of overweight and obesity in the intervention school decreased by 0.4-5.6%, as compared with the increase by 0.6-4.5% in the control school. The average energy expenditure and intensity per 10-min session ranged from 25.0 to 35.1 kcal and from 4.8 to 6.2 kcal kg(-1) h(-1), respectively, in grades 1-5. The Happy 10 programme provides a useful strategy to promote physical activity among school children, and also plays a positive role in building up physical growth and development of girls.

The prevalence of overweight and obesity among Chinese children and adolescents has increased steadily over the past 15 years with the increase being apparent in all age, sex and income groups. However, the most noticeable increase was in children from urban areas and those from higher income backgrounds.

Few studies have examined nutrition transition in children in China. Our aim, in the present study, was to examine temporal trends in dietary energy, fat, carbohydrate and protein intake in Chinese children aged 7–17 years. The analysis used individual level, consecutive 3 d dietary recall data from seven rounds of the China Health and Nutrition Surveys in 1991 (n 2714), 1993 (n 2542), 1997 (n 2516), 2000 (n 2142), 2004 (n 1341), 2006 (n 1072) and 2009 (n 996). Mixed-effect models were constructed to obtain adjusted means and to examine trends after adjusting for intra-class correlation within clusters and for covariates including age, sex, urban/rural residence and income. From 1991 to 2009, daily energy intake steadily declined from 9511·0 to 7658·2 kJ (P < 0·0001). There was a steady decline in daily carbohydrate intake from 382·5 to 254·1 g (P < 0·0001), and in the proportion of energy from carbohydrate from 66·7 to 56·8 % (P < 0·0001). In contrast, daily fat intake steadily increased from 54·8 to 66·0 g (P < 0·0001), as did the proportion of energy from fat from 21·5 to 30·0 % (P < 0·0001). The proportion of children who consumed a diet with more than 30 % of energy from fat increased from 20·1 to 49·4 % (P < 0·0001). The proportion of energy from protein increased from 11·8 to 13·1 % (P < 0·0001), although daily protein intake dropped from 66·2 to 58·0 g (P < 0·0001). Our data suggest that Chinese children have been undergoing a rapid nutrition transition to a high-fat diet.

BackgroundCryptosporidium spp. are zoonotic parasites responsible for diarrhoeal diseases in animals and humans worldwide. Cattle are the most common mammalian species in which Cryptosporidium is detected, with pre-weaned calves considered to be reservoirs for zoonotic C. parvum. In October 2013, severe diarrhoea was observed in 396 pre-weaned calves at a farm in the Ningxia Autonomous Region of Northwestern China. 356 of the infected calves died despite antibiotic therapy.Findings252 faecal samples were collected from the investigated farm. The identity of Cryptosporidium species was determined by polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) analysis, and by DNA sequence analysis of the small subunit (SSU) rRNA gene. C. parvum was subtyped using sequence analysis of the 60 kDa glycoprotein (gp60) gene. The highest infection rate of 83.3% (40/48) was seen in 2–3-week-old calves with diarrhoea, corresponding to the age at which animals died. Three Cryptosporidium species were identified, including C. parvum (n = 51), C. bovis (n = 1), and C. ryanae (n = 1). All C. parvum isolates were further identified as subtype IIdA15G1.ConclusionsCryptosporidium parvum was likely to be most responsible for diarrhoea and death. This is the first report of a cryptosporidiosis outbreak caused by C. parvum IIdA15G1 in Chinese dairy cattle.