Background Newborn telomere length is considered as an effective predictor of lifespan and health outcomes in later life. Selenium is an essential trace element for human health, and its antioxidation is of great significance for the prevention of telomere erosion. Methods We recruited 746 mother–newborn pairs in Wuhan Children’s Hospital between 2013 and 2015. Urine samples were repeatedly collected at three time points during pregnancy, and umbilical cord blood samples were collected right after parturition. Urinary selenium concentration was detected using inductively coupled plasma mass spectrometry, and newborn telomere length was measured using quantitative real-time polymerase chain reaction. We applied general estimating equations to examine the trimester-specific association between maternal urinary selenium during pregnancy and newborn telomere length. Results The median of creatinine-corrected selenium concentrations during pregnancy were 16.29, 18.08, and 18.35 μg/g·creatinine in the first, second, and third trimesters, respectively. Selenium concentrations in all the three trimesters were significantly associated with newborn telomere length. Per doubling of maternal urinary selenium concentrations was associated with 6.44% (95% CI: 0.92, 12.25), 6.54% (95% CI: 0.17, 13.31), and 6.02% (95% CI: 0.29, 12.09) longer newborn telomere length in the first, second, and third trimesters, respectively, after adjusting for potential confounders. Conclusions This is the first study to provide evidence for the effect of maternal selenium levels on fetal telomere erosion. Findings from our study suggested that maternal urinary selenium was positively associated with newborn telomere length, indicating that intrauterine selenium exposure might have effect on initial setting of human telomere length.

Background: Growing evidence suggested that lifestyle factors including dietary habits may influence the telomere length which is a reliable marker of biological aging and predictor for chronic diseases. However, the role of dietary selenium intake in telomere length maintenance is rarely examined. Objective: We aimed to test the relationship between dietary selenium intake and telomere length among middle-aged and older adults in America. Methods: A total of 3194 United States adults older than 45 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) in 1999-2000 and 2001-2002. Leukocyte telomere length was measured using the quantitative real-time polymerase chain reaction (qPCR). Dietary selenium intake was assessed by a trained interviewer using 24-h dietary recall method. Generalized linear models were performed to evaluate the association of dietary selenium intake with telomere length. The restricted cubic spline analysis was used to further explore the nonlinear dose-response relationship between dietary selenium intake and telomere length. Results: After adjusting potential confounders, every 20 jig increase in dietary selenium intake was associated with 0.42% (95% CI: 0.02%, 0.82%) longer telomere length in all participants. In the subgroup analyses, dietary selenium intake was related to longer telomere length in females (Percentage change: 0.87%; 95% CI: 0.26%, 1.49%) and non-obese participants (Percentage change: 0.53%; 95% CI: 0.04%, 1.02%), but not in males (Percentage change: 0.04%; 95% CI: -0.49%, 0.57%) and obese participants (Percentage change: 0.21%; 95% CI: -0.47%, 0.91%). The restricted cubic spline analysis showed a linear association between dietary selenium intake and telomere length. Conclusions: This study indicated that the increased dietary selenium intake was associated with longer telomere length among middle-aged and older adults in America. These findings require further corroboration from future prospective studies. (C) 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Context: Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence regarding the association between higher glycated hemoglobin A1c (HbA1c) within the normal range and adverse birth outcomes is limited. Objective: We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. Design and Setting: The data were abstracted from the Information System of Guangdong Women and Children Hospital, China, from September 2014 to March 2018. Patients: A total of 5658 pregnant women with normal gestational HbA1c were included in this analysis. Main Outcome Measures: The adverse birth outcomes include preterm birth, macrosomia, and large for gestational age (LGA). Results: Among 5658 subjects, the rates of preterm birth, macrosomia, and LGA were 4.6% (261/5658), 3.5% (200/5658), and 5.7% (325/5658), respectively. The results of multivariate logistic regression model showed that each 1% increase in maternal HbA1c was positively associated with increased risks of preterm birth (OR 1.58; 95% CI, 1.08-2.31), macrosomia (OR 1.70; 95% CI, 1.10-2.64), and LGA (OR 1.38; 95% CI, 0.98-1.96). The association between gestational HbA1c and preterm birth was more evident among women with prepregnancy body mass index (BMI) <= 24 kg/m(2). Conclusions: Gestational higher HbA1c level within the normal range is an independent risk factor for preterm birth, macrosomia, and LGA. Intervention for reducing HbAc1 may help to prevent adverse birth outcomes.

Background: Prior studies have suggested exposure to heavy metals and endocrine disrupting chemicals could disturb the homeostasis of thyroid stimulating hormone (TSH), but no epidemiology study concerning the influence of rare earth elements (REE) exposure during pregnancy on neonatal TSH levels. The present study aimed to investigate the relationships between prenatal REE exposure and neonatal TSH levels. Methods: A total of 7367 pregnant women were recruited from Wuhan Children's Hospital between September 2012 and October 2014 in Wuhan, China. Urinary concentrations of cerium (Ce), and ytterbium (Yb) were measured by inductively coupled plasma mass spectrometry (ICP-MS). Immunofluorescence assay was used to detect neonatal TSH levels. The associations between REE exposure and neonatal TSH levels were evaluated using multivariate linear regression models. Results: The geometric means of maternal urinary Ce and Yb concentrations were 0.060 mu g/g creatinine and 0.025 mu g/g creatinine, respectively. The results showed that per doubling of maternal urinary Ce and Yb were associated with 4.07% (95% CI: -5.80%, -2.31%), 5.13% (95% CI: -6.93%, -3.30%) decreased neonatal TSH levels respectively in the adjusted model. Sex stratified analysis demonstrated that the decreased neonatal TSH levels were observed both in male infants and female infants, and the decrease was greater in male infants in urinary Ce. There were no significant interactions between maternal urinary Ce, Yb and infant sex (Ce: P for interaction = 0.173, Yb: P for interaction = 0.967). Conclusions: Our findings demonstrated that increased maternal urinary Ce and Yb were associated with decreased neonatal TSH levels. Further researches from different populations are warranted to verify the association and to explore the mechanisms.

Background: Arsenic (As) is a widely distributed environmental chemical with potentially different toxicities. However, little is known about the impact of maternal As exposure on newborn mitochondrial DNA copy number (mtDNAcn), which may lie on the pathway linking As exposure to adverse health impacts. Objectives: We aimed to explore whether maternal As exposure was associated with newborn mtDNAcn. Methods: We conducted a birth cohort study of 762 mother-infant pairs in Wuhan, China, 2013-2015. Cord blood mtDNAcn was determined using qPCR. Maternal urinary As levels in each trimester were quantified by ICP-MS. Multiple informant models were used to examine the associations of repeated urinary As levels with cord blood mtDNAcn. Results: The median urinary As levels in the first, second, and third trimesters were 17.2 mu g/L, 16.0 mu/L, and 17.0 mu g/L, respectively. In the multivariate model, each doubling increase in the first-trimester urinary As level was associated with a 6.6% (95% CI: -12.4%, -0.5%) decrease in cord blood mtDNAcn. The highest versus lowest quintile of first-trimester urinary As level was associated with a 19.0% (95% CI: -32.9%, -2.2%) lower cord blood mtDNAcn. No significant associations of urinary As levels in the second and third trimesters with cord blood mtDNAcn were observed. The inverse relationship between first-trimester urinary As level and cord blood mtDNAcn was more pronounced among female infants. Conclusions: First-trimester As exposure was related to decreased cord blood mtDNAcn. The potential health impacts of decreased mtDNAcn in early life need to be further clarified. (C) 2019 Elsevier Ltd. All rights reserved.

Objective To explore the motor development and how it is influenced by gestational age and birth weight in children with autism,and provide evidence for the applications of motor development in the early diagnosis of autism. Methods A 1 ∶ 1 matched case-control study was conducted between 2012 and 2014. A total of 396 children under 5 years old with autism were enrolled in this study,their counterparts were healthy children 3 month younger/ older and with the same gender and residence. Guardians of partici-pants were investigated using self-designed childhood psychological and behavioral development and related factors questionnaire. EpiData 3. 0 software was used to establish the data base and SAS 9. 4 software was used for data analysis. Results 396 pairs were enrolled in this study which including 342 pairs of boys (86. 3%) and 54 pairs of girls(13. 7%),the gender ratio was 6. 33 ∶ 1; The average month age of case group was (39. 44±11. 99) months and (39. 96±12. 24) months for the control group. There was no signifi-cant difference observed in the distribution of birth weight(χ2=3. 888,P=0. 140) and gestational age specif-ic birth weight(χ2=0. 462,P=0. 794)between two groups. But the distribution of gestational age was signifi-cantly different(χ2=9. 476,P=0. 009) . Children with autism have significant delaying in motor develop-ment compared with healthy children at same age,which including head lifting(3. 50(1. 00) month),rolling (6. 00(3. 50)month),sitting(8. 00(2. 50)month),etc. Preterm birth could have an effect on head lifting, rolling and sitting in children with autism,and also was the risk factor of delaying occurrence of head lifting (OR=2. 911,95%CI=1. 491-5. 681);Small for gestational age( SGA) was also a risk factor of delaying in walking(OR=1. 703,95%CI=1. 053-2. 754). Conclusion Evident delaying of motor development is ob-served among children with autism. Both preterm and SGA are risk factors for delayed motor development. Thus,early recognization of abnormities in motor development should raise awareness among caregivers and children care workers and assist in early diagnosis of children with autism.

目的 探究围孕期相关因素与儿童孤独症的关系,为孤独症的防治提供依据.方法 选取2013-2015年武汉市两所医疗卫生机构中确诊的180例武汉市孤独症患儿,采用1∶3配对病例对照研究方法,选择与病例匹配的540例武汉市健康儿童.采用自行设计的《儿童心理行为发育及相关因素调查表》对儿童的主要监护人进行问卷调查.使用Epidata 3.1软件录入数据,利用SPSS 24.0软件对数据进行统计分析.结果 儿童孤独症与母亲孕期精神压力(OR=20.118,95％CI:9.812～60.696)、过期妊娠(OR=7.379,95％ CI:1.328～40.985)、孕期患病(OR=2.876,95％ CI:1.528～5.414)、孕前超重/肥胖(OR=2.309,95 ％CI:1.184～4.501)、不良孕产史(OR=1.678,95％CI:1.056～2.665)、新生儿窒息/缺氧(OR=4.624,95％CI:1.416～15.105)、父亲生育年龄≥30岁(OR=2.712,95％CI:1.711～4.299),父亲大专/本科及以上学历(OR=6.511,95％CI:3.878～10.931)有关.结论 围孕期的多种因素在儿童孤独症的发生发展中起到一定作用,积极做好围孕期保健,减少这些因素的发生有助于降低孤独症风险.

Objective To examine the status and influence factors of mental health among rural left-behind school children.Methods With convenience sampling,1 925 pupils of grade 6,junior and high school students were recruited from 6 primary and high schools at two towns of Macheng municipality of Hubei province and were self-administered anonymously with a general questionnaire,Health Kids Resilience Assessment (HKRA),and Mental Health Inventory of Middle-School Students (MMHI-60) in September 2012.Results The total MMHI-60 score was 128.58 ± 39.25 for the 725 (37.66％ of all students surveyed) left-behind school children and 127.76 ±37.2 for the 1 200 (62.34％) non-leftbehind school children,without significant difference.The left-behind school children identified with mental health problems showed significantly lower MMHI-60 total score and domain scores than the non-left-behind school children (P ≤0.05 for all),except for scores of social ability and goal and ambition domain.Among the left-behind school children,those not missing their parents had a lower mental health status,with the highest MMHI-60 total score (153.58 ±44.88),and those presenting positive attitude towards their parents' migrant working had a better mental health status,with the lowest MMHI-60 total score (121.18 ± 38.04).The MMHI-60 total score differed among the left-behind school children with different amount of monthly pocket money and those with the monthly pocket money of less than 50 RMB yuan had the lowest MMHI-60 total score (125.53 ± 41.19),suggesting that they had a better mental health status.Multivariate analyses showed that grade of study,the attitude towards their parents' migrant working,and psychological resilience were major influencing factors for mental health among the left-behind school children.Conclusion Psychological resilience is a protective factor for mental health;whereas,being at higher grade of study and negative attitude towards their parents' migrant working are risk factors for mental health among rural left-behind school children.

Background: Childhood trauma has been regarded as a risk factor for adolescent depression. Resilience has been found to be a protective factor for adolescent mental health. However, it is not clear about the role of resilience in the relationship between childhood trauma and depression.Methods: School attending adolescents (n=6406) aged 9-17 years were drawn from five primary schools, three middle schools and two high schools in Wuhan city of China in 2015. The participants were invited to complete self-report questionnaires, including demographics, childhood trauma, resilience and depressive symptoms.Results: Resilience played a partially mediating role in the relationship between childhood trauma and depressive symptoms. Resilience also moderated the association of childhood trauma with depressive symptoms.Limitation: The limitations of this study include cross-sectional study and self- reported instruments.Conclusions: We conclude that resilience may play an important role in the relationship between childhood trauma and depressive symptoms. Our results suggest that enhancing resilience may provide new possibilities for prevention and intervention of depression in adolescents.

Objective:To investigate the current situation of depressive symptoms among adolescents in Wuhan city and explore the association among childhood trauma,resilience and depressive symptom.Methods:Totally 5906 students were chosen from 5 primary schools,3 middle schools and 2 high schools in Wuhan.The Childhood Trauma Questionnaire (CTQ) was used to evaluate childhood trauma experience,the Connor-Davidson Resilience Scale (CD-RISC) and the Center for Epidemiological Studies Depression Scale (CES-D) were used to assess resilience level and depressive symptoms respectively.Results:The rates of depressive symptoms and childhood trauma were 16.1％ (953/5906) and 32.4％ (1915/5906).The subjects with experience of childhood trauma (n =1915) showed higher CES-D scores lower CD-RISC scores and each factor scores compared with those without experience of childhood trauma (n =3991).Multivariate logistic regression analysis showed that the experience of childhood trauma (OR =2.81,95％ CI:2.41-3.29) was risk factor for depressive symptoms.Resilience (51 ≤ CD-RISC ≤ 63:OR =0.53,95 ％ CI:0.44-0.64;64 ≤ CD-RISC ≤ 77:OR =0.32,95 ％ CI:0.26 ～ 0.39;78 ≤ CD-RISC ≤ 100:OR =0.17,95％ CI:0.13-0.22) was protective factor for depressive symptoms.Conclusion:The adolescences with experience of childhood trauma are more likely to suffer from depressive symptoms.Resilience may be a protective factor for depressive symptoms.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解湖北省武汉市青少年抑郁和早期应激现状,探讨早期应激与抑郁的关系。方法整群抽样选取武汉市6所中小学校共2 888名学生,利用自编一般情况问卷、儿童抑郁症状量表（CDI）和儿童期虐待自评量表（PRCA）进行调查。结果武汉市青少年抑郁检出率为14.3%,性别和年级间抑郁检出率差异无统计学意义,父亲和母亲文化程度较低以及有抑郁家族史青少年抑郁的检出率较高;早期应激总检出率为51.9%,男生（56.6%）高于女生（46.1%）,差异有统计学意义（χ²=31.416,P&lt;0.01）;除忽视外,男生在躯体虐待（64.4%）、情感虐待（57.6%）、性虐待（72.3%）的检出率均高于女生的35.7%、42.4%、27.7%（χ²=42.493、6.430、10.537,均P&lt;0.01）;抑郁组早期应激检出率为83.0%,高于非抑郁组的63.4%（χ²=54.46,P&lt;0.01,OR=2.277,95%CI=1.822².845）;非条件多因素logistic逐步回归控制人口学特征因素后分析显示,影响抑郁的因素以及与抑郁关联强度由大到小依次为父亲文化程度为小学（OR=2.429,95%CI=1.384⁴.265）、忽视（OR=1.911,95%CI=1.468².488）、情感虐待（OR=1.742,95%CI=1.325².291）、躯体虐待（OR=1.443,95%CI=1.117¹.839）。结论早期应激与青少年抑郁密切相关,躯体虐待、情感虐待和忽视是青少年抑郁的危险因素。</span>

目的 探讨母亲孕期危险因素与子代孤独症的关系.方法 运用Stata10.0软件对2005～2013年国内外发表的有关孤独症孕期影响因素的文献进行Meta分析,通过异质性检验并计算合并优势比值(OR)及95％可信区间(CD,评估发表偏倚并进行敏感性分析.结果 共有23篇文献入选,包括病例组5 619例,对照组140 056例.孕期的7个危险因素合并OR值及95％CI为:孕期反应2.80(1.28～6.41)、孕妇年龄(＞35岁)1.58(1.32～1.91)、孕期疾病史3.35(2.53～4.44)、孕期药物史2.52(1.52～4.19)、先兆流产4.76(3.18～7.14)、胎龄异常3.75(2.95～4.77)、孕期接触有害物质2.12(1.53～3.00).结论 母孕期患病或服药、先兆流产、早产或过期产和接触有害物质等与子代孤独症有较强相关性.

通过对某医学院大学三年级护理系部分学生进行Sandwich教学法授课,采用课后考试、问卷调查以及小组访谈等方法实证研究评价Sandwich教学法的学习效果.研究显示Sandwich教学法对学生学习能力、言语表达及综合能力等有较好的促进和培养作用,学习效果可保证,通过改进Sandwich教学法可提升学习质量.

为建立中小城市外来人口的传染病预防控制策略提供依据，笔者调查荆州市、黄冈市、宜昌市城区外来人口传染病防治资料。得到结果：外来人口传染病发病人员市内流动占95.53%。98.6%本地居民和97.4%外来人口愿意接受上门预防接种服务；55.64%以上的外来人口赞成传染病防治知识宣传方式以医生为主。外来人口患病后回家探亲期间容易造成传染病远距离传播，疫情报告方式直接影响流动人口疾病的管理。外来人口的传染病预防和治疗应该纳入本地人口的医疗管理体制。

OBJECTIVE:To explore the relationship between mothers' body mass index (BMI) before pregnancy or weight gain during pregnancy and autism in children.METHODS:From 2013 to 2014, the 181 children with autism and 181 healthy children matched by sex and age from same area were included in this study. According to mothers' BMI before pregnancy, the selected cases were divided into 3 groups: low, normal and high group. Then 3 groups were divided into 3 subgroups based on mother' s weight gain during pregnancy: low, normal and high group, according to the recommendations of Institute of Medicine. Logistic regression analysis and χ(2) test were conducted with SPSS 18.0 software to analysis the relationship between mothers' BMI before pregnancy or weight gain during pregnancy and autism in children.RESULTS:The age and sex distributions of case group and control group were consistent (χ(2)=0.434, P>0.05). The mothers' BMI before pregnancy of case group was higher than that of control group (χ(2)=9.580, P<0.05) ,which was (21.28±3.80) kg/m(2) for case group and (19.87±2.83) kg/m(2) for control group. The proportion of cases in high BMI group (10.5%) was much higher than that in control group (2.8%) . The risk of children with autism in high BMI group was 3.7 times higher than that in normal BMI group (OR=3.71, 95% CI: 1.34-10.24). In normal BMI group, the proportion of mothers who had excessive weight gain during pregnancy was higher in case group (44.1%) than in control group (33.9%). In high BMI group, the proportion of mothers who had excessive weight gain was higher in case group (52.6%) than in control group (20.0%) . In normal BMI group (χ(2) =8.690, P<0.05) and high BMI group (χ(2)=4.775, P<0.05), the weight gain during pregnancy was associated with autism in children. Logistic regression analysis showed that mothers' BMI before pregnancy (unadjusted OR=1.89, 95% CI: 1.26-2.85, adjusted OR=1.52, 95% CI: 1.19-2.27) and weight gain during pregnancy were the risk factors for autism in children (unadjusted OR=1.63, 95% CI: 1.08-1.25, adjusted OR=1.64, 95% CI: 1.21-2.21).CONCLUSION:Overweight or obesity before pregnancy and excessive weight gain during pregnancy were associated with autism in children, suggesting that women who plan to be pregnant should pay attention to body weight control.

OBJECTIVE:To understand the symptoms of autism of children that caused the first notice of guardian, related risk factors and the influence on the time to seek medical care.METHODS:The children with autism aged <5 years were selected from autism rehabilitation centers in Wuhan, Changsha, Haikou, Liuzhou and Changsha between September 2012 and April 2014, and their guardians were retrospectively surveyed by using questionnaire. SPSS 13.0 software was used for statistical analysis.RESULTS:A total of 415 children with autism were included in the study. Including 355 boys (85.54%) and 60 girls (14.46%), the sex ratio was 5.9 : 1. The most common concern of guardian were: language dysplasia (20.72%); ignoring of people or lack of interaction with others (18.55%); repeat and weird action pattern (14.94%). The age when the first symptom occurred, which causing guardians' concern, ranged from 8 months to 28 months, the time when guardian began to concern varied with symptom (χ² =46.64, P<0.000 1). Guardian's educational level, guardian's contact time with the children, guardian's intimate degree with the children, the age of guardian, family type and tie had no statistical association with the fist autism symptom that caused guardian's concern. The age of the children at first medical care seeking ranged from 10.5 months to 33 months, the time of the first medical care seeking varied with symptom (χ² =46.10, P<0.000 1). Up to 90.74% of the guardians delayed the medical care seeking of the children with autism, but the symptom specific differences in medical care delay had no statistical significance (χ² =9.46, P=0.579 6).CONCLUSION:The symptom of the children with autism causing guardian's first notice were mainly verbal communication barrier, social interaction barrier and restricted interests and behaviors. Guardian's educational level and intimate degree with children had no correlation with the symptom which caused guardian's first notice. The time when guardian began to concern and the time for children's medical care varied with guardian's first notice.