Introduction This study investigates the impact of different feeding methods (direct breastfeeding, expressed milk feeding, formula feeding) on the infant microbiota at 6 weeks of age. Methods A total of 217 healthy infants stool samples were collected from Hong Kong between August 2018 and December 2019. Results Various microbial taxa, including the genera Enterobacter and Raoultella were identified in the expressed breast milk feeding group. The richness and composition of the major bacterial phyla showed similar abundance between direct breastfeeding and expressed breast milk. Discussion These findings suggests that these bacteria may have colonized the milk during expression or could be introduced from other external sources. The mode of breastfeeding did not significantly alter microbiota parameters in the infant gut at 6 weeks.

Previous studies showed a significant association between screen time (ST) and health-related quality of life (HRQoL) in children. However, the mechanisms underlying the association are unclear. To determine the extent to which time spent (physical activities and sleep duration) and relationship factors (dysfunctional parent-child interaction and peer problems) mediate the association between children’s ST and their HRQoL. A population-representative sample of 1,033 parents of primary school children (49.3% female; Mage = 8.5, SDage = 1.9) in Hong Kong participated in the study over the course of one year (two waves). Children’s ST was reported by parents. The study outcome, children’s HRQoL, was assessed using the 23-item Pediatrics Quality of Life Inventory Parent-Proxy Report (PedsQL). Mediators, including dysfunctional parent-child interaction (PCDI), peer problems (SDQ-PP), weighted daily time spent in moderate-to-vigorous physical activity (MVPA), and weighted average of daily sleep duration, were assessed to test the displacement and relational hypotheses. Multilevel structural equation modeling with a 1-1-1 mediation framework showed a statistically significant direct effect (β = -0.77, 95% CI -1.02 to -0.53) of ST on PedsQL. The association was partially mediated by both relationship factors (PCDI: β = -0.09, 95% confidence interval [CI] -0.15 to -0.03; mediation proportion = 8.33%; SDQ-PP: β = -0.13, 95% CI -0.23 to -0.03; mediation proportion = 12.74%) at the within-person level, but not time spent factors (i.e., sleep duration and MVPA). Impairments in parent-child and peer relationships partially mediated the association between duration of screen time and children’s HRQoL. These findings suggest that relationship-focused intervention might buffer the negative associations of increased screen time on children’s functioning. Not applicable.

OBJECTIVE:To develop a YouthFit Index, a comprehensive and easily interpretable measure of youth health-related quality of life (HRQoL). METHOD:A repeated cross-sectional design was employed to develop and validate the YouthFIt index using the Pediatric Quality of Life Inventory (PedsQL). Activity level and sleep data were collected by a wearable device, Actigraph. Questionnaires were used to gather demographic information and PedsQL data. Multiple-factor analysis of mixed data was employed to identify principal components (PCs) of the modifiable lifestyle variables. The YouthFit Index was calculated by summing the weighted PCs. Logistic regression models were used to assess the odds ratios for risks associated with the YouthFIt Index. RESULTS:A total of 1,867 students were recruited for the study. The findings showed that having YouthFit Index scores greater than 5 was significantly associated with a lower risk of identifying with special health care needs. Compared to the group with YouthFit Index scores below or equal to 5, the group with scores above the cut-off demonstrated a significant 43 % reduction in the risk of PedsQL total score. The results also revealed that increased sleep duration and physical activity are associated with better HRQoL, while longer sedentary periods and later bedtimes are linked to worse HRQoL. CONCLUSIONS:The YouthFit Index is a user-friendly tool for assessing the HRQoL of Hong Kong Chinese children between the ages of 6 and 17. It can help raise awareness about healthy quality of life and promote health and well-being among children in Hong Kong.

Purpose:To determine the relationship of attention-deficit hyperactivity disorder (ADHD) with myopia among school children. Methods:Children aged six to eight years in Hong Kong were recruited through a stratified, clustered randomized sampling frame and subsequently invited to undergo cycloplegic autorefraction and axial length measurements between 2016 and 2021. ADHD diagnoses were made by qualified physicians according to ICD-10 criteria. ADHD symptoms were assessed using the Strengths and Weaknesses of ADHD-symptoms and Normal-behaviors Questionnaire. Results:Totally 474 children with ADHD and 9950 control children were included. The age- and sex-adjusted myopia prevalence was lower in ADHD group (21%) versus controls (26%; P = 0.02). Multivariable regression analysis showed less myopia (odds ratio [OR] = 0.75; P = 0.03), higher spherical equivalent refraction (SER) (β = 0.13; P = 0.04), and shorter axial length (AL) (β = -0.07; P = 0.03) in children with ADHD. Specifically, ADHD with oral methylphenidate (MPH) treatment had less myopia (OR = 0.61, P = 0.04), higher SER (β = 0.36; P < 0.001) and shorter AL (β = -0.25; P < 0.001) compared to controls. Each additional month of MPH treatment was associated with a higher SER (β = 0.02; P = 0.01) and shorter AL (β = -0.01; P = 0.01). For each one-point increase in attention-deficit scores, children were found to be less myopic (OR = 0.88, P = 0.01), having higher SER (β = 0.07; P = 0.003) and shorter AL (β = -0.04; P = 0.001). The prevalence of myopia among ADHD increased to 32% during COVID-19 pandemic compared with 23% before COVID-19 pandemic (P = 0.04). Conclusions:This cross-sectional study found that ADHD is associated with reduced myopia prevalence, more hyperopic SER, and shorter AL. Of note, the observed effect sizes of these associations were small; therefore the interpretation of the clinical meaning needs to be cautious.

Background Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective The objective of this paper was to describe the development of a breastfeeding-friendly app called “bfGPS” (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged—bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant’s growth, and provides suggestions for further development. Conclusions The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app’s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies.

Abstract Aims The association between a pregnant mother’s vitamin D status and depressive symptoms has yielded inconsistent results. It is possible that other factors play a role in this association, as depression can have multiple causes. Recognizing the significance of the husband’s participation in antenatal care, this study aimed to examine whether the husband’s involvement moderates the link between the mother’s vitamin D status and depressive symptoms during pregnancy. Methods A total of 2983 Chinese married pregnant women, in their 25–35 weeks of pregnancy, completed questionnaires to assess their levels of depressive symptoms and the involvement of their husbands in their antenatal care appointments. Additionally, their serum levels of vitamin D were measured. Results After adjusting for maternal age, parity, and socio-economic status, the husband’s involvement in antenatal care moderated the association between maternal vitamin D status and depressive symptoms during pregnancy (β = 2.03, p = 0.035). Specifically, when their husbands were not regularly present for antenatal care appointments, mothers with suboptimal vitamin D levels experienced more depressive symptoms than those with optimal levels. However, there were no noticeable differences in depressive symptoms between vitamin D groups for mothers whose husbands attended all antenatal care appointments. Conclusions Pregnant women who have suboptimal vitamin D levels and lack support from their spouses are most vulnerable to experiencing depression. It is crucial to holistically assess the social and physiological needs of expectant mothers to reduce their risk of antenatal depression.

Intimate partner violence (IPV) against pregnant women negatively impacts women's and infants' health. Yet inconsistent results have been found regarding whether pregnancy increases or decreases the risk of IPV. To answer this question, we systematically searched for studies that provided data on IPV against women before pregnancy, during pregnancy, and after childbirth. Nineteen studies met our selection criteria. We meta-analyzed the nineteen studies for the pooled prevalence of IPV across the three periods and examined study characteristics that moderate the prevalence. Results showed the pooled prevalence estimates of IPV were 21.2% before pregnancy, 12.8% during pregnancy and 14.7% after childbirth. Although these findings suggest a reduction in IPV during pregnancy, our closer evaluation of the prevalence of IPV after childbirth revealed that the reduction does not appear to persist. The prevalence of IPV increased from 12.8% within the first year after childbirth to 24.0% beyond the first year. Taken together, we should not assume pregnancy protects women from IPV, as IPV tends to persist across a longer-term period. Future studies are needed to investigate if IPV transits into other less obvious types of violence during pregnancy. Moderator analyses showed the prevalence estimates significantly varied across countries by income levels and regions.

Existing literature suggests that lengthy durations of screen time (ST) are associated with lower levels of health-related quality of life (HRQoL) and other negative outcomes in children. Nonetheless, the current available evidence largely relies on cross-sectional studies. In addition, data on the content and context (parent–child co-use and solitary use) of ST are scarce. We set out to conduct a one-year, two-wave longitudinal study to investigate the association between exposure to different types of ST and HRQoL among primary school children in Hong Kong, from 2021 to 2022. A population representative random sample (N = 1,428) participated in the study. Results from pooled ordinary least squares regressions showed children’s ST duration was significantly associated with worse HRQoL (β = -1.101, p < 0.0001). However, interactions of ST content and context, including parent–child co-use × TV viewing (β = 1.305, p < 0.0001), parent–child co-use × video gaming (β = 0.280, p < 0.0001), solitary use × video gaming (β = 0.198, p < 0.0001), and solitary use × social media use (β = 0.454, p < 0.0001) were significantly associated with better HRQoL. Our findings suggest that increased overall durations of ST are associated with worse HRQoL in children, but this association is impacted by the types of ST content and context.

Recent studies showed that ABO-adjusted calculated panel reactive antibody (ABO-cPRA) may better reflect the histocompatibility level in a multi-ethnic population, but such data in Asians is not available. We developed an ABO-adjusted cPRA metric on a cohort of waitlist kidney transplant patients (n = 647, 99% Chinese) in Hong Kong, based on HLA alleles and ABO frequencies of local donors. The concordance between the web-based ABO-cPRA calculator and the impact on kidney allocation were evaluated. The blood group distribution for A, B, O and AB among waitlist kidney candidates were 26.2%, 27.5%, 40.1%, and 6.1%, and their chances of encountering incompatible blood group donors were 32.6%, 32.4%, 57.6%, and 0%, respectively. There is poor agreement between web-based ABO-cPRA calculator and our locally developed metrics. Over 90% of patients showed an increase in cPRA after ABO adjustment, most notably in those with cPRA between 70% and 79%. Blood group O patients had a much greater increase in cPRA scores after adjustment while patients of blood group A and B had similar increment. 10.6% of non-AB blood group waitlist patients had ABO-cPRA elevated to ≥80%. A local ABO-adjusted cPRA metric is required for Asian populations and may improve equity in kidney distribution for patients with disadvantageous blood groups. The result from the current study potentially helps other countries/localities in establishing their own unified ABO-cPRA metrics and predict the impact on kidney allocation.

This study aims to develop and validate the Post-COVID Symptom Scale for Children/Youth (PCSS-C/Y), which is a comprehensive tool for measuring the symptom burden of post-COVID-19 conditions—persistent symptoms after SARS-CoV-2 infection, commonly known as Long COVID—and its impact on health-related quality of life among children and adolescents. Parents of children and adolescents, adolescents, and young adults with and without a history of COVID-19 were invited to fill in a questionnaire from October 2022 to June 2023. There were 386 valid parent proxy-reported responses, 433 valid adolescent self-reported responses, and 324 valid young adult self-reported responses included in the final analysis. The PCSS-C/Y demonstrated stable factor structure and good internal consistency in different sampling groups. The scale score was negatively associated with Paediatric Quality of Life Inventory (PedsQL) scores (young adult self-report, adjusted R2 = 0.394; adolescent self-report, adjusted R2 = 0.219; parent-report, adjusted R2 = 0.292), while it was positively associated with Strengths and Difficulties Questionnaire (SDQ) scores (young adult self-report, adjusted R2 = 0.195; adolescent self-report, adjusted R2 = 0.154; parent-report, adjusted R2 = 0.239). The scale can also discriminate the post-infected cases and control cases, Cohen’s d = 0.41, 0.50, and 0.38 for adult self-report, adolescent self-report, and parent-report, respectively. Conclusions: The PCSS-C/Y is a valid and reliable tool for quantifying the diverse symptomatology of post-COVID-19 conditions in children and adolescents. It provides quantifiable measurements that enable clinicians to monitor post-COVID-19 symptoms in children and young people and facilitates the development of interventions for post-COVID-19 conditions.

Aim The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community. Design Quasi-experimental research design. Method The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women. Results A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1. Conclusion In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation. Implications for the profession and/or patient care Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families. ImpactWhat problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding. What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community. Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families. Impact What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding. What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community. Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families. Reporting Method This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline. Patient or Public Contribution No patient or public contribution. What Does This Paper Contribute to the Wider Global Clinical Community? This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.

Hand hygiene compliance is well known as an important measure in preventing the transmission of infectious disease. Even though general public was aware of this health message during the COVID-19 pandemic, sustaining such personal hygiene behavior is difficult. While personal hygiene virtual reality intervention via an immersive experience has been found as an effective health promotion strategy, its prior implementation was mostly among healthcare workers but not among people in the community. Using a mixed methods approach, this study draws on the theory of planned behaviors to design two experimental studies for testing this interventional approach's sustainability and applicability to the general population. The result confirmed the virtual reality scenario with both presence and embodiment demonstrated a more sustainable treatment effect in boosting individual's self-efficacy over other experimental arms. Post-hoc analysis revealed the reduction of perceived barrier after exposure to immersive environment was attributable to treatment effect. The findings were reconfirmed through triangulation in the qualitative post-intervention interviews. Finally, we highlight the theoretical and practical implication of the study for the future development of personal hygiene immersive environment-based intervention.

Early childbearing is associated with high maternal stress and family violence. However, the long-term effects of rapid repeat pregnancy (RRP) in young motherhood on child outcomes remain largely unknown. This study examined the pathways between maternal RRP at young ages and child psychosocial problems and emergency room visits in later years. A total of 232 Chinese mother-child dyads provided baseline data in 2015 (Time 1; T1) and follow-up data 6 years later in 2021 (Time 2; T2). At T1, mothers completed questionnaires about child physical abuse frequency and family cohesion and reported their own stress levels. At T2, mothers were re-surveyed with the same questionnaires about child physical abuse frequency and family cohesion. Children’s psychosocial problems were assessed through parent proxy-reports and records of emergency room visits were retrieved from hospital databases. After adjusting for demographic information, maternal history of RRP was associated with child physical abuse at T1 (β = .15, p < .05) and in turn linked to child physical abuse recurrence (β = .22, p < .01) and emergency room visits at T2 (β = .22, p < .001). Improved family cohesion over time did not break the link between maternal RRP and child physical abuse recurrence. Poor family dynamics can lead to child physical abuse recurrence and worsen developmental outcomes in children, particularly when coupled with other risk factors such as maternal RRP at young ages. Early interventions to enhance support and reduce vulnerabilities are important for preventing child physical abuse in at-risk families.

Introduction: This cross-sectional survey research investigated mental health symptoms and quality of life among Chinese parents and their children with eczema at a paediatric dermatology clinic in Hong Kong from November 2018 to October 2020. Methods: Health-related quality of life, eczema severity, and mental health among children with eczema, as well as their parents' mental health, were studied using the Children's Dermatology Life Quality Index (CDLQI), Infants' Dermatitis Quality of Life Index (IDQOL), Nottingham Eczema Severity Score (NESS), Patient-Oriented Eczema Measure (POEM), and the Chinese version of the 21-item Depression, Anxiety, and Stress Scales (DASS-21). Results: In total, 432 children and 380 parents were recruited. Eczema severity (NESS and POEM) and health-related quality of life (CDLQI) were significantly positively associated with parental and child depression, anxiety, and stress levels according to the DASS-21, regardless of sex (children: r=0.280.72, P<0.001 to 0.007; parents: r=0.20-0.52, P<0.001 to 0.034). Maternal depression was marginally positively associated with increased anxiety in boys with eczema (r=0.311; P=0.045). Younger parents had higher risk of developing more anxiety and stress compared with the older parents (adjusted odds ratio [aOR]=-0.342, P=0.014 and aOR=-0.395, P=0.019, respectively). Depression level of parents with primary to secondary education was 58% higher than their counterparts with post-secondary education or above (aOR=-1.579; P=0.007). Conclusion: Depression, anxiety, and stress among children with eczema and their parents were associated with eczema severity and impaired quality of life in those children. These findings regarding impaired mental health in children with eczema and their parents highlight the need to include mental well-being and psychosocial outcomes in future studies and clinical practice.

IntroductionIdentifying the knowledge, attitudes, and practices (KAP) gaps of healthy eating can inform the design of effective interventions. This study aimed to test the validity and psychometric properties of a KAP of Healthy Eating Questionnaire (KAP-HEQ) tailored to the Chinese culture.MethodsThe dimensions and potential items of each KAP scale were identified from published KAP and health literacy questionnaires, which were supplemented by the findings of a previous qualitative healthy eating study. Content validity of the KAP-HEQ was evaluated by eight experts and eight Chinese parent–adolescent dyads in Hong Kong through content validity ratio (CVR), content validity index (CVI), and qualitative feedback. The feasibility, construct validity, reliability, and sensitivity of the KAP-HEQ were evaluated in this pilot study among 60 adolescent–parent dyads (120 persons) through an online survey. The first 30 dyads who completed the KAP-HEQ were invited to repeat the KAP-HEQ 2 weeks later to assess the test–retest reliability.ResultsThe final 44-item KAP-HEQ was completed in 10–15 min by both adolescents and their adult parents. The CVR ranged from −0.38 to 1, and the CVI ranged from 0.56 to 1. Over 80% of the items achieved convergent validity (a significantly positive correlation with its hypothesized scale) and discriminant validity (a higher correlation with its hypothesized scale than with the other two scales). Cronbach’s alpha for the internal consistency of the Overall, Attitude, and Practice scales was >0.7, while that of the Knowledge scale was 0.54. The intraclass correlation coefficient (ICC) on test–retest reliability of the Overall and individual scales were all >0.75 except that of the Knowledge scale (ICC = 0.58). The significant differences in KAP scale scores with small to large effect sizes were found between known groups as hypothesized, except the Attitude score between groups by household income, which supported the sensitivity of the KAP-HEQ.ConclusionThe KAP-HEQ has shown good validity, reliability, and sensitivity among Chinese adolescents and adults, which can be applied to evaluate KAP status and gaps to inform the design and assess the effectiveness of healthy eating interventions.

Background Previous research has well-documented that family functioning is an important predictor of individuals’ physical and mental health. However, relatively little research has explored family functioning at the family and population levels, such as changes in family functioning across years and whether predictors of family functioning differ across different family structures. Understanding of the changes in family functioning across years and factors promoting family functioning will inform the development of preventive measures to enhance family health and resilience. Objectives of the study were: (1) to examine the changes in family functioning across a 6-year study period and (2) to study protective factors associated with family functioning and the extent to which the factors are the same or different across different family structures. Method: The study involved secondary data analysis of the biannual Family Survey carried out by the Family Council, an advisory body to the Hong Kong government. A series of ANOVA and regression analyses were conducted using data of four population-based cross-sectional household surveys conducted in Hong Kong in 2011, 2013, 2015, and 2017. Results: There were some fluctuations in overall family functioning scores across the study period, but no significant difference was found between the scores in 2011 and 2017. Different predictors of family functioning were found for different family types, and frequent family communication was a common protective factor for most family types, including never married, married/cohabiting with children, and married/cohabiting with no children. Conclusion: The study is among the first to examine changes in family functioning at the population level. Monitoring and addressing family functioning may help tackle various social problems and future public health crises. Interventions to promote family functioning should address both common and different protective factors of different family types.

ObjectiveResearch has documented the associations of child maltreatment with a range of physical health problems, but little is known about the physical growth patterns of children who experience maltreatment in early childhood. This study aimed to examine the association between various discipline approaches and physical growth in preschool-aged children.MethodsIn the first year of preschool, parents of 661 Chinese preschool-aged children completed a questionnaire with items pertaining to the frequency of using physical maltreatment, psychological aggression, neglect, and nonviolent discipline toward the child. Children's weight and height were assessed annually using direct assessment in the first and two subsequent years. Longitudinal analyses were performed using multiple regression models.ResultsMore frequent neglect and psychological aggression during the first year of preschool were associated with a higher likelihood of a decreased BMI z score in subsequent years. Conversely, increased experience of physical maltreatment in the first year was associated with an increased likelihood of having overweight or obesity in the third year.ConclusionsResults indicate that early maltreatment experience can impact physical growth. This highlights the importance of preventing abusive parenting and encouraging healthy habits in young children who have experienced maltreatment to decrease their future risk for weight problems.

Objective: Not all women experience the same changes in depression from pregnancy through the years following childbirth, but the patterns of prenatal and postnatal depression are underexplored. This study investigated the trajectories and associated predictors of depressive symptoms in women from pregnancy through the first 3 years postpartum. Method: We followed 340 pregnant women from an antenatal clinic in Hong Kong, first at 20-24 weeks of gestation, then at 4 weeks after childbirth, and again at 3 years after childbirth. Pregnant women reported their depressive symptoms whether they had intimate partner violence, health conditions, adverse childhood experiences, family support, and perceived partner involvement. Latent class growth analysis was applied to identify distinct trajectories of depression, and binary logistic regressions were performed to analyze predictors of trajectories. Results: We found that 26.5% of women showed clinical depressive symptoms at 20-24 weeks of gestation, 9.7% at 4 weeks after childbirth, and 12.6% at 3 years after childbirth. Two classes were identified: a low-stable group (86.2%) and a relapsing/remitting group (13.8%). Women with a history of trauma (i.e., intimate partner violence and adverse childhood experiences) and mental health difficulties were more likely to be classified in the relapsing/remitting group than in the low-stable group. Family support and partner emotional involvement appeared to protect the women from suffering relapsing/remitting depression. Conclusions: The findings highlight the importance of screening for depression throughout pregnancy and extending several years postpartum. Distinguishing the different trajectories of depression and identifying its associated factors are critical to providing targeted interventions to the most vulnerable women (i.e., a relapsing/remitting group in the present study).

Abstract Background This study aims to evaluate the 5-year impact of a Health Empowerment Program (HEP) on mitigating problematic conducts and enhancing the health-related quality of life (HRQOL) among children living in poverty. Methods A prospective cohort study (N = 239, Intervention group: n = 124, Comparison group: n = 115) was established with participants recruited between July 2013 and March 2016 and followed until November 2021. During the 5-year study period, children and their parents from the intervention group were invited to join a multi-dimensional HEP. At baseline and follow-up, both intervention and comparison groups were assessed using the Chinese Strengths and Difficulties Questionnaire (SDQ) and Chinese Child Health Questionnaire Parent Form 28 (CHQ-PF28). Multiple linear regressions were conducted to identify changes in outcome variables as the effect of the HEP. Results Upon completion of the 5-year follow-up, children in the intervention group showed a larger decline in conduct problems (B = − 0.66, p <.001), hyperactivity inattention (B = − 0.67, p =.005), and total difficulties score (B = − 1.89, p =.002) of SDQ, a greater increase in prosocial behavior of SDQ (B = 0.53, p =.040), and more substantial enhancement in CHQ-PF28’s psychosocial summary score (B = 2.75, p =.017) compared to the comparison group. Conclusions HEP is effective in mitigating behavioral problems and improving psychosocial HRQOL of children of low-income families, as evident by this 5-year cohort study. Trial Registration: This study received approval (UW 12–517) from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster.