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author:("Xu, guilan")
1.  A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity 
BMC Public Health  2017;17:79.
With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity.
We propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions.
The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children’s BMI in the early years of life. If proven to be feasible, effective as well as cost-effective, the trial results will inform a series of recommendations for policy and practice related to promoting healthy infant feeding and physical activity in young children in the first years of life.
Trial registration
The CHAT Trial is registered with the Australian Clinical Trial Registry (ACTRN12616001470482p). It was registered on October 21, 2016.
PMCID: PMC5237545  PMID: 28088203
Randomised controlled trial; Childhood obesity; Health promotion; Intervention; Telephone consultation; Text messaging; Infant feeding practice; Breastfeeding; BMI
2.  A 5-year longitudinal analysis of modifiable predictors for outdoor play and screen-time of 2- to 5-year-olds 
Early childhood is a critical time for establishing physical activity and sedentary behaviours. Identifying modifiable predictors of physical activity and sedentary behaviours in the early life stages can inform the development of early intervention programs. The aim of this study was to identify modifiable predictors of outdoor play (a proxy of physical activity) and screen-time in 2- to 5-year-olds.
A longitudinal data analysis was conducted using 5-year follow-up data from the Healthy Beginnings Trial undertaken in Sydney, Australia from 2007 to 2013. A total of 667 pregnant women were recruited for the study. Information on mothers’ demographics, physical activity, screen-time, knowledge of child development, and awareness of childhood obesity during pregnancy (at baseline); children’s tummy time (a colloquial term describing the time when a baby is placed on his or her stomach while awake and supervised) at 6 months old and screen-time at 1 year old was collected via interviews with participating mothers as potential modifiable predictors. Main outcomes were children’s outdoor playtime and screen-time at ages 2, 3.5, and 5 years. Mixed linear and logistic regression models were built to determine these modifiable predictors.
Mothers’ screen-time during pregnancy (β = 2.1, 95 % CI 0.17–4.12; P = 0.030) and children’s daily screen-time at age 1 year (β = 15.2, 95 % CI 7.28–23.11; P < 0.0001) predicted children’s daily screen-time across ages 2 to 5 years after controlling for confounding factors. Practising tummy time daily (β = 13.4, 95 % CI 1.26–25.52; P = 0.030), mother’s physical activity level (β = 3.9, 95 % CI 0.46–7.28; P = 0.026), and having been informed about playing with child at baseline (β = 11.6, 95 % CI 1.56–21.54; P = 0.023) predicted children’s outdoor playtime across ages 2 to 5 years.
Mothers played an important role in their children’s outdoor play and screen-time in the first years of live. Children’s early exposure to screen devices could be associated with their later screen-time. Early interventions to improve young children’s physical activity and sedentary behaviour should focus on improving pregnant women’s physical activity, awareness of playing with their child, reducing their own screen-time as well as practicing daily tummy time for infants after giving birth.
Trial registration
The Healthy Beginnings Trial is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459). Registered 13 March 2007. Prospectively registered.
PMCID: PMC5000406  PMID: 27561357
Physical activity; Outdoor play; Screen-time; Predictor
3.  A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China 
BMJ Open  2016;6(5):e011077.
This study was designed to examine the effect of health literacy on diabetes prevention and control and risk factors for low diabetes health literacy among elderly individuals with prediabetes in rural areas in China.
Design setting and participates
A cross-sectional survey was conducted among elderly individuals in rural communities in Yiyang City in China. Multi-staged cluster random sampling was used to select 42 areas and 434 individuals with prediabetes who were interviewed using a questionnaire on diabetes health literacy in China.
Main outcome measures
Participants were asked for general information (age, gender, marital status, history of hyperglycaemia, family history of diabetes mellitus, presence of other diseases and level of education). Binary logistic regression analysis was used to identify risk factors for poor health literacy concerning diabetes prevention and control among elderly subjects with prediabetes.
The median health literacy score for diabetes prevention and prediabetes control was 10.0 (IQR 7.0–13.0). The level of diabetes health literacy among men was lower than among women (OR 2.831, 95% CI 1.818 to 4.408), and lower among respondents with 1–6 years of education than among those with 6 years or more of education (OR 14.274, 95% CI 5.927 to 34.375). Those with less than 1 year of education had the lowest literacy (OR 31.148, 95% CI 11.661 to 83.204). The level of diabetes health literacy among elderly individuals with prediabetes but no history of hyperglycaemia was lower than among those with a history of hyperglycaemia (OR 2.676, 95% CI 1.101 to 6.504).
Health literacy concerning diabetes prevention and control among elderly individuals with prediabetes was very low in rural China. Appropriate health education for elderly individuals with low educational levels should be incorporated into diabetes prevention efforts.
Trial registration number
ChiCTR-IOR-15007033; Results.
PMCID: PMC4885445  PMID: 27235299
health literacy; prediabetes; elderly; rural areas
4.  A cross-sectional study on risk factors and their interactions with suicidal ideation among the elderly in rural communities of Hunan, China 
BMJ Open  2016;6(4):e010914.
To identify risk factors, and their interactions, for suicidal ideation among the elderly in rural communities of Hunan and to provide some scientific basis for suicide prevention.
Design, setting and participants
A cross-sectional survey was conducted among the elderly in rural communities in China's Hunan Province. Thirteen areas were selected by multi-staged cluster random sampling, and 1887 rural elders were investigated via face-to-face interviews.
Main outcome measures
Measures included sociodemographic information, suicidal ideation, activities of daily living (ADL), major depression disorder (MDD), drinking, stressful life events and social support. Non-conditional logistic regression was preformed to explore the influencing factors for suicidal ideation, and additive interaction was used to analyse the interaction between risk factors.
Incidence of suicidal ideation among the elderly was 14.5% (95% CI 12.9% to 16.1%) in rural communities of Hunan. The independent influencing factors for suicidal ideation were annual personal income (OR 3.14; 95% CI 2.15 to 4.59), MDD (OR 17.04; 95% CI 11.91 to 24.39), chronic diseases (OR 2.99; 95% CI 1.84 to 4.85) and ADL (OR 2.00; 95% CI 1.37 to 2.94). Additive interactions were detected between MDD and ADL with a relative excess risk of interaction (RERI) of 21.18 (95% CI 5.47 to 36.89), and between MDD and annual personal income with an RERI of 35.00 (95% CI 9.00 to 61.00).
The independent risk factors for suicidal ideation are annual personal income (≤2200 CNY), MDD, chronic diseases and disabled ADL status. MDD has additive interactions with ADL and annual personal income. These findings have significant implications for the prediction and prevention of suicidal behaviours.
PMCID: PMC4838719  PMID: 27084285
suicide ideation; risk factors; interactions; elderly
5.  Associations of Parental Influences with Physical Activity and Screen Time among Young Children: A Systematic Review 
Journal of Obesity  2015;2015:546925.
Parents play a critical role in developing and shaping their children's physical activity (PA) and sedentary behaviours, particularly in the early years of life. The aim of this systematic review is to identify current literature investigating associations of parental influences with both PA and screen time in young children. This systematic review was conducted in November 2013 using 6 electronic databases covering research literature from January 1998 to November 2013. Thirty articles that met inclusion criteria were identified. These studies covered five important aspects of parenting: (1) parenting practices; (2) parents' role modelling; (3) parental perceptions of children's PA and screen viewing behaviours; (4) parental self-efficacy; and (5) general parenting style. Findings suggest that parents' encouragement and support can increase children's PA, and reducing parents' own screen time can lead to decreased child screen time. Improving parenting practices, parental self-efficacy or changing parenting style may also be promising approaches to increasing PA time and decreasing screen time of young children.
PMCID: PMC4383435  PMID: 25874123
6.  Measuring Workplace Travel Behaviour: Validity and Reliability of Survey Questions 
Background. The purpose of this study was to assess the (previously untested) reliability and validity of survey questions commonly used to assess travel mode and travel time. Methods. Sixty-five respondents from a staff survey of travel behaviour conducted in a south-western Sydney hospital agreed to complete a travel diary for a week, wear an accelerometer over the same period, and twice complete an online travel survey an average of 21 days apart. The agreement in travel modes between the self-reported online survey and travel diary was examined with the kappa statistic. Spearman's correlation coefficient was used to examine agreement of travel time from home to workplace measured between the self-reported online survey and four-day travel diary. Moderate-to-vigorous physical activity (MVPA) time of active and nonactive travellers was compared by t-test. Results. There was substantial agreement between travel modes (K = 0.62, P < 0.0001) and a moderate correlation for travel time (ρ = 0.75, P < 0.0001) reported in the travel diary and online survey. There was a high level of agreement for travel mode (K = 0.82, P < 0.0001) and travel time (ρ = 0.83, P < 0.0001) between the two travel surveys. Accelerometer data indicated that for active travellers, 16% of the journey-to-work time is MVPA, compared with 6% for car drivers. Active travellers were significantly more active across the whole workday. Conclusions. The survey question “How did you travel to work this week? If you used more than one transport mode specify the one you used for the longest (distance) portion of your journey” is reliable over 21 days and agrees well with a travel diary.
PMCID: PMC3730218  PMID: 23956757
7.  Degree of Suicide Intent and the Lethality of Means Employed: A Study of Chinese Attempters 
This study was designed to determine if there is a relationship between the degree of suicide intent and the lethality of means employed by those who try to kill themselves. The study sample consists of 74 suicide attempters admitted to emergency rooms in a northeastern area of China. Structured interviews were performed with the patients and their companions to the hospital if necessary. It was found that the reason for the suicide attempt claimed by the highest percentage of attempters (35 of 74) was love/marriage issues, and there were significant gender differences in suicide reasons. It also was found that the choice of suicide means is generally independent of gender, and the lethality of means is positively correlated with the degree of suicide intent. One of the implications of the findings is a better understanding of the higher suicide rates for Chinese women than Chinese men. A hypothesis for future study on Chinese suicide may be that the high fatality rate of Chinese women who have swallowed poisonous pesticide is a function of the strong intent of death of the victim coupled with the well-known lethality of the pesticides.
PMCID: PMC3210858  PMID: 17882622
China; degree of suicide intent; lethality; suicide; suicide means
Omega  2007;55(3):185-197.
Previous studies have tried to account for the uniqueness of gender ratios in Chinese suicide through physiological and psychological differences between men and women, and the means employed in the fatal act. From the point of view of the socio-psychological traits, this study examines the effects of religion (religiosity), superstition, and perceived gender inequality among Chinese women on the degree of their suicide intent. A four-page structured interviews were performed to the consecutively sampled serious attempters of suicide hospitalized to emergency rooms immediately after the suicidal act in Dalian areas, China. Both univariate analyses and the multiple regression model have found that the higher the degree the religiosity and superstition on metempsychosis, the stronger the suicide intent Chinese women had. The perceived gender inequality is positively correlated with suicide intent, and it is especially true for Chinese women. The socio-psychological traits and traditional culture values and norms have important impacts on suicide patterns in Chinese societies.
PMCID: PMC3205909  PMID: 18214067
9.  Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study 
BMJ : British Medical Journal  2005;331(7507):23.
Objectives To investigate whether age at onset of epilepsy, type of epilepsy, family history of psychosis, or family history of epilepsy affect the risk of schizophrenia or schizophrenia-like psychosis among patients with epilepsy.
Design Comparison of population based data.
Setting Danish longitudinal registers.
Subjects The cohort comprised 2.27 million people.
Main outcome measures Epilepsy, psychosis, personal birth data.
Results We found an increased risk of schizophrenia (relative risk 2.48, 95% confidence interval 2.20 to 2.80) and schizophrenia-like psychosis (2.93, 2.69 to 3.20) in people with a history of epilepsy. The effect of epilepsy was the same in men and in women and increased with age. Family history of psychosis and a family history of epilepsy were significant risk factors for schizophrenia and schizophrenia-like psychosis, and the effect of epilepsy, both in cases and families, was greater among people with no family history of psychosis. In addition, the increased risk for schizophrenia or schizophrenia-like psychosis did not differ by type of epilepsy but increased with increasing number of admissions to hospital and, particularly, was significantly greater for people first admitted for epilepsy at later ages.
Conclusions There is a strong association between epilepsy and schizophrenia or schizophrenia-like psychosis. The two conditions may share common genetic or environmental causes.
PMCID: PMC558534  PMID: 15964859

Results 1-9 (9)