Limited number of studies examined the relationship between factors  affecting adolescents’ health and well-being. The aims of this study were to identify the more important variables of the different components affecting adolescents’ health , and explore the relationship between the aforementioned components., by using KIDSCREEN-52 and cognitive processing using the Stroop Test. School engagement was estimated through questions concerning the scholastic achievement.Data were collected between 2017 and 2018 from 756 eligible students, recruited from 5 Italian junior high schoolp < .0001). The most important aspects in the SC were the relationship with the parents (p < .0001), and the adolescent’s relationships with peers (p < .0001). For ES, mood variables had the greatest contribution (p < .0001). The School performance related to Language & Literature (p < .0001) was the most important predictor in the CA latent variable. LH was positively associated with SC (p < .0001), ES (p < .0001), and CA (p < .0001). SC was positively associated with ES (p < .0001) and with CA (p < .0001).Of 756 adolescents, 395 were boys with a mean (SD) age of 12.19 (0.81) years. Compared to International T-value of reference group for KIDSCREEN-52, autonomy, bullying, psychological well-being and mood were lower than the reference groups, while self-perception score was higher. For LH, the most important predictor was autonomy (This study suggests the importance of an integrated approach to characterize adolescents’ health and well-being. The approach suggested here may highlight additive synergistic effects of the various components in health and well-being assessment that may not be considered with a late approach and focused only on single factors. In the last decades, we have witnessed a substantial change in definition of health, from absence of disease to a state of well-being, intending adolescence as a period when potentially deleterious behaviours begin . AdolescThe approach suggested here may highlight additive synergistic effects of the various components in health and well-being that may not be considered when focused only on single factors.Aim of the study was to identify the principal variables of the different components affecting adolescents’ health , and explore the relationship between the aforementioned components, assuming that these are not independent to each other, according to a multifactorial and multisectorial perspective.Between 2017 and 2018, 785 adolescent students were enrolled from five junior high schools across Italy, according to the following inclusion criteria: age 10–14 years, absence of neuropsychiatric or other diseases, informed consent signed, and filling of the entire questionnaires proposed. Among these, 5 were excluded for diagnosed neuropsychiatric or other diseases, 10 who did not sign informed consent, and 14 who did not fill all the questionnaires. Therefore, the final population consisted of 756 adolescents . In every school class, all the adolescents filled out the questionnaire, and those who were not eligible due to exclusion criteria reasons were excluded from the study retrospectively.All the schools joined the AVATAR project, that is the acronym for “A new purpose for promotion and eVAluation of healTh and well-being Among healthy teenageRs”. AVATAR project aim is to develop a new tool to assess lifestyle habits, social context, emotional status, and mental skills in adolescents, and to define an integrated index of the best indicators of well-being .All students belonged to the AVATAR school Italian network called Rete Ulisse - Schools joining scientific research and educational innovation, in order to guarantee the heterogeneity of social, cultural, socioeconomic, and geographical background.Participants were previously instructed on how to fill out the questionnaires and how to conduct the tests (see Data collection section for more details). All tests were conducted during participants’ computer lesson in school time. No incentive was provided to adolescents or parents. A research assistant was available to provide information and technical support to complete questionnaires. All parents or legal guardians gave informed consent, and authorized researchers to use their data in accordance with Italian law. All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.The proposed multifactorial approach is focused on the integration of four components of health-related well-being , as perceived by adolescent, and how they relate to each other.Conceptually, the AVATAR methodology is based on a multidimensional construct, covering physical, emotional, mental, social, and cognitive components of well-being and functioning as perceived by adolescents, developed within the AVATAR project  were considered. The cognitive processing was evaluated with the Stroop Color and Word Test Children’s Version . This teThe school engagement has been estimated through questions concerning the scholastic achievement in Language & Literature, Language acquisition, and Science.p < .05.All statistical analyses were completed using Stata/SE 13.1 and SPSS Version 24. Categorical variables were expressed as percentages, and continuous variables were expressed as mean and standard deviation (SD) and mean and standard error for standardized regression coefficient for the Structural Model  using Stata/SE 13.1, used to test the proposed model  , Comparative Fit Index (CFI) , and Standardized Root Mean Square Residual (SRMR)  . The mea2 (4.41).Participants consisted of 756 students with average age of 12.19 years (0.81). The number of males was 395 (52%), while females were 360 (48%). The whole sample had normal weight with BMI average of 19.2 Kg/mHealth-related quality of life variables, expressed as mean T scores , 11, andIn LH, physical well-being score was equal in comparison with the international T-value of reference group (mean 48.57-SD 9.64- median 47.08- IQR 42.53–55.60) . For autT-value of parent relations, peers, and school environment (SC component) was equal respect to the reference group. The dimension of bullying behaviours was lower than the threshold of the mean of the reference group (mean 50.94- SD 9.62- median 58.85- IQR 42.20–58.85). According to T-value in the psychological well-being and mood dimensions (ES component), our mean group was just below the threshold of the mean of the reference group. Self-perception score  was higher than the reference group (mean 48.28- SD 9.56).In CA, the mean value of executive function dimension was 3.73 SD 2.18). The descriptive value of school performance, language & literature and science, are reported in Table 8. The deCorrelations among the variables were determined prior to verification of the hypothetical model Table . The dimp < .0001), intended as the opportunity given to a child or adolescent to create his/her social and leisure time. The most important aspects in SC component were the relationship with the parents and the atmosphere in the child’s/adolescent’s home , and the adolescent’s relationships with other adolescents . For ES component, the mood observed variable was that with the greatest contribution . Finally, school performance related to language & literature  was the most important predictor in CA component.As described in Table p < .01], RMSEA = .053, SRMR was .041, and CFI = .94). The indices for hypothetical model showed that the measurement model fits adequately [The standardized paths of the hypothesized health theory constructs from all the four components to their respective variables were specified in Fig. equately , 21.Figp = 0.945). LH was positively associated with SC , ES , and CA . SC was positively associated with ES  and CA .As presented in Fig. To the best of our knowledge, this is the first study that explores, through an integrated approach, the best indicators of health and well-being in adolescents, considering both the involvement of each variable of the different components affecting adolescents’ health  and the relationship between the four components.Our results are in line with the International T-value of reference group for KIDSCREEN-52, obtained in a multicentre European study comprising a sample of 22,827 children recruited in 13 countries, except for variables belonging to emotional status and autonomy, in which our subjects exhibited lower score than the reference groups.This could be partly attributable to some factors not evaluated in this study, including sleep quality, family socioeconomic status, and previous psychophysical condition.The rationale to adopt an integrated approach for adolescence health and well-being is based also on the evaluation of successful individual functioning and positive social relationships.Even though the variables considered in the present study have been previously described as influencing health status and well-being in adolescents , 6, 8, tThe main results can be summarized as follows: 1) the evaluation of the single variables within each component, autonomy, parental relation, mood and scholastic achievement, were the most determinant factors in the component definition; 2) the analysis of the relationship among the 4 components revealed the strongest relationship between LH and SC and between SC and ES.Adolescence is considered the healthiest time of life, characterized by many of the requisite components of ideal health . AccordiHowever, epidemiological data showed that adolescence is a susceptible stage of life where other variables belonging to the psychosocial and mental skill components are matter of health status and well-being, potentially representing the early substrate of chronic degenerative diseases . In lineTherefore, we observed that autonomy, intended as opportunity in leisure time, and financial resources, had the highest weight among the LH variables. Leisure time has been shown to be associated with better life outcomes, scholastic achievement, and self-identity . Also, iWith regard to the role of financial resources, it has been well described a relationship with physical activity . Data obIn the SC component, parents’, peers’, and schools’ support, exerted a positive effect on adolescents’ social environment . PreviouFor ES component, feelings such as loneliness, sadness, sufficiency/insufficiency, resignation, and self-perception are determinant. This suggests that positive or negative affective states and self-esteem are associated with emotional well-being and thus, with health status (i.e. life satisfaction) .For CA definition, our results suggest that the most important variable is scholastic achievement, with particular focus on literature and scientific disciplines .This study shows that LH and SC have the strongest bidirectional link on adolescents’ health and well-being, when compared to other components in our model. In general, large body of research supports the role of LH and SC factors in high healthy behaviours engagement , howeverIn particular, during adolescence there are significant changes in grey matter and white matter volumes in brain regions responsible for complex human behaviours, such as social relationships, mentalizing and self-related processing , 35. TheResilience, defined as the ability to bounce back or recover after difficulty/hardship, can support the role of the social setting on the emotional component during adolescence . In factMeanwhile, ES component showed a statistically bidirectional link with lifestyle habits. In healthy conditions, this relation is poorly known, while great amount of research focused on the association between unhealthy lifestyle factors, mainly diet and physical activity, and symptoms of anxiety and depression . MoreoveBased on our results, LH and SC were equally linked with CA. In this regard, a body of literature showed that adolescents’ perceived social support, from family, peers, teachers, was associated with higher scholastic achievement . Dubow aThis study included a large number of known variables in order to assess throughout an integrated approach, the best indicators of health status and well-being in adolescents. However, certain limitation of the study should be acknowledged. First, given the reliance on self-report data, it would have been beneficial to conduct focus groups with students, to explore concepts in more depth. Secondly, since the questionnaires were completed during a school class, it is possible that the school classroom environment may have biased the students’ responses. Moreover, given the results related to the perception of the parental relationship and its link with lifestyle habits, it might be particularly interesting to examine the socioeconomic family status. Also, we did not include parameters such as sleep quality questionnaire that is usually associated with parental quality of life and well-being. In addition, for cognitive assessment, as reported in literature, we have chosen only Stroop test for its application in attention, processing speed, cognitive flexibility, and working memory evaluation . FurtherPreventive interventions in healthy adolescent population is useful to improve resilience, happiness, social involvement, self-esteem and sociability, in order to reduce potential risk factors. In this perspective, the integrated approach proposed here is highly flexible and adaptable in its potential applications. This approach would help teachers to select more appropriately personalized educational programs aiming to monitor their compliance and effectiveness. Moreover, evaluation of the best indicators of health and well-being in adolescents represents an important goal in primordial prevention field in order to identify the needs and try to meet them in a more active way. Thus, the possibility of using this integrated approach might be of public health relevance in which a network of different stakeholders dedicated to adolescent education may cooperate together to increase awareness, change behaviour, and create environments that support good health practices.There are two major issues for future research. First, more studies measuring health and well-being objectively or at least a wide range including other parameters linked to social environment are needed. Second, more longitudinal studies are necessary to clarify the direction of causality between single variables and components of adolescent’s health and well-being.Based on the aforementioned findings, the proposed approach suggests the importance of an integrated perspective to characterize adolescents’ health status and well-being. The results highlight the role of different components, life-style, social, emotional, and mental ones, according to a multifactorial and multisectorial approach. The integrated approach suggested here may highlight additive synergistic effects of the various components in health and well-being assessment that would be overlooked if a single factor approach was used.


Previous studies have shown that the behavioral inhibition/activation systems (BIS/BAS) have substantial effects on substance use disorder and emotional disorders, and substance use disorder and emotional disorders often occur; in particular, females with substance use disorder are more likely to also have serious emotional disorders including depression than their male counterparts. However, the associations between the BIS/BAS and depression in females with substance use disorder have received little attention. Furthermore, the underlying mechanisms of these relations are largely unknown. The present study examines the mediating roles of intolerance of uncertainty and anhedonia in the associations between the BIS/BAS and depression among females with substance use disorder from the Research Domain Criteria (RDoC) framework. A total of 303 females with substance use disorder from a compulsory substance abuse detention center were tested using a cross-sectional survey involving BIS/BAS Scales, Intolerance of Uncertainty Scale, Snaith-Hamilton Pleasure Scale, and Center for Epidemiologic Studies Depression Scale. The path analysis model revealed that both the BIS and BAS had a direct effect on depression, that the BIS had an indirect effect on depression through intolerance of uncertainty, and that the BAS had an indirect effect on depression via anhedonia. These findings contribute to a more thorough understanding of how the BIS/BAS influence depression among females with substance use disorder and suggest that the utility of targeting these associations in treatments would help reduce depression in females with substance use disorder. Globally, substance use disorder (SUD) has been increasing rapidly over the past decade . In addiThe National Institute of Mental Health (NIMH) recently launched the Research Domain Criteria (RDoC) initiative, which provides a new classification framework with transdiagnostic psychopathological dimensions for research on psychiatric disorders . These cGray's neuropsychological reinforcement sensitivity theory postulates that two basic dimensions of motivation, including a behavioral inhibition system (BIS) and a behavioral activation system (BAS), govern avoidance and approach behaviors in response to various types of stimuli , 22. AccLife is full of uncertainty, but the extent to which uncertainty is tolerable varies across individuals. Intolerance of uncertainty (IU) is a cognitive bias that influences individuals' perceptions, interpretations, and responses to uncertain scenarios at the cognitive, emotional, and behavioral levels . IndividTraditionally, anhedonia has been conceptualized as the inability to experience pleasure or interest in things . RecentlThe purpose of the present study was to examine how the BIS/BAS influence depression in females with SUD. Specifically, this study explored the mediating effects of IU and anhedonia on the BIS/BAS and depression. A previous study found that high BIS levels had an indirect effect on depression via increased rumination and that low BAS levels had an indirect effect on depression through decreased self-reflection in a sample of participants who had attempted suicide . To our age = 34.97 years, SD = 8.52 years, age range: 18–57 years) included 41.9% were unmarried, 21.5% were married, 35.0% were divorced and 1.7% had missing marital status data. More detailed sociodemographic information is shown in Participants were recruited from a compulsory substance abuse detention center inTianjin, a Representative Municipality city of China. Inclusion criteria included: current diagnosis SUD, between the ages of 18–59, being sufficiently fluency in Chinese to complete the research questionnaires, and being willing to provide written informed consent prior to their inclusion. In addition, exclusion criteria comprised the following: traumatic brain injury and severe suicide risk. Based on the cluster sampling method, a total of 303 Chinese females with SUD were eligible. Of the participants  to 5 (Entirely characteristic of me) . The IUSThe SHAPS is a self-administered scale including 14 items that is used to assess anhedonia . Each ofThe CES-D is used to assess depressive symptoms and includes 20 items in Likert format, using four possible responses anchored by 0 (rarely or none of the time) and 3  . Total sThe participants were given a packet of questionnaires that included instructions on how to respond to the questions and assurances of anonymity as well as questions regarding their basic sociodemographic information , the BIS/BAS scales, IUS, SHAPS, and CES-D. All scales were administered to the participants individually. All scales were printed in the Chinese language and took approximately 25 min to finish. No personal identifying information was collected, and all the information collected was confidential.t-test or analysis of variance (ANOVA). Next, Mplus 7.0 was used to test the hypothesized model. Because depression may be correlated with a variety of sociodemographic factors, the hypothesized model was conducted by adding age, marital status (married or not), education, duration of substance use, number of compulsory detoxifications, and type of substance used as control variables, which is a common statistical method to reduce the confounding effects of personal characteristics  , mean substitution was used to deal with missing data. First, we conducted descriptive statistics and Pearson's correlation analysis with IBM SPSS statistics 24.0. Specifically, we analyzed the influence of demographic variables on depression among females with SUD using Student's eristics . A path ex (TLI) , the comex (TLI) , the staex (TLI)  and the ex (TLI) . A TLI aex (TLI) . The biat(296) = 1.60, p = 0.11), among education groups  = 1.12, p = 0.34), among occupational status groups  = 1.20, p = 0.31), among duration of substance use groups  = 0.40, p = 0.81), and among number of compulsory detoxification groups  = 0.04, p = 0.96). However, there was a significant difference in depression between the two types of substance used groups (t(290) = 2.37, p = 0.02). Females with traditional substance (M ± SD = 17.37±9.46) had higher level of depression than others with new substance (M ± SD = 14.41 ± 8.85). In addition, according to a CES-D cutoff score of ≥16 indicating depressive symptoms, there were 137 (45.2%) depressed females in our sample.Briefly speaking, there were no significant differences in depression between two kinds of marital status including married or not  showed that the fit of the model was suboptimal, but there were eight non-significant pathways for age and depression , marital status and depression , education and depression , duration of substance use and depression , number of compulsory detoxification and depression , type of substance used and depression , the BIS and anhedonia , and the BAS and IU  in this model. After removing these eight pathways, the results of the measurement showed that the modified model fit the data excellently . Standardized pathway coefficients within factors are displayed in The results of the initial hypothesized model with age, marital status, education, duration of substance use, number of compulsory detoxifications, and type of substance used as control variables , and the specific indirect effect of the BIS on depression through IU was also significant . In addition, the results of the bootstrap analyses showed that the direct effect of the BAS on depression was significant , and the specific indirect effect of the BAS on depression via anhedonia was also significant .When the final model was chosen, bias-corrected bootstrapping was performed to further test the significance of the mediators. Compared to traditional mediation analyses, bootstrapping as a non-parametric resampling procedure can provide greater statistical power to test indirect effects . The resTo the best of our knowledge, this is the first study to explore the direct and indirect effects of the BIS/BAS on depression through IU and anhedonia in females with SUD within the RDoC framework. The present results provide strong evidence supporting our proposed model. We found a high prevalence of depression in this population and that the BIS significantly positively predicted depression, while the BAS significantly negatively predicted depression. In addition, IU was a significant mediator between the BIS and depression, while anhedonia was a significant mediator between the BAS and depression in this population. Considering that SUD differ in course and outcome between women and men, the present results for females with SUD could contribute to understanding depression status, understanding the mechanism of depression, and providing important guidelines for the identification, intervention and treatment of depression in this special population.In the current study, 45.2% of the females with SUD reported having depression, which is much higher than the rates in other populations  in previous studies , 74. SevCompared to the positive predictors of high BIS and BAS levels for SUD found in a previous study , 25, theIn the current study, we found that IU mediated the relationships between the BIS and depression and that anhedonia served as a mediator of the relationships between the BAS and depression among females with SUD, which shows that these variables serve as indicators of differential risk factors with great importance to support the unique mechanisms corresponding to depressive symptoms in females with SUD within the RDoC framework . On the via anhedonia in the present study, which suggests that it is imperative to explore the specific mechanisms unique to specific psychiatric symptoms (The present study may have some theoretical and practical implications. From a theoretical perspective, these results provide strong evidence in support of the RDoC initiative. First, consistent with previous findings , 47, 55,symptoms . From a symptoms . On the symptoms .However, there are some limitations in the present study that have to be addressed. First, there was the absence of structured assessment data to validate the clinical diagnoses of depression in the sample, although the CES-D has been widely used to assess depression in epidemiological research . Thus, fThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the ethics committee of Department of Psychology, Capital Normal University. The patients/participants provided their written informed consent to participate in this study.JX and PF designed the study and wrote the protocol. BD and ZZ collected the research data. JX and BD conducted the statistical analyses and wrote the manuscript. RL conducted the literature searches and created the figures. All authors approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Globally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys.The current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command “svy.”A total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower  compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection.The risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place. Acute respiratory infection (ARI) is a leading cause of mortality in children under 5 years old worldwide . About 9Multiple risk factors are associated with ARI including exposure to toxic pollutants in the indoor environment, biomass smoke being one of the most common ones –10. SmokIn Ethiopia, there are 55 deaths per 1000 live births in children under-five due to acute respiratory infection, placing it among the world’s highest mortality rates . Prior sIn Ethiopia, more than 90% of the population uses solid biomass fuel –28; therAccording to the world population review report in 2020, Ethiopia has an estimated 114.96 million population, making it the second-largest country in Africa, the twelfth most populous country worldwide . EthiopiThe Ethiopian Demographic and Health survey 2005, 2011, and 2016 were used for the current study. The surveys were conducted among women aged 15–49 years from urban and rural areas in the nine regions and two cities. During the surveys, each of the regions was stratified into urban and rural areas. Samples of Enumeration Areas (EAs) were selected independently from each stratum from where the samples were determined using a stratified, two-stage cluster design. The number of EAs from the 2016 survey was 645 ; for the 2011 survey, 624 ; for the 2005 survey, and 540  –28. The The data collection method was face-to-face interviewing of mothers or respondents, as indicated elsewhere –28.The outcome of interest was acute respiratory infection (ARI). The DHS survey assessed whether the children of participating mothers suffered from a cough in the last 2 weeks before the survey. The respondents were further probed whether the cough was associated with shortness of breath or rapid breathing problems during the specified period. Therefore, children who suffered a cough with shortness of breathing were considered to have ARI.During each survey, households were asked about the type of fuels they reportedly used and the place of cooking food. Respondents were categorized into solid biomass fuel users  or non-solid biomass fuel users . Besides, households were asked about the location where they cooked the food .Variables were selected based on prior findings that revealed their association with children’s ARI , 32–36. Variables were classified into three levels: (1) child-level variables , (2) household-level variables , and (3) survey-level variables . However, the type of fuel was excluded from analysis as more than 98% of households were reportedly using solid biomass fuel.Yi the binary response of mother on child i about ARI status in the j household in k survey, ajk and β are the intercept and coefficient vector for child-level variables Xi,gj0 is a household-specific intercept, and gk survey-level intercept which is a function of survey-level variable Dk, survey-level coefficient lk, and survey-level intercept l0. Finally, ei, ej, and ek are error terms at each level.Data were analyzed using the Stata 14 version . The “svy” command was used to weigh the survey data to adjust cluster sampling design in the merged data set of three surveys. First, the study population’s characteristics were presented by ARI status and by exposure variables. The association of ARI with the place of cooking food was examined using a three-level multilevel logistic regression to assess variability in the outcome using a household and survey as level. A multilevel analysis was used due to the level of observation at which the child’s ARI status is nested within households and surveys. Inclusion of the higher-level (household and survey-level) characteristics as child-level factors can lead to the understatement of standard error, as one value was replicated across all members of the same group. Using a multilevel model, the value was applied once, at the group level, and information from the pooled regression helped generate reliable estimates even for groups with insufficient numbers of first-level observations. The model also allowed to include error terms at each level, tracking changes in variance across models , 39. Thep value of less than 0.2 were considered for the multivariable analysis to estimate the adjusted odds ratios and the extent of random variations between households and surveys. Three models containing variables of interest was fitted using the “svy: xtmelogit” command in Stata: model-I (empty model): model fitted without factors to test the random variability in the intercept, model-II: to assess the effect of the survey-level variable and (random intercept and slope for survey-level variables), and model-III (full model): to evaluate the impact of survey-level variables and other variables and simultaneously. In a full model, the child-related variables included were age, sex, birth weight, and nutrition status and the household-related variables were wealth quintiles, listening radio, watching television, drinking water source, toilet type, maternal age, maternal education, paternal education, paternal occupation, maternal occupation, and residence. All statistical tests were considered significant at p value < 0.05.Before the model building, a binary multilevel logistic regression was applied. Those variables with a The three EDHS were conducted after obtaining ethical approval from the ICF Institutional Review Board (IRB), Ethiopia Health and Nutrition Research Institute Review Board, and the Ministry of Science and Technology. The data collectors were instructed in how to obtain informed consent statement and voluntary participation prior to data collection. The confidentiality of the information was maintained. For this particular study, a brief description of the protocol was submitted to the MEASURE DHS program to access and analyze the data.Nine thousand nine hundred seventy-one children were included in the analysis from the 2005 survey, 10729 from the 2011 survey, and 10195 from the 2016 survey, with a total of 30895. Two-fifths of the children had an average size, and nearly one-fifth of the children had an age of 3 years and 4 years each. In total, nearly nine-tenths of the children reside in rural, 42% of the children were stunted, 30% were underweight, and 17% were wasted. The majority of participants were from rural areas, and about two-fifths were stunted. Stunting decreased over time, with 50% stunting in 2005, 42% in 2011, and 38% in 2016. Similarly, the number of underweight children also decreased from 50% (2005), 27% (2011), and 24% in 2016. Households’ experience of listening to the radio twice a week in 2005 was nearly 25% which increased to 32% in 2011 and dropped to 13% in 2016. On the other hand, household television watching increased to three times a week in 0.7% in 2005 to 8.3% in 2011 and 8.1% in 2016. Of mothers included in the survey, the majority was unemployed and more than 70% did not attend school  with 98.8% , 99.5% , and 96.9% , respectively, in 2005, 2011, and 2016. The data concerning cooking foods’ locations indicate that 57%, 35%, and 8% cooked the foods inside the house, a separate building, and outside the house, respectively. The cooking location in each survey year shows that 71% of households cooked inside the house in 2005, and the number dropped to 43% in 2016  were used, families cooking the food outdoor had a 30%  lower risk of having under-five children with ARI compared to those cooking inside the home. The random intercepts for the households and survey in model-II also indicate significant differences among households within the survey (between households of the same study) and surveys having under-five children with ARI. The full model  showed that cooking the food outdoor had a 44%  lower risk of having under-five children with ARI compared to cooking inside the house. Similarly, the children’s risk of having ARI among households that cooked the food in a separate kitchen was 19% less likely . The standard deviations of random intercepts and random slopes in a full model were higher than their respective standard errors showing variability from survey to survey. However, the standard deviation of the household’s random intercepts was near zero, meaning there was no house to house variation in this term . This finding is consistent with a prior study conducted in 27 African countries  and AfghThe older children have a lower ARI risk than children below 1 year, suggesting less exposure to induced indoor air pollutants due to less time spent indoors. Mothers with younger children prefer to cook indoors while caring for their children. The finding is similar to previous studies in urban areas of the Oromia region, Ethiopia ; in WondThe mother’s watching of television at least once a week was protective of her child to develop ARI, which is consistent with the prior study . WatchinThe variation in the number of children with ARI among households of different surveys from multilevel modeling suggests a change in the practice of families using non-solid biomass or preparing their food outside and/or ventilated kitchen. This could result from a country-level effort to improve the use of non-solid biomass fuels, and improved stove use, by health extension workers since 2003 –48.2 are predisposing factors for ARI, as reported in a prior study in Tanzania [The higher risk of having children under-five with ARI in the households while cooking inside compared to both the outdoor environment and separate buildings implies that exposures to a high concentration of particulate matter (PM10) and NOTanzania , and pooTanzania . Thus, cTanzania . The hisTanzania . BiomassTanzania . As the Tanzania .The problem can be reduced by changing the country’s community practices, mainly shifting to alternative energy sources, using an improved stove, and behavior change. These were indicated to be effective , 50. A pThis study’s strengths include that it used nationally representative data with a representative sample size collected in three different periods and analyzed using multilevel modeling. However, it has the following limitations: the data were based on a cross-sectional study design. The variables like ARI and size of the children were based on the respondent’s self-report, leading to bias.More than 10% of children suffer from an acute respiratory infection, and about 98% of households used solid biomass fuel in the country. In the families where the food was cooked outdoor, there was a lower risk of having children with ARI than that cooked inside the house. There was an inclining trend in the number of households that cooked the food in the outdoor environments and a separate building. The multilevel modeling shows a variation in the infection of the disease among households of different surveys. But still, an effort remains mainly on awareness creation on cooking indoor homes of well-ventilated and shifting to alternative energy sources. Besides, promoting the use of improved stoves can affect reducing the problem in the country. This can be through the integration of health sectors, mainly health extension programs of the Ministry of Health, designed to deliver health services at the grass-root level, including healthy housing, and the Ministry of Water, Irrigation, and Energy providing alternative energy sources, mainly biogas and others.


Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility . In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility  and the UE mobility-oriented task . Second, in patients with non-acute CNSD , LMC showed low-quality evidence of a medium effect on grip strength (GS)  and on gross motor dexterity (GMD)  in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD  and fine motor dexterity (FMD) . In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT. Central nervous system diseases (CNSDs) include a wide group of diseases that affect the brain  or the spinal cord, causing motor, balance, and cognitive impairments . CNSD caCurrently, conventional therapy (CT) is the most commonly used approach to improve the UE motor impairments caused by CNSD . Specifihttps://leapmotion.com, accessed on 1 February 2021) that does not require sensors to be placed on the participant’s body [® , which is the most widely used body recognition device in balance and gait analysis [The LMC is a consumer-grade and contact-free interaction  developet’s body . The LMCt’s body . In addit’s body . This det’s body . The LMCt’s body . The sent’s body . Fingertt’s body . The LMCt’s body . Compareanalysis , LMC shoanalysis , its smaanalysis , and theanalysis ,42 and manalysis . Severalanalysis ,45. Smeranalysis  reportedanalysis  suggesteanalysis  reportedTo date, different studies have analyzed the validity , feasibiA systematic review with meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement proposed by Moher et al. 2009  and the A bibliographic search was conducted in PubMed Medline, Web of Science (WOS), Scopus, CINAHL Complete, and PEDRO (Physiotherapy Evidence Database) independently by two authors (I.C.-P. and D.M.-C.) between November 2020 and January 2021. Furthermore, the authors also performed a search in the reference lists of the full-text articles retrieved with the original search strategy, in the gray literature and in expert documents. The search strategy was based on the use of the PICOS tool proposed by the Cochrane Library : (1) popThe study selection process was carried out by two authors (I.C.-P. and D.M.-C.). Each of these authors independently screened each article retrieved by title/abstract. When a reference was selected as a potentially eligible study by one of the reviewers, it was examined in detail. Disagreements arising during this phase were resolved by consulting with a third author (M.C.O.-P).The inclusion criteria proposed were as follows: (1) randomized controlled trials (RCTs); (2) RCTs with a sample composed of patients diagnosed with a CNSD; (3) studies that used LMC video game-based therapy as an intervention ; (4) studies in which the comparison group did not receive an intervention or received a therapy different from LMC; (5) studies that assessed different outcomes related to the motor function of the UE; and (6) studies that provided data to perform the meta-analysis. As exclusion criteria, we used (1) RCTs with a population study that included CNSD and other pathologies and (2) studies with only one group.The data extracted from the included studies were collected using a Microsoft Excel standardized collection form by two authors (N.Z.-A. and I.C.-P.). A third author (R.L.-V.) resolved any possible discrepancies related to the extracted data.p-values. When a study did not provide data related to standard deviation, these data could be obtained from other data presented in the study, such as range, interquartile range or standard error, according to standardized statistical procedures [From each study, we extracted the following data: (1) data related to the general characteristics of each study ; (2) characteristics of each group ; (3) characteristics of the intervention in experimental and comparison groups ; and data regarding outcomes . Data used in our meta-analysis were the means and their standard deviations and/or mean differences between groups and ocedures ,62.The main outcome assessed was UE motor function . Specifically, different outcomes related to UE motor function were susceptible to assessment, such as UE mobility, the UE mobility-oriented task, the GS, and the GMD and FMD.In this study, the authors assessed the quality evidence of our findings and the risk of bias. First, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system  was usedThe Cochrane Collaboration Risk of Bias Tool was chosen to analyze the risk of bias of the individual studies included in the present review . This scTwo reviewers (D.M.-C. and E.O.-G.) independently assessed the methodological quality. The quality evidence of each meta-analysis was downgraded one level according to the limitations found. However, if several limitations were present in the findings, the quality evidence was downgraded two levels. Finally, we established a meta-analysis classified into four levels of evidence: (1) high when the findings are robust due to the absence of limitations; (2) moderate if limitations may change the generalization of our results; (3) low if the presence of various limitations decreases the level of confidence in our results; and (4) very low when the estimation of the effect is very uncertain. Any lack of consensus regarding downgrading the level of evidence was resolved by a third author (M.C.O.-P.).p < 0.1 suggests risk of publication bias) [2I) may be small (<25%), medium (25–50%), or large (>50%), and p < 0.1 indicates the presence of heterogeneity [The meta-analyses were performed by two authors (E.O.-G. and I.C.-P.) using Comprehensive Meta-Analysis 3.3.070  . We follon bias)  and withon bias) . Relatedogeneity ,75.A sensitivity analysis was performed using the leave-one-out method with the aim of assessing the contribution of each study to the overall pooled effect in each analysis . In addin = 81), 29 studies were screened by title/abstract. Three studies were excluded by title/abstract. Of the 26 remaining studies, 21 were excluded for not meeting the inclusion criteria (reasons in A PRISMA flow chart  was cons® Wii games (tennis and boxing games) and 2 LMC-based videogames  to try to improve GS and hand function. Finally, Ögun et al. [Five studies with 22 independent comparisons provided data from 174 participants (mean age of 48.35 ± 21.45 years old), of whom 91 participants (57.48 ± 3.76 years old) were diagnosed with stroke ,80, 30 wn et al. ,78,79 orn et al. . The numn et al. ,78, 3 inn et al. ,80, 1 stn et al. ,78 usingn et al. ,78 with n et al. ,78 usingThe assessment of the risk of bias and methodological quality of the studies included in the present review is shown in p < 0.001) was shown on UE mobility in patients with stroke , and the precision of the findings was low (45.5 participants per study). The leave-one-out method yielded pooled estimates that varied 37% when compared to the original pooled effect.Two studies ,80 with h stroke . Althougp = 0.002) , both versus CT.After a subgroup analysis, according to the specific therapy used, our findings showed very low-quality evidence of a higher effect size of the combined use of LMC than when LMC was used alone  of the use of LMC therapy on UE mobility-oriented task in subjects with stroke , and the precision level was low (45.5 participants per study). After applying the leave-one-out analysis, the pooled effect varied by only 2% with respect to the original SMD.Two studies ,80 provih stroke . Publicap = 0.003) or isolated  versus CT.After performing the subgroup analysis according to the specific use of LMC, our findings showed very low-quality evidence of a higher effect of LMC when it was combined with CT  on the recovery of GS in the most affected UE compared to CT (p = 0.165) compared to CT  or combined with CT  compared to CT. Similar results were found in the least affected UE when LMC was used alone  or when a CT program was added .When the subgroup analysis was performed in the most affected UE, LMC did not produce an effect on GS independently if it was used alone  on GMD in the most affected UE compared to CT (p = 0.376)  . The ris= 0.376)  , and inp = 0.039) and a moderate effect of LMC used alone  were found in the comparison CT. However, when the subgroup analysis was performed in the least affected UE, LMC did not show an effect versus CT when it was combined with CT  or when it was used independently .After performing the subgroup analysis in the most affected UE, very low-quality evidence of a high effect of LMC and more CT , in the least affected UE , and bilateral UE  on FMD in comparison with CT  was found in the most affected UE and in bilateral UE , both versus CT, on FMD in patients with non-acute CNSD.When subgroup analysis was performed, only very low-quality evidence of a high effect of LMC and more CT  was analyzed in other meta-analyses. Our overall findings showed a moderate effect of LMC therapy on GS in the most affected UE. However, LMC did not report an effect on GS in the least affected UE. With very low-quality evidence, we suggest that LMC may be a valid tool to train GS in subjects with CP, multiple sclerosis, or Parkinson’s disease. Quantitatively, LMC has been demonstrated to be a valid tool to improve GS in healthy subjects , and thi® Wii or Sony Eye, produces a positive and weak effect for improving gross motor function in patients with cerebral palsy. Jonsdottir et al. [® Wii does not improve GS or hand function in cerebral palsy patients. The main difference between LMC and the major non-immersive VR devices, such as Nintendo® Wii, is that LMC does not need a manual controller, allowing the reproduction of natural hand gestures when the patients interact with the game. This may explain the differences in gross motor recovery and GS between the use of LMC therapy or Nintendo® Wii. Our results can complement the previous findings, support a guarantee to use LMC to improve GMD in subjects with cerebral palsy and other non-acute CNSDs and suggest the use of LMC with one of the best non-immersive VR devices, without manual contact, to be used in the neurorehabilitation of UE in patients with CNSDs. Unlike other VR devices, such as the Kinect®, which are more geared towards reproducing global movements while standing to maintain balance [When LMC was used to improve the GMD in these patients with respect to CT, our findings showed its positive effects in the most affected UE, which were higher when it was combined with CT. To date, only Clutterbuck et al. , in a syr et al. , in a rer et al.  support  balance , LMC is  balance ,42.Finally, in relation to the FMD, in an overall analysis, LMC did not produce an effect on this outcome. However, when LMC was used in combination with CT, very low-quality evidence of a higher effect in the most affected and bilateral UE was shown. Our results are consistent with those recently published by Şahin S. et al. (2020) , who shoThe results derived from this review are consistent with previously published literature because, in most cases, a higher recovery in UE motor function was obtained when LMC was used in combination with CT in different CNSD patients ,102,107.Vanbellingen et al.  describe® and Nintendo® Wii gaming systems, which are more specialized for posture and balance. The LMC is a highly accurate sensor; therefore, it will allow training of fine and precise hand and finger movements. The low cost of LMC favors its inclusion in well-designed home treatments and could increase the level of UE recovery in patients with difficulties accessing the rehabilitation center. In addition, LMC is being implemented to develop a 3D point of intent determination method using multimodal fusion between hand pointing and gaze for a virtual 3D display, which will expand its use to new challenges in the future [Finally, our review supports LMC as the leading haptic VR sensor for UE mobility recovery compared to other non-immersive VR devices, such as Doctor Kinetice future .Some limitations must be considered in this review. First, the low number of studies included can reduce the generalization of our findings. Second, the low sample size reduces the precision level of our findings and increases the possibility of selection bias. However, a lower sample size is a characteristic of the majority of studies published with CNSD patients. The low number of comparisons in each meta-analysis considerably decreased the quality evidence of our findings. It is important to take into account the impossibility of blinding the participants in each group, which can increase the risk of performance bias. Finally, another limitation is the difficulty of studying the risk of publication bias in meta-analyses of fewer than three studies. For further research, it will be necessary to increase the sample size in each study and perform more RCTs with the aim of obtaining more robust findings regarding the use of LMC as a successful therapy on different aspects of UE motor function, such as UE mobility, UE mobility-oriented tasks, GS, GMD, and FMD, in patients with different CNSDs. In the future, it will be essential to develop RCTs to assess hand skills in disabled UE patients with stroke.Our results suggest that LMC may be considered a useful and effective a haptic VR device to improve different aspects of UE motor function in patients with CNSD. Very low-quality evidence of a large effect favoring LMC therapy compared to CT was found on UE mobility and UE mobility-oriented tasks in patients with stroke, and LMC showed large effects on these outcomes when it was used combined with CT. In patients with non-acute CNSD, our findings showed (1) low-quality evidence of a moderate effect of LMC on GS of the most affected UE in comparison with CT; (2) low-quality evidence of a moderate effect of LMC on GMD on the most affected UE, which was higher when LMC was used combined with CT in comparison with CT alone; and (3) very low-quality evidence of a large effect of LMC in combination with CT was shown on FMD of the most affected UE and bilateral CNSD. Finally, our findings postulate the higher effect of LMC on UE motor function when it is added to a CT program in patients with CNSD.


The algae and microalgae are an extremely diverse group of organisms that contain many bioactive molecules, including pigments, polyunsaturated fatty acids, polysaccharides, polyphenol, etc. Algae and microalgae and their bioactive molecules have a variety of health benefits such as antioxidant, anti-inflammatory, anticancer or antiobesity effects. However, due to the extraordinarily rich variety of species and molecules, one could be sure that new effects and/or new molecules are yet to be discovered. Thus, the objective of this special issue entitled “Algae and Microalgae and Their Bioactive Molecules for Human Health” is to present some recent advances in the description and understanding of the action of algal molecules or the effect of whole organism consumption on human health. It is also an opportunity to present new molecular and/or cellular mechanisms of action of bioactive molecules and new pathologies, such as nonalcoholic fatty liver disease (NAFLD) or viral infection, which could benefit from treatment with algae or microalgae. In addition, reports on the isolation and characterization of new bioactive compounds from algae and microalgae will also be of interest to further increase the already large chemodiversity. Altogether, this makes algae and microalgae great candidates for functional food and or preventive drugs. The use of microalgae as a bioengineering factory is also an avenue to be explored.Undaria pinnatifida, Arthrothamnus bifidus, Thalassiophyllum clathrus and Agarum turneri. By contrast, it was around twofold higher in the water extract for Sargassum pallidum and Kjellmaniella crassifolia. The highest antioxidant activity was found for Agarum turneri ethanol extracts, which is also the species with the highest content of phlorotannin. Interestingly, the authors highlighted the presence of major phenols in the extract of Thalassiophyllum clathrus, such as phenolic acid , hydroxycinnamic acids  and flavonols .In the present Special Issue, the biodiversity and chemodiversity of macroalgae species was explored from brown seaweeds from the Russian coast  to chlorCaulerpa racemosa and Ulva fasciata from the Philippines. This research work highlighted the nutritional value of both algae, which contain high amount of proteins  with a portion of essential amino acids around 42–45% comparable to FAO/WHO requirements. However, the main essential amino acids were different in the two algae; leucine, valine, isoleucine, and lysine being the most abundant in C. racemosa, while leucine, valine, lysine, and phenylalanine dominate in U. fasciata. Concerning fatty acids, the two species are divergent since monounsaturated fatty acids and polyunsaturated fatty acids are dominant in C. racemosa (56.2%), while saturated fatty acids (72.1%) are prevailing in U. fasciata. Nevertheless, both species display a high ratio of C18/C20 polyunsaturated fatty acid. The main difference between these two species was the total pigment content, which was found 20-fold higher in C. racemosa (140.84 mg/g dw) compared to U. fasciata (7.54 mg/g dw). Mineral contents for both seaweeds were within levels considered safe for functional foods and the nutritional characteristics of C. racemosa make it interesting for human consumption and functional food ingredient. In addition, the hot water extract from C. racemosa showed in vitro antiherpetic activity without cytotoxicity.The paper by Magdugo et al.  is focusUlva rigida and Codium tomentosum, three red seaweeds Gracilaria gracilis, Palmaria palmata and Porphyra dioica, and the brown algae Fucus vesiculosus, were obtained from a land-based integrated multitrophic aquaculture system and analyzed for their lipid quality indices based on their fatty acid profiles and their bioactivities. Results highlighted the species specificity of the health benefits. U. rigida displayed the lowest atherogenicity and thrombogenicity indices. The lipid extracts from Palmaria palmata and F. vesiculosus showed the lowest inhibitory concentration in the free radical scavenging antioxidant assays. Ulva rigida, C. tomentosum, P. palmata and P. dioica inhibited the cyclooxygenase-2 activity by up to 80%, while P. dioica and P. palmata extracts showed the highest cytotoxic potential in the MDA-MB-231 breast cancer cells. Altogether, these results support the use of macroalgae as functional foods and promising ingredients for sustainable and healthy diets, in a species-specific context.Six other species of marine edible macroalgae have been investigated by Lopes et al.  for theiColpomenia sinuosa collected on the Lebanese coast. The dichloromethane:methanol extract was the more potent against HCT-116 colon cancer cell line proliferation by increasing the subG1 population of cells and inducing apoptosis. Apoptosis was induced via upregulation of p21 protein and downregulation of the antiapoptotic Bcl 2. This extract also decreased the migration potential of HCT-116 cells with minimal effects on nontumorigenic cells. An increased level of reactive oxygen species was observed in cells treated by the extract of C. sinuosa and its effects were inhibited by the addition of an antioxidant. These results indicate that C. sinuosa is a source of bioactive compounds possessing proapoptotic and antimigratory efficacy, but the nature of these compounds remain to be elucidated.The research paper by Al Monla et al.  focused Two review papers emphasize the importance of polysaccharides from seaweeds ,6. The pFurthermore, the review by Hentati et al.  focuses The microalgal biodiversity was less explored in the present Special Issue but their variety of potential was exemplified by four papers ,8,9,10 sThis includes a general review of the health benefits of the various molecules that can be extracted from eukaryotic microalgae and cyanobacteria . MoreovePhaeodactylum tricornutum. P. tricornutum is a marine microalga, which is rich in bioactive molecules known to be hepatoprotective, such as n-3 long-chain polyunsaturated fatty acids and the carotenoid pigment fucoxanthin. However, its effect on NAFLD, which is a common liver disease characterized by an excess of lipid accumulation, has been poorly studied. Here, the authors have used the hepatocarcinoma cell line HepG2 treated with palmitate as a cellular model of NAFLD. The addition of carotenoid extract (6 μg/mL) or total lipophilic extract (100 μg/mL) prevented the accumulation of triglycerides, total cholesterol and cholesterol esters. Both extracts decreased the mRNA levels of genes involved in lipogenesis  and cholesterol esterification (ACAT1/SOAT1). By contrast, while the total lipophilic extract also downregulated the LXR/NR1H3 and SREBF1 genes, which are involved in lipogenesis regulation, the carotenoid extract increased the mRNA level of CPT1A, a β-oxidation related gene, and reduced the lipid droplet accumulation. Altogether, the presented results suggest that both P. tricornutum extracts may have preventive effects against NAFLD.The research paper by Mayer et al.  provide Nannochloropsis gaditana for nutritional enrichment of farmed salmon [N. Gaditana significantly increased Vitamin D3, eicosapentaenoic and docosapentaenoic fatty acids levels in boneless and skinless salmon meat. Thus, this original work showed that N. Gaditana may be a novel, functional and natural ingredient and a sustainable source of n-3 long-chain polyunsaturated fatty acids that can raise the levels of healthy fats and vitamin D3 in farmed salmon meat.The health benefit of microalgae as functional food was also highlighted through the use of d salmon . Lozano-Finally, Rosales-Mendoza et al.  provide Overall, this special issue will have shown the diversity and the very rich potential of algae and microalgae in functional foods, nutraceuticals, and preventive drugs and as a biotechnology resource for the production of biopharmaceuticals. Although limited to a few specific examples, this panorama augurs well for many developments and has prompted us to renew this theme in a future special issue “Algae and Microalgae and Their Bioactive Molecules for Human Health 2021”.Molecules editorial team, and in particular its managing editor Alvina Wu, for their kind and professional assistance in making this special issue a success. Finally, I hope that this special issue will bring satisfaction and knowledge to the readers.As guest editor, I would like to thank all the authors for their important contributions, as well as all the reviewers, who greatly contributed to ensuring the high scientific quality of the content. I would also like to thank the authors of the contributions that were not selected and I hope that they will find their place in the next issue. Special thanks to the


Existing literature shows several discrepancies in parenting style between urban and rural China, but conclusions are confusing. Therefore, the aim of this meta-analysis is to consider these inconsistencies and explore the influences of several moderator variables.Literature search will be conducted on PubMed, OVID, the Web of Knowledge, China National Knowledge Infrastructure, Wan fang and Chongqing VIP database without language/date/type of document restrictions. The Software Comprehensive Meta-Analysis 3.0 will be used to compare all the selected articles. Moreover, study quality was assessed with a checklist.Literature search will be conducted on PubMed, OVID, the Web of Knowledge, China National Knowledge Infrastructure, Wan fang and Chongqing VIP database without language/date/type of document restrictions. We will use Comprehensive Meta-Analysis Software to conduct main meta-analysis. The primary outcomes are scores/subscores measured by the Chinese version of Egna Minnen Beträffande Uppfostran, Parental Bonding Instrument, and any other questionnaires including parenting style.Not needed because no data will be collected.INPLASY202050010. Authoritarian parenting style is a risk factor for cyberviolence. Authoritarian or rejecting parenting styles was related to behavioral and emotional disorders. A meta-analysis proved that negative parenting behavior is related to a moderate increase of risk for becoming a bully/victim and small to moderate effects on victim status at school. More warmth and behavioral control was related to high level of agreeableness, conscientiousness, and openness and lower levels of neuroticism. Meta-analysis also showed that parenting styles are significantly correlated with aggression of children in mainland China.As indicative of the overall emotional climate in the home, According to Jay Belsky's process of parenting model, parenting is multiply determined and is influenced by characteristics of the parent, child, and social context. Bronfenbrenner classified the external environment of the family as meso-systems and exosystem. Mesosystems refer to the relationship between 2 or more systems in which family members participate, such as the relationship between family and school or job while exosystems are the contexts we experience vicariously and yet they have a direct impact on us, such as the political and economic characteristics of society, natural and physical environment, etc. Both mesosystems and exosystem have an impact on parent-child interaction in the family. College-educated parents tend to spend more time with children in the absence of the child's siblings than do less-educated parents. Therefore, the socioeconomic status are linked with parenting style.It is realized that unearthing the specific origins of parenting style is a critically important research objective. The household system since the mid-1950s has strengthened the social structure of the urban-rural divide, and led to the great difference between urban and rural residents. In recent years, China has published a series of policies to promote balanced development between urban and rural areas, and has also achieved positive results. Over the past 2 decades, tremendous changes have occurred in urban and rural areas in China and people's educational level has risen dramatically. However, the traditional dual structure of urban and rural areas still exists. There are huge differences in the geographical environment, social conditions, economic level, cultural education, medical and health care between urban and rural areas, which may have a significant effect on parenting styles.From ancient time, there have been 2 Chinas: the myriad agricultural communities of the peasantry in the countryside and the more mobile overlay of walled towns and cities peopled by the families of property and position. But another study found that urban parents have more emotional warmth and understanding for their children, but at the same time they have more rejections. A third study found that urban parents have more emotional warmth, understanding and rejection than rural parents. Therefore, effects of rurality on parenting style have not been systematically evaluated. Therefore, there are 2 topics in this study:However, due to the differences in research objects, survey tools, sample size and statistical methods, findings have been mixed. A study found that rural parents had more rejection due to the inequality of economic income and parents’ education level.1.to compare the difference in parenting style between urban and rural areas;2.to explore the influences of several moderator variables  on the rural-urban difference in parenting style.2 The protocol of this systematic review is registered in INPLASY.COM (INPLASY202050010).The recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement will be followed.2.1The following electronic databases will be searched with no language/date/type of document restrictions: PubMed, OVID, the Web of Knowledge, China National Knowledge Infrastructure, Wan Fang database and Chongqing VIP database. Search terms in PubMed are as follows: (China or Chinese) and (egna minnen av barn doms uppforstran or Egna Minnen Beträffande Uppfostran (EMBU) or parenting style or parental rearing or parenting behavior or parenting pattern or education style or My memories of upbringing) and (urban or city or cities) and .Additional details about the search strategy/syntax, including search terms for each database, will also be listed. In addition, references of included studies will be scanned to find any potential pertinent study detected with the electronic search.2.2We will only include studies that met the following criteria:1.cross-sectional or observational study using EMBU, Parental Bonding Instrument (PBI), and any other questionnaires including parenting style;2.rural and urban group reported mean (M), standard deviation, number (N) and other parameters such as t, p.The subjects are normal subjects and criminals and patients will be excluded.2.3The eligibility process will be conducted in 2 separate stages:1.Two authors will independently screen titles and abstracts of all nonduplicated papers and exclude those not pertinent.2.The full-text version articles which get over stage 1 will be downloaded and assessed for eligibility by 2 authors, independently.Discrepancies will be resolved by consensus between the 2 authors and, if needed, a third senior author will act as arbitrator.Two researchers will perform independently data extraction; any discrepancies will be resolved by consensus between the 2 authors. The following data will be extracted:1.Study details: study citation, year(s) of study or publication, region ;2.Participants details, including number, gender distribution, mean and range of age, in both groups;3.Outcomes: Mean, standard deviation of total score and subscores in both groups and other parameters such as t, p.2.4The primary outcome will be score measured by the Chinese version of EMBU, PBI and any other questionnaires including parenting style. EMBU is a Swedish self-report scale of perceptions about the behavior used by the respondent's parents in bringing them up. The Chinese version of the questionnaire was revised by Yue and comprises 66 items, with 58 in the six sub-scales about the father  and 57 in the five sub-scales about the mother . Responses are on a four-point Likert-type scale, from 1 (never) to 4 . Because of the 1-child family planning policy adopted by China before 2011, most of the subjects in the study had no brothers or sisters. F4 and M5 are not suitable for the current situation, so no further investigation was made. The Chinese version of PBI included 2 dimensions of care and overprotection.2.5 It consists of 10 items, including study design, sampling method, rural group information, education level/age of child participants, data collection methods, response rate, comparison group information, measurement, statistical procedure, and data sufficiency.Methodological quality of selected articles will be assessed by using the revised checklist by Chen.Two authors will independently assess the quality of each selected study and disagreements will be resolved by further discussion.2.6 We will also use the I-squared index to assess the heterogeneity of effect sizes. A significant I-squared indicates that the degree of heterogeneity is greater than would be expected by chance. We will use Egger test and funnel plots to estimate publication biases.Analyses will be performed with comprehensive meta-analysis. The urban subjects will be considered as the experimental group, while the rural subjects as the control group. Given the inherent heterogeneity of studies, random-effect model will be used.2.7Based on the age of subjects (High school and below vs college and beyond), regions, and questionnaires, we will do subgroup meta-analysis. Additionally, we will plan a meta-regression analysis including parenting style score as outcomes and year of publication, region, age group, and rating on the checklist of quality assessment as regressor.3With regard to the strengths, we preregistered the protocol in INPLASY.COM, reducing the risk of reporting bias. In addition, we will endeavor to perform a comprehensive and systematic search in several databases, with no restrictions in terms of language or document type.However, our results should be considered very cautiously due to a number of methodologically relevant issues in the retained studies. This is why we would urge caution in the interpretation of these results.4As to parenting style, what are the similarities and differences between urban and rural parenting style in China? More high-quality and representative studies will also need to be considered.Conceptualization: Junhua Zhang.Formal analysis: Yu Zhang, Fang Xu, Junhua Zhang.Funding acquisition: Junhua Zhang.Project administration: Yu Zhang, Fang Xu.Software: Junhua Zhang.Supervision: Junhua Zhang.Writing – review & editing: Yu Zhang, Fang Xu, Junhua Zhang.


Chitosan is an environmentally friendly agent that is used to achieve the antimicrobial properties of textiles. Nowadays, the binding of chitosan to the textiles has been thoroughly researched due to the increasing demands on the stability of achieved properties during the textile care processes. Most crosslinking agents for chitosan are not safe for humans or environment, such as glutaric aldehyde (GA) and formaldehyde derivatives. Eco-friendly polycarboxyilic acids (PCAs) are usually used in after-treatment. In this work, chitosan powder was dissolved in citric acid with sodium hydrophosphite (SHP) as a catalyst. Standard cotton (CO) and polyester/cotton (PES/CO) fabrics were pretreated in 20% NaOH, similar to mercerization, in order to open the structure of the cotton fibers and hydrolyze polyester fibers, continued by finishing in the gelatin chitosan bath. Afterwards, the hot rinsing process, followed by drying and curing, closed the achieved structure. The main objective was to achieve durable antimicrobial properties to multiple maintenance cycles CO and PES/CO fabric in order to apply it in a hospital environment. The characterization of fabrics was performed after treatment, first and fifth washing cycles according ISO 6330:2012 by field emission scanning electron microscopy (FE-SEM), Fourier transform infrared spectroscopy (FTIR-ATR), electrokinetic analysis (EKA), by the determination of tensile properties and mechanical damage (wear), and the antimicrobial activity. The application of 20% NaOH led to the swelling and mercerization of cotton cellulose, and hydrolysis of polyester, resulting in better mechanical properties. It has been confirmed that the chitosan particles were well implemented into the cotton fiber and onto to the polyester component of PES/CO blend. The presence of chitosan was confirmed after five washing cycles, but in lower quantity. However, achieved antimicrobial activity is persistent.  Chitosan, which is one of the most important derivatives from natural biopolymer chitin that can be found in crustacean shells, insect exoskeletons, fungal cells walls, and plankton, has been highly evaluated for medical purposes, as antibacterial, antimicrobial, anticancer, antidiabetic, wound dressings, drug delivery systems, enhancing immune activities, and lately for medical devices ,23,24,253 acetate or chloride). Therefore, the papers related to chitosan treatment mainly discuss its crosslinking to improve durability. The chemicals that are used for crosslinking of chitosan to cotton cellulose are common auxiliaries in finishing, as dimethyloldihydroxyethyleneurea (DMDHEU) , 0F is breaking force of start fabric [N], and F is breaking force of treated and/or washed fabric [N]. For this calculation, as start fabric standard CO or PES/CO fabric was used, and secondly each sample was compared to its pair regarding the number of washing cycles.Tensile properties were measured according to EN ISO 13934-1:1999 Textiles—Tensile properties of fabrics—Part 1: Determination of maximum force and elongation at maximum force using the strip method on a TensoLab Strength Tester , distance between clamps 100 mm, bursting speed 100 mm/min and pretension 2 N. The measurements were performed on four strips, and the average value, coefficient of variation, standard deviation with interval of confidence of 95% (IC95%) and 99% (IC99%) were automatically calculated. From these results, mechanical damage was calculated according to ISO 4312:1989 Surface active agents—Evaluation of laundering—Methods of analysis and tests for unsoiled cotton control cloth:The antimicrobial activity was determined according to AATCC TM 147-2016, Antibacterial Activity Assessment of Textile Materials: Parallel Streak Method. The activity was determined to Gram-positive bacteria Staphylococcus aureus ATCC 6538 , Gram-negative bacteria Escherichia coli ATCC 8739 , and microfungi–yeast Candida albicans ATCC 10231 .In this paper, chitosan powder was implemented into cotton (CO) and polyester/cotton (PES/CO) blended fabric by exhaust-dry-cure finishing method on a jigger and dryer. Five washing cycles were performed in order to determine treatment durability. The results are presented after treatment, first and fifth washing cycle.FE-SEM is the most widely used tool for morphological analyses different materials. In this study, FE-SEM was used to study the surface morphology of cotton and polyester/cotton blends untreated and treated fabrics with chitosan before and after the first and fifth washing cycle. The SEM images are presented in The FE-SEM images presented in The SEM images of cotton fibers in untreated standard cotton fabric  show chaIt is clearly evident that chitosan forms an uneven layer on the surface of cotton fiber a,b, but From the SEM images of PES/CO fabric, the difference in morphology of fibers in the blend can be clearly seen: CO fibers’ morphological structure show the appearance of a flat ribbon with a central canal in comparison to the PES even flat smooth surface. The SEM image of the PES/CO_Ch sample  clearly −1 and are presented in The characterization of CO and PES/CO fabrics before and after treatments and several washing cycles was performed by FTIR-ATR spectroscopy within the region of 4000–380 cm−1 due to stretching within the -OH group and amines and at 2163 cm−1 due to stretching within the C-H group. At the wave number of 1640 cm−1 on the treated specimens before and after the washing cycles, changes in the peak intensity relative to the CO fabric can be seen. It is known that, in this specific area, cellulose materials have a peak due to adsorbed water molecules, whilst, in chitosan, the peak occurs due to C=O stretching within amine I. −1 and 1425 cm−1, as well as increased intensity at 895 cm−1, are characteristic for mercerized cotton [−1 is confirmation of change the cellulose crystal structure from cellulose I to cellulose II. The peak at 897 cm−1 resulting from vibrations within C-H can be attributed to both cellulose II and chitosan (−1). The increment of intensity can be result of its overlapping. The changes in the appearance of the peak at 1424 cm−1, due to the symmetric bending of the CH2 bond at the C-6 atom, indicate the presence of chitosan in the cellulose structure, because for mercerized cellulose II is characteristic decreased intensity of this peak. The clear peak at 1424 cm−1 in the bands of chitosan treated cotton fabrics , confirms the persistent physico-chemical modifications of the cellulosic material by chitosan particles. Lower or missing peak at 1105 cmd cotton ,43. Sinc−1, which is due to stretching within the -OH group, and the amine and 1089 cm−1 is due to stretching C-O all refer to changes due to the impact of citric acid as a crosslinking agent and the presence of chitosan in the material structure.−1 (C-H wagging) and 1157 cm−1 (C-O-C asymmetric stretching) become weaker and broader, most probably due to covering and reaction chitosan with the PES/CO fabric. A very interesting change is seen in the area of 1157 cm−1 (C-O-C asymmetric stretching), where the peak completely disappears after finishing, and the reappears after the first washing cycle in a very small intensity indicating constant changes in the fabric. All of the mentioned changes in the treated fabric are also visible after the five washing cycles, which indicates a permanent change in the physico-chemical properties of the treated PES/CO fabrics [Peaks on 1310 cm fabrics ,45,46,47plateau= −20 mV. The reason for that are mainly hydroxyl and carboxyl groups of raw cotton, which were made available after the removal of non-cellulose compounds  in the scouring process. Additionally, chemical bleaching processes caused the formation of new surface groups  [From the results of the electrokinetic analysis, it can be seen that standard cotton fabric (CO) has negative zeta potential at pH 9 ζd –COOH) ,37,48. Td –COOH) ,38.On the other hand, polyester/cotton blended fabric (PES/CO), in electrolytic solution of 0.001 M KCl, shows zeta potential that depends on both components. In neutral and alkaline solutions, PES/CO fibers in blend dissociate, giving a negative surface charge and shows negative zeta potential, due to the presence of hydroxyl and carboxyl functional groups of cotton and to a carboxyl ester group of polyester. However, according to the literature , hydrophIn the laundry process ,50, duriThe implementation of chitosan results in higher zeta potential in alkali and neutral electrolyte solution due to chitosan amino groups. For CO fabric zeta potential goes from ζ = −20 mV to ζ = −13.4 mV for CO_Ch, and for PES/CO fabric zeta potential goes from ζ = −16.4 mV to ζ = −16.2 mV for PES/CO_Ch. If the changes during mercerization are considered, then this effect is even more enhanced. As said above, in mercerization 20% NaOH penetrate into the lumen of the cotton fiber, it swells, the lattice changes from cellulose I into cellulose II, whereby the rotation of chains cause the formation of new bonds, resulting in improved mechanical properties of the cotton. The swelling of cotton fiber during mercerization resulted in fiber morphological changes while the new available groups increased the surface sorption. All of these changes are causing a shift of shear plane into the liquid phase thus reducing the zeta potential eg. from ζ = −20.9 mV for bleached to ζ = −24.7 mV for mercerized cotton . AccordiWhen comparing the zeta potential results of CO and PES/CO fabrics to fabrics with implemented chitosan after the washing cycles, it can be seen that a certain amount of chitosan is still present in the fabric, because, at pH 4, the zeta potential values are higher. For example, at pH 4, the zeta potential of PES/CO_1w is ζ = −9.8 mV, and PES/CO_Ch_1w is ζ = −2.8 mV; and, after five cycles the zeta potential of PES/CO_5w is ζ = −12.3 mV and PES/CO_Ch_5w is ζ = −7.8 mV.The mechanical properties of CO and PES/CO fabrics after chitosan implementation and the washing process were analyzed through the tensile properties and mechanical damage (wear). From the results that are shown in A similar phenomenon can be observed when analyzing the mechanical properties of PES/CO fabric, but in less intensity. The reason for this is that only cellulosic part goes through mercerization, swelling and the shrinkage after drying, whilst polyester one hydrolyze.The yarn count and breaking force have been increased during the washing process. The washing process is regulated by four factors: chemical and mechanical action, temperature, and time, usually being represented by Sinner’s circle. Water is a medium that connects all factors in the process: to dissolve detergent and all chemicals, transfer heat to the fabric, and also plays an important role in the application of mechanical force. The frequent washing cycles can cause fiber surface modification as a result of the swelling capacity of cellulose based fiber in the alkaline detergent washing bath. Namely, swelling in the alkali medium brings changes in pore structure and has a tendency towards fibrillation and surface changes of cotton fibers. The degree of swelling is proportional to the amount of adsorbed water at a relative humidity (RH) 65% and temperature 20 °C. Under these conditions, cotton absorbs approximately 10% moisture, while the polyester absorbs less than 1%. Therefore, no changes due to fibrillation are observed on the surface of PES/CO fabric, only a peeling characteristic of the PES fibres ,51,52. For all of these reasons, the values for mechanical damage of cotton and PES/CO fabrics after washing are higher. It can be seen that the biggest change occurs in the first washing cycle, and do not significantly change for five washing cycles. The reason for such behavior is caused by mechanical and chemical action on the cellulose based materials, which tends to fibrillate, whilst polyester does not. PES/CO has less pronounced shrinkage than cotton due to the increased proportion of PES component (65%) when compared to cotton (35%). The hydrophobic properties of PES reduce swelling in water baths, thus reducing the shrinkage of PES/CO fabric after washing ,51. In the case of chitosan implementation, the improvement of tensile properties can be seen. The reason can be mercerization that occurred and the shrinking of fabric in the weft direction, because all treatments were done in jigger where the tension was oriented on warp direction. For chitosan implemented cotton fabrics, an insignificant increment of breaking force after first and fifth washing cycle can be seen. This indicates dimensional stability achieved by this treatment.When comparing PES/CO chitosan implemented fabrics after the first and fifth washing cycles with the one after treatment, it can be seen that some mechanical damage has occurred since the values are 15% less. The reason for that can be cellulose crosslinking to chitosan by CA, and breaking these bonds during washing process, as well as curing at 150 °C. The SEM images  clearly The bath containing CA is highly acidic (pH 2.5). When cotton fabric is treated in such bath, hydrocellulose is produced, and the thermocondenzation of acid treated fabric can lead to cellulose degradation, weakness of yarns, and damage of fabrics, which then become unusable. The results of mechanical damage confirmed that the pretreatment in NaOH leads to opened structure and activation of surface groups of cellulose, as well as contributing to pH neutralization when the acid bath of CA, SHP, and chitosan is applied. This combination of processes led to pH 5.5, which is the optimal pH for chitosan application and, at the same time, cellulosic component stays undamaged.Staphylococcus aureus, Gram-negative bacteria Escherichia coli, and microfungi Candida albicans. However, it can be seen that chitosan treatment leads to antibacterial activity, regardless of the applied fabrics. Both of the fabrics show good activity towards Staphylococcus aureus. Even better activity can be seen for Escherichia coli. The difference between chitosan treated fabrics can be seen for Candida albicans. Cotton fabric did not show activity to microfungi, whilst the PES/CO fabric did. It is to point out that the achieved antimicrobial activity stays after five washing cycles, which indicates a sufficient amount of chitosan on the fabric structure. In addition to these results, it is to point out once again that chitosan is an eco-friendly chemical that will have no negative influence to humans or environment if applied.The morphological analysis by SEM, physical-chemical characterization by FTIR-ATR and zeta potential, tensile properties, and antimicrobial activity determination are confirmed next:-Chitosan particles are well implemented in the cotton and PES/CO blend fabrics. Five washing cycles confirmed the presence of chitosan, but in lower quantity. However, achieved antimicrobial activity is persistent.-The application of 20% NaOH led to the swelling and mercerization of cotton cellulose, and the hydrolysis of polyester, as well as the neutralization of forthcoming acid bath, which led to better mechanical properties. It opened the structure for better chitosan particles implementation into the cotton fiber and onto to the polyester component of PES/CO blend, which is certainly a major contribution in the field of achieving persistent processing of cellulosic materials. The application of citric acid was proven as a good crosslinking agent between the cellulose components and chitosan.-The newly applied semi-continuous combination of finishing process methods, exhaust-dry-cure on jigger, and dryer, because of simplicity gives the possibility of application in industrial conditions and presents a challenge for further research in cooperation with the textile industry.