T. callipaeda, the parasite has not been found until now.Despite the increasing number of reports of autochthonous cases of ocular thelaziosis in dogs in several European countries, and the evident emergence of human cases, the distribution and spreading potential of this parasite is far for being fully known. In Romania, despite intensive surveillance performed over recent years on the typical hosts of c oxidase subunit 1 gene, followed by sequencing).In October 2014 a German Shepherd was presented for consultation to a private veterinary practice from western Romania with a history of unilateral chronic conjunctivitis. Following a close examination of the affected eye, nematodes were noticed in the conjunctival sac. The specimens collected were used for morphological examination (light microscopy) and molecular analysis (amplification of the cytochrome T. callipaeda. The history of the dog revealed no travel outside Romania, and during the last year, not even outside the home locality. The BLAST analysis of our sequence showed a 100% similarity T. callipaeda haplotype h1.Thirteen nematodes were collected, all identified morphologically as T. callipaeda in Romania, which we consider to be with autochthonous transmission. These findings confirm the spreading trend of T callipaeda and the increased risk of emerging vector-borne zoonoses.This is the first report of  Thelazia callipaeda is a vector-borne zoonotic eyeworm, parasitizing the conjunctival sac of domestic and wild carnivores , rabbits and humans. Its presence is associated with mild to severe ocular disease [et al. [Phortica variegata . disease ,2. The d disease . In Euro disease  followed disease -7. Howev [et al. ,9, when T. callipaeda isolates in Europe for which sequences of partial cytochrome c oxidase subunit 1 (cox1) are available belong to the haplotype 1 (h1), suggesting a high degree of nematode-host affiliations for this haplotype [All the aplotype .et al. [Based on climatic analysis, a wider European distribution was suggested already in 2003 by Otranto et al. . Despiteet al. -24, untiT. callipaeda in Europe and to identify the haplotype circulating in Romania.The aim of this study was to extend the knowledge on the geographical distribution of In October 2014, a dog  was presented for consultation to a private veterinary practice from Oradea, Bihor County, in western Romania  with a history of unilateral chronic conjunctivitis (right eye). After one month of local intra-conjunctival treatment with antibiotics, as the animal’s condition was not improving, the owner brought the case to our attention (by author RC). Following a close examination of the affected eye, alive, white, medium-sized nematodes were noticed in the conjunctival sac. As part of the treatment, all nematodes were collected during superficial anaesthesia (Xylazine + Ketamine), using a fine blunt tweezers and preserved for further examination in absolute ethanol (3 specimens) and 5% formalin (10 specimens). We have obtained the verbal consent of the owner to use the collected material for a scientific publication and he kindly provided the travel history of the dog.The specimens collected in formalin were used for morphological examination. The nematodes were mounted on a glass slide, cleared with lactophenol and examined using an Olympus BX61 microscope. Photographs and measurements for morphologic identification were taken using a DP72 camera and Cell^F software .c oxidase subunit 1 (cox1) gene of spirurid nematodes (670 bp) was performed using the NTF/NTR primer pair, following reaction procedures and protocols described in literature [The specimens collected in absolute ethanol were analysed using molecular techniques. Genomic DNA was extracted from a gravid female using a commercial kit  according to the manufacturer’s instructions. Amplification of a partial cytochrome terature . PCR proFrom the conjunctival sac of the right eye, 12 nematodes were collected. Additionally, one nematode was also found in the conjunctival sac of the apparently non-affected left eye. A close examination of the affected right eye revealed the presence of proliferative lesions in the inferior conjunctival sac  showed a 100% similarity to a sequence (GenBank™ accession number AM042549) of otype h1 .T. callipaeda for the first time in Romania. Considering that the host dog has never travel to other known endemic areas, nor outside the city limits in the last year, we regard this as a sufficient proof for the existence of an autochthonous transmission cycle. So far, this is the most easternmost report in Europe (except previous records from the former USSR), confirming in our opinion the spread of this nematode.After the previous records in Europe , the current study reports the presence of the zoonotic eyeworm T. callipaeda was not found to date in any of the neighbouring countries .Often, disease emergence and spreading, is only apparent due to lack of sufficient investigation, mainly in the case of non-clinical infections which require targeted laboratory diagnosis. However, in the case of canine ocular thelaziasis, we consider the disease new to Romania, as the infection is usually clinical and can be hardly overlooked by owners and clinicians. Moreover, in the past 5 years, the authors of the present paper had intensively focused on the surveillance of vector-borne pathogens in domestic and wild carnivores, with more than one thousand potential hosts individuals investigated and specifically examined for eye worms from various regions of the country (including western Romania). Additionally, to our knowledge, T. callipaeda is Phortica variegata  has been reported in Romania on various occasions [P. variegata occurrence in Romania, the vector is also probably present here. However, further entomological surveys are required for its confirmation.The only confirmed vector for ccasions . Its preccasions . As Oradcox1 confirmed the existence in Europe of a single haplotype, as defined earlier [Genetic analysis of  earlier , suggestT. callipaeda, with reports from Italy, France, Portugal and Switzerland [Cats have been also implicated in clinical cases of ocular infections with tzerland ,10,28-31tzerland -34.T. callipaeda is an emerging zoonotic infection [As nfection , our fin


Frailty is a highly prevalent condition in old age leading to vulnerability and greater risk of adverse health outcomes and disability. Detecting and tackling frailty at an early stage can prevent disability. The purpose of this study is to evaluate the effectiveness of a multifactorial intervention program to modify frailty parameters, muscle strength, and physical and cognitive performance in people aged 65 years or more. It also assesses changes from baseline in falls, hospitalizations, nutritional risk, disability, institutionalization, and home-care.The current study is a randomised single-blind, parallel-group clinical trial, with a one and a half year follow-up, conducted in eight Primary Health Care Centres located in the city of Barcelona. Inclusion criteria are to be aged 65 years or older with positive frailty screening, timed get-up-and-go test between 10 to 30 seconds, and Cognition Mini-Exam (MEC-35) of Lobo greater than or equal to 18. A total of 352 patients have been equally divided into two groups: intervention and control. Sample size calculated to detect a 0.5 unit difference in the Short Physical Performance Battery . In the intervention group three different actions on frailty dimensions: rehabilitative therapy plus intake of hyperproteic nutritional shakes, memory workshop, and medication review are applied to sets of 16 patients. Participants in both intervention and control groups receive recommendations on nutrition, healthy lifestyles, and home risks.Evaluations are blinded and conducted at 0, 3, and 18 months. Intention to treat analyses will be performed. Multivariate analysis will be carried out to assess time changes of dependent variables.It is expected that this study will provide evidence of the effectiveness of a multidisciplinary intervention on delaying the progression from frailty to disability in the elderly. It will help improve the individual’s quality of life and also reduce the rates of falls, hospital admissions, and institutionalizations, thus making the health care system more efficient. This preventive intervention can be adapted to diverse settings and be routinely included in Primary Care Centres as a Preventive Health Programme.NCT01969526. Date of registration: 10/21/2013.ClinicalTrials.gov PRS: The concept of frailty has long been associated with advancing age although only recently has it been specifically defined as a medical syndrome–4. DisabDespite considerable discussion, frailty remains to be systematically defined. There iet al. who identify someone as having a frail phenotype when three or more of the following components are presented[et al. proposed a review to slightly modify Fried’s measurements in order to strengthen the predictive validity of the concept[et al. introduced two tests of physical ability strongly associated with disability development and progression: the Rapid-Gait Test and the Stand-Up Test[There is no agreement on a valid evaluation model for both research and clinical approaches, and sompresented: unintenpresented. Avila-Fe concept, with vae concept, 14. In d-Up Test. Other ud-Up Test, 17.Sarcopenia is linked to physical frailty and is a key feature of this condition in older people. In factEpidemiological studies have linked physical frailty and cognitive impairment: frailty increases the risk of cognitive decline and cognitive impairment increases the risk of frailty, therefore, both dimensions would benefit from being addressed, 24.Identifying interventions to prevent or delay the loss of autonomy is currently a public health priority for the successful management of the ageing, 26. MulA comprehensive geriatric assessment, followed by a multidimensional intervention on disability risk factors -medical, functional, psychological, and environmental problems- through disease management and health promotion in a low-risk elderly population, succeeds in reducing institutionalization and the risk of falls, delaying disabled functional decline, and improving physical performance. The effects, however, are not statistically significant–29.Strategies involving mass screening in Primary Care to apply preventive approaches based on healthy ageing advice, long-term exercise programs, assistance devices including home telecare kits, and envExercise programs improve strength, aerobic capacity, balance, and function, 34, butRecent surveys have put forward new strategies for the management of sarcopenia to slow down the decline of muscle features: resistance training in combination with adequate protein and energy intake and, additionally, treatment of vitamin D deficiency, 37.Nutritional interventions alone show weak correlation with health improvement in the vulnerable, elderly population. However, dietary advice in association with protein supplementation intake seems to have some effects on sarcopenia, inducing muscle hypertrophy, accelerating weight gain in undernourished older people, and redFindings from cognitive training studies show positive effects. Memory training can aid maintaining long-term improvement in performance, 42.Exercise also leads to enhanced cognitive functioning and psychological well-being in frail, older adults. AerobicThere are few randomized, controlled trials concluding that cognitive interventions, plus complementary physical exercise, can produce significant global improvements in cognitive function, and quality of life, and delay the onset of disability.What about medication use in frail, older adults? The rates of adverse drug events are higher in the elderly population, as many of them have comorbidities, multiple drug prescriptions, and deteriorated physical and cognitive impairment. In the Such a wide range of interrelated factors gives weight to our proposal to conduct a multifactorial intervention aimed at non-disabled, i.e. frail, elderly individuals. Our objective is to focus on this population whose health status still permits some positive modifications in the inevitable evolution from frailty to dependence so that by preventing home confinement or institutionalization, older people can stay active and live by themselves in the community.This is a research protocol for a randomized, controlled trial aimed at assessing the effectiveness of a multifactorial intervention program to modify parameters of frailty, muscle strength, and physical and cognitive performance in elderly people living in the community. The intervention includes various professional disciplines and is based on physical activity, diet supplementation, memory workshops, and medication review.Secondary aims include evaluating changes in rates of falls fractures, hospital admissions, inclusions in home care programs, and institutionalizations.The study design is a single-blind, parallel-group, pragmatic, randomised, clinical trial with one year and a half follow-up.Changes from baseline measurements (month 0) in the parameters of frailty, muscle strength, and physical and cognitive performance are compared between the intervention (IG) and control group (CG) at the end of the intervention (month 3). An 18 month follow-up after randomization will be established in order to determine whether intervention effects can be sustained. The 18 month changes in rates of falls, fractures, hospital admissions, inclusions in home care programs, institutionalizations and vital status will be analysed.The CONSORT Statement extensions for trials of non-pharmacological interventions and pragmatic intervention trials were used to design the study and will be used to report it.Sample size has been calculated to detect minimal significant effects on the variable of physical performance (SPPB): Accepting an alpha risk of 0.05 and a beta risk of 0.20 in a bilateral contrast, 318 individuals are required in order to detect a difference equal to or greater than 0.5 units in the SPPB, 50. TheWritten informed consent has been obtained from all recruited subjects. Objectives, tests and other details about methodology and interventions were explained orally and in writing. The trial was approved by the Ethics Committee of the IDIAP Jordi Gol (code number P12/047) on June 1st, 2012. Funding from the Carlos III Health Institute was granted on December 20, 2012 (project code PI12/01503).From February 2013 to January 2014, 370 individuals aged 65 years and over were recruited from 8 Primary Healthcare Centres (PHCC) located in two different districts of Barcelona. A total population of 33,857 aged 65 years and over live in the reference area.Subjects were recruited by referral from the PHCC where the opportunity to participate in the study was offered on a regular daily basis to all patients meeting preliminary frailty criteria (Barber Questionnaire). EligibInclusion and exclusion criteria are shown in Table The flow-chart of the trial according to CONSORT 2010 is visualized in Figure Eligible patients who agreed to participate in the study were invited to sign the informed consent. Baseline variable collection was carried out by the CMN. Patients were then randomly assigned to the intervention and control groups. The computer-assisted simple randomization process was performed not by the recruiters but by an independent researcher. Random allocation sequence was implemented using sequentially numbered containers. Sequence was concealed until the interventions were assigned. Baseline and outcome measurements were blinded to group assignment. Follow-up evaluations are conducted by blind trained clinical researchers.Both cohorts receive identical baseline and follow-up evaluations. Table Unintentional weight loss (3 kg in past 6 months)Self-reported exhaustion Weakness Slow walking speed (more than 10 seconds) evaluated by Timed -up-and-Go test (TGUGT). This is a reliable test for quantifying functional mobility (lower extremities function) and for measuring balance . The person may wear their usual footwear and can use any assistive device normally employed. The TGUGT is conducted using a chair with arms, and a seat height of 46 cm, placed upon a flat surface with a line marking the 3m turning point. Subjects are instructed on the word ‘go’, to get up and walk as quickly and as safely as possible to cross the line marked on the path, turn around, walk back to the chair and sit down again. The activity will be timed from the subject’s back leaving the back of the chair to the return of the subject to this same position.Low physical activity measured by the IPAQ Questionnaire.Fried modified criteria for frailty   is a simple standardised objective assessment tool of lower limb function that tes2.1.1)Balance testParticipants are asked to hold three increasingly challenging standing positions for 10 seconds each: (1) a side-by-side position, (2) semi-tandem position (the heel of one foot beside the big toe of the other foot), (3) tandem position (the heel of one foot in front of and touching the toes of the other foot).2.1.2)Repeated chair stands testThis is performed using a straight-backed chair, placed with its back against a wall. Participants are first asked to stand from a sitting position without using their arms. If they are able to perform the task, they are then asked to stand up and sit down five times, as quickly as possible, with arms folded across their chest. The time to complete five stands is recorded and used for future analyses.2.1.3)Gait speed 2.1.3)2.2Functional Reach Test (FRT).This is a valuable test used to measure standing balance and stretching, detecting balance impairment over time. It can predict the risk of falling. After the examiner explains and shows the FRT, each subject performs 2 trial tests. Functional reach is measured by using a levelled yardstick attached to the wall at the height of the subject’s right acromion. To measure the subject’s reaching distance, an examiner stands 0,5 m away from the measuring tape and records the end reach position, checking that the initial position is correct: subjects stand comfortably with feet approximately shoulder-width apart, just before a line marked on the floor at the same level as the measuring tape beginning (0cm); participants then extend the right arm parallel to the yardstick and, without touching the wall, place the third metacarpal along the measuring tape and have to reach as far forward as they can without losing their balance (end position). Subjects are allowed to balance on their toes; however, touching the wall, stepping while reaching forward, or holding onto their clothing with the left hand invalidate the trial. If invalidated, the trial is repeated with a maximum of 2 tests more to achieve 2 valid trials. All subjects are protected during the test. The best result from the two attempts is recorded.2.3Unipodal stationThe patient is placed in a standing position, arms crossed over the chest, with one leg used for support in an extended position, and the other slightly bent at the knee (there can be no contact between the two legs). Once placed in the correct position (eyes open), the chronometer is activated and then stopped when either the patient moves the foot used as a base or when 30 seconds have passed; two attempts with the same foot are made and the best result recorded.Physical performance: 3.1Evaluation of upper extremities strength is assessed through the measurement of force with a handgrip dynamometer. Grip strength is assessed using a portable hand dynamometer . The participants are seated with their shoulder in a neutral position and their elbow flexed at 90°. Three attempts are performed alternately in each hand; the mean of the three measures is recorded.3.2Evaluation of lower extremities strength is assessed through the bilateral measurement of the quadriceps muscle force using a digital dynamometer (Chronojump 1.4.5-1.4.6 Boscosystem® Encoder).Muscle strength. 4.1 Lawton & Brody Instrumental Activities of Daily Living scale[ing scale.This is an instrument assessing independent living skills which are considered more complex than the basic activities of daily living. The instrument is most useful for identifying how a person is functioning at the present and for observing improvement or deterioration over time. There are 8 domains of function measured with the Lawton & Brody scale. Women have been traditionally assessed in all 8 areas of function whilst men have not been asked about the domains of food preparation, housekeeping, and laundering. Individuals are scored according to their highest level of functioning in that category. A summary score ranges from 0  to 8 .4.2Barthel Index of Basic Activities of Daily Living[ly Living.First developed in 1965, it measures functional disability by quantifying patient performance in 10 activities of daily life. These activities can be grouped according to self-care  and mobility . 5-point increments are used in scoring, with a maximal score of 100 indicating that a patient is fully independent in physical functioning, and a lowest score of 0 representing a totally dependent bed-ridden state.Activities of Daily Living (ADL) assessment: Nutritional Assessment:Mini Nutritional Assessment MNA®[ment MNA®. The MNANeuropsychologist Performance:6.1.Short and Medium-Term Verbal Memory is the capacity to hold a small amount of information in the mind in an active, readily available state for a short period of time (seconds) and medium-term period of time (minutes). For the condition referred to as short term, subjects will be instructed to listen to a little story text, 21-pieced-sentences (elements), read by a blind evaluator; once finished, the patient will be asked to repeat the general content and as many details as he or she can remember; the duration of short-term memory is believed to be in the order of seconds. Then, the participant will be submitted to other cognitive trials to divert attention. After 25 minutes, the subject is directly asked for the story again to evaluate medium-term verbal memory. A commonly cited capacity of short and medium-term is 7±2 elements.6.2. Animal Naming Test consists of asking the patient to name as many animals as possible in one minute. A blind evaluator must write down the answers, so they can be checked for duplicate responses . The goal of this test is to score at least 14.6.3. Evocation of words beginning with one explicit letter, similar to the previous test, in this case the participant will tell the examiner as many words beginning with “p” as possible in three minutes . All kinds of words are allowed, except plurals or the masculine and feminine of the same word, conjugating verbs, and diminutives. The goal of this test is to score at least 27.6.4.   Designation of famous people names, the identification of 30 famous faces and their corresponding name permits an examination of the semantic brain area and can identify a possible clinical syndrome of prosopagnosia. Evaluated by “success”, “failure” or “tip of the tongue (TOT) phenomenon”, goal is 23 success, 3 failure, 4 TOT.6.5.   Verbal designation of images. Fourteen pictures of different objects or animals are presented to participants and they have to identify each name as quickly as they can: if subjects guess the name between 0–3 seconds this signifies 3 points, between 3–10 seconds, 2 points, and if takes 10–30 seconds it represents 1 point. If the patient does not recognize the picture-name, it is equivalent to 0 points. Goal of the test is to score 41 points.6.6.  Verbal abstraction of word pairs, also called “Similarities – Abstraction”, explores patients’ concept formation ability, as the participant must “extract” the common abstract element that links the two words featured. Through this test the ability to discriminate “concrete thinking “from” abstract thought” can be evaluated. The goal of this test is to score at least 5 of 6 pair of words.The first neuro-psychometric instrument developed in Spain to measure semi-quantitatively cognitive status in clinical neurology was the Barcelona Test (BT). A shortened version of the BT, named Barcelona Test Review, is used7.1.Number of prescribed drugs.7.2.Number of prescribed benzodiazepines.7.3.Presence of antidepressants (yes/no).7.4.Withdrawal of drugs (yes/no).7.5.Number of drugs retired at the closing date of the study.Medication Quality of life. 12-Item Short-Form Health Survey (SF-12) .Adverse Outcomes: Falls, fractures, hospital admissions, institutionalization, inclusion in a Home-Care Program, or death.Age. Gender. Marital status. Cohabitation. Education Level. Socioeconomic status. Existence of elevator in the building. Provision of regular company.Comorbidity measured with Charlson Index .Biological variables: weight, height, body mass index, waist circumference, blood pressure.Analytical variables: hemoglobin, serum lipid profile, serum protein, serum albumin, glomerular filtration rate, plasma creatinine, glycated hemoglobin, ferritin, iron, vitamin D, vitamin B12, folic acid.Incontinence .Urinary catheter (yes/no).Wearing a diaper (yes/no).Usual sensation of light-headedness.Smoking .Devices for mobility .Falls, fractures, and hospitalizations in the previous year.Co-morbidities assessed in the clinical record: osteoarthritis, fractures in the last 5 years (hip fracture specified), presence of prosthetic joints, vision impairment, hearing impairment, cardiovascular diseases , pulmonary diseases (Chronic Obstructive Pulmonary Disease (COPD), asthma), endocrinology diseases , hematological (anemia), neurologic (Parkinson’s disease), psychiatric , chronic kidney disease.The intervention consists of a triple disability preventive therapy, consecutively applied to each subject in the intervention group, in groups of 16 participants . Subjects must incorporate a progressive increase in the intensity of the exercise in each session. One session a week is dedicated to work with balance and the other to strength training. Both balance and strength are based on functional exercises. All sessions begin with a warm up for 5 minutes, and end by cooling off for another 5 minutes with relaxing exercises. The sessions are conducted under the supervision of a specialist in physical activity. A hyperproteic nutritional shake is provided at the end of each session, and the amount of shakes needed for one month’s consumption post-physical therapy is assigned. The safety of the exercise program is measured by reviewing the record sheet for each patient in the training program, ascertaining cardiovascular decompensation and musculoskeletal injuries.Memory workshops. Two speech therapists from the rehabilitation unit conduct 12 sessions of practical exercises  in groups of 16 participants. Each of the 12 sessions lasts 90 minutes and is conducted twice a week. Each person in the intervention group has their own material to work short and long-term memory, with exercises for the identification of figures and images, evocation of words, true or false sentences, crosswords, completion of unfinished sentences, and other language exercises such as synonyms and antonyms.Medication Review. Reduction of potentially inappropriate medications, especially in polymedicated patients, after review from general practitioners. A patient is considered to be polymedicated when taking more than five medications daily and continuously for a period not less than six months. Medication review follows the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria . In addiThe intervention group also receives two group sessions regarding dietary advice, lifestyles, and home hazards.Subjects in the control group continue with their daily activities and receive regular monitoring and treatment of their diseases by their general practitioners. They are also invited to two group sessions regarding dietary advice, lifestyles, and home hazards.Intention to treat analyses will be performed. Baseline characteristics will be compared between groups by independent t tests and Chi-square tests. Outcome variables will be calculated for each individual and time point , and 95% confidence intervals for the differences between groups will be calculated. Data will be analysed using repeated measures analysis of variance (ANOVA) consisting of intervention and control groups and time .Also, for longitudinal adverse outcome measures , survival analyses using Cox’s regression models will be applied. The statistical significance level will be set at p <0.05.Our study is addressed at evaluating the effectiveness of a multifactorial intervention to improve frailty parameters and prevent disability in patients 65 years or older. Improvements in physical performance, muscle strength, nutritional status, and cognitive performance are expected, as well as a reduction in the incidence of new complications such as falls, fractures, hospital admissions, and worsening of ADL scales, all of which are related to the appearance of disability, 34. TacIn the field of preventive geriatrics, studies have shown that exercise training has clinical benefits inducing positive physiologic changes in muscle and function while multi-nutrient supplementation alone, without concomitant exercise, does not reduce muscle weakness or physical frailty.The innovation of our study lies in regard to the follow-up and evaluation of a multifaceted strategy focused on different risk factors: physical decline, cognitive impairment, nutritional status, and polypharmacy. Previous series have provided a certain degree of evidence about improvement with these interventions on only an individual basis.The greatest limitation of this study could proceed from the lack of agreement in the scientific community with respect to the definition of frailty and the most suitable measurements to gauge it. Including non- frail subjects (non-homogeneous risk state) could affect generalizability. The initial inclusion criterion, the low specificity Barber Questionnaire, has been included in this study because it was the first frailty test to be used in our clinical records. It has been also complemented, however, with other inclusion criteria such as the TGUGT. Participants scoring lower than 10 seconds or higher than 30 are excluded as they are considered either too frail or not frail enough to benefit from the intervention. The exclusion of more severely affected frail patients, because of their poor physical or cognitive condition, may limit external validity. Nevertheless, the random distribution of our patients to both groups guarantees comparability. Also, additional information about potential confounders  and the use of other parameters and tests of frailty are expected to solve the possible selection bias and help to further characterize the study population. Losses to follow-up are minimized through contacting the participants by telephone.If evidence of a multi-strategy composed of physical exercise and a cognitive workshop, along with nutritional support and medication review, is achieved as an effective approach, a future implementation should be considered as a Frail-Community Prevention Program for the elderly to prevent or delay disability.


Background: To examine whether stress management mediates the relationship between purpose in life and self-rated health status (SRH). Methods: A cross-sectional survey was conducted among 6840 teachers in 2013 in Guangzhou, China. Purpose in life was assessed through the Purpose in Life Subscale of the Psychological Well-being Scale. Stress management was assessed using the eight-item questionnaire adapted from the Health-promoting Lifestyle Profile II. SRH was assessed by the Suboptimal Health Measurement Scale Version 1.0. The mediation hypothesis was tested by the structural equation model for path analysis. Results: It was found that purpose in life had direct and indirect effects on SRH. The path analysis showed the total effect (β = 0.563) of purpose in life on SRH was comprised of a direct effect (β = 0.319) and an indirect effect (β = 0.244), which was mediated by stress management. Conclusions: By supporting the mediation hypothesis, our results indicate that stress management mediated the effect of purpose in life on SRH. Enhancement of teachers’ purpose in life and improvement of training skills of stress management should be incorporated in the strategy of improving teachers’ health. Purpose in life is a self-organizing life aim that stimulates goals, manages behaviors, and provides a sense of meaning . StudiesStudies have shown that individuals with higher levels of education had higher purpose in life . TeacherStress management involves changing the stressful situation, dealing with problems, taking care of yourself, and making time for rest and relaxation. Stress management is reported to be positively associated with better SRH . StudiesTherefore, our hypothesis is that stress management could be a potential explanatory factor in the association between purpose in life and SRH. The current study aimed to investigate the relationship between purpose in life, stress management and SRH and the effect of stress management on the relationship between purpose in life and SRH in teachers.A cross-sectional, descriptive survey was conducted among 8111 public school teachers during April to July 2013 in Guangzhou, the capital of Guangdong Province, South China. Three districts  were randomly selected from 12 in Guangzhou and are representative of economic characteristics, population demographics, and geographic distribution. Then all the primary and secondary public schools in each area were chosen. An additional 1271 participants were removed due to inconsistent or potentially biased responding, and missing or incomplete information. Finally, 6840 teachers were included in the current analysis, resulting in a valid response rate of 84.3%.SRH was assessed via the Suboptimal Health Measurement Scale Version 1.0 (SHMS V1.0), which was developed by our research group. According to Chinese research data, the SHMS V1.0 has displayed an excellent level of content reliability and validity, supported by Cronbach’s alpha and split-half reliability coefficients of 0.917 and 0.831, respectively . These sPurpose in life was assessed through the Purpose in Life Subscale of the Psychological Well-being Scale ,31, withStress management was measured through an eight-item questionnaire , adapted from the Health-Promoting Lifestyle Profile II, which was developed by Walker . The resp-values < 0.05 considered statistically significant. The analyses were conducted using SPSS 13.0  and AMOS 22.0  software.Descriptive statistics including means, standard deviations, and frequencies were calculated. Bivariate correlations were calculated using Pearson correlation coefficients to examine relationships among purpose in life, stress management, SRH and dimensions of SRH. The structural equation model (SEM) for path analysis was constructed to analyze the direct and indirect effects of purpose in life on SRH. A model was established with purpose in life as the independent variable, SRH as the dependent variable and stress management as the mediating variable. Confirmatory factor analysis (CFA) was run on the subscales. All significance tests were two-sided, with The study was approved by the ethics committee of Nanfang Hospital in Guangzhou, China (2012) LunShenZi (No. 035). It complied with the principles outlined in the Helsinki Declaration. All procedures were performed in accordance with the ethical standards. Written consent was obtained from each participant.p < 0.001), while it had a moderate and positive correlation with SRH , and self-rated physiological , psychological  and social  health. Stress management showed a strong and positive correlation with SRH , self-rated psychological health , while it had a moderate and positive correlation with self-rated physiological  and social  health.Sample characteristics are shown in p < 0.001). These statistics indicate that the items can reflect the subscales. The composite reliability (CR) of purpose in life, stress management, self-rated physiological, psychological and social health were 0.798, 0.813, 0.840, 0.876 and 0.861, respectively. The CRs were all >0.7, which revealed that the subscales have good internal consistency reliability and validity.The structural equation model was constructed and is shown in The study aimed to investigate the relationship between purpose in life, stress management and SRH, and the effect of stress management on the relationship between purpose in life and SRH. In the current study, we found that purpose in life positively and directly affected SRH among teachers. Stress management also plays a partial mediator role in the relationship between purpose in life and SRH.Firstly, purpose in life had a positive and direct effect on SRH in our study. Correlation analysis also indicated that teachers showed a moderate but significantly positive correlation between purpose in life and SRH. Previous studies have indicated that persons with high purpose in life report better SRH  and haveSecondly, our data indicated that purpose in life affected SRH indirectly through the mediation of stress management. To our knowledge, this study is the first to indicate the mediating effect of stress management on the relationship between purpose in life and SRH. On one hand, our study found that stress management was significantly directly affected by purpose in life. It has been reported that individuals with higher purpose in life have better skills for dealing with stress and facilitating recovery from stress , have grThe results of the structural equation modeling confirmed stress management as a partial mediator of the relationship between purpose in life and SRH in teachers. There could be several reasons for this partial mediation. First of all, purpose in life had a direct effect on SRH in the model. Additionally, researches show that people with higher purpose in life may engage in healthier behaviors  ,6,38,39,Several limitations should be considered when interpreting results from the current study. First, this study was of cross-sectional design. A replication of the mediation effect in a longitudinal study is necessary to consolidate the hypothesized directions of the causal relationships within the mediation model. Second, as with any self-report questionnaires, the data obtained in the current study may contain information bias. Future studies should address these limitations.In summary, our findings indicated that purpose in life had direct and indirect effects on SRH. The indirect effect of purpose in life on SRH was mediated by stress management. In regard to the role and importance of purpose in life and stress management, besides the enhancement of teachers’ purpose in life, the improvement of training skills of stress management should also be incorporated in the strategy of improving teachers’ health.


The causative pathogen is rarely identified in the emergency department (ED), since the results of cultures are usually unavailable. As a result, antimicrobial treatment may be overused. The aim of our study was to investigate the pathogens, risk factors of acute gastroenteritis, and predictors of acute bacterial gastroenteritis in the ED.We conducted a matched case-control study of 627 stool samples and 612 matched pairs.Giardia lamblia (12.4%). Taking antacids , household members/classmates with gastroenteritis , attending a banquet , dining out , and eating raw oysters  were highly associated with gastroenteritis. Elders , those with CRP >10 mg/L , or those who were positive for fecal leukocytes  or fecal occult blood  were more likely to be hospitalized in ED. In addition, presence of fecal leukocytes , abdominal pain , and frequency of vomiting  were significantly associated with the duration of acute gastroenteritis. Presence of fecal leukocytes , winter season , frequency of diarrhea , and eating shrimp or crab  were highly associated with bacterial gastroenteritis. The area under the receiver operating characteristic curve of the final model was 0.68 .Viruses (41.3%) were the leading cause of gastroenteritis, with noroviruses (32.2%) being the most prevalent, followed by bacteria (26.8%) and Acute bacterial gastroenteritis was highly associated with season, frequency of diarrhea, frequency of vomiting, and eating shrimp or crab. The epidemiologic settings and clinical and laboratory features that are associated with acute gastroenteritis influence the probability of each pathogen.2 The causative pathogens are rarely identified in the ED because the results of cultures are usually unavailable due to time constraints or failure to obtain specimens.3 Nonetheless, antimicrobial treatment is still indispensable in patients with suspected invasive diarrhea, which is marked by the presence of fever, abdominal pain, fecal leukocytes, and hemoccult. However, clinical features of invasive diarrhea also present in cases of viral gastroenteritis, so antimicrobial treatment may be overused in the ED. Research on using clinical attributes to identify the cause of acute gastroenteritis in the ED is still limited. The aims of the present study were to investigate the pathogens and risk factors of acute gastroenteritis cases presenting to the ED, factors affecting the odds for admission, and the criteria for ancillary testing to diagnose bacterial gastroenteritis.Acute gastroenteritis is a common disease in the emergency department (ED). Viruses are the leading cause of acute gastroenteritis presenting to the ED.1 Each case patient was matched one-to-one with a non-gastroenteritis control patient of the same gender, age (within 5 years), and date of ED visit (within 1 month). If several control patients appeared for one case patient, the one admitted on the date nearest to the case’s ED visit date was selected. If the selected control refused to participate, we chose the non-gastroenteritis patient with the next nearest admission date to that of the case’s ED visit as the matched control. We followed this protocol until we found a matched control for each case.A matched case-control study was conducted in in the ED of Ren-Ai branch of Taipei City Hospital. Data on 754 patients were collected from August 1, 2005, to July 31, 2009. Inclusion criteria for cases were: at least three loose stools or three instances of vomiting; or either diarrhea and/or vomiting plus two or more additional symptoms, including abdominal pain, fever, nausea, blood in the stool, or stool mucus. We excluded patients who were less than 15 years old; exhibited coughing, a sore throat, or runny nose; or were bedridden (defined as anyone who needs help to leave the bed).We sent questionnaires to all participants after they gave consent to participate in the study. Socio-demographic information, clinical history of gastroenteritis, and factors responsible for the disease, such as consumption of food items, water, and beverages, dining location, travel history, contact with ill persons, contact with animals, habits, medications taken, and previous morbidity, were collected in the questionnaires see . A case-We assumed that the estimated odds ratio was 1.29 (0.45/0.35), respectively. A two-sided McNemar test for no effect with a significance level of 0.05 was considered to indicate statistical significance. Hence, a sample size of 626 matched pairs was required.1 In this study, the newly developed PCR assays for detecting B. fragilis and C. difficile were performed.4A total of 627 stool samples were collected immediately after visiting the ED or within 3 days after discharge. Follow-up telephone interviews with all participants were conducted 7–10 days after the ED visit. Blood cultures were performed for patients with fevers. All specimens were sent to the Centers for Disease Control, Taiwan and were analyzed for viruses, parasites, and bacteria.1 The threshold for positive fecal leukocytes was defined as more than 1 cell/high-power field (HPF), and fecal occult blood test was assessed using o-tolidine.All blood tests (including blood cultures) and tests for fecal leukocytes and fecal occult blood were performed at the Taipei City Hospital laboratory.t-test or ANOVA were used for continuous data. Medians were compared using the Wilcoxon rank-sum test.Returned questionnaires were coded, and data were entered into Epi Info  and analyzed using SAS software . Chi-square test or Fisher exact test were used for categorical data, and P to enter <0.10; P to remove >0.05) was used to identify the most important determining factors for acute gastroenteritis.We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression. Conditional logistic regression model with a stepwise selection procedure  to identify the most important determining factors for admission and predictors of bacterial gastroenteritis. The duration of illness, from the onset of symptoms to the final resolution of symptoms, was evaluated using an accelerated failure time (AFT) model with a Weibull distribution. Parameter coefficients connected with the AFT model were reported as time ratio  in illness duration, a TR >1 is associated with a prolonged survival time, whereas a TR <1 is associated with a decrease in survival time. The AFT model, a parametric approach, can estimate the baseline hazard, which cannot be obtained with the Cox proportional hazards regression. Therefore, the AFT model is useful for analysis of time to event (the duration of illness). The AFT formulation allows the derivation of a time ratio, which is easier to interpret than the Cox proportional hazards regression model.5 In addition, the AFT model does not need the assumption of proportional hazards and provides more precise results in the analysis of censored data compared with the Cox proportional hazards regression model.In the case-case study, we estimated ORs and 95% CIs using the logistic regression model with a stepwise selection procedure  provides a tool for comparison of the discriminatory capacity of different ancillary tests and risk factors.For comparison of the discriminatory capability of fecal leukocyte testing and the final model, a summary receiver operating characteristic (ROC) curve was constructed. A summary ROC curve was plotted to present the true-positive rate (sensitivity) against the false-positive rate (1 − specificity).The study was approved by the Taipei City Hospital Institutional Review Board.Of 2341 patients with gastroenteritis during the study period, only 754 (32.2%) patients participated in our study. Among the 754 patients who met the study criteria and returned completed and usable questionnaires, 627 stool samples were collected. There were no significant differences between participants and non-participants in terms of age, gender, and diarrhea symptoms. The participants’ characteristics and reported symptoms are shown in Table Stool specimens were obtained immediately in 202 patients, and the others were obtained within 24 hours. The mean duration of taking stool specimens  did not differ significantly between the discharge group (mean 15.2 hours) and the admission group (mean 15.3 hours). There was also no difference in the proportion of patients with pathogen findings between the discharge (63.3%) and the admission (63.2%) groups.P = 0.026). Of the 152 patients with blood cultures, 6 (3.9%) were positive for Bacteroides fragilis, E. coli, or Aeromonas salmonicida. The distributions of fecal occult blood and pus cells among different etiologies are listed in Table Distributions of microbiologic findings are shown in Table Our case-control study sample consisted of 612 matched pairs . Factors significantly associated with gastroenteritis in univariate analysis are shown in Table P = 0.006), C-reactive protein (CRP) level (P = 0.005), presence of fecal leukocyte (P < 0.001) and fecal occult blood (P < 0.001), and the number of cases with vomiting (P = 0.036) among cases of acute gastroenteritis with different etiologies  as a predictor of bacterial gastroenteritis were 48.5%, 60.6%, 30.5%, and 76.7%. The ROC curve for CRP level (>10 mg/L), presence of fecal occult blood, presence of fecal leukocytes, and the composite of factors included in our final model  is shown in The current study assesses many aspects, including the etiology and risk factors of gastroenteritis in adolescents and adults, as well as factors affecting the odds for admission, the duration of illness, and ancillary testing for bacterial gastroenteritis in the ED. We found that viral infection was the leading cause of gastroenteritis and tends to cause gastroenteritis in winter. Older age, elevated CRP level, presence of fecal leukocytes, and presence of fecal occult blood were significantly associated with hospital admission. In addition, presence of fecal leukocytes, frequency of vomiting, and abdominal pain were significantly associated with the duration of illness. Presence of fecal leukocytes, winter, frequency of diarrhea >10 times/day, and eating shrimp or crab were highly associated with bacterial gastroenteritis. The presence of fecal leukocytes or fecal occult blood and elevated CRP level (>10 mg/L) have low sensitivity and specificity for predicting bacterial gastroenteritis. The AUROC of elevated CRP level, presence of fecal occult blood, presence of fecal leukocytes, and presence of all risk factors included in our final model were 0.546, 0.583, 0.589, and 0.681, respectively.1,7–10Clostridium difficile was not thought to be a dominant pathogen for community-acquired diarrhea until Huhulescu et al proved it.7 However, community-acquired Clostridium difficile is still not a great problem in Taipei: it was identified in only 2.2% of all cases in our study. About 15.3% of patients were diagnosed with co-infection with bacteria and other non-bacterial pathogens; the relatively high detection rate of non-bacterial pathogens was due to our use of PCR to detect norovirus, giardia, B. fragilis, and C. difficile. The majority of co-infected patients were co-infected with norovirus and other pathogens. It should be noted that norovirus may not be the cause of illness in all cases that were positive for norovirus because healthy people can deliver false-positive results on PCR.11 We also observed a higher pathogen detection rate for patients with 6 or more daily episodes of diarrhea, which was similar to the results of a previous study.12Our finding that norovirus was the leading cause of gastroenteritis cases in both adolescents and adults agrees with previous reports.13,14 Further studies are needed to clarify the possible pathogenicity of unexplained gastroenteritis.About 36.7% of gastroenteritis cases in our study were unexplained. Picobirnavirus may account for a proportion of these unknown cases, according to recent studies.1,15 Attending a banquet has also been associated with outbreaks of gastroenteritis.1,16 Decreasing gastric acidity is a risk factor for infectious diarrhea-related illnesses1,17 because gastric acid is capable of killing ingested bacteria.18 Household transmission is a known risk factor for gastroenteritis.1,19–21 Eating raw oysters has also been shown to increase the risk of gastroenteritis.1,22–25Our findings about the risk factors of gastroenteritis are similar to previous studies. Dining out (defined as eating anywhere away from one’s home) was found to be associated with food poisoning cases at the ED in previous studies.3 However, fever and abdominal pain were not predictors of bacterial diarrhea in the present study. Further, eating shrimp or crab has been reported to be associated with diarrheagenic E. coli,26Vibrio spp.,27–29Aeromonas spp.,30 and Listeria monocytogenes31 infection in previous studies. Eating shrimp or crab was a predictor of bacterial gastroenteritis in the present study. Diarrhea in winter tends to be viral gastroenteritis because norovirus and rotavirus spread more easily in winter than in other seasons.Most gastroenteritis tends to be self-limiting and requires only supportive therapy. Antibiotic treatment is suggested in patients with a suspected invasive process and severe diarrhea, systemic symptoms, fever, or abdominal pain, as well as in patients who show toxic signs.Though the presence of fecal leukocytes or fecal occult blood had low power for prediction of bacterial gastroenteritis, they were highly associated with hospital admission, and patients with fecal leukocytes were also found to have longer duration of illness than those without fecal leukocytes. However, patients with higher frequency of vomiting were found to have shorter duration of illness because such symptoms tended to result from viral gastroenteritis and no severe dehydration.32 No consistent trend in the test threshold (cells per HPF) to any of the diagnostic parameters has been observed. Our study demonstrated that the AUROC of bacterial gastroenteritis prediction was elevated after adding other predictors  to the ED. The epidemiological evidence and clinical evidence were associated with the probability of “not norovirus” from as low as 8% to as high as 100%.2 However, there are still no ancillary tests or good models to predict bacterial gastroenteritis, and the guidelines for antimicrobial treatment of acute gastroenteritis are also ambiguous. One study reported that body temperature, abdominal pain, leukocyte count in stool, and poor dietary hygiene can be used as predictors of acute bacterial diarrhea in hospitalized patients.33 The AUROC was 0.975  in their study. As acute bacterial diarrhea is also highly dependent on the environments in which patients live, the AUROC result may vary from study to study. The diagnostic accuracy of bacterial gastroenteritis using our model was not good enough due to the high percentage of cases with unknown etiology and co-infection with viruses in our study group. Further studies on the prediction of non-viral or bacterial gastroenteritis using the Bayesian approach should be considered.The sensitivity and specificity of microscopy for fecal leukocytes was heterogeneous in previous studies.34 Selection bias may result from the low response rate of the ED cases. Greater frequency of diarrhea was noted in enrolled cases compared to in non-participators,1 and younger patients and patients with minor symptoms/signs were less likely to provide stool samples. In addition, patients with longer duration of gastroenteritis were more likely to visit the ED  than those with shorter duration of illness. However, selection bias was minimized in this study by adjusting for these factors, including the frequency of diarrhea, age, and duration of gastroenteritis, when they were measured in all study subjects. Our findings tend to overestimate the positive detection rate of diarrheagenic E. coli using the O serotyping method alone.35The case-case comparison is more efficient and less biased than standard case-control studies for determining exposure to infectious agents, but general factors that are responsible for whether acute gastroenteritis occurs after the exposure cannot be studied.In summary, taking antacids, having household members/classmates with gastroenteritis, attending a banquet, dining out, and eating raw oysters were highly associated with gastroenteritis. The elderly and those with elevated CRP levels and the presence of fecal leukocytes and fecal occult blood tended to be hospitalized in the ED. The presence of fecal leukocytes, winter, frequent diarrhea, and eating shrimp or crab were highly associated with bacterial gastroenteritis.eTable 1. eQuestionnaire.


The number of left-behind children in China is gradually increasing. This study aimed to understand the mental health status and changes in resilience of rural, left-behind middle school students in Yunyang County of the Three Gorges area in China.A prospective cohort study, including two follow-up surveys, with a frequency of once every 6 months was conducted among middle school students in Yunyang County. A self-designed questionnaire was used to obtain socio-demographic factors of participants, the Mental Health Test (MHT) scale was used to assess their mental health statuses, and resilience levels were collected using Resilience Youth Development Module (RYDM) scale at baseline and at the first and second follow-up investigations.χ2 = 1.056, P = 0.304). The detection rates of medium resilience rose gradually , while that of high resilience declined gradually  in the baseline, first and second follow-up investigations. There was no significant difference between LBS and NLBS in resilience level (P > 0.05). The average RYDM scores were 2.990, 2.926, 2.904 among LBS in the baseline, first and second follow-up investigation, respectively, and the effect of time on the average RYDM scores was significant . The average MHT scores in LBS were 41.54, 39.79, 38.84 in the baseline, first and second follow-up investigations, respectively, and the detection rates of students who had psychological problems increased gradually . The simple correlation coefficients between the RYDM and MHT scores were−0.227,−0.158, and−0.204 in the baseline, first and second follow-up survey, respectively (P = 0.000).Of the 1401 students who completed the baseline survey, 1322 students were eligible for the cohort study, of whom 1160 were investigated in the first follow-up survey. Ultimately, 1101 students completed the 1-year cohort. The detection rate of mental health problems for middle school students in the rural Three Gorges area was 5.64 %, and there was no significant difference between left-behind students (LBS) and non-left-behind students (NLBS) (The detection rate of mental health problems for middle school students in the rural Three Gorges area is relatively low and most of the LBS in area have medium or high resilience. The mental health status of LBS positively correlated with their resilience levels. Resilience declined gradually as time went on, but further studies with longer follow-up durations are needed to confirm the variation of resilience. China has been undergoing rapid urbanization in the last few decades. By 2013, over 166 million people in China were internal migrants . There wIn recent years, studies about the mental health of left-behind students (LBS) have gradually increased, and most of these studies were focused on the risk factors associated with mental health , 11. NotThe Three Gorges area, as one of the most economically underdeveloped regions in China, has extreme geographic features and low agricultural and industrial productivity levels. Most farmers are forced to move away from their home to seek employment opportunities, leaving their children at home. Our study was conducted in Yunyang County, Chongqing, China, which is located in the center of the rural Three Gorges area and is one of the first immigrant counties with more than 100,000 LBC.Firstly, according to a multi-staged stratified cluster random sampling method, Yunyang County was chosen from the rural Three Gorges area. Second, considering the geographic location, economic conditions and demographic characteristics, three townships of Yunyang County and one middle school from each selected township were selected as the sampling areas. Then, three to five classes were randomly selected from the junior grade and from the senior grade in each middle school. A total of 23 classes with 1401 students were selected in the baseline survey. The study was approved by the Medical Ethics Review Committee of Chongqing Medical University. All subjects completed informed consent. Informed consents by both the students and their guardians were sought by signing informed consent forms.During October 2012, the baseline survey was conducted in whole, selected classes with the assistance of school leaders and teachers. Before the survey, we illustrated the objectives and main contents of the study to the teachers, students, and guardians. Students were asked to complete the self-administered questionnaires under the guidance of the investigators, including the self-designed questionnaire, Resilience Youth Development Module (RYDM) scale and Mental Health Test (MHT) scale.A self-designed questionnaire was used to obtain the socio-demographic factors including age, gender, living situation (in school or out of school), siblings (yes or no), marital status of parents (divorced or not divorced), subjective economic status (five levels from ‘very good’ to ‘very bad’), type of guardians , conflict with the guardian , students’ worry about their parents working outside of the county  and working status of parents .The RYDM scale  was a paThe MHT scale  was reviReliability and validity of the RYDM and MHT scales were psychometrically qualified in the children of the rural Three Gorges area. The Cronbach’s alpha coefficient, Spearman-Brown coefficient and test-retest reliability of the RYDM scale in our study were 0.945, 0.865, 0.838, respectively, and the correlation coefficients between total scale and sub-scales of the RYDM scale were 0.896 and 0.974, respectively, which were in accordance with a previous study . The Cron = 79). The remaining 1322 students, including 986 LBS and 336 NLBS, were chosen to complete a 1 year follow-up observation; thus, a total of two follow-ups with a frequency of one every 6 months were conducted. All questionnaires and survey methods were the same as the baseline survey. 1160 students (860 LBS and 300 NBLS) and 1101 students (822 LBS and 279 NLBS) were investigated in the first and second follow-up surveys, respectively. The loss rate was 12.25 and 16.72 %, respectively, and there were no significant differences in the loss rates between LBS and NLBS in the first  and second  follow-up surveys. Of the 221 students lost in the follow-up surveys, 168 students transferred to another school, 47 dropped out of school and six students were on sick leave. Significant differences between LBS and NLBS were found in the comparison of siblings, living situation and economic status in the baseline survey (P < 0.05). Significant differences were also found in the comparison of grade, living situation and economic status in LBS and NLBS between baseline and the last follow-up survey (P < 0.05). The socio-demographic factors are shown in Table Of the 1401 students who completed the baseline survey, we excluded those considered to have mental illness or mental health problems based on the MHT scales  was used to build our database and data management system. The data were analyzed using SPSS 17.0  and SAS 9.2 . We calculated the detection rates of mental health problems and resilience levels among middle school students. Chi-square tests were used to analyze the comparison of socio-demographic factors, loss rate, detection rate of mental health problems and resilience levels between LBS and NLBS. The chi-square test for trend was used to analyze the trend of resilience levels and the LBS who have psychological problems. Repeated measure analysis of variance was used to compare the average RYDM scores in two groups. Simple correlation and linear regression analysis were used to analyze the association between the scores and the changes of RYDM and MHT scores. The P > 0.05), while more students in the LBS group were boys and had siblings (P < 0.05).Ultimately, 1101 students aged 9 to 18 (M = 14) completed our survey, including 822 LBS and 279 NLBS, 634 boys and 467 girls, 594 junior high school students and 507 senior high school students. There were no significant differences between LBS and NLBS by grade, living situation, marital status of parents and the subjective economic conditions (n = 1401), and there was no significant difference between LBS and NLBS . After excluding those considered to have mental illness or mental health problems based on the MHT scale, the detection rate of LBS who had mental health problems were 0.00, 2.71 and 4.75 % in the baseline, first and second follow-up surveys, respectively .The detection rate of mental health problems among middle school students in the rural Three Gorges area was 5.64 % (n = 1401) and were 0.95, 54.15 and 44.90 %, respectively, for LBS. After excluding those with mental illness or those who had mental health problems based on the MHT scale, the detection rates of low resilience in LBS were 0.86, 1.48, 0.85 %, medium resilience were 50.86, 57.44, 61.14 %, and those of high resilience were 48.27, 41.08, 38.00 % in the baseline, first and second follow-up investigations, respectively. The detection rates of medium resilience rose gradually  while that of high resilience declined . There was no significant difference between LBS and NLBS in resilience level (P > 0.05). The changes of resilience are shown in Table The detection rate of low, medium and high resilience among middle school students in the rural Three Gorges area was 1.00, 53.32, 45.68 %, respectively , and the average scores in LBS declined continuously.χ2 = 26.470, P = 0.000). Repeated measures analysis of variance showed that the effect of time on the average RYDM scores was significant . The difference in RYDM and MHT scores between the baseline and last follow-up surveys were calculated and the simple correlation coefficient between the difference values was−0.185 (P = 0.000) and the regression coefficient was−5.513 .The average MHT scores in LBS were 41.54, 39.79, 38.84 in the baseline, first and second follow-up surveys, respectively, showing a continuous decline. The simple correlation coefficients between the RYDM and MHT scores were−0.227,−0.158, and−0.204 in the baseline, first and second follow-up surveys, respectively  . In addiThe average RYDM scores in LBS declined gradually and the effect of time on the average scores was significant, indicating that the long-term separation from parents may have adverse effects on a child’s resilience. The longer the time of separation, the worse off the child’s resilience. Therefore, parents of LBC should try to avoid working outside of the country for long periods of time and increase the frequency of traveling back home to live with their children as much as possible, or more time should be taken to communicate with their children in order to reduce their loneliness. Meanwhile, schools may hold some activities to make their lives after class more colorful, and teachers may try to give them more love, care, support and understanding, which were proved to be effective , 36. HowThe average MHT scores in LBS declined steadily, which indicated that the mental health of LBS improved overall during our survey time, while the number of students who had psychological problems and the detection rate increased gradually. One possible reason might be that the mental status of LBS matured continuously with age and their ability to cope well with adversity also strengthened over time; however, as learning stress increased and as other adverse factors continued to build up, such as long-term separation from parents, some of the students might have developed some psychological problems. Thus, targeted mental health interventions, such as group psychology counseling or face-to-face conversations, should be conducted with these students.The negative correlation between the mental health score and resilience in the baseline, first and second follow-up investigations showed that the higher the resilience levels, the better the mental health status, and the less prone to psychological problems, which was consistent with previous studies , 38. TheLBS were found to have siblings, lived in schools and were relatively poor, as compared with NLBS in the baseline survey. However, a previous study showed that these differences may not influence resilience directly , thus, tThere are several limitations in our study. Firstly, we focused on LBS in the rural Three Gorges area compared with the local NLBS. The resilience in this group may be unique, which may not be generalized to other LBS. Secondly, we observed the change of resilience in a relatively short period of time; however, the change in resilience might be a long-term process and needs more time to confirm the variation.Our study indicates that the detection rate of mental health problems for middle school students in the rural Three Gorges area is relatively low and most of the LBS in the rural Three Gorges area have medium or high resilience. The mental health status of LBS positively correlated with their resilience levels. Resilience declines gradually as time goes on, but further studies with longer time of follow-up are needed to confirm the variation of resilience.


There is growing evidence that several forms of cancer may originate during fetal life. We conducted a large study linking the high-quality population-based medical birth- and cancer registries in Norway, Sweden and Denmark, to explore whether hyperemesis is associated with increased cancer risk in offspring.Hyperemesis gravidarum is a serious condition affecting 0.8–2.3 % of pregnant women and can be regarded as a restricted period of famine. Research concerning potential long-term consequences of the condition for the offspring, is limited, but lack of nutrition A registry-based nested case–control study. Twelve types of childhood cancer were selected; leukemia, lymphoma, cancer of the central nervous system, testis, bone, ovary, breast, adrenal and thyroid gland, nephroblastoma, hepatoblastoma and retinoblastoma. Conditional logistic regression models were applied to study associations between hyperemesis and risk of childhood cancer, both all types combined and separately. Cancer types with five or more exposed cases were stratified by age at diagnosis. All analysis were adjusted for maternal age, ethnicity and smoking, in addition to the offspring’s Apgar score, placental weight and birth weight. Relative risks with 95 % confidence intervals were calculated.In total 14,805 cases and approximately ten controls matched on time, country of birth, sex and year of birth per case  were identified. None of the cancer types, analyzed combined or separately, revealed significant association with hyperemesis. When stratified according to age at diagnosis, we observed a RR 2.13 for lymphoma among adolescents aged 11–20 years ((95 % CI 1.14–3.99), after adjustment for maternal ethnicity and maternal age, RR 2.08 (95 % CI 1.11–3.90)). The finding was not apparent when a stricter level of statistical significance was applied.The main finding of this paper is that hyperemesis does not seem to increase cancer risk in offspring. The positive association to lymphoma may be by chance and needs confirmation. Hyperemesis gravidarum is characterized by severe nausea and vomiting during early pregnancy resulting in maternal weight loss, nutritional deficiencies and hospital admissions . Little The fetal programming hypothesis suggests that adverse exposures during critical periods of embryonic development, in particular the first trimester, may permanently alter disease-susceptibility in later life . Lack ofHyperemesis is a severe complication occurring in early pregnancy that in many ways mimics starvation thereby providing a model to explore the consequences of under nutrition during a critical period of fetal development. Specific hormonal alterations related to hyperemesis may also influence epigenetic mechanisms affecting the offspring’s susceptibility to other diseases, such as cancer. Given the sparse data on associations between maternal hyperemesis and cancer risk in offspring, large, population-based studies based on data collected in a standardized protocol are needed. The aim of this study was therefore to investigate whether hyperemesis is associated with cancer in the offspring, using merged national medical birth- and cancer registries in Norway, Sweden and Denmark.This nested case–control study is based on pooled data from population-based registries in each of the Scandinavian countries. The unique identification number assigned to all citizens in these countries at birth or upon immigration was used to link the medical birth registries (MBRs) to the national cancer registries. The MBRs in Norway, Sweden and Denmark, founded in 1967, 1973 and 1977, respectively, are based on mandatory reporting of all births on standardized forms, completed by the attending midwife or physician shortly after birth and supplemented by the antenatal health card and hospital records. The MBRs contain information on maternal background, pregnancy and birth, and selected short-term outcomes for the offspring. The Scandinavian cancer registries, established in 1943 (Denmark), 1951 (Norway) and 1957 (Sweden), are also population-based, with mandatory reporting of all incident tumors. Data in these registries have been reported to be complete and of high quality -18.For the Norwegian and Swedish data, information on maternal country of birth was obtained from Statistics Norway and Statistics Sweden, respectively. In Denmark, demographic variables were obtained from the Civil Registration System. Information on smoking habits became available in Sweden in 1982, in Denmark in 1991 and in Norway in 1999. For Apgar scores, information was available in Sweden in 1972, in Denmark in 1978 and in Norway in 1976. Placental weight was available in Sweden during 1982–1999, in Denmark in 1997 and in Norway in 1999. Because these data became available at different times in the three countries, the number of missing values is relatively high in our study.th edition of the International Classification of Disease (ICD-10); leukemias (C91-95), lymphomas (C81-C85), tumors of the brain and nervous system (C70-72 and D42-43), breast, females only (C50), bone (C40-C41), testis (C62), ovary (C56), thyroid gland (C73), adrenal gland (C74), retinoblastoma (C69.2), Wilms’ tumor (C64.9) and hepatoblastoma (C22). Cases were Scandinavian children and adolescents registered in the MBRs at birth, diagnosed with one of the above types of cancer before the age of 21 years and registered in the corresponding National Cancer Registry. The first 21 years of life were selected to focus primarily on the potential effect of perinatal exposure. Only singletons born between 23–43 weeks of gestation, and only primary cases of cancers were included.Our study included the twelve most common types of cancer in childhood and adolescence, defined according to the 10For each case, we sampled up to ten controls who were cancer-free at time of diagnosis for the case, and matched by birth registry, sex and year of birth. Children with Downs’s syndrome were excluded as they are known to be at higher risk for several types of cancer.In Sweden, hyperemesis was defined through ICD-8 codes 638.0 and 638.9 until 1987, ICD-9 code 643 until 1997 and subsequently with ICD-10 code O21, O21.1 and O21.9, gathered from the MBR and supplemented from the National Patient Registry (NPR) to increase the validity of the diagnosis. In Norway and Denmark, hyperemesis was defined through ICD-8 codes until ICD-10 codes were available. In Denmark, information on hyperemesis was gathered from the NPR, while in Norway this information was obtained from the MBR solely.Maternal country of birth, smoking (smoker/nonsmoker) and age (in five-year age-groups) were considered as possible confounders, and adjusted for, as were placental weight , birth weight  and Apgar score . In line with previous research on hyperemesis, maternal country of birth was categorized into six immigrant groups that were culturally and geographically related.Conditional logistic regression models were used to study associations between hyperemesis and all selected types of childhood cancer. The models were stratified by age for each cancer type with five or more exposed cases. The regression models were adjusted by maternal age, ethnicity and smoking, in addition to offspring’s Apgar score, placental weight and birth weight. We then implemented a backward elimination procedure, removing explanatory variables one by one and observing if the estimate changed. Crude and adjusted relative risks (RR) were calculated with 95 % confidence intervals (CI). Due to multiple testing, we performed the analyses with 99 % confidence intervals as well, for selected cancer types. SPSS for Windows version 20.0  was used for all analyses.The study was approved by the Danish Data Protection Agency (record no 2008-41-2767) and the Regional Ethical Board in Stockholm, Sweden and the Regional Ethical Committee in Oslo, Norway.Demographic variables for mothers and offspring are presented in Table n = 5114), followed by tumors of the central nervous system (30.6 %) and lymphoma (12.5 %). Cancers of the breast, testis, thyroid and ovary were more common in the oldest age group, while tumors of the adrenal gland, nephroblastoma and retinoblastoma were more frequent among the youngest age-groups  are important risk factors ,28. hCG in-utero [in-utero exposure to hyperemesis and subsequent breast cancer. At the same time, with age it becomes more difficult to distinguish the biological from the environmental impacts on cancer risk. In addition, as the MBRs were founded in the 1960s, the majority of offspring have yet to enter higher risk age-group.As risk of breast cancer has been linked to estrogen exposure in-utero , offspriin-utero , our datIn contrast to findings of an American study of 131 men with testicular cancer, we found no association between hyperemesis and risk of testicular cancer in offspring . HoweverThe major strength of this study is its large sample size, resulting from collaboration between the three Scandinavian countries. As well, merging population-based registries provided a relatively high number of cases making selection bias therefore unlikely and increasing the generalizability of our results. Registration of hyperemesis was performed prior to development of cancer in the offspring, which eliminated the risk of recall-bias. The MBRs offer extensive information on maternal and fetal variables making it possible to control for more potential confounders than earlier studies.Differences in the MBRs pose potential limitations. An important example is high numbers of missing values for several variables, including maternal smoking. However, a previous study on hyperemesis and risk of short-term adverse outcomes for offspring, using the Norwegian MBR, included sub-analysis specifically exploring the possible impact of smoking on risks associated with hyperemesis, with no change in the observed associations . Althougnd week of gestation. Previous research has shown that the majority of women experience hyperemesis during the first and second trimesters [Another possible limitation is that information on severity and onset of hyperemesis was unavailable. However, widely used definitions of hyperemesis, including the one applied by the ICD-10, pinpoints time of onset before the end of 22imesters . The valimesters .We found no association between hyperemesis and the over-all or site-specific risk of cancer in offspring, except for a suggested increase in lymphoma in adolescence and early adulthood. The latter finding may be due to chance and requires validation in other studies.


Background. This study aimed to investigate whether a lifestyle-based physical activity program could contribute to reduced medical expenditure. Methods. The study participants were 60 adults aged 63.1  years in the intervention group; the case-control group consisted of 300 adults who were randomly selected from Japan's national health insurance system. This community-based retrospective study incorporated a 3-year follow-up. Results. The total and outpatient medical expenditure in the intervention group were significantly lower than in the control group: total expenditure, $US640.4/year; outpatient expenditure, $369.1/year. The odds ratio for outpatient visiting was 6.47-fold higher in the control than in the intervention group. Conclusion. Our study suggests that a health program to promote physical activity can result in reduced total medical expenditure, outpatient medical expenditure, and possibly also inpatient medical expenditure. It is predicted that the global population will age rapidly during the next half century . The incJapan has a national health insurance (NHI) system, and all residents are covered by some form of medical insurance. With NHI, major health services, such as health promotion, disease prevention, medical treatment, and rehabilitation, operate at a cost that is affordable by all people . It has According to a growing body of evidence, regular physical activity is significantly associated with decreased risk of noncommunicable diseases and mortality –12. SeveTo the best of our knowledge, no intervention study has been reported about increasing physical activity to reduce medical expenditure. It is therefore necessary to develop and assess a community-level intervention program for promoting physical activity toward reducing healthcare costs. Thus, the objective of the present study was to investigate the effects of a lifestyle-based physical activity program, supported by a local government, on changes in medical expenditure compared with a randomly selected matching control group from a community over a 3-year observation period.2; the total area is 133.47 km2 [The participants in the intervention group were 60 individuals who engaged in a 9-month physical activity program in Kazo, Japan. Kazo is a city located in Saitama Prefecture. In 2011, it had an estimated population of 117,339, with 42,778 households, and a population density of 879.14/km3.47 km2 . The parTo measure their daily life physical activity, participants were required to wear a pedometer  for 7 days before the start of the physical activity program. We measured total and brisk-walking step counts using the pedometer at baseline and every day during the intervention. We defined brisk walking as a pace equivalent to ≥4 metabolic equivalents and at least 10 min of continuous walking . We also2). We measured the body fat mass index (percentage) and weight-adjusted skeletal muscle mass (percentage) using a bioelectrical impedance device .We calculated the body mass index (BMI) as the body weight (kg)/height .We expressed the participants' baseline characteristics as means and standard deviation (SD) and as percentages. We analyzed the mean difference in age and total, inpatient, and outpatient medical expenditure between the intervention and control groups using the Mann-Whitney We determined whether the physical activity intervention contributed to change in medical expenditure: we examined the association between the physical activity program and average annual change in total, outpatient, and inpatient medical expenditure from baseline; we did so using mixed-effects models and treating participant-specific intercepts and linear change with time as random effects. This approach allowed us to assess the physical activity program (the key fixed effect) on the average rate of change in total, outpatient, and inpatient medical expenditure while accounting for the dependence of within-participant repeated measures over time. The mixed-effect models included age (continuous), sex , and intervention status (intervention or control group). Based on previous studies, all the data for medical expenditure were presented as least-squares means  per year during the 3-year intervention period.P < 0.05 statistically significant.We also evaluated the odds ratio (OR) and 95% CI for outpatient visits and hospitalization using a generalized linear model after adjusting for age, sex, and baseline medical expenditure. To determine changes in physical activity, physical fitness, and body composition produced by the intervention, we performed repeated measures analysis of variance (ANOVA) for the total step count and brisk walking; we conducted post hoc analysis using the Bonferroni test . We performed all statistical analyses with SPSS; we considered At baseline, the total medical expenditure for the intervention group was $822.8, which is lower than the total medical expenditure of $2,008.9 for residents of Kazo. P = 0.02) and outpatient medical expenditure of $361.9 . However, we observed no significant difference for inpatient medical expenditure (P = 0.18).We used generalized linear models to evaluate the OR for visiting hospital for medical care with respect to participation in the physical activity program . We obseAt baseline, the average total and brisk-walking steps were, respectively, 7171  and 2217  steps/day. The total step count significantly increased to 10,120  steps/day after 6 months, 8697  steps/day after 9 months, and 8652  after 15 months . The briThis study investigated the effects of a health promotion program, which took the form of a community-based intervention for increasing physical activity, on medical expenditure. To our knowledge, this is the first investigation to use an intervention to examine the effects of a physical activity program on change in medical expenditure. Our results indicate that participation in the physical activity program was associated with decreased medical expenditure—particularly total and outpatient medical expenditure. This decreased expenditure was probably due to the reduced number of outpatient visits as a result of promoting the health status of participants.In Japan, local governments have implemented health promotion programs to halt increasing medical expenditure; some studies have demonstrated that increased physical activity clearly decreased the risk of lifestyle diseases , 14, 24.In this study, we found a significant difference in total and outpatient medical expenditure between the intervention and control groups. Compared with the control group, total medical expenditure for the intervention group was lower by $640.4 and outpatient medical expenditure was lower by $361.9. We could not directly compare our results with those of previous epidemiological investigations owing to differences in the study methods and participant characteristics; however, the reduced economic cost effect we observed in the intervention group was 44.6%, which is higher than the reduced medical costs that were 13.0% reported in one cohort study . Using aOne strength of the present study is that it adopted a longitudinal design, employing a randomly sampled dataset; the analyses incorporated repeated measurements made on the same participants using mixed-effects models. However, our study also has several limitations. First, participants in the intervention group were self-sufficient, healthy, and it is possible that they were highly conscious of their health. Indeed, the participants in the intervention group had lower total medical expenditure  than the general population in Kazo . However, we selected our control group from among individuals of the same age and sex as well as with the same medical expenditure. Furthermore, we excluded from the present study subjects who required long-term care. We also excluded medical costs for prescription drugs and rehabilitation from total medical expenditure, even though there may have been some savings in medical costs through the physical activity program. Moreover, although the total medical expenditure for residents of Kazo included all age groups, our analysis did not cover individuals aged ≥ 75 years. However, because of the greater medical costs in older populations, it is also possible that we underestimated the effects of the physical activity program.Another limitation of this study is that it employed a randomly selected matching control group and was not a randomized controlled study. To validate the effects of the intervention, we performed a randomly selected matching for sex, age, and place of residence. However, we did not consider other physical health conditions, healthy behavior , or demographic factors (education levels and income).In response to the social issue of increasing medical expenditure caused by Japan's aging population, it is necessary to implement health promotion programs to prevent lifestyle diseases, which account for over half of the country's total medical expenditure. We observed lower medical expenditure in participants of the health promotion program over a 3-year period than in a control group with the same medical expenditure at baseline.


This study explored longitudinal associations between personality and body-mass-index (BMI) in school-age children, including the potential mediating role of screen time and physical activity, and the potential moderating roles of child demographics and neighbourhood socioeconomic position. Participants were the parents (and teachers) of 3857 ten-year-old children, who completed questionnaires at baseline with a two-year follow-up. After controlling for child demographics , we found that personality was unimportant for concurrent BMI, but was important for subsequent BMI and change in BMI over two years. Low levels of introversion and persistence at baseline, and decreases in persistence over time, were associated with a higher BMI at follow-up and a greater increase in BMI over time. Moderator analyses showed that introversion was more strongly related to subsequent BMI for children listed as aboriginal or Torres Strait Islander. The relationship between personality and change in BMI was mediated by screen time, but not by physical activity. To conclude, findings demonstrate that personality is important for change in body mass in Australian children (particularly indigenous children), and that screen-based sedentary behaviour features an important role in this association. The prevalence of child and adolescent obesity has risen substantially over the past 30 years. In developed countries, 23.8% of boys and 22.6% of girls were overweight or obese in 2013 , 5. In t2)–is a useful indirect estimate of total body fat in children and adolescents , d = 0.08, persistence, t(3543) = 5.96, mean diff. = .07 , d = 0.08, and reactivity, t(3543) = 7.89, mean diff. = .09 , d = 0.11, and a medium increase in BMI, t(3543) = 44.77, mean diff. = 1.53 , d = 0.42.Means, standard deviations, skewness values, and missing cases for study variables at Time 1 and Time 2 are presented in b = –.05, s.e. = .01) and a higher pubertal status . Baseline BMI was also higher in girls than in boys . The personality traits of introversion, persistence and reactivity were unrelated to concurrently measured BMI. For Model 2, all demographic and socioeconomic control variables were associated with follow-up measures of BMI. Children with a lower neighbourhood socioeconomic position , a higher pubertal status , and a greater increase in pubertal status over time  had a higher BMI at follow-up. A higher BMI at follow-up was also observed for girls  and for children listed as aboriginal or Torres Strait Islander . Lower levels of introversion  and persistence  at baseline were associated with a higher BMI at follow-up, and a greater increase in persistence over time  was associated with a lower BMI at follow-up.Findings from the linear regression models are presented in b = –.02, s.e. = .01), a higher pubertal status , and a greater increase in pubertal status over time  had a greater increase in BMI. A greater increase in BMI was also observed for boys  and for children listed as aboriginal or Torres Strait Islander . Children with lower levels of introversion  and persistence  at baseline also had a greater increase in BMI over time, and a decrease in persistence over time  was associated with an increase in BMI over time. Taken together, the linear regression models demonstrate that child personality traits are important for subsequent BMI and change in BMI over two years, but are unimportant for concurrent BMI.For Model 3, all demographic and socioeconomic control variables were associated with change in BMI over time. Children with a lower neighbourhood socioeconomic position , demonstrating a stronger association between introversion and subsequent BMI for children listed as aboriginal or Torres Strait Islander. The association between personality and subsequent BMI was not moderated by child sex, pubertal status or NSP. For Model 3, the association between personality and change in BMI was not moderated by child sex, indigenous status, pubertal status, or NSP.For Model 1, the association between personality and concurrent BMI was not moderated by child sex, indigenous status, pubertal status, or NSP. For Model 2, there was a significant moderation by child indigenous status for introversion on subsequent BMI , persistence  and reactivity  on physical activity levels, and a significant effect for persistence  and reactivity  on screen time. Screen time, but not physical activity, was associated with change in BMI in all three models  and reactivity  on change in BMI. Bootstrap results for indirect effects showed a mediating effect for screen time in the association between persistence and change in BMI  and a mediating effect for screen time in the association between reactivity and change in BMI . The upper- and lower-bound confidence intervals were outside of zero indicating that these mediation effects were meaningful.Findings from the multiple mediator models are presented in e models , b pathsThis prospective longitudinal study tested associations between child personality and change in body fat estimates over two years, including the assessment of demographic and socioeconomic moderators of this association and the potential mediating roles of screen-based sedentary behaviour and physical activity. Personality traits were unimportant for concurrent BMI, but were important for subsequent BMI and change in BMI. In particular, low levels of introversion and persistence at baseline, and decreases in persistence over time, were associated with a higher BMI at follow-up and a greater increase in BMI over time. Moderator analyses demonstrated that the negative association between introversion and subsequent BMI was stronger for indigenous Australian children. Mediation analyses demonstrated that personality was related to change in BMI through the variance shared with sedentary behaviour.The finding that introversion and persistence were unrelated to concurrent BMI, but were important for subsequent BMI and change in BMI is intriguing and somewhat consistent with what has been observed in previous studies of school-age children. Indeed, cross-sectional studies have often reported no association between personality and BMI , 47, witThere was little evidence that child demographics moderate associations between personality and BMI. In previous studies, only child sex has been explored as a potential moderator in school-age children, with little evidence that associations differ between boys and girls , 19–althStudies have started to explore behaviours that might mediate associations between personality and BMI, with enjoyment of food  and physStrengths of this investigation include the objective assessment of child BMI, the large nationally-representative sample, and the longitudinal nature of the data. However there are also some important limitations that readers must consider in their interpretation of study findings. First, the assessment of physical activity included only within-school activity levels as perceived by the child’s teacher, and the assessment of sedentary behaviour was parent report and did not include non-screen-based sedentary behaviour . More objective measures of physical activity and sedentary behaviour might provide more accurate estimates of effect sizes for mediation models than those reported in the current investigation. Second, missing data analyses show that study dropouts and excluded participants had a higher BMI, higher scores for reactivity and lower scores for persistence, potentially weakening observed associations. Third, that multiple tests were conducted to explore moderator variables increases the probability of a Type I error. Replication studies are required to test further the meaningfulness of the ethnicity moderation effect identified in this study. Fourth, the measure of body composition used in the study (BMI) provides an indirect estimate of child adiposity and other measures  might provide more accurate estimates  and offThis study explored associations between child personality and change in body fat estimates over two years, including potential demographic and socioeconomic moderators and the potential mediating roles of screen-based sedentary behaviour and physical activity. Our findings show that more sociable and less persistent 10-year-old children have an increased risk of higher body fat at age 12, and that children who increase the trait of persistence between age 10 and age 12 tend to decrease body fat between age 10 and age 12. Importantly, the negative association between introversion and subsequent BMI was stronger for children listed as aboriginal or Torres Strait Islander and personality traits were related to BMI, in part, through the variance shared with screen-based sedentary behaviour. These findings (should they be replicated) might be of value to health consultants targeting the reduction of body fat in children. Personality tests might offer a useful approach to identifying children at greater risk of excessive sedentary behaviour and in turn a higher BMI, particularly among indigenous Australian populations. In addition to identifying ‘at risk’ populations, these findings might also be of interest to parents and general practitioners. Limiting the number of hours children spend in screen-based activities, rather than increasing physical activity, might be a more effective approach to preventing the accumulation of excessive body fat. We recommend replication studies that directly address study limitations and experimental research targeting the reduction of screen-based sedentary behaviour and body fat in children.