Health, nutritional and behavioural indicators in adolescents in urban and rural China

Objectives: to determine differences in health, nutritional and behavioural indicators in adolescents in urban and rural Zhejiang Province, and to make recommendations for the development of adolescent health services and health education in eastern China. Setting: Twelve secondary schools in three distinct socio-economic and geographic areas: Hangzhou (urban). Xiaoshan (wealthy rural) and Chunan (poor. mountainous rural) in Zhejiang Province, eastern China. Methods: A two stage cross-sectional survey was carried-out. The first stage was carried out in six middle and high schools and involved the development, testing and administration of a questionnaire covering a range of health and lifestyle issues. Areas of importance highlighted in Stage One informed the content of Stage Two which consisted of anthropometry. haemoglobin measurement, and a further questionnaire focusing pm1icularly on nutritional status and psychological morbidity. Results: There were 4197 respondents aged predominantly 12-18 in Stage One and 1577 respondents aged 12-16 in Stage 2. Key findings included significant differences in sociodemographic patterns in the three areas: 90% of Hangzhounese were only children. compared with 55% in Xiaoshan and 8% in Chunan. Regular smoking was very rare (0.3%) and non-existent in girls. Underweight was far more prevalent than overweight 18% and 3.6% (P<O.OO 1). The strongest predictor of overweight was urban residence OR 9.1(95% Cl 3.7,23). Over half of all girls (51%) were anaemic, with significantly more in Chunan.(P<O.OOI). Anxiety and depression were common in both sexes and in both urban and rural areas, but very few sufferers had sought professional help. Much of the psychological morbidity was related to academic pressure. Conclusions: As a result of the study, the first of its kind in the Province, changes have been made to the health education curriculum for secondary schools in Zhejiang and there are plans to introduce counselling services into schools

Internet use and cyberbullying: Impacts on psychosocial and psychosomatic wellbeing among Chinese adolescents

The use of the internet for entertainment has increased hugely over the last decade among Chinese adolescents, but the psychosocial impacts remain unclear. The aims of this study are to explore the associations between internet use, cyberbullying and psychosocial wellbeing among Chinese adolescents. Questionnaires were completed in the classroom setting by 3378 middle school students aged 11–16 years old (M = 13.58, SD = 0.87) in three provinces representing eastern, central and western China. Key findings included: 1) Internet use of over 3 h per day was associated with higher prevalence of anxiety [OR = 1.6, 95% CI (1.1, 2.2), p = 0.006], depression [OR = 2.1, 95% CI (1.7, 2.6), p < 0.001] and psychosomatic health problems, such as abdominal pain [OR = 2.4, 95% CI (1.8, 3.3), p < 0.001]. 2) Boys were much more likely to play online games. 3) Moderate time of gaming was overall beneficial to well-being. 4) Cyberbullying was common, with 37.5% admitting involvement. 5) Bully-victims were most vulnerable to mental and psychosomatic health problems, and only-bullies were the least vulnerable group. Our findings suggest moderate internet use for entertainment is not detrimental to mental health, but excessive use is. Schools should promote adolescents’ responsible use of the internet and incorporate anti-cyberbullying programs into the curriculum

China’s excess males, sex selective abortion, and one child policy: analysis of data from 2005 national intercensus survey

Objectives To elucidate current trends and geographical patterns in the sex ratio at birth and in the population aged under 20 in China and to determine the roles played by sex selective abortion and the one child policy

Effectiveness of integrating primary healthcare in aftercare for older patients after discharge from tertiary hospitals-a systematic review and meta-analysis

BACKGROUND: Quality of aftercare can crucially impact health status of older patients and reduce the extra burden of unplanned healthcare resource utilisation. However, evidence of effectiveness of primary healthcare in supporting aftercare, especially for older patients after discharge are limited. METHODS: We searched for English articles of randomised controlled trials published between January 2000 and March 2022. All-cause hospital readmission rate and length of hospital stay were pooled using a random-effects model. Subgroup analyses were conducted to identify the relationship between intervention characteristics and the effectiveness on all-cause hospital readmission rate. RESULTS: A total of 30 studies with 11,693 older patients were included in the review. Compared with patients in the control group, patients in the intervention group had 32% less risk of hospital readmission within 30 days (RR = 0.68, P < 0.001, 95%CI: 0.56-0.84), and 17% within 6 months (RR = 0.83, P < 0.001, 95%CI: 0.75-0.92). According to the subgroup analysis, continuity of involvement of primary healthcare in aftercare had significant effect with hospital readmission rates (P < 0.001). Economic evaluations from included studies suggested that aftercare intervention was cost-effective due to the reduction in hospital readmission rate and risk of further complications. CONCLUSION: Integrating primary healthcare into aftercare was designed not only to improve the immediate transition that older patients faced but also to provide them with knowledge and skills to manage future health problems. There is a pressing need to introduce interventions at the primary healthcare level to support long-term care

Self-Harm, Suicidal Ideation and Attempts among School-Attending Adolescents in Bamako, Mali

Suicide and self-harm are major public health concerns for adolescents globally, but there is a dearth of related research in West Africa. This study aims to examine the prevalence and associated factors for self-harm, suicidal ideation and suicide attempts among adolescents in the West African country of Mali. A questionnaire survey was conducted among adolescents attending school or university in August 2019 in Bamako, the capital of Mali. Logistical constraints necessitated convenience sampling. Outcome measures were self-harm and suicide ideation and attempts. Predictor variables included sociodemographic characteristics, bullying and mental health problems. There were 606 respondents who completed questionnaires; their mean age was 16.1 (SD = 2.4); 318 (52.5%) were identified as male; and 44.4% reported self-harm at some point in their life, with 21% reporting suicide ideation and 9.7% actual suicide attempts. For all three outcomes, older age, knowing somebody personally who had experienced self-harm or taken their own life, moderate to severe depression or anxiety, and being a victim of bullying were highly significant risk factors for self-harm, suicidal ideation and suicide attempts in these adolescents, while high self-esteem decreased the risk. The study suggests that self-harm and suicidal behaviour are relatively common in Malian adolescents who are still in education. However, much more research is needed to better understand this phenomenon

Effects of reproductive and demographic changes on breast cancer incidence in China: A modeling analysis

Background: Breast cancer incidence is currently low in China. However, the distribution of reproductive and lifestyle risk factors for breast cancer among Chinese women is changing rapidly. We quantified the expected effect of changes in breast cancer risk factors on future rates of breast cancer in China. Methods: We first validated and calibrated the Rosner-Colditz log-incidence breast cancer model in Chinese women who participated in the Shanghai Women's Health Study cohort (N = 74 942). We then applied the calibrated model to a representative sample of Chinese women who were aged 35-49 years in 2001 using data from the Chinese National Family Planning and Reproductive Health Survey (NFPRHS, N = 17 078) to predict the age-specific and cumulative breast cancer incidence among all Chinese women of this age group. We evaluated the relative impact of changes in modifiable risk factors, including alcohol intake, parity, postmenopausal hormone use, and adult weight gain, on cumulative incidence of breast cancer. Results: Breast cancer incidence in China is expected to increase substantially from current rates, estimated at 10-60 cases per 100 000 women, to more than 100 new cases per 100 000 women aged 55-69 years by 2021. We predicted 2.5 million cases of breast cancer by 2021 among Chinese women who were 35-49 years old in 2001. Modest reductions in hormone and alcohol use, and weight maintenance could prevent 270 000 of these cases. Conclusions: China is on the cusp of a breast cancer epidemic. Although some risk factors associated with economic development are largely unavoidable, the substantial predicted increase in new cases of breast cancer calls for urgent incorporation of this disease in future health care infrastructure planning

Effectiveness of Educational Interventions for Health Workers on Antibiotic Prescribing in Outpatient Settings in China: A Systematic Review and Meta-Analysis

Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before-after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed

Meat consumption and all-cause mortality in 5763 patients with inflammatory bowel disease: A retrospective cohort study

Background: Whether meat consumption is related to risk of mortality in patients with inflammatory bowel disease (IBD) remains poorly understood. Methods: In the UK Biobank, 5763 patients with IBD were recruited from 2007 to 2010 and finished a brief food frequency questionnaire at baseline. We followed them until March 13, 2021 to document all-cause death events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for all-cause mortality associated with consumptions of fish, unprocessed poultry, unprocessed red meat, and processed meat among the patients. Findings: During 67,095 person-years (mean follow-up 11·7 years, mean age 57·3, 52·5% female), we documented 590 death events. Higher consumption of processed meat was associated with an increased risk of all-cause mortality in patients with IBD (HR comparing >4·0 with 0-0·9 time/week=1·52, 95% confidence interval (CI) 1·05-2·19), but the P-trend for each 25 g increment was 0·075. This association remained significant in patients with Crohn's disease (HR 1·77, 95% CI 1·01-3·10) but not in patients with ulcerative colitis (HR 1·34, 95% CI 0·82-2·20). Consumptions of fish (HR 1·27, 95% CI 0·84-1·91), unprocessed poultry (HR 0·59, 95% CI 0·28-1·21), or unprocessed red meat (HR 0·87, 95% CI 0·60-1·26) were not significantly associated with the mortality of patients with IBD. Interpretation: More frequent consumption of processed meat was associated with an increased risk of mortality in patients with IBD, while no associations were observed for consumption of other types of meat. Our exploratory and speculative findings should be cautiously interpreted and need further replication in other cohorts. Funding: The National Natural Science Foundation of China (81,970,494); Key Project of Research and Development Plan of Hunan Province (2019SK2041)

Is domestic work a worst form of child labour? The findings of a six-country study of the psychosocial effects of child domestic work

In this paper, we report on a study of the psychosocial effects of child domestic work (CDW) in six countries and the relevance of our findings to international legislation. Our results suggest that CDW is highly heterogeneous. While some young child domestic workers work long hours, suffer physical punishment and are at risk of psychosocial harm, others are able to attend school and benefit from good relationships with their employers and networks of support. Child domestic workers in India and Togo were most at risk of psychosocial harm. We conclude that classification of this employment as hazardous would not be appropriate and could be counterproductive and instead propose that legislation focuses on protective factors such as a social and community support

Obesogenic behaviours in South Asian adolescents in England: : A literature review and quantitative investigation

This document is the Accepted Manuscript version, made available under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.BackgroundWHO has stated that childhood obesity is one of the most serious challenges facing public health in the 21st century, with obese children and adolescents facing a plethora of health complications and increased risk of many chronic diseases. Using a literature review and quantitative analysis of the WHO Health Behaviour in School-Aged Children (HBSC) data, we aimed to better understand obesogenic behaviours in South Asian adolescents in England.MethodsWe searched electronic databases (Embase, Scopus, Medline, Web of Science) from inception of the database to April 10, 2016, and the references of relevant papers. Grey literature including reports and non-peer reviewed sources were also included. Inclusion criteria were: adolescents aged 11–18 years of age, articles in English language, and studies based in England. Quantitative analysis of HBSC data from 2010 examined variables such as physical activity, dietary behaviours, and mental health indicators. We compared adolescents from Bangladeshi, Indian, and Pakistani groups for each variable, by sex, with white British adolescents. Pearson's χ2 test was carried out to compare all groups against each other. Ethics approval was given by the University of Hertfordshire Ethics committee for Health and Human Sciences (HSK/SF/UH/00007). Ethical sensitivity was also enhanced through the work of reference groups with young people, which informed the conduct of the study within schools.FindingsThe HSBC 2010 sample consisted of 51 Bangladeshi, 96 Indian, 111 Pakistani, and 3476 white British adolescents. Two (8·7%) of 23 Bangladeshi girls undertook 5 or more days' physical activity, compared with 744 (44·1%) of 1688 white British girls, 13 (27·7%) of 47 Indian girls, and 16 (33·3%) of 48 Pakistani girls. South Asian adolescents had significantly worse outcomes in terms of number of times physical activity was undertaken per week (p=0·023) or any physical activity in the previous 7 days (p=0·002). 11 (20·0%) of 55 Pakistani girls never ate vegetables or ate them less than once a week, compared with 94 (5·3%) of 1771 white British girls (consumption of vegetables, p<0·0005).InterpretationKey findings from the literature review and HBSC 2010 data were that South Asian adolescents have lower physical activity levels compared with their white peers, have worse dietary behaviours, and have barriers to engaging in healthier lifestyles, compared with their white British counterparts. These negative lifestyle behaviours will need careful consideration of upstream policy and local health service provision and interventions in South Asian adolescents in England. Taking this evidence into action will be crucial to address the obesity epidemic and reduce existing health inequalities.Peer reviewe