Behaviour problems in Chinese primary school children.

PURPOSE: This study aimed to determine levels of behaviour problem in primary school children, and to explore key determinants relevant to the Chinese context: being an only child, urban living, school stressors, being bullied and physical punishment. METHODS: We administered a child self-completion questionnaire to children aged 7-13 and Rutter Parent Scales to their parents in nine primary schools, in urban and rural Zhejiang Province, eastern China. RESULTS: Full data were available for 2,203 child-parent pairs. Rutter Scores showed that 13.2% of the children (16.4% of boys, 9.4% of girls) had a behaviour problem. Girls manifest more emotional problems (5.3 vs. 2.3%) and boys more conduct problems. Questions about school stress showed that 78% worry "a lot" about exams, 80% felt pressure to perform at school "all the time", and 44% were bullied at least sometimes. Seventy-one percent were sometimes or often physically punished by their parents. Conduct problems were strongly significantly associated with male gender (OR 3.8 95% CI 3.0-4.6), rural residence OR 2.3, 1.3-3.4, having been bullied (1.8, 1.5-2.2) and frequent physical punishment (4.5, 3.2-5.8). Emotional problems were most strongly associated with being bullied (OR 4.9, 2.3-7.7). Being an only child was not associated with behaviour problems. CONCLUSIONS: High levels of behaviour problems in these Chinese children could relate to high expectations in a very competitive educational environment. Our results raise concerns for the future mental well-being of those children with behaviour problems.

Stress and psychosomatic symptoms in Chinese school children: cross-sectional survey.

OBJECTIVE: The Chinese educational system is highly competitive from the start of primary school with great emphasis on academic performance and intolerance of failure. This study aimed to explore the pressures on primary schoolchildren, and to determine the relationship between these pressures and psychosomatic symptoms: abdominal pain and headache. DESIGN: Cross-sectional survey using self-completion questionnaires. SETTING/PARTICIPANTS: 9- to 12-year-olds in primary schools in urban and rural areas of Zhejiang Province, eastern China. OUTCOME MEASURES: Proportion of children with defined school-related stressors and frequency of psychosomatic illness. RESULTS: Completed questionnaires were obtained from 2191 children. All stressors were common in boys and girls and in urban and rural schools. Eighty-one per cent worry 'a lot' about exams, 63% are afraid of the punishment of teachers, 44% had been physically bullied at least sometimes, with boys more often victims of bullying, and 73% of children are physically punished by parents. Over one-third of children reported psychosomatic symptoms at least once per week, 37% headache and 36% abdominal pain. All individual stressors were highly significantly associated with psychosomatic symptoms. Children identified as highly stressed (in the highest quartile of the stress score) were four times as likely to have psychosomatic symptoms. CONCLUSIONS: The competitive and punitive educational environment leads to high levels of stress and psychosomatic symptoms in Chinese primary schoolchildren. Measures to reduce unnecessary stress on children in schools should be introduced urgently.

Abnormal sex ratios in human populations: causes and consequences.

In the absence of manipulation, both the sex ratio at birth and the population sex ratio are remarkably constant in human populations. Small alterations do occur naturally; for example, a small excess of male births has been reported to occur during and after war. The tradition of son preference, however, has distorted these natural sex ratios in large parts of Asia and North Africa. This son preference is manifest in sex-selective abortion and in discrimination in care practices for girls, both of which lead to higher female mortality. Differential gender mortality has been a documented problem for decades and led to reports in the early 1990s of 100 million "missing women" across the developing world. Since that time, improved health care and conditions for women have resulted in reductions in female mortality, but these advances have now been offset by a huge increase in the use of sex-selective abortion, which became available in the mid-1980s. Largely as a result of this practice, there are now an estimated 80 million missing females in India and China alone. The large cohorts of "surplus" males now reaching adulthood are predominantly of low socioeconomic class, and concerns have been expressed that their lack of marriageability, and consequent marginalization in society, may lead to antisocial behavior and violence, threatening societal stability and security. Measures to reduce sex selection must include strict enforcement of existing legislation, the ensuring of equal rights for women, and public awareness campaigns about the dangers of gender imbalance.

Using the premarital examination for population-based surveillance for HIV in China: a pilot study.

All couples attending the premarital examination at four selected sites in Zhejiang and Yunnan provinces in China were included in this study. Blood from 9952 individuals was tested for HIV-1 using a gelatin particle agglutination technique. There were no HIV-positive individuals in Zhejiang. In Yunnan, 28 of 3742 individuals were positive, a prevalence of 0.75%. The premarital examination should be used for voluntary counselling and testing and anonymous surveillance for HIV in high prevalence areas.