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1.
Lancet Public Health ; 5(6): e302-e303, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32504582
2.
Pediatr Obes ; : e12664, 2020 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-32543108

RESUMEN

BACKGROUND: Economic development has brought rapid shifts in the food environment of Chinese children and adolescents. OBJECTIVES: To assess the changes in childhood nutritional status across ethnic groups and economic status from 2005 to 2014. METHODS: 664 094 Chinese Han and 224 151 ethnic minority children and adolescents aged 7 to 18 years were assessed in three national cross-sectional surveys (2005, 2010 and 2014). Gross domestic product (GDP) per capita of each ethnic group was categorized into four strata of socioeconomic status. To assess ethnic disparities at each time point, we used logistic regression to estimate the prevalence odds ratios (OR) for thinness, overweight and obesity in the 24 ethnic minority groups vs Han Chinese. RESULTS: Children in the two upper economic strata (over about US$4000 GDP per capita) had a high prevalence of overweight and obesity, while those in the two lower economic strata (below US$4000 GDP per capita) had a high prevalence of thinness. From 2005 to 2014, the prevalence of thinness decreased from 18.6% to 13.1% in Han children, and from 20.4% to 17.1% in ethnic minority students. At the same time, the prevalence of overweight and obesity increased from 10.4% to 17.7% in Han children, and from 4.3% to 9.2% in ethnic minority students, respectively. CONCLUSIONS: A rapid nutritional transition has occurred from 2005 to 2014 with shifts from thinness to overweight and obesity in both Han and ethnic minority children and adolescents, reflecting local GDP per capita.

3.
J Affect Disord ; 272: 521-528, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32553396

RESUMEN

BACKGROUND: Parental depression and anxiety have been consistently linked to offspring behavior problems across childhood. However, many of the risks for these common mental health problems are established well before pregnancy. This study takes advantage of rare, prospective data to examine relations between parental mental health histories (from adolescence onwards) and next generation offspring behavior problems. METHODS: Data were drawn from a multi-generational cohort study that has followed Australians from infancy to adulthood since 1983, and 1171 of their offspring assessed prospectively from pregnancy. Generalized estimating equation models were used to estimate associations between parents' depression/anxiety symptoms in adolescence and young adulthood and offspring behavior problems at 1 year. RESULTS: In analyses of 648 mother-infant and 423 father-infant dyads, after adjustment for confounders and concurrent mental health problems, mean behavior problem scores in infants of mothers with a history of mental health problems in both adolescence and young adulthood were over half a standard deviation higher than those of mothers without problems during these periods, B = 2.19, 95% CI 1.21 - 3.17, ß = 0.52. No association was observed for fathers. LIMITATIONS: We only included infants born to participants aged 29-35 years and we assessed behavior problems via parent-report. CONCLUSIONS: A mother's history of persistent depression and anxiety from adolescence to young adulthood can predict higher levels of behavior problems in her infant. Findings support calls for greater policy and prevention focus on preconception and postnatal mental health, particularly a mother's early emotional health history, prior to parenthood.

4.
Lancet Glob Health ; 8(7): e954-e964, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32562651

RESUMEN

BACKGROUND: Early marriage and fertility are major social determinants of health and wellbeing. Rapid shifts in the past three decades, including a rise in sexual activity in unmarried adolescents, a large population of young migrant workers, and a high proportion of males relative to females, have the potential to alter patterns of reproductive health in Chinese adolescents and young women. We aimed to establish long-term trends of marriage and fertility for girls and women aged 15-24 years in China. METHODS: We did a longitudinal study in which we extracted aggregated data for marriage and childbearing status for Chinese girls and women aged 15-24 years from the Chinese National Population Census (in 1990, 2000, and 2010) and the Chinese 1% National Population Sample Survey (in 1995, 2005, and 2015). The census included all individuals with Chinese nationality who resided in China when the survey was done. For the 1% sample survey, communities or villages were randomly selected and all residents with Chinese nationality in the selected communities or villages were included. In all censuses and sample surveys, forms that included information on basic demographic characteristics, education, marriage, and fertility were completed and verified by the census enumerators at the household residence, based on responses provided by the householder or another adult in the household. We calculated the ever-married rate and age-specific fertility rate (ASFR) for all included individuals. We built multivariate random-effects generalised least squares regression models on panel data to test whether marriage or fertility rate was associated with education level, sex ratio, and the proportion of the population who are an ethnic minority in a province. FINDINGS: The ever-married rate for those aged 15-19 years decreased from 4·7% in 1990 to 1·2% (95% CI 1·2-1·3) in 2000, but rebounded to 2·4% (2·4-2·5) in 2015. The ASFR for this age group decreased from 22·0 births per 1000 individuals in 1990 to 6·0 (5·9-6·0) births per 1000 in 2000, and rebounded to 9·2 (8·9-9·4) births per 1000 in 2015. The rebound was found in most provinces. In women aged 20-24 years, the ever-married rate generally declined from 58·6% in 1990 to 25·5% (95% CI 25·4-25·6) in 2015, and the ASFR decreased from 198·8 births per 1000 in 1990 to 55·0 (54·5-55·5) births per 1000 in 2015. In 2015, the ever-married rate and ASFR for girls and women in rural areas aged 15-19 years were three-times higher than those of their urban counterparts (3·8% [95% CI 3·7-3·9] vs 1·1% [1·1-1·1] for the ever-married rate and 15·4 [14·9-15·9] vs 4·1 [3·9-4·3] births per 1000 for the ASFR). There were large disparities in ever-married rate across individuals of different education levels, with increases in the ever-married rate of 15-19-year-olds not attending senior high school between 2000 and 2010. Those aged 15-19 years were more likely to be married or give birth in the western provinces. Education held a protective association against adolescent childbearing, whereas a high ratio of males to females and a high proportion of ethnic minorities were associated with greater risk. INTERPRETATION: Although China's total fertility rate remains far less than replacement, after a period of steady decline, there has been a rebound in adolescent marriage and childbearing in the past decade. A range of adolescent-targeted strategies will be needed across provinces, including scaling up comprehensive sex education, ensuring that girls continue in school, and providing adequate reproductive health services, which specifically meet the needs for modern contraception in sexually active unmarried girls. FUNDING: Humanities and Social Sciences Planning Fund Project, Sports and Health Special Project of Education and Scientific Research, and China Scholarship Council.

5.
Asian J Psychiatr ; 52: 102148, 2020 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-32450491

RESUMEN

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses.

6.
Eur J Pediatr ; 2020 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-32394267

RESUMEN

Adults with sleep problems are at higher risk for onset of musculoskeletal pain, but the evidence is less clear for children. This prospective cohort study investigated whether children with sleep problems are at higher risk for onset of musculoskeletal pain and explored whether sex is a modifier of this association. In a prospective cohort study of Australian schoolchildren (n = 1239, mean age 9 years), the associations between sleep problems at baseline and new onset of both musculoskeletal pain and persistent musculoskeletal pain (pain lasting > 3 months) 1 year later were investigated using logistic regression. The potential modifying effect of sex was also assessed. One-year incidence proportion for musculoskeletal pain onset is 43% and 7% for persistent musculoskeletal pain. Sleep problems were associated with musculoskeletal pain onset and persistent musculoskeletal pain onset in boys, odds ratio 2.80 (95% CI 1.39, 5.62) and OR 3.70 (1.30, 10.54), respectively, but not girls OR 0.58 (0.28, 1.19) and OR 1.43 (0.41, 4.95), respectively.Conclusions: Rates of musculoskeletal pain are high in children. Boys with sleep problems are at greater risk of onset of musculoskeletal pain, but girls do not appear to have higher risk. Consideration of sleep health may help prevent persistent musculoskeletal pain in children.What is Known:• Sleep problems are associated with the onset of musculoskeletal pain in adults.• It is not clear if the association between sleep problems and the onset of musculoskeletal pain is present also in children and if sex plays a role in this association.What is New:• This is the first large population-based study that has prospectively investigated the relationship between sleep problems and onset of musculoskeletal pain in school-aged children.• Children, especially boys with sleep problems, were at increased risk for the development of persistent musculoskeletal pain.

7.
Drug Alcohol Rev ; 39(4): 384-393, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32372532

RESUMEN

INTRODUCTION AND AIMS: This study prospectively investigates behavioural and social antecedents of different patterns of adolescent cannabis use, specifically, early adolescent onset cannabis use and late onset occasional use. DESIGN AND METHODS: The sample comprised 852 adolescents (53% female) drawn from the Australian arm of the International Youth Development Study. Data were collected via self-report surveys. Risk and protective factors from a modified version of the Communities That Care youth survey were measured in fifth grade (mean [M] = 10.9 years, SD = 0.4). Frequency of cannabis use was measured at six time-points throughout adolescence (ages 12-19 years). RESULTS: Early adolescent onset cannabis use (10.7% of the sample [n = 91]) was predicted by childhood family-related factors including poor family management, family history of antisocial behaviour and attachment to parents. Cigarette use and drinking until drunk were the strongest predictors of early adolescent onset cannabis use. Cumulative risks associated with community, family, peer/individual environments and early substance use (cigarettes, alcohol) in childhood were predictive of early adolescent onset cannabis use (e.g. relative risk ratio = 2.64; 95% confidence interval 1.40-4.97 for early substance use). Family and early substance use-related cumulative risks were predictive of late adolescent onset occasional cannabis use (n = 231; 27%). Cumulative early substance use risk was the strongest independent predictor of both early adolescent onset and late adolescent onset occasional cannabis use. DISCUSSION AND CONCLUSIONS: Primary prevention efforts should focus on reducing exposure and access to licit substances during late childhood and delaying the onset of use. Prevention and intervention targeted toward the family environment also appears likely to be important in the prevention of early adolescent onset cannabis use.

8.
BMJ ; 369: m1043, 2020 04 02.
Artículo en Inglés | MEDLINE | ID: mdl-32241761

RESUMEN

OBJECTIVES: To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province. DESIGN: National surveillance studies, 2008-17. SETTING: 31 provinces in mainland China. PARTICIPANTS: 4 959 790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups: quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne. MAIN OUTCOME MEASURES: Diagnosis of, and deaths from, 44 notifiable infectious diseases. RESULTS: From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4 959 790 participants (3 045 905 males, 1 913 885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from infectious diseases decreased steadily from 0.21 per 100 000 population in 2008 to 0.07 per 100 000 in 2017. Quarantinable conditions with high mortality have effectively disappeared. The incidence of notifiable infectious diseases in children and adolescents decreased from 280 per 100 000 in 2008 to 162 per 100 000 in 2015, but rose again to 242 per 100 000 in 2017, largely related to mumps and seasonal influenza. Excluding mumps and influenza, the incidence of vaccine preventable diseases fell from 96 per 100 000 in 2008 to 7 per 100 000 in 2017. The incidence of gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline. Vectorborne diseases all declined, with a particularly noticeable reduction in malaria. Zoonotic infections remained at low incidence, but there were still unpredictable outbreaks, such as pandemic A/H1N1 2009 influenza. Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases. CONCLUSIONS: China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus.


Asunto(s)
Control de Enfermedades Transmisibles , Programas de Inmunización , Vacunación , Enfermedades Prevenibles por Vacunación , Adolescente , Betacoronavirus , Niño , China/epidemiología , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/normas , Infecciones por Coronavirus , Brotes de Enfermedades , Femenino , Humanos , Incidencia , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/prevención & control , Malaria/economía , Malaria/prevención & control , Masculino , Pandemias , Neumonía Viral , Estudios Retrospectivos , Escarlatina/epidemiología , Escarlatina/prevención & control , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Tuberculosis/epidemiología , Tuberculosis/prevención & control , Enfermedades Prevenibles por Vacunación/prevención & control
9.
Psychol Med ; : 1-8, 2020 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-32340651

RESUMEN

BACKGROUND: Rates of common mental health problems (depression/anxiety) rise sharply in adolescence and peak in young adulthood, often coinciding with the transition to parenthood. Little is known regarding the persistence of common mental health problems from adolescence to the perinatal period in both mothers and fathers. METHODS: A total of 393 mothers (686 pregnancies) and 257 fathers (357 pregnancies) from the intergenerational Australian Temperament Project Generation 3 Study completed self-report assessments of depression and anxiety in adolescence (ages 13-14, 15-16, 17-18 years) and young adulthood (ages 19-20, 23-24, 27-28 years). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms at 32 weeks pregnancy and 12 months postpartum in mothers, and at 12 months postpartum in fathers. RESULTS: Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems. After adjustment for potential confounders, the odds of self-reporting perinatal depression in both women and men were consistently higher in those with a history of persistent mental health problems across adolescence and young adulthood than those without (ORwomen 5.7, 95% CI 2.9-10.9; ORmen 5.5, 95% CI 1.03-29.70). CONCLUSIONS: Perinatal depression, for the majority of parents, is a continuation of mental health problems with onsets well before pregnancy. Strategies to promote good perinatal mental health should start before parenthood and include both men and women.

10.
Circulation ; 141(10): 790-799, 2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-31941371

RESUMEN

BACKGROUND: Brazil, Russia, India, China, and South Africa (BRICS) are emerging economies making up almost half the global population. We analyzed trends in cardiovascular disease (CVD) mortality across the BRICS and associations with age, period, and birth cohort. METHODS: Mortality estimates were derived from the Global Burden of Disease Study 2017. We used age-period-cohort modeling to estimate cohort and period effects in CVD between 1992 and 2016. Period was defined as survey year, and period effects reflect population-wide exposure at a circumscribed point in time. Cohort effects are defined as differences in risks across birth cohort. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks were calculated. RESULTS: In 2016, there were 8.4 million CVD deaths across the BRICS. Between 1992 and 2016, the reduction in CVD age-standardized mortality rate in BRICS (-17%) was less than in North America (-39%). Eighty-eight percent of the increased number of all-cause deaths resulted from the increase in CVD deaths. The age-standardized mortality rate from stroke and hypertensive heart disease declined by approximately one-third across the BRICS, whereas ischemic heart disease increased slightly (2%). Brazil had the largest age-standardized mortality rate reductions across all CVD categories, with improvement both over time and in recent birth cohorts. South Africa was the only country where the CVD age-standardized mortality rate increased. Different age-related CVD mortality was seen in those ≥50 years of age in China, ≤40 years of age in Russia, 35 to 60 years of age in India, and ≥55 years of age in South Africa. Improving period and cohort risks for CVD mortality were generally found across countries, except for worsening period effects in India and greater risks for ischemic heart disease in Chinese cohorts born in the 1950s and 1960s. CONCLUSIONS: Except for Brazil, reductions of CVD mortality across the BRICS have been less than that in North America, such that China, India, and South Africa contribute an increasing proportion of global CVD deaths. Brazil's example suggests that prevention policies can both reduce the risks for younger birth cohorts and shift the risks for all age groups over time.

11.
Lancet Public Health ; 5(2): e114-e126, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31954434

RESUMEN

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0-95%), substance use disorders (22-96%), self-harm (12-65%), neurodevelopmental disabilities (2-47%), infectious diseases (0-34%), and sexual and reproductive conditions (pregnant by age 19 years 20-37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

12.
Paediatr Perinat Epidemiol ; 34(1): 86-98, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31960474

RESUMEN

BACKGROUND: There is increasing evidence that parental determinants of offspring early life development begin well before pregnancy. OBJECTIVES: We established the Victorian Intergenerational Health Cohort Study (VIHCS) to examine the contributions of parental mental health, substance use, and socio-economic characteristics before pregnancy to child emotional, physical, social, and cognitive development. POPULATION: Men and women were recruited from the Victorian Adolescent Health Cohort (VAHCS), an existing cohort study beginning in 1992 that assessed a representative sample of 1943 secondary school students in Victoria, Australia, repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). METHODS: Victorian Adolescent Health Cohort participants with children born between 2006 and 2013 were recruited to VIHCS and invited to participate during trimester three, at 2 months postpartum, and 1 year postpartum. Parental mental health, substance use and socio-economic characteristics were assessed repeatedly throughout; infant characteristics were assessed postnatally and in infancy. Data will be supplemented by linkage to routine datasets. A further follow-up is underway as children reach 8 years of age. PRELIMINARY RESULTS: Of the 1307 infants born to VAHCS participants between 2006 and 2013, 1030 were recruited to VIHCS. At VIHCS study entry, 18% of recruited parents had preconception common mental disorder in adolescence and young adulthood, 18% smoked daily in adolescence and young adulthood, and 6% had not completed high school. Half of VIHCS infants were female (48%), 4% were from multiple births, and 7% were preterm (<37 weeks' gestation). CONCLUSIONS: Victorian Intergenerational Health Cohort Study is a prospective cohort of 1030 children with up to nine waves of preconception parental data and three waves of perinatal parental and infant data. These will allow examination of continuities of parental health and health risks from the decades before pregnancy to offspring childhood, and the contributions of exposures before pregnancy to offspring outcomes in childhood.

13.
Matern Child Nutr ; 16(2): e12936, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31943779

RESUMEN

Economic growth has brought improvements in many areas of child health, but its effects on anaemia among school-aged children remain unknown. However, this is important because iron deficiency anaemia is common and is the main cause of disability-adjusted life years for school-aged children. In this study, we included 429,222 Chinese children aged 7-17 years from five consecutive national cross-sectional surveys during 1995-2014. Using altitude-adjusted haemoglobin concentration measured from capillary blood samples, we defined anaemia status according to World Health Organization's recommendation. We used logistic regressions weighted by provincial population to examine the association between provincial gross domestic product (GDP) per capita and anaemia, adjusting for sex, age, urban-rural location, regional socio-economic status (SES), fixed effect of province, and clustering of schools. We used generalised additive mixed models to evaluate a potentially non-linear relationship. For each 100% growth in GDP per capita, there was a 40% (odds ratio [OR] = 0.60; 95% confidence interval [CI; 0.56, 0.65]) reduction in anaemia. However, the association was weaker for girls and in cities with a lower SES. The association was weaker across 2005-2014 (OR = 0.75, 95% CI [0.62, 0.90]) compared with 1995-2005 (OR = 0.52; 95% CI [0.44, 0.61]), reflecting a weaker association when GDP per capita reaches around $2,000. The results were similar for moderate-to-severe anaemia. We concluded that economic growth has been associated with reductions in anaemia among school-aged children in China but with fewer benefits for girls and those in poorer settings. Further economic development in China is unlikely to bring similar reductions in anaemia, suggesting that additional population level and targeted interventions will be needed.

14.
Psychol Med ; 50(5): 827-837, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30968786

RESUMEN

BACKGROUND: Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied. METHODS: We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum. RESULTS: Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4-3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure. CONCLUSIONS: Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.

16.
J Res Adolesc ; 30 Suppl 1: 143-157, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30260070

RESUMEN

There is a dearth of research on delinquency, school context, and risk factors across developed and developing nations. Using representative samples and matched surveys, we examined delinquency among cohorts in Mumbai, India (N = 3,717); Victoria, Australia (N = 1,842); and Washington State (WA), United States (N = 1,828). We used multivariate Poisson hierarchical linear modeling. Risk factor and delinquency levels varied across sites. Delinquency clustered within certain schools, particularly in Mumbai. Community disorganization exhibited an association with delinquency as a school-level context effect in Mumbai and Victoria. Peer delinquency, sensation seeking, and poor family management exhibited cross-nationally consistent associations with delinquency. Programs that target schools, the clustering of problem behaviors, and cross-nationally consistent risk factors should be considered internationally.

17.
Lancet Child Adolesc Health ; 3(12): 871-880, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31582349

RESUMEN

BACKGROUND: Physical fitness is strongly associated with health. Despite the extent of the nutritional transition from food scarcity to diets high in fats and refined carbohydrates that has occurred in China, to our knowledge, trends in physical fitness have not been described. We aimed to assess trends in physical fitness and its association with the nutritional transition among Chinese children and adolescents. METHODS: In this retrospective analysis, data from Chinese school students aged 7-18 years were extracted from six successive national surveys undertaken between 1985 and 2014. Six components of physical fitness (forced vital capacity, standing long jump, sit-and-reach, body muscle strength, 50 m dash, and endurance running) were measured repeatedly in each survey and aggregated as a summary physical fitness indicator (PFI). Growth and nutritional status (stunting, thinness, normal weight, overweight, and obesity) were defined by use of WHO definitions, and we combined stunting and thinness as undernutrition and overweight and obesity as overnutrition. Urbanisation levels were obtained from the statistical yearbook of the National and Provincial Bureau of Statistics of China. We used fractional polynomial regression and generalised additive models to assess associations between PFI and nutritional outcomes and between PFI and levels of urbanisation. FINDINGS: Between 1985 and 2014, 1 513 435 students participated in the Chinese National Survey on Students' Constitution and Health, and 1 494 485 were included in our study. We observed a decline of the PFI during 1985-2014 (overall PFI change -0·8), albeit with an increase from 1985 to 1995 (PFI change 1·2), coinciding with a shift in the major nutritional problems from stunting and thinness to overweight and obesity. Both undernourished (PFI -2·44 for thin and -3·42 for stunting) and overnourished (-1·49 for overweight and -3·63 for obese) students had a lower PFI than that of those with normal weight (-0·41) in 2014. Boys had a larger decline in PFI than girls in 1985-2014, especially boys with obesity (PFI change -2·7). We observed the highest PFI in 1995 (1·17), when the proportion of students with normal weight was highest. Advancing urbanisation was accompanied by declines in physical fitness, which occurred in both students in rural settings and those in urban settings in these regions. INTERPRETATION: Our study supports the continuation of policies to improve physical fitness that focus on undernutrition, including economic subsidies, in poorer rural regions. However, for most of China, taxation of unhealthy foods, promotion of physical activity, reduction in academic pressures, promotion of dietary diversity, reduction of sedentary time, and engagement in formal sporting activities should be elements of policies to promote healthy weight status and prevent obesity in school students, which will also support physical fitness. FUNDING: National Natural Science Foundation, Humanities and Social Sciences Planning Fund Project, China Scholarship Council, and Innovation Fund for Outstanding Doctoral Candidates of Peking University Health Science Center.

18.
Lancet Child Adolesc Health ; 3(11): 822-830, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31542355

RESUMEN

The epidemiological transition towards non-communicable diseases is characterised by an upward shift in age of disease burden across the lifecourse. One response, within a suite of wider actions, would be to extend the upper age limit of paediatric practice to embrace adolescent health. We did an online survey to explore the upper age limit of paediatric care, obtaining responses from 1372 paediatricians in 115 countries. Marked variation in the upper age limit was apparent. Among high-income countries, a higher upper age limit was associated with greater disease burden in adolescents relative to young children (<5 years). Although paediatricians reported the mean upper age limit of paediatrics had risen over the past 20 years, the mean preferred age of 18·7 (SD 2·6) years was higher than the mean current age of 17·4 (SD 2·5) years (p<0·0001). Paediatricians reported the main reasons for the rising age over time was their greater awareness of adolescent health and leadership by professional associations. Reports of the quality of adolescent health education within national paediatric training suggest that this education is largely inadequate. A greater focus on adolescent health is required within paediatrics to ensure that the future paediatric workforce is appropriately equipped to respond to the changing disease burden across childhood and adolescence.

19.
Obesity (Silver Spring) ; 27(9): 1503-1512, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31328902

RESUMEN

OBJECTIVE: This study aimed to compare the secular trends of high blood pressure (HBP) and the effects of overweight and obesity on HBP between Chinese ethnic minority and Han children and adolescents . METHODS: Data were collected from 224,151 Chinese ethnic minority and 664,094 Han children and adolescents aged 7 to 18 years during three successive, national cross-sectional surveys (2005, 2010, and 2014). Logistic regression and population-attributable risk analyses were used to evaluate the association between HBP and overweight and obesity. RESULTS: HBP prevalence in ethnic minorities increased from 4.8% in 2005 to 6.3% in 2014, which was significantly higher than the variable HBP trends (4.1% to 5.5%) in Han children and adolescents. Both ethnic minority and Han children and adolescents experienced a rapid increase in overweight and obesity, but the pace of growth for HBP, overweight, and obesity was faster in ethnic minorities than in their Han peers. Moreover, the effects of obesity on HBP in ethnic minorities showed a sustained increase over time but were stable for the Han. CONCLUSIONS: Higher HBP prevalence, faster obesity increases, and a stronger impact of obesity on HBP in children and adolescents of Chinese ethnic minorities predict their looming burden of HBP, which suggests that attention to the cardiovascular disease risks in children and adolescents from ethnic minorities is indicated to reduce their future adult risk.


Asunto(s)
Hipertensión/etiología , Obesidad/complicaciones , Sobrepeso/complicaciones , Adolescente , Grupo de Ascendencia Continental Asiática , Niño , Estudios Transversales , Femenino , Humanos , Masculino
20.
Int J Eat Disord ; 52(8): 885-894, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31215675

RESUMEN

OBJECTIVE: Despite known associations between eating disorders and obesity, little is known about the current prevalence of symptoms of eating disorders across the weight spectrum. This study therefore aimed to estimate the population prevalence of eating disorder symptoms in relation to weight status in adolescents. METHOD: The sample comprised 3,270 participants (14-15 years; 52% boys) drawn from Wave 6 of the Longitudinal Study of Australian Children. Symptoms of anorexia nervosa (AN) and bulimia nervosa (BN) were assessed using self-report on the Branched Eating Disorder Test. This measure identifies clinically significant symptoms in the past 3 months according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Using study-derived cross-sectional population weights, the prevalence of each symptom was estimated for the total population and by sex and weight status. RESULTS: The estimated population prevalence was high (14.3-25.7%) for body image symptoms such as fear of weight gain and overvaluation of body weight but lower (0.5-3.7%) for behavioral symptoms such as binge eating and compensatory behaviors. Symptoms were more prevalent among adolescents with overweight or obesity. Although most symptoms tended to have higher prevalence among girls than boys, boys with obesity had higher prevalence of binge eating and excessive exercise than girls with obesity. The overall estimated population prevalence for AN and BN was 0.20% and 0.10%, respectively. DISCUSSION: The study highlights a need for clinicians to be cognizant of disordered eating behaviors regardless of weight status and has implications for both eating disorder and obesity prevention and intervention.


Asunto(s)
Anorexia Nerviosa/diagnóstico , Imagen Corporal/psicología , Bulimia Nerviosa/diagnóstico , Conducta Alimentaria/psicología , Adolescente , Anorexia Nerviosa/epidemiología , Australia/epidemiología , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/epidemiología , Peso Corporal , Bulimia Nerviosa/epidemiología , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Estudios Longitudinales , Masculino , Obesidad/psicología , Sobrepeso/psicología , Prevalencia , Autoinforme , Factores Sexuales
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