Psychological adjustment and behaviours in children of migrant workers in China.

BACKGROUND: In China, there are around 274 million rural-urban migrants, an estimated 61 million children left behind in rural areas by parents, and 29 million children who accompany their parents to cities. The aim of this study was to compare the psychosocial adjustment and behaviours of left-behind children and migrant children. METHODS: Full data were available for 761 left-behind children and 1,392 migrant children aged 11 to 17 in Zhejiang Province, eastern China. Participants completed a questionnaire focusing on migration status, risks behaviours, and psychological well-being, measured with the Strengths and Difficulties Questionnaire. RESULTS: There were more left behind girls and more urban migrant boys (p < .001). The mean scores on the Strengths and Difficulties Questionnaire were all higher in left-behind children than migrant children: for emotional symptoms (3.82 vs. 3.03, p < .001), conduct problems (2.55 vs. 2.41, p = .048), hyperactivity (4.25 vs. 3.81, p < .001), and total difficulties (13.46 vs. 12.00, p = .020), whereas the prosocial score was lower (6.68 vs. 6.90, p < .001), all indicating lower levels of well-being in left-behind children. Overall, 11.4% of left-behind children and 8.8% of migrant children scored in the abnormal range for total difficulties. Left behind girls were particularly vulnerable to emotional problems. Left-behind children were more likely to admit to stealing and cheating on exams, but there were no differences in other risks behaviours, such as smoking and drinking. CONCLUSIONS: Migration with parents, rather than separation from parents, was associated with better psychological well-being and fewer behavioural problems. Our findings have relevance for migrant parents in helping to inform decisions about where to raise their children as well as for policymakers in countries where migration is a major issue. When children are left behind, models of community support need to be considered, especially for those who are most vulnerable.

Experiences and perspectives of children attending a weight loss camp in China: a qualitative study.

BACKGROUND: Modernisation, urbanisation and the globalisation of food markets have exposed Chinese children to an obesogenic environment. With the dramatic increase in the prevalence of overweight and obesity among Chinese children, there are now over 2000 weight loss camps for children. The aim of this study was to investigate how one typical weight loss camp operates and to explore the experiences and perceptions of children attending the camp. METHODS: This study utilised ethnographic techniques and semi-structured interviews with children attending a 28-day summer weight loss camp in Hangzhou, China. All children attending at the time of the study were included. Field notes were taken, and interviews with children were recorded, transcribed and analysed into themes. RESULTS: Nine boys and 10 girls aged 7-18 years with a body mass index ranging from 21 to 37 kg/m(2) were interviewed. The weight loss programme combined dietary restriction (<350 calories/meal) and a daily schedule of 8 h of exercise in outdoor temperatures of around 40 °C. Field observation and interviews showed that the regime was distressing for all the children who suffered hunger and exhaustion leading to crying, squabbling, fighting and desperate phone calls to parents. All felt their weight loss could not be sustained. CONCLUSIONS: The extreme conditions and total absence of health and nutrition education at the camp were of great concern. Parents should be aware of the potential dangers and long-term ineffectiveness of such interventions. At the very least, these camps must be subject to regulation.

The high sex ratio in China: what do the Chinese think?

High sex ratios are well documented in many Asian countries, including China. This study was conducted in three Chinese provinces to explore awareness of the high sex ratios and its effects. Questionnaires were completed by 7435 respondents; 46% were urban and 53% were female. Sixty-four per cent were aware of the high sex ratio, and the majority were able to identify a range of consequences both for society and for unmarried men. These high levels of awareness of the negative impacts of high sex ratios should ultimately help to reduce the sex ratio at birth.

Feeding difficulties in children with cerebral palsy: low-cost caregiver training in Dhaka, Bangladesh.

BACKGROUND: The majority of children with cerebral palsy have feeding difficulties, which, if not managed, result in stressful mealtimes, chronic malnutrition, respiratory disease, reduced quality of life for caregiver and child, and early death. In well-resourced countries, high- and low-cost medical interventions, ranging from gastrostomy tube feeding to caregiver training, are available. In resource-poor countries such as Bangladesh, the former is not viable and the latter is both scarce and its effectiveness not properly evaluated. The aim of this study was to evaluate the effectiveness of a low-cost, low-technology intervention to improve the feeding practices of carers of children with moderate-severe cerebral palsy and feeding difficulties in Bangladesh. METHODS: An opportunistic sample of 37 caregivers and their children aged 1-11 years were invited to a six-session training programme following an initial feeding assessment with brief advice. During home visits, pre- and post-measures of nutritional status, chest health and feeding-related stress were taken and feeding practices were observed. A control phase was evaluated for 20 of the participant pairs following initial assessment with advice, while awaiting full training. RESULTS: A minimum of four training sessions showed significant improvements in the children's respiratory health (P = 0.005), cooperation during mealtimes (P = 0.003) and overall mood (P < 0.001). Improvements in growth were inconsistent. Dramatic reductions were observed in caregiver stress (P < 0.001). A significant difference in the outcomes following advice only compared with advice plus training was also observed. CONCLUSIONS: In situations of poverty, compliance is restricted by lack of education, finances and time. Nonetheless, carers with minimal formal education, living in conditions of extreme poverty were able to change feeding practices after a short, low-cost training intervention, with highly positive consequences. The availability of affordable food supplementation for this population, however, requires urgent attention.

Syphilis in China: the great comeback.

China is currently witnessing a major resurgence of syphilis from the elimination of the disease in the 1960s to 5.3 per 100,000 people incidence in 2000-2005. The reasons for the elimination and subsequent resurgence of syphilis in China lie at the heart of much public health debate, highlighting both the relationship between politics and public health, and the role of government in controlling disease. Were the Draconian measures to control syphilis during the early Mao years a price worth paying for the effective control? Is the recent resurgence of syphilis an inevitable consequence of economic development and greater freedom for the individual, which will ultimately lead to better health for the majority of the population? Could tougher control measures such as those of the early Mao years be re-introduced in the current social and economic climate in China? In this review, we briefly chart the history of the syphilis epidemic in China, its elimination in the 1960s, and its gradual resurgence in the past two decades. We explore the reasons for this resurgence, and we conclude with a discussion on the options for control.

Exposure of young children working on Mexican tobacco plantations to organophosphorous and carbamic pesticides, indicated by cholinesterase depression.

BACKGROUND: Organophosphorous (OP) and carbamic pesticides are used in large quantities on tobacco plantations in Nayarit State, Mexico, where up to 3000 children and their families work. OP and carbamic pesticides are easily inhaled or absorbed through the skin and children may be particularly vulnerable to pesticides because of their smaller body mass, their height and more regular hand-mouth contact. The aim of this study is to assess the effect of pesticide exposure on acetylcholinesterase levels of very young migrant Mexican tobacco workers and younger siblings. METHODS: Blood samples were collected from 160 children aged 0-14 years during harvest (exposure) and from 62 children in their home communities 6-9 months after harvest (baseline). Samples were tested for cholinesterase corrected for haemoglobin and ambient temperature. RESULTS: Fifteen per cent of children had depression scores ranging from -40% to 190% of their baseline levels. Thirty-three per cent of children had depression scores of at least 15% and 86% of children were anaemic. CONCLUSION: These results suggest that very young children are exposed to potentially harmful and toxic amounts of pesticides while working. Further research is needed to assess the actual acute and chronic health impacts of such exposures.

HIV and syphilis in migrant workers in eastern China.

OBJECTIVE: To measure the prevalence of HIV and syphilis in migrant and urban workers in eastern China, and to determine their knowledge and attitudes towards HIV. METHODS: A cross sectional survey involving dried blood spot testing and self completion questionnaires. Migrants and urban workers in 39 work units in two districts of Hangzhou, Zhejiang Province, were recruited. Respondents completed a questionnaire about knowledge and attitudes towards HIV. Testing for antibodies to HIV-1 and syphilis was carried out on dried blood spots using a gelatin particle agglutination technique. RESULTS: Data were obtained from 4148 migrants and 2197 urban workers. There were no HIV infections detected in either the migrant or urban populations. Syphilis was detected, but the prevalence was not significantly different between urban workers (0.68%, 95% CI: 0.35 to 1.02) and migrant workers (0.48%, 95% CI 0.26 to 0.66, p = 0.07). 36% of the migrants had migrated with a partner, and 7% had also migrated with children. Urban workers were consistently more knowledgeable than migrants about HIV, but knowledge of the major modes of transmission was good in both groups. Traditional attitudes to sexual behaviour were still pervasive in both groups and attitudes towards individuals with HIV were generally intolerant. The use of sex workers appears rare and no more common in migrants than urban workers. CONCLUSION: At present HIV is probably not spreading in the internal migrant population in eastern China. Syphilis is a problem in both the migrant and urban populations. The tendency to migrate with partners makes migrants relatively low risk for engaging in casual sex.

HIV knowledge and risk behaviour of female sex workers in Yunnan Province, China: potential as bridging groups to the general population.

There is growing evidence about the importance of female sex workers (FSWs) and their clients as bridging groups for the HIV epidemic. In China the role of FSWs is key to the future trajectory of the epidemic. This study was carried out to explore factors which may increase the potential for FSWs to act as vectors for HIV transmission. Semi-structured interviews were carried out with 84 sex workers in two types of brothel in Yingjiang County of Yunnan Province, where sex work and injecting drug use are common. The key findings are that the FSWs are young, (median age 17.8 years), their engagement in sex work is short term (69% plan to work for less than one year) and the throughput of clients is low (23% only 1-2 clients per week, 71% less than seven). Awareness of HIV, STIs and condom use was generally good, but only 32% always used condoms and 18% never did. Fifty-five percent had had a health check. FSWs at the cheaper, higher throughput brothels where condom use is uncommon are a potential bridge to the general population. Interventions must focus on these FSWs and their clients to prevent them from becoming drivers of the epidemic.

Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes.

OBJECTIVES: To assess knowledge and attitudes towards HIV and its testing among pregnant women and health professionals in Yunnan Province, south west China, to inform the introduction of voluntary counselling and testing (VCT) programmes. METHODS: The study design was a cross sectional survey using self completion questionnaires. It was carried out in 12 hospitals in four high prevalence areas of Yunnan Province. Questionnaires were completed under examination conditions by health professionals, and at the routine antenatal examination by pregnant women. RESULTS: Completed questionnaires were obtained from 840 pregnant women and 780 health professionals. Knowledge of HIV and its modes of transmission were good in health professionals but patchy in pregnant women. The weakest area in both groups was knowledge of maternal to child transmission. There was strong support for compulsory testing in pregnancy and at the premarital examination. But attitudes towards HIV/AIDS were negative: 23% of health professionals and 45% of pregnant women thought HIV was a disease of "low class and illegal" people, 48% of health professionals and 59% of pregnant women thought that HIV positive individuals should not be allowed to get married, and 30% of the health professionals were not willing to treat an HIV positive individual. Levels of knowledge were higher and attitudes more positive in younger health professionals and better educated pregnant women. CONCLUSIONS: Community education programmes and intensive training of health workers must precede or accompany VCT programmes. They must particularly address negative attitudes towards people with HIV. Pilot VCT programmes are now under way in two of the areas studied.

HIV and syphilis in young Chinese adults: implications for spread.

Our objective was to explore the epidemiology of HIV and syphilis at population level in young Chinese adults. The study was carried out in six areas of three Chinese provinces: Zhejiang, Yunnan and Shaanxi. All couples attending the compulsory premarital examination were recruited. Routinely taken blood was collected onto filter paper. Tests for HIV and syphilis used modified particle agglutination techniques. In all, 17,226 individuals were tested. There were no HIV infections in Zhejiang or Shaanxi. In Yunnan, there were 28 positives: 0.75% (95% confidence interval: 0.5, 1.1), with 22 (78%) in men and 16 (57%) in known high-risk individuals. Syphilis prevalence ranged from 0.33% to 0.71% across study sites, with 58% in men. Although syphilis levels suggest that unsafe sexual activity is occurring in all areas, HIV is not yet affecting the general population of Zhejiang or Shaanxi. The epidemic in Yunnan is being driven by injecting drug users, but there may now be transmission in the general population.

Health effects of family size: cross sectional survey in Chinese adolescents.

AIMS: To determine whether only children differ in terms of morbidity, nutritional status, risk behaviours, and utilisation of health services from children with siblings, in China. METHODS: A cross sectional survey was carried out using self completion questionnaires, anthropometry, and haemoglobin measurement in middle schools (predominant age 12-16 years) in three distinct socioeconomic areas of Zhejiang province, eastern China. RESULTS: Data were obtained for 4197 participants. No significant differences were found between only children and those with siblings for some key indicators: underweight 19% v 18%, suicide ideation 14% v 14%, and ever smoking 17% v 15%. Only children were more likely to be overweight (4.8% v 1.5%), and to have attended a doctor (71% v 63%) or dentist (17% v 10%) in the past year. Sibling children are significantly more likely to be anaemic (42% v 32%) and to admit to depression (41% v 21%) or anxiety (45% v 37%). However, after adjusting for area, sex, and parental education levels only two differences remained: sibling children are more likely to be bullied (OR 1.5, 1.1-2.0; p = 0.006) and are less likely to confide in parents (OR 0.6, 0.3-0.8, p = 0.009). There were no significant differences in the key parameters between first and second born children. CONCLUSIONS: We found no detrimental effects of being an only child using the indicators measured. Being an only child may confer some benefits, particularly in terms of socialisation.

Suicide ideation in Chinese adolescents.

BACKGROUND: The suicide rate in China is estimated to be around three times the global average, with women in the 15- to 24-year-old age group particularly vulnerable. Despite this, there is a dearth of information on the prevalence and predictors of depression and suicide ideation in Chinese adolescents. The specific aims of the study were, therefore, to quantify the rates and severity of self-reported depression and suicide ideation in middle-school students, to examine the relationship between depression and attempted suicide, and to identify socio-demographic associations. METHODS: A cross-sectional survey using self-completion questionnaires was carried out in six middle schools (predominant age range 13-17 years) in an urban and a rural setting in Zhejiang Province in eastern China. RESULTS: There were 1,576 completed questionnaires. One-third of the students had suffered symptoms of severe depression, with 16 % admitting to suicide ideation and 9 % to actually having attempted suicide. Factors independently associated with severe depression were female gender, poor self-reported academic performance and rural residence. Similar factors were associated with suicide ideation and attempted suicide. Depression was less common in those without siblings. Patterns of help-seeking showed reliance on friends and parents, with very low levels of professional help-seeking (around 1 %) and 30 % having sought no help from any source for psychological problems. CONCLUSION: The results of the study contributed to service developments and the addition of psychological issues to the school health education curriculum.

Smoking among youths in China.

OBJECTIVES: To inform a prevention strategy, this study determined the prevalence of and attitudes toward smoking among Chinese secondary school students. METHODS: Self-completion questionnaires were administered to 13- to 18-year-olds attending school in Zhejiang Province, eastern China. RESULTS: Of the 6674 respondents, 15.9% (25.7% of the boys, 5.4% of the girls) were ever smokers. Only 0.3% were regular smokers. Of the ever smokers, 41.9% had smoked before 10 years of age and 7.9% before 5 years of age. Parental smoking was the strongest predictor of smoking. CONCLUSIONS: The very low prevalence of regular smoking found in this age group suggests that prevention programs in school may be beneficial. Parents should be encouraged to adopt more responsible attitudes toward smoking in the home.

Expression of alternatively spliced human latent transforming growth factor beta binding protein-1.

Latent transforming growth factor beta binding protein-1 (LTBP1) is important in regulating the localisation and activation of transforming growth factor beta(TGFbeta). Three forms of LTBP1 mRNA have previously been described, LTBP1L, LTBP1S and LTBPdelta53. Here, we have analysed the LTBP1 coding sequence and identified two other spliced forms, LTBP1delta55 and LTBP1delta41. LTBP1delta55 is a short form of LTBPIL which lacks 55 amino acids including two consensus N-glycosylation sites and LTBP1delta41 is a form of LTBP1 which lacks the 12th EGF-like repeat. Furthermore, sequencing of genomic clones showed that splicing to generate LTBP1L occurs using an intra-exonic 3' splice acceptor site in the first coding exon of LTBP1S and that LTBP1delta55 arises from the alternative use of an exonic 3' splice acceptor site at the end of the following intron. LTBP1delta41 arises from skipping the exon which encodes the 12th EGF-like repeat. LTBP1delta55 and LTBP1delta41 mRNA are expressed in a wide variety of human tissues but the proportions of each splice form vary in the tissues.

Loss of a consensus heparin binding site by alternative splicing of latent transforming growth factor-beta binding protein-1.

Latent transforming growth factor-beta binding protein-1 (LTBP-1), plays an important role in controlling localisation and activation of transforming growth factor-beta (TGF-beta). We show that alternative splicing generates a form of mRNA which lacks bases 1277-1435 (termed LTBP-1delta53). The 53 amino acids encoded by these bases include the eighth cysteine of the first cysteine repeat and a consensus heparin binding sequence. Sequencing of genomic clones showed that alternative splicing resulted from the use of an intra-exonic 3' splice acceptor site. The loss of the heparin binding site implies that LTBP-1delta53 will bind to the extracellular matrix less efficiently than LTBP-1.