Establishing a child and adolescent mental health center in Herat,Afghanistan:a project description

Objective:Afghanistan has witnessed a long-lasting 4-decade armed conflict,which together with high levels of poverty and interpersonal violence,resulted in high incidence and prevalence of mental disorders in general population,including children and adolescents.Until mid-2018,there was neither mental health care facility nor a child psychiatrist in Afghanistan.Here,we report the establishment of the first children and adolescents'mental health center(CAMHC)in Herat province of Afghanistan.Methods:In July 2018,CAMHC was initiated at Mental Health Training Center-Herat.CAMHC was initially planned by the International Assistance Mission(IAM)and Herat Public Health Directorate;and financially supported by the Tearfund UK,the United Methodist Committee on Relief and Tearfund Australia.The target population of CAMHC was children and adolescents in Herat and neighboring provinces,healthcare professionals,staff of government and non-governmental organizations,school teachers and community leaders.Results:A group of eight mental health professionals were trained and made the interdisciplinary board for diagnosis and management of mental disorders in children and adolescents.During the initial three-year period,2448 patients,including 1264(51.6%)boys and 1184(48.4%)girls,presented with mental disorders to CAMHC.Diagnosis and management of mental disorders were performed according to standard international protocols.Eighteen awareness-raising seminars were held;2000 leaflets,10000 posters,and 30000 brochures were prepared and distributed;and two short video clips were produced and broadcast via IAM website,social media and local TV channels.A database was developed to house for project data,assessment of outcomes and reporting to stakeholders.Conclusion:Establishment of CAMHC resulted in significant achievements in diagnosis and management of mental disorders among children and adolescents,healthcare staff capacity building,and awareness-raising about mental disorders.Data obtained in CAMHC offers government,mental health professionals and the community the opportunity of improving mental health in the region.

Secular Changes of Stature in Rural Children and Adolescents in China, 1985-2010

Objective To analyze and assess secular change in stature in rural children and adolescents in China from 1985 to 2010. Methods Data were obtained from the 6 rounds of the Chinese National Survey on Student＇s Constitution and Health. The subjects enrolled in the study were children and adolescents aged 7-18 years in rural areas of provincial capitals. Results An overall positive secular trend in stature occurred in rural areas of provincial capitals in China from 1985 to 2010. The overall average increase rates were 3.1 and 2.4 cm/decade for boys and girls, respectively. The total body height increases for grown up boys and girls were 3.6 and 2.3 cm and the increase rates were 1.4 and 0.9 cm/decade, respectively. There were differences in body height increase among eastern, central and western regions. The average body height of the children or adolescents in eastern region was highest, followed by central region and western region. The overall increase rates in central region were highest among the three regions. The difference between eastern/central region and western region was obvious. 〈br〉 Conclusion Positive secular trend in stature of children or adolescents has occurred in rural area of China, and rural boys and girls showed a great potential for continuous growth. More attention should be paid to the differences in children＇s body height between western region and eastern/central region.

Abnormal Adipokines Associated with Various Types of Obesity in Chinese Children and Adolescents

Objective To explore the role of adipokines including insulin, resistin, leptin, adiponectin, acylation stimulating protein （ASP） and complement C3 （C3） in various types of obesity （peripheral obesity, abdominal obesity and mixed obesity） in Chinese children and adolescents, and their relationships with body size and pubertal development. Methods Children and adolescents （n=3 508） aged 6 to 18 years, with 1 788 boys and 1 720 girls were assessed for body mass index, waist circumference, pubertal development, blood insulin, resistin, leptin, adiponectin, ASP and C3 levels. Three types of obesity [peripheral obesity （n=43）, abdominal obesity （n=473）, mixed obesity （n=1 187）] and non‐obese control （n=1 805） were defined with combined use of Chinese body mass index and waist circumference criteria. Results Serum resistin, leptin and adiponectin levels were higher in girls than those in boys （all P0.01）. Insulin and leptin increased and adiponectin decreased across five Tanner stages in both girls and boys （all P0.001）, while ASP changed only in girls （P0.001） and C3 only in boys （P0.001）. Insulin, leptin and ASP were higher, but adiponectin was lower in all three types of obesity vs. the non‐obese control （all P0.05）. The greatest abnormalities of all six adipokines were found in the mixed obesity group. With inclusion of body mass index and waist circumference in simultaneous regression analyses, both body size indices were independently and significantly correlated with insulin, leptin and adiponectin after age and gender adjustment. Compared with waist circumference, the body mass index was stronger in interpreting insulin, leptin, adiponectin and ASP levels, whereas it was weaker in explaining variance of plasma C3. Conclusions Obese children have a worse metabolic profile with high insulin, resistin, leptin, ASP and C3, and low adiponectin levels. The adipokine profile in mixed obesity is worse than that in peripheral or abdominal obesity. Identification of obese subjects with a malignant adipokine profile using a combination of body mass index and waist circumference is important for the prevention of obesity‐related disease.

Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents

Background The age of onset of hypertension(HTN)is decreasing,and obesity is a significant risk factor.The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied.This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.Methods Seven thousand,five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8–18 years from the 2013–2015 China Child and Adolescent Cardiovascular Health study and the 2011–2018 National Health and Nutrition Examination Surveys were analyzed.Blood pressure and body composition(fat and muscle)were measured by trained staff.The crude prevalence and age-standardized prevalence rate(ASPR)of primary HTN and its subtypes[isolated systolic hypertension(ISH)and isolated diastolic hypertension(IDH)]were calculated based on 2017 American Academy of Pediatrics guidelines.Multivariable-adjusted linear regression coefficients and odds ratios(ORs)were calculated to assess the associations of body composition indicators with HTN,ISH and IDH.Results The ASPR of HTN was 18.5%in China(CN)and 4.6%in the United States(US),whereas the obesity prevalence was 7.4%and 18.6%,and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN.Increased fat mass,muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries.The percent of muscle body mass had a protective effect on HTN and ISH in both countries[HTN(CN:OR=0.83,95%CI=0.78–0.88;US:OR=0.72,95%CI=0.64–0.81);ISH(CN:OR=0.87,95%CI=0.80–0.94;US:OR=0.71,95%CI=0.62–0.81)],and the protective effect was more common among children and adolescents with high levels of physical activity.Conclusions The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US,and the contribution of obesity to HTN was higher in the US than in CN.Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations.Optimizing body composition positively influences blood pressure in children and adolescents,particularly those with high-level physical activity.

Clinical Dissemination and Implementation of EBTs From the Ground Up:How to Develop a Multi-Site CBT“Clinical Dissemination Practice”The Case Example of the Child&Family Institute

The recent proliferation of empirically-supported treatments(ESTs)into the private sector has led to more U.S.children and families receiving high quality treatments and improved treatment outcomes.However,there remains a significant dearth of evidence-based clinics,service providers,and training programs nationally,particularly in more remote communities.The Child&Family Institute(CFI)was founded in 2011 as the world’s first Clinical Dissemination Practice and training institute,comprising five core unifying stages and initiatives:(1)Dissemination Through Training,(2)Dissemination Through Community Partnership,(3)Dissemination Through Integrated Behavioral Health,(4)Dissemination Through Technology,and(5)Dissemination Through Multi-State,Multi-Site Program Development and Implementation,all with a common goal of raising awareness and leveraging local and national resources to disseminate and implement accessible,affordable,evidence-based care to children,families,and communities across the United States,and beyond.Perhaps most central and unique to CFI’s five initiatives,and its overall core values and mission,is the accessibility and affordability of services for each and every child.Preliminary feedback from patients,students,collaborators,local politicians and stakeholders,partner organizations,and the broader communities in the regions served has been enthusiastic,and several grant submissions and research partnerships are underway,to test the effectiveness of CFI programming and evidence-based treatments in“real-world”clinics nationwide.

长三角地区儿童青少年心理健康促进现状、问题与建议

儿童青少年心理健康促进是健康中国建设的重要内容。随着我国经济社会快速发展,儿童青少年心理健康问题发生率逐渐上升,已成为关系国家和民族未来的重要公共卫生问题。本文梳理了长三角地区(江苏、浙江、上海)儿童青少年心理健康促进的现状,结合典型案例,分析问题,提出长三角地区儿童青少年心理健康促进的建议。

Epidemiology of biopsy-proven glomerular diseases in Chinese children: A scoping review

Background: Glomerular disease is the leading cause of chronic kidney disease globally. No scoping review reports have focused on China’’s spectrum of glomerular diseases in children. This study aimed to systematically identify and describe retrospective studies on pediatric glomerular disease based on available data on sex, age, study period, and region.Methods: Six databases were systematically searched for relevant studies from initiation to December 2021 in PubMed, Embase, Web of Science, Global Health Library, Wangfang Database, and CNKI.Results: Thirty-four studies were identified in the scoping review, including 40,430 patients with biopsy-proven diagnoses. The proportion of boys was significantly higher than that of girls. In this study, 28,280 (70%) cases were primary glomerular disease, 10,547 (26.1%) cases were diagnosed as secondary glomerular disease, and 1146 (2.8%) cases were hereditary glomerular disease. Minimal change disease is the most common glomerular disease among children in China, followed by mesangial proliferative glomerulonephritis, IgA nephropathy, and purpura nephritis. We observed increments in glomerular diseases in periods 2 (2001–2010) and 3 (2011–2021). The proportion of major glomerular diseases varies significantly in the different regions of China.Conclusion: The spectrum of pediatric glomerular diseases varied across sex, age groups, study periods, and regions, and has changed considerably over the past 30 years.