Global, regional, and national burden of suicide, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Deaths from suicide are a tragic yet preventable cause of mortality. Quantifying the burden of suicide to understand its geographical distribution, temporal trends, and variation by age and sex is an essential step in suicide prevention. We aimed to present a comprehensive set of global, regional, and national estimates of suicide burden.

METHODS

We produced estimates of the number of deaths and age-standardised mortality rates of suicide globally, regionally, and for 204 countries and territories from 1990 to 2021, and disaggregated these results by age and sex. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 estimates of deaths attributable to suicide were broken down into two comprehensive categories: those by firearms and those by other specified means. For this analysis, we also produced estimates of mean age at the time of death from suicide, incidence of suicide attempts compared with deaths, and age-standardised rates of suicide by firearm. We acquired data from vital registration, verbal autopsy, and mortality surveillance that included 23 782 study-location-years of data from GBD 2021. Point estimates were calculated from the average of 1000 randomly selected possible values of deaths from suicide by age, sex, and geographical location. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles from a 1000-draw distribution.

FINDINGS

Globally, 746 000 deaths (95% UI 692 000-800 000) from suicide occurred in 2021, including 519 000 deaths (485 000-556 000) among males and 227 000 (200 000-255 000) among females. The age-standardised mortality rate has declined over time, from 14·9 deaths (12·8-15·7) per 100 000 population in 1990 to 9·0 (8·3-9·6) per 100 000 in 2021. Regionally, mortality rates due to suicide were highest in eastern Europe (19·2 [17·5-20·8] per 100 000), southern sub-Saharan Africa (16·1 [14·0-18·3] per 100 000), and central sub-Saharan Africa (14·4 [11·0-19·1] per 100 000). The mean age at which individuals died from suicide progressively increased during the study period. For males, the mean age at death by suicide in 1990 was 43·0 years (38·0-45·8), increasing to 47·0 years (43·5-50·6) in 2021. For females, it was 41·9 years (30·9-46·7) in 1990 and 46·9 years (41·2-52·8) in 2021. The incidence of suicide attempts requiring medical care was consistently higher at the regional level for females than for males. The number of deaths by suicide using firearms was higher for males than for females, and substantially varied by country and region. The countries with the highest age-standardised rate of suicides attributable to firearms in 2021 were the USA, Uruguay, and Venezuela.

INTERPRETATION

Deaths from suicide remain variable by age and sex and across geographical locations, although population mortality rates have continued to improve globally since the 1990s. This study presents, for the first time in GBD, a quantification of the mean age at the time of suicide death, alongside comprehensive estimates of the burden of suicide throughout the world. These analyses will help guide future approaches to reduce suicide mortality that consider a public health framework for prevention.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national burden of injuries, and burden attributable to injuries risk factors, 1990 to 2019: results from the Global Burden of Disease study 2019

OBJECTIVES

In this study, the trends and current situation of the injury burden as well as attributable burden to injury risk factors at global, regional, and national levels based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 are presented.

STUDY DESIGN

To assess the attributable burden of injury risk factors, the data of interest on data sources were retrieved from the Global Health Data Exchange (GHDx) and analyzed.

METHODS

Cause-specific death from injuries was estimated using the Cause of Death Ensemble model in the GBD 2019. The burden attributable to each injury risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life years. The Socio-demographic Index (SDI) was used to evaluate countries' developmental status.

RESULTS

Globally, there were 713.9 million (95% uncertainty interval [UI]: 663.8 to 766.9) injuries incidence and 4.3 million (UI: 3.9 to 4.6) deaths caused by injuries in 2019. There was an inverse relationship between age-standardized disability-adjusted life year rate and SDI quintiles in 2019. Overall, low bone mineral density was the leading risk factor of injury deaths in 2019, with a contribution of 10.5% (UI: 9.0 to 11.6) of total injuries and age-standardized deaths, followed by occupational risks (7.0% [UI: 6.3-7.9]) and alcohol use (6.8% [UI: 5.2 to 8.5]).

CONCLUSION

Various risks were responsible for the imposed burden of injuries. This study highlighted the small but persistent share of injuries in the global burden of diseases and injuries to provide beneficial data to produce proper policies to reach an effective global injury prevention plan.

Mapping the quality of basic and comprehensive emergency obstetric care services in Haiti

OBJECTIVE

To investigate geographical inequalities and changes in the quality of emergency obstetric care services available in Haiti over time.

METHODS

We utilized data from the Service Provision Assessment survey of all health facilities in Haiti in 2013 and 2017.We developed a quality index for basic emergency obstetric care (BEmOC) and comprehensive emergency obstetric care (CEmOC) based on the items in the signal functions of an emergency obstetric care framework, using a structure, process and outcome framework. We measured the quality index of all facilities in 2013 and 2017. We also assessed geographical trends and changes in quality between 2013 and 2017 using geospatial analysis.

RESULT

Our analysis showed that basic structure items such as connection to electricity grid, manual vacuum extractors, vacuum aspirators and dilation and curettage kits were widely unavailable at healthcare facilities. There was a significant improvement in indicators of structure (P < 0.001) and BEmOC (P = 0.03) in primary facilities; however, there was no significant change in the quality of CEmOC in primary facilities (P = 0.18). Similarly, there was no significant change in any of the structure or process indicators at secondary care facilities.

CONCLUSION

The availability of BEmOC at several Haitian facilities remains poor; however, there was significant improvement at primary care facilities, with little to no change in overall quality at secondary health facilities.

Validation of sociocultural attitudes towards appearance questionnaire and its associations with body-related outcomes and eating disorders among Chinese adolescents

INTRODUCTION

The Sociocultural Attitudes Towards Appearance Questionnaire-4 Revised (SATAQ-4R) has been widely used in Western countries to link body appearance that is related to eating disorders and body dissatisfaction being commonly reported by adolescents. However, a comprehensive psychometric validation of the SATAQ-4R in Chinese adolescent samples is still lacking. To this end, the aim of the current study was to validate the gender-appropriate SATAQ-4R in a sample of Chinese adolescents, following by an investigation of its associations with body-related outcomes and eating disorder symptoms.

METHODS

Two gender-specific studies were conducted to examine the psychometric properties of the SATAQ-4R-Female and SATAQ-4R-Male respectively among adolescent girls (Study1, N=344, with 73 participants at retest) and boys (Study2, N=335, with 64 participants at retest). Confirmatory factor analysis was employed to examine the factor structure and their test-retest reliability, the internal consistency and convergent validity were subsequently examined.

RESULTS

For the SATAQ-4R-Females, the seven-factor model has a reasonable fit, with Chi-square =1112.769 (p < 0.001), CFI = 0.91, RMSEA = 0.071, SRMR = 0.067. For the SATAR-4R-Males, an acceptable seven-factor model with Chi-square = 982.92 (p<0.001), CFI = 0.91, RMSEA = 0.08, SRMR= 0.06 was observed. With respect to test-retest reliability, the internal consistency for 7 subscales was rated as good (Cronbach's alpha =0.74 to 0.95) among female adolescents, likewise the internal consistency of the seven subscales was also rated as good (Cronbach's alpha =0.70 to 0.96) among male participants. Good convergent validity was observed, reflected by associations of the subscales of the gender-specific SATAQ-4R with muscularity-related attitude, body image-acceptance, body appearance, perceived stress level, symptoms of eating disorder and self-esteem.

DISCUSSION

For women and men, the original 7-factor structure was validated among Chinese adolescents, internal reliability coefficients for the seven subscale scores were good and test-retest reliability was acceptable. Our results also confirmed the convergent validity of the two different gender-appropriate scales.

Deep serum lipidomics identifies evaluative and predictive biomarkers for individualized glycemic responses following low-energy diet-induced weight loss: a PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World (PREVIEW) substudy

BACKGROUND

Weight loss through lifestyle interventions, notably low-energy diets, offers glycemic benefits in populations with overweight-associated prediabetes. However, >50% of these individuals fail to achieve normoglycemia after weight loss. Circulating lipids hold potential for evaluating dietary impacts and predicting diabetes risk.

OBJECTIVES

This study sought to identify serum lipids that could serve as evaluative or predictive biomarkers for individual glycemic changes following diet-induced weight loss.

METHODS

We studied 104 participants with overweight-associated prediabetes, who lost ≥8% weight via a low-energy diet over 8 wk. High-coverage lipidomics was conducted in serum samples before and after the dietary intervention. The lipidomic recalibration was assessed using differential lipid abundance comparisons and partial least squares discriminant analyses. Associations between lipid changes and clinical characteristics were determined by Spearman correlation and Bootstrap Forest of ensemble machine learning model. Baseline lipids, predictive of glycemic parameters changes postweight loss, were assessed using Bootstrap Forest analyses.

RESULTS

We quantified 439 serum lipid species and 9 related organic acids. Dietary intervention significantly reduced diacylglycerols, ceramides, lysophospholipids, and ether-linked phosphatidylethanolamine. In contrast, acylcarnitines, short-chain fatty acids, organic acids, and ether-linked phosphatidylcholine increased significantly. Changes in certain lipid species (e.g., saturated and monounsaturated fatty acid-containing glycerolipids, sphingadienine-based very long-chain sphingolipids, and organic acids) were closely associated with clinical glycemic parameters. Six baseline bioactive sphingolipids primarily predicted changes in fasting plasma glucose. In addition, a number of baseline lipid species, mainly diacylglycerols and triglycerides, were predictive of clinical changes in hemoglobin A1c, insulin and homeostasis model assessment of insulin resistance.

CONCLUSIONS

Newly discovered serum lipidomic alterations and the associated changes in lipid-clinical variables suggest broad metabolic reprogramming related to diet-mediated glycemic control. Novel lipid predictors of glycemic outcomes could facilitate early stratification of individuals with prediabetes who are metabolically less responsive to weight loss, enabling more tailored intervention strategies beyond 1-size-fits-all lifestyle modification advice. The PREVIEW lifestyle intervention study was registered at clinicaltrials.gov as NCT01777893 (https://clinicaltrials.gov/study/NCT01777893).

Trend and Burden of Vitamin A Deficiency in 1990-2021 and Projection to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021

Background/Objectives: In this study, we aim to provide an update on the global, regional, and national trends in VAD-associated mortality and morbidity for children under 20 years of age, across different age groups and sociodemographic backgrounds, to identify populations at risk that require further attention. Methods: Data from the Global Disease of Burden study were analysed to determine the temporal trends in VAD mortalities and VAD disease burden through disability-adjusted life years (DALYs) and Years Lived with Disability (YLD). Data on children under 20 years of age from 1990 to 2021 from 204 countries and territories were included for analysis. The Average Annual Percentage Change (AAPC) was used to show a temporal trend over a 30-year period. Results: Global VAD-associated mortality has decreased significantly, with an AAPC of -0.91 (95% CI= -0.95 to -0.85). No significant improvements in VAD morbidities were identified across Sub-Saharan African regions. In Central Sub-Saharan Africa, the number of VAD-associated disabilities increased from 70,032.12 to 73,534.15. Significant heterogeneity in changes in VAD morbidities were also identified across different countries. The highest age-standardized rate (ASR) of VAD YLD was 282.36 in Somalia, while countries with high sociodemographic indices had an ASR of 0. Conclusions: Significant global improvements in VAD mortalities indicate the efficacy of wide-scale high-dose vitamin A supplementation for children under 5 years of age. However, the lack of improvements in VAD morbidities in low-SDI countries highlights the need to continue crucial high-dose vitamin A supplementation and to implement additional vitamin A supplementation programs.

Mapping the quality of prenatal and postnatal care and demographic differences on child mortality in 26 low to middle-income countries

BACKGROUND

Closing the gap between child mortality in low- and middle-income countries (LMICs) and high-income countries is a priority set by the WHO in sustainable development goals (SDGs). We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs.

METHODS

The Demographic and Health Survey (DHS) was used to examine data from 26 countries to compare prenatal, postnatal, nutritional, and demographic factors across LMICs. Outcome of child death was classified into death before one month of age, between 1 to 11 months, between one to two years, between three to five years, and overall death before five years. Chi-square analyses identified differences in prenatal care, postnatal care, nutrition, and demographic factors between children who died and those who survived. Logistic regression identified factors that increased child mortality risk.

RESULTS

The majority of deaths occurred before the ages of one month and one year. Considerably poorer quality of prenatal care, postnatal care, and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s. High child mortality and poor quality of prenatal and postnatal care coincide with low income. Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries. The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk. Significant socio-demographic risk factors were associated with an increased mortality rate in children, including lack of education, maternal marital status, family wealth index, living rurally, and financial problems hindering access to healthcare.

CONCLUSIONS

Poor nutrition remains a vital factor across all LMICs, with numerous children being exposed to foods low in iron and vitamin A. Significantly, most deaths occur in neonates and infants, indicating an urgent need to address risk factors associated with early child death.

Safety and efficacy of adding postbiotics in infant formula: a systematic review and meta-analysis

Postbiotics, as emerging products, were added to infant formula, but their safety and efficacy are unclear. To clarify this issue, we wrote this meta-analysis. We searched PubMed, Embase, Web of Science and ProQuest from its establishment to February 2023. The review was registered on PROSPERO database (CRD42022352405). The effects of infant formula with and without postbiotics were compared, and the incidence of serious adverse events (SAEs), digestive symptoms, concentration of stool secretory immunoglobulin A (SIgA), and growth and development indexes were analyzed. Nine randomized controlled trials with 2065 participants were included. The addition of postbiotics to infant formula was found to increase the concentration of stool SIgA (P < 0.05) with very low certainty of evidence, without significantly impacting the incidence of SAEs, infantile colic, flatulence, diarrhea, vomiting, abdominal pain and gastrointestinal disorders, the daily weight gain, the total gain in body length and the daily head circumference gain (all P > 0.05). Adding postbiotics to the formula is safe for infants, which would not increase the incidence of SAEs, infantile colic, flatulence, diarrhea, vomiting, abdominal pain, and gastrointestinal disorders, and could increase the concentration of stool SIgA. IMPACT: Our study provides evidence that the addition of postbiotics to infant formula is safe but not effective. This is the first systematic review and meta-analysis of postbiotics. This study provides strong evidence for the safety of postbiotics and lays a foundation for related clinical trials.

Efficacy of Remote Cognitive Behavioural Therapy for Insomnia in Improving Health Status of Patients with Insomnia Symptoms: A Meta-analysis

Background

Insomnia is highly prevalent and cognitive behavioural therapy is the first-line treatment for it. This study aimed to assess the efficacy of remote cognitive behavioural therapy for insomnia, specifically, treatment fully delivered through the internet, mobile phones and telephones for sleep and other health outcomes in adults diagnosed with insomnia or reporting insomnia symptoms. This study also aimed to evaluate the effect of various intervention components as subgroup variables to explain the efficacy of remote cognitive behavioural therapy on health outcomes.

Methods

Randomised controlled trial studies were obtained from five electronic databases. The PEDro scale was used to assess the quality of the studies. A random effect model was used to assess the mean difference, standardised mean difference and standard deviation of the outcome variables. Heterogeneity among the study articles was assessed using I2 and Q tests. Egger regression analysis was used to assess publication bias.

Results

Remote cognitive behavioural therapy for insomnia had significant and positive effects on improving sleep outcomes, depression, anxiety, fatigue and mental health compared with the control conditions. Its effect on physical health was not significant. The effect of the therapy was enhanced when the total length of intervention was shorter than 6 weeks, delivered via the internet and did not include therapist support.

Conclusion

Remote cognitive behavioural therapy for insomnia is effective in improving sleep quality, depression, anxiety, fatigue and mental health in insomnia patients.

Urbanisation and mental health in left-behind children: systematic review and meta-analysis using resilience framework

BACKGROUND

Prolonged parental separation at young ages has significant adverse effects on development in left-behind-children (LBC). We aimed to compare mental health status, emotional and behavioural problems, and their association with socioemotional development between LBC and their counterparts.

METHODS

Cross-sectional studies comparing LBC and non-LBC published from 2000 onwards were searched. Primary outcomes included depression, anxiety emotional and behavioural problems. Secondary outcomes included loneliness, self-harm, suicide, and risk-related behaviours. Quality of all included articles was assessed by Joanna Briggs Institute (JBI) critical appraisal. Data was analyzed by random model-based effect method.

RESULTS

78 observational studies comprising of 394,308 children aged 2-18 were included. Compared to NLBC, LBC had significantly more depression, anxiety, emotional and behavioural problems, conduct problems, self-harm, loneliness, peer bullying, attempts of smoking and alcohol consumption. Subgroup analyses found that younger LBC between the ages of 6 to 12 were at greater risks of poor mental health, emotional and behavioural problems.

CONCLUSION

Absent parental care prevents healthy socio-emotional development and hinder the formation of secure attachment. Poor social-emotional development leads to worse emotional resilience against psychological stressors, while LBC residing in rural areas also experience additional risk factors of low household income and poor access to mental health services.

IMPACT STATEMENT

Prolonged parental separation negatively influences mental health, especially in younger children between the ages 6 to 12. Poor social-emotional development in left-behind children is associated with worse emotional resilience against psychological stressors. Additional risk factors including residing in rural areas, low household income, and poor access to mental health services predisposes left-behind children to high risks of mental illness. Timely support services targeted towards strengthening resilience factor such as learning better emotional and behavioural coping strategies and improving school and peer support to address increased risk of mental health problems are required for current left-behind children.

Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050.

METHODS

Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends.

FINDINGS

Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989-1·01) adult males and 1·11 billion (1·10-1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397-407] individuals), followed by India (180 million [167-194]) and the USA (172 million [169-174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8-160·3) in males and 104·9% (95% UI 100·9-108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39-4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4-269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121-162) by 2050, making it the country with the fourth-largest population with overweight and obesity.

INTERPRETATION

No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels.

FUNDING

Bill & Melinda Gates Foundation.

Temporal trends in the incidence and mortality of road injuries in China: Current trends and future predictions

BACKGROUND

China has the highest number of road injury deaths in the world. The aim of this study was to determine the long-term incidence and mortality trends of road injuries in China between 1990 and 2019 and to make projections up to 2030.

METHODS

Incident and death data were extracted from the Global Burden of Disease (GBD) 2019 study and population data were extracted from the GBD 2019 and World Population Prospects 2019 studies. An age-period-cohort framework was used for the analysis.

RESULTS

In 2019, 16.1 million road injuries (age-standardized incidence rate [ASIR]: 991.3/100,000) occurred in China. Between 1990 and 2019, the ASIR of road injuries in China increased by 87.4 %. In 2019, there are 250.0 thousand road deaths (age-standardized mortality rate [ASMR]: 14.79/100,000), and the ASMR decreased by 27.0 % between 1990 and 2019. Period and cohort risks for the incidence of road injuries were increased for both sexes. Period and cohort risks for road injury mortality appeared to increase in recent period and birth cohorts. The ASIR of road injuries was projected to increase in the future, and the ASMR was projected to decrease; however, the ASIR of cyclist road injuries in females was projected to increase in the future. Among road injuries, elderly individuals were projected to have an increasing proportion of occurrence and death. Although the proportion is decreasing, pedestrian road injuries were projected to still account for more than half of road injury deaths in China up to 2030.

CONCLUSIONS

The incidence of road injuries in China has increased overall, while the overall mortality rate has decreased over the past 30 years, and this trend is expected to continue in the future. Effective effort is needed to improve road safety, especially for elderly individuals and female cyclists. In addition, pedestrian road safety also needs to be improved.

Correlates of suicidal ideation in rural Chinese junior high school left-behind children: A socioecological resilience framework

INTRODUCTION

Suicide is one of the top five causes of adolescent mortality around the world. The socioecological resilience framework in explaining the risk factors and protective factors for suicidal ideation in left-behind children (LBC) has not been well explored. The current study aims to compare the prevalence of suicidal ideation in LBC and non-LBC, and explore its correlations with resilience factors among LBC.

METHODOLOGY

This study was part of an epidemiological survey conducted by UNICEF exploring mental health outcomes in left-behind children. We implemented a cross-sectional study collecting data from 11 provinces and 1 municipal, with 5,026 participants (3,359 LBC, 1,667 controls) in year one junior high school living in impoverished areas of rural China. Data on suicidal ideation, self-harm, resilience factors including health-risk behaviors, psychological wellbeing as it was measured by the Strengths and Difficulties Questionnaire, peer relationship within the school environment, and family support were collected.

RESULTS

Overall prevalence of suicidal ideation among LBC was 7.2% which is significantly different from 5.5% reported by NLBC (χ2 = 4.854, p = 0.028). LBC reported a higher prevalence of self-harm (16.4%) than NLBC (13.0%; χ2 = 10.232, p = 0.001), but there was no difference in the prevalence of suicide plan, suicide attempt or help-seeking. LBC had significantly poorer psychological feeling, and greater emotional and behavioral difficulties peer relationship in the school environment than controls. In the multiple logistic regression, history of self-harm was the greatest predictor for suicidal ideation among LBC (OR = 2.078, 95% CI: 1.394-3.100, p < 0.001). Health risk behavior including previous smoking attempt, poor psychological feeling, and emotional and behavior difficulties, and poor peer relationship within school environment, were also significant risk factors for suicidal ideation among LBC.

CONCLUSION

The prevalence of suicidal ideation and self-harm was greater among left-behind than non-left-behind children. Our results show resilience factors including previous self-harm, emotional and behavioral problems, smoking, and poor peer relationship are significantly associated with suicidal ideation in left-behind adolescents.

Effect of Cognitive Behavioural Therapy in Improving Sleep and Health Status in Patients with Cardiometabolic Syndrome: a Meta-Analysis

The aim of this study was to assess the effect of cognitive behavioural therapy intervention on sleep and health improvement in patients with cardiometabolic syndrome and sleep problems. This study also aimed to assess the effect of different study designs to explain the overall intervention effect through subgroup analysis. Relevant randomized controlled trial studies were searched through six online databases. The PEDro scale was used to assess the quality of the included studies. The random effects model was used to assess the mean difference, effect size, and standard deviation of the outcome variables. The heterogeneity of the included studies was assessed using I2 and Q tests. Publication bias was assessed by the Egger test. Cognitive behavioural therapy intervention provided a significant effect in improving the Pittsburgh Sleep Quality Index, Insomnia Severity Index, total sleep time, sleep efficiency, depression, fatigue, and HbA1c. The effect of cognitive behavioural therapy is more significant when relaxation training and education components are included. Cognitive behavioural therapy is suitable for the treatment of sleep problems in patients with cardiometabolic syndrome. Cognitive behavioural therapy is also effective on depression and fatigue but has a limited effect on blood pressure and biomedical indicators related to cardiometabolic syndrome.

A comparison between a Tai Chi program and a usual medical care program in chronic cardiovascular disease participants in quality of life, psychological health, resilience, blood pressure and body mass index

Background: There is increasing evidence that cardiovascular disease (CVD) is linked to a number of psychosocial risk factors and biophysiological risk factors such as metabolic syndrome. The development of effective therapeutic interventions for CVD patients, such as Tai Chi practice, to modify high-risk lifestyles and behaviours and reduce psychosocial and biophysiological risk factors, is a promising primary healthcare approach. This study compared Tai Chi programme CVD participants with CVD patients who did not participate in the Tai Chi programme as the control group in health-related quality of life (HRQoL), including physical health, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. In addition, psychological distress and resilience, body mass index (BMI), systolic blood pressure, and diastolic blood pressure were measured.

Methods: In 2012, a case-control study was conducted to compare a group of CVD patients participating in a community based meditation intervention programme with CVD patients who did not participate in the programme. Measures included the Short-Form 12 Health Survey (SF-12), General Health Questionnaire (GHQ30), Resilience Scale, BMI, and blood pressure. Univariate analysis of variance was used to compare the difference between participants with cardiac chronic diseases who had taken part in 2 years regular Tai Chi and cardiac patients who did not participate in the Tai Chi programme.

Results: Outcomes differed in significance and magnitude across four HRQoL measures, psychological distress, and resilience. The Tai Chi group also showed fewer incidences of being overweight or suffering from obesity and psychological distress.

Conclusions: Regular and more than 2 years meditation exercises had a beneficial effect on HRQoL, reducing psychological distress, promoting resilience, managing and taking an active role in managing health condition, and reducing BMI and blood pressure level in CVD patients.

3D Surface Analysis as a Method to Evaluate Progress of Students' Restorative Skills Over Time

INTRODUCTION

Digital scanning technology in dental education is on the rise offering precise feedback for indirect restorations. This technology could have similar applications for direct restorations worth exploring. To this end, this study used 3D surface analysis to measure students' ability to restore teeth's occlusal and proximal contours over time.

METHOD

169 teeth restored with composite were scanned with a desktop scanner (E3, 3Shape, Copenhagen) at the end of an academic year. Compound composite restorations were performed in three iterations by 2nd year students enrolled in their first preclinical course. Standard Tessellation Language (STL) files of all restored teeth were analysed for fit with a digital reference using a surface matching software (Geomagic Control 2021; 3D systems). The 3D digital surface analysis output was compared at the different iterations. Additionally, the association between the 3D surface analysis output and scores awarded by tutors was assessed to evaluate this technology's potential to enhance students' independent learning.

RESULTS

Assessment of restored surfaces using 3D surface analyses showed statistically significant differences between second and third iterations (p < 0.001). There was a positive association between tutors' scores and the 3D surface analysis data.

CONCLUSION

The results suggest that digital scanning and 3D surface analysis technology could enhance feedback and promote students' independent learning.

Urbanization, self-harm, and suicidal ideation in left-behind children and adolescents in China: a systematic review and meta-analysis

PURPOSE OF REVIEW

Economic development and urbanisation have prompted many Chinese parents to move from rural to urban regions for better job opportunities. Their children, who remain behind in rural regions, become left-behind children (LBC). With absent parents, children and adolescents are unable to maintain the secure attachment required for healthy social and emotional development, increasing the risk of mental illness. This study aimed to compare risk of self-harm and suicidal ideation in LBC and non-LBC in China.

RECENT FINDINGS

Greater risks for poor mental health outcomes including worse depression, loneliness and anxiety have been identified in LBC in cross-sectional studies. Previous studies have also identified higher prevalence of bullying victimization, poorer school performance and worse school attendance amongst LBC.

SUMMARY

Findings indicate that prolonged separation from parents put LBC at greater risks of poor mental health. Policy changes to allow children to migrate with their parents and policies to reduce inequalities in job opportunities between urban and rural regions are needed.

The evaluation of cognitive-behavioral therapy-based intervention on type 2 diabetes patients with comorbid metabolic syndrome: a randomized controlled trial

BACKGROUND

Cognitive behavior therapy (CBT) has been applied in intervention research in diabetes patients with satisfying results. However, there was no research on type 2 diabetes (T2DM) patients with comorbidities. This study aimed to investigate the effectiveness of CBT on psychological variables, behavior variables, quality of life, sleep quality, and physical variables among adult T2DM patients with comorbid metabolic syndrome (MS).

METHODS

281 patients aged 18-75 years were recruited from Ningbo First Hospital in China from October 2021 to March 2022. Patients were randomized to the intervention group (IG, N = 148) or control group (CG, N = 133). Patients in the IG received 12 CBT-based sessions during a six-month intervention time. Patients in the CG received the usual care only. Univariate General Linear Model was used to analyze the effect of CBT-based interventions. The analysis was conducted by SPSS Version 28.

RESULTS

Results indicated that CBT-based intervention was superior in the following aspects: relieving depression symptoms: IG (4.11 ± 4.35 vs. 1.99 ± 2.12), CG (3.40 ± 3.26 vs. 2.32 ± 1.88), interaction effect (F = 4.074, P = 0.044); enhancing diabetes self-care behaviors: IG (26.79 ± 12.18 vs. 37.49 ± 10.83), CG (25.82 ± 13.71 vs. 31.96 ± 11.72), interaction effect (F = 5.242, P = 0.022); promoting the efficacy of CBT: IG (47.45 ± 6.83 vs. 50.76 ± 4.98), CG (46.74 ± 6.94 vs. 47.87 ± 5.11), interaction effect (F = 5.198, P = 0.023); improving subjective sleep quality: IG (0.93 ± 0.68 vs. 0.69 ± 0.63), CG (1.03 ± 0.72 vs. 1.01 ± 0.68), interaction effect (F = 3.927, P = 0.048).

CONCLUSIONS

The CBT-based intervention was beneficial in improving depression symptoms, diabetes self-care behaviors, the efficacy of CBT, and sleep quality in T2DM patients with comorbid MS. The downtrend of body mass index, systolic blood pressure, diastolic pressure, and glycated hemoglobin was larger in the intervention group but not to a significant level.

TRIAL REGISTRATION

This study has been prospectively registered at Australia New Zealand Clinical Trials Registry (Registration ID: ACTRN12621001348842 website: https://www.anzctr.org.au/trial/MyTrial.aspx ).

Cross-sectional comparison of risk factors associated with mental illness and learning difficulties in kindergarten and elementary, middle, and high school children in the United States: a socio-ecological resilience framework

Aim

Mental illness and learning difficulties in children can be explained using the socio-ecological resilience (SER) model, which states that personal characteristics and an individual’s social relationships coupled with environmental factors of adverse life events influence mental health. We aimed to identify factors associated with anxiety, depression, and learning difficulties in kindergarten and elementary, middle, and high school children.

Subject and methods

This study utilized data collected from the 2019 National Health Interview Survey (NHIS) questionnaire administered across the United States. Children aged 4 to 17 were included. Risk factors were categorized into personal characteristics, lack of peer support, adverse family events, and socioeconomic status (SES). Logistic regression was used to estimate the risk for each risk factor and SER layers for anxiety, depression, and learning difficulties.

Results

In relation to the SER model, factors from personal, relational, and structural layers all influenced the likelihood of anxiety, depression, and learning difficulties in children across all ages. Negative personal characteristics of emotional dysregulation were the most significant risk factor associated with anxiety and depression. For children in kindergarten, relational factors of poor peer relations were more significant in influencing learning difficulties, while behavioural dysregulation measured by hyperactivity had a greater influence on learning difficulties for older children in elementary, middle, and high school. Having experienced adverse family events was significantly associated with worse mental health, while low SES was associated with worse depression and learning difficulties.

Conclusion

Comprehensive interventions that strengthen personal characteristics, peer interactions, and environmental stressors are needed to address mental illness in children.

Drug addiction and impact of urbanization: a systematic review

PURPOSE OF REVIEW

Using the ecological public health framework, this study aims to systematically review the risk of illicit drug use and its associated negative health outcomes relating to urbanization.

RECENT FINDINGS

Previous studies have indicated that urbanization associated with increased population density drives segregation of vulnerable communities of low socioeconomic status (SES). Marginalized individuals in segregated communities have increased risk of poor mental health and illicit drug use.

SUMMARY

The results indicated that urban-specific environmental risk factors, individual characteristics and level of social support all influenced risk of drug use, substance use disorder (SUD), overdose, and drug-use associated death. Urban environmental risk factors of economic disparity, marginalization and barriers in accessing healthcare and negative individual characteristics of low education, low income and comorbid diagnosis of mental illness significantly increased risk of drug use. In contrast, better social support reduced the risk of drug use.

Global, Regional, and National Burden of Child Growth Failure, 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021

Background/Objectives: Child growth failure is a manifestation of chronic malnutrition expressed in stunting, wasting, and underweight in children. This study aimed to analyze global trends in child growth failure disease burden and mortality across children of all age groups on a global, regional, and national level. Methods: This cross-sectional study utilized data from the 1990 and 2021 Global Burden of Disease (GBD) study. Growth failure Disability-adjusted life years (DALYs), years lived with a disability (YLDs), and mortality in children under 20 years of age were analyzed. Average annual percentage change (AAPC) was calculated to determine and identify improvements in growth failure disease burden and mortality in the past 30 years. Results: Greatest reduction in growth failure DALYs (AAPC = -0.96, 95% CI = -0.97 to -0.95), YLDs (AAPC = -0.73, 95% CI = -0.77 to -0.66) and mortality rate (AAPC = -0.96, 95% CI = -0.97 to -0.95) in children under 5 years of age was observed in high-middle SDI countries. In contrast, improvements in the number of growth failure DALYs (AAPC = -0.64, 95% CI = -0.76 to -0.53), YLDs (AAPC = -0.21, 95% CI = -0.25 to -0.13) and mortalities (-0.57, 95% CI = -0.59 to -0.52) are less pronounced in regions with low SDI scores. Improvements in disease burden and mortality are reduced in older age groups, with the lowest reduction observed in children 15-19 years old. Conclusions: Barriers hindering the delivery of nutritional supplements and access to quality healthcare in regions with low SDI scores need to be overcome to address the disproportionately high numbers of growth failure DALYs, YLDs, and mortalities in regions with low SDI.

Urbanization and substance use in left-behind children and adolescents: a systematic review and meta-analysis

PURPOSE OF REVIEW

Inequalities in job opportunities between urban and rural regions have driven many parents to move from rural to urban regions with aims to improve household income. Financial and political barriers prevent children from moving with their parents, meaning that their children become left-behind in rural regions. This study aims to meta-analyse the risk of drinking, smoking, illicit drug use and drunk experiences in left behind children (LBC) and non-LBC.

RECENT FINDINGS

Previous studies have indicated the negative effects of prolonged parental separation on children and adolescent mental health. Parental separation and poor mental health have both been identified as proximal risk factors for substance use in adolescence.

SUMMARY

The results indicated that LBC were at significantly greater risk of drinking, smoking, using illicit drugs, and having drunk experiences. Positive psychology interventions are required to help provide LBC with positive coping strategies against psychological distress. Policy changes to reduce inequalities in job opportunities between urban and rural regions are required to reduce the prevalence of LBC.

Population attributable fractions for modifiable risk factors of neonatal, infant, and under-five mortality in 48 low- and middle-income countries

Background

Identifying the modifiable risk factors for childhood mortality using population-attributable fractions (PAFs) estimates can inform public health planning and resource allocation in low- and middle-income countries (LMICs). We estimated PAFs for key population-level modifiable risk factors of neonatal, infant, and under-five mortality in LMICs.

Methods

We used the most recent Demographic and Health Survey data sets (2010-22) from 48 LMICs, encompassing 35 sub-Saharan African countries and 13 countries from South and Southeast Asia (n = 506 989). We used generalised linear latent mixed models to compute odds ratios (ORs), and we calculated the PAFs adjusted for commonality using ORs and prevalence estimates for key modifiable risk factors.

Results

The highest PAFs of neonatal mortality were attributed to delayed initiation of breastfeeding (>1 hour of birth) (PAF = 23.9; 95% confidence interval (CI) = 23.1, 24.8), uncleaned cooking fuel (PAF = 6.2; 95% CI = 6.4, 7.8), infrequent antenatal care (ANC) visits (PAF = 4.3; 95% CI = 3.3, 5.9), maternal lack of formal education (PAF = 3.9; 95% CI = 2.7, 5.3), and mother's lacking two doses of tetanus injections (PAF = 3.0; 95% CI = 1.9, 3.9). These five modifiable risk factors contributed to 41.4% (95% CI = 35.6, 47.0) of neonatal deaths in the 48 LMICs. Similarly, a combination of these five risk factors contributed to 40.5% of infant deaths. Further, delayed initiation of breastfeeding (PAF = 15.8; 95% CI = 15.2, 16.2), unclean cooking fuel (PAF = 9.6; 95% CI = 8.4, 10.7), mothers lacking formal education (PAF = 7.9; 95% CI = 7.0, 8.9), infrequent ANC visits (PAF = 4.0; 95% CI = 3.3, 4.7), and poor toilet facilities (PAF = 3.4; 95% CI = 2.6, 4.3) were attributed to 40.8% (95% CI = 36.4, 45.2) of under-five deaths.

Conclusions

Given the current global economic climate, policymakers should prioritise these modifiable risk factors. Key recommendations include ensuring that women enter pregnancy in optimal health, prioritising the presence of skilled newborn attendants for timely and proper breastfeeding initiation, and enhancing home-based care during the postnatal period and beyond.

Temporal Mortality Trends Attributable to Stroke in South Asia: An Age-Period-Cohort Analysis

South Asia contributes the most to stroke mortality worldwide. This study aimed to determine the long-term trends in stroke mortality across four South Asian countries and its associations with age, period, and birth cohort. In 2019, nearly one million stroke deaths occurred across South Asia, and the associated age-standardized mortality rate (ASMR) was 80.2 per 100,000. Between 1990 and 2019, India had the largest decrease in the ASMR (-35.8%) across the four South Asian countries. While Pakistan had the smallest decrease in the ASMR (-7.6%), an increase was detected among males aged 15 to 34 years and females aged 15 to 19 years. Despite a 22.8% decrease in the ASMR, Bangladesh had the highest ASMR across the four South Asian countries. Nepal reported a witness increase in the stroke ASMR after 2006. Improved period and cohort effects on stroke mortality were generally indicated across the analyzed countries, except for recent-period effects in males from Nepal and cohort effects from those born after the 1970s in Pakistan. Stroke mortality has decreased in the four South Asian countries over the past 30 years, but potentially unfavorable period and cohort effects have emerged in males in Nepal and both sexes in Pakistan. Governmental and societal efforts are needed to maintain decreasing trends in stroke mortality.

Sleep Quality and Its Determinants Among Type 2 Diabetes Patients with Comorbid Metabolic Syndrome

PURPOSE

The prevalence of poor sleep quality in patients with diabetes was higher than the general population. This study aimed to explore risk factors for not only poor sleep quality, but also long sleep latency, short sleep duration and low sleep efficiency, in type 2 diabetes patients (T2DM) with comorbid metabolic syndrome (MS).

PATIENTS AND METHODS

A total of 281 patients aged 18-75 years were enrolled from Ningbo First Hospital during October 2021 to March 2022. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). Sleep latency, sleep duration and sleep efficiency were obtained by a response to the questionnaire. Descriptive, independent two-sample t-test, Chi-square test and multiple logistic regression were conducted using SPSS Version 28.

RESULTS

The prevalence of poor sleep quality in T2DM with comorbid MS patients was 59.10%. The factors significantly associated with poor sleep quality were depression symptoms (OR = 3.10, 95% CI: 1.38 to 6.96, P = 0.006), poor quality of life (OR = 2.49, 95% CI: 1.24 to 4.99, P = 0.010), and age (OR = 1.07, 95% CI: 1.04 to 1.10, P < 0.001). The factor significantly associated with long sleep latency was depression symptoms (OR = 2.19, 95% CI: 1.15 to 4.16, P = 0.017). The factors significantly related to short sleep duration were depression symptoms (OR = 2.56, 95% CI: 1.31 to 5.00, P = 0.006) and age (OR = 1.05, 95% CI: 1.02 to 1.08, P = 0.002). The factor significantly related to short sleep efficiency was age (OR = 1.03, 95% CI: 1.01 to 1.06, P = 0.019).

CONCLUSION

This study found that depression symptoms, together with poor quality of life, and increasing age were associated with poor sleep quality. Symptoms of depression were related to long sleep latency and short sleep duration. The increasing age was associated with short sleep duration and low sleep efficiency.