Child Health Research Articles

Roma mothers of infant children in the health system - a qualitative study

Abstract Background The Roma in Bulgaria constitute the third largest group - 4% of the population. Data on demographic processes by ethnicity are scarce. A national survey in 2003 found significant differences in infant mortality - 9.9‰ for Bulgarian, 18‰ for Turkish, and 28‰ for Roma infants. Poverty among Roma children, risk of poor education, especially for girls, barriers to accessing health services remain high. We aim to reveal the cultural specificity in prenatal behavior and infant care among Roma mothers in the context of the role of the Bulgarian health service. Methods In-depth interviews with Roma mothers of infants up to 1 year were utilized for data collection. To ensure heterogeneity among the interviewees, several “nests” with varying socio-cultural status in the Varna district were identified in advance for participants recruitment. A list of interview themes concerning respondents’ relationships with the public health system with an emphasis on the experiences of mothers was drawn up. Results Ten interviews with mothers having between 1 and 7 children were conducted in 2023. The mothers recounted discriminatory experiences during their interactions with certain health facilities (maternity wards), which act as barriers to accessing and utilizing health services. Maternity and infant counselling services are highly esteemed with favorable influence on child health outcomes. There has been a positive shift away from early marriage and childbirth towards prioritizing education for Roma girls. Mothers prioritize their children, and there is no neglect in their care. Family relations and support are being upgraded, with Roma fathers becoming involved in child care. Respondents express their educational needs and hopes for community-based support to better cope with their roles as mothers. Conclusions Ethno-cultural factors shaping the mother’s role maintain traditional family support, while also reflecting significant modernization that needs societal support. Key messages • A glimpse into people’s experiences of the healthcare system - a clue to its effectiveness. • Тhe ethno-cultural factors in Roma are subject to modernization.

Intersectional inequalities in child social-emotional health: a case for proportionate universalism

Abstract Background Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications. Methods This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy. Results Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities. Conclusions This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness. Key messages • Intersecting dimensions of social inequalities are associated with an increased risk of social-emotional problems in children aged 3. • Universal public health policies are needed in addition to policies targeting vulnerable population groups with regards to social-emotional problems in young children.

Health disparities continue to report in DEIS schools: Irish COSI Round 6 study

Abstract Background Previous reports have identified clear differences in the prevalence of overweight and obesity among children living with disadvantaged compared to those living in advantaged circumstances. Childhood obesity is influenced by factors in the home environment, including lifestyle behaviours and socio-economic status. The Childhood Obesity Surveillance Initiative (COSI) family survey provides insights into these factors, particularly in children that attend disadvantaged (DEIS) and non-disadvantaged (non-DEIS) schools. Aim This study aims to compare various demographic and socioeconomic factors within the home environment of primary school children across DEIS and non-DEIS schools in Ireland, elucidating the differences in their performance with implications for health policy. Methods Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on demographics, diet, transportation, activities, and clinical characteristics of children in Ireland were collected, anonymised and analysed in SPSS, comparing children from DEIS (n = 147) and non-DEIS (n = 1014) schools. Results Around 88% of respondents of returned surveys included in the study (n = 1161) were mothers. Significant disparity in families with diabetes diagnosis or treatment observed between DEIS and non-DEIS schools (10.6% vs. 5.4%, p = 0.016). Breastfeeding rates were higher in non-DEIS schools (57.0% vs. 46.9%, p = 0.015). Children consuming at least 3 portions of fruits and vegetables daily were also higher in non-DEIS schools (58.9% vs. 46.0%, p < 0.001). More children in non-DEIS schools engaged in physical activities outside of school hours (93.7% vs. 74.5%, p < 0.001). Conclusions The findings underscore the significant socioeconomic disparities between families whose children attend DEIS and non-DEIS schools in Ireland. Key messages • Irish COSI R6 reveals disparities in health-related factors between disadvantaged and advantaged schools. • Targeted interventions and policies are necessary to address factors influencing child health.

Declining trends of overweight and obesity in 4-year-olds during 2007-2022 in Northern Sweden

Abstract Background Overweight among preschool children is a huge public health issue. The prevalence of both childhood overweight and obesity increased during the COVID-19-pandemic. Our aim was to study the development of overweight and obesity among 4-year-olds in Västerbotten, Sweden, from 2007 until 2022 with special focus on the COVID-19-pandemic and the year after. Methods This is a repeated cross-sectional study that utilized individual data from most 4-year-old children living in Västerbotten County, Sweden in 2007-2022, implying that the children were born 2003-2108. We included encrypted and anonymized individual anthropometrical data from the routine 4-year-old Child Health Care visit. There were 47 004 4-year-old children living in the county and we included data from 42 584 children, 21 966 boys and 20 618 girls at the age of 46-51 months. Results Overweight and obesity decreased over the study period. In 2007 the prevalence of overweight was 13.4% for boys and 14.9% for girls and obesity 3.7% for boys and 2.7% for girls. In 2022 the prevalence of overweight had declined to 9.5% for boys and 12.1% for girls and the prevalence of obesity to 1.8% and 2.1%, respectively. During the COVID-19-pandemic the prevalence of overweight and obesity for both boys and girls increased and then rapidly returned to the pre-pandemic level in 2022. Conclusions In a setting with free standardized Child Health Care, we present a clear decline in the prevalence of overweight and obesity among Swedish preschool children over time. As in other settings the prevalence of overweight and obesity increased during the COVID-19-pandemic, but we also report a rapid decline in overweight and obesity after the pandemic. It is essential to understand the underlying mechanisms responsible for this favorable trend. Key messages • We present clear decline in the prevalence of overweight and obesity in preschool children over time in a setting with free standardized Child Health Care. • It is important to understand the possible mechanisms of the favorable trend of decrease of the prevalence of overweight and obesity in children pre- and post-pandemic.

The relationship between perceived parenting styles and anxiety in adolescents

Adolescence is a crucial period of growth and the best time to recognize, rebuild, and improve different psychological and social aspects of a person's life. Anxiety is one of the variables that affect a person's mental health. Also, there is a connection between parenting styles and mental health during adolescence. The purpose of this study was to determine the relationship between perceived parenting styles and anxiety of adolescents in Isfahan (Iran). This descriptive-analytical study was conducted with the participation of 197 teenagers in the age group of 12–18 years in Isfahan, Iran. The participants were selected by cluster random sampling. The Parenting Styles Questionnaire (PSQ) and March Children's Anxiety Questionnaire were used to collect information. Data were analyzed using descriptive and analytical statistics through SPSS 26. The mean and standard deviation of anxiety in adolescents were 45.96 and 16.51, respectively (at a low level). The participants evaluated their parenting style in order as permissive (32%), authoritative (24.9%), neglectful (21.8%), and authoritarian (21.3%). A significant difference was observed between the anxiety level of adolescents and their parenting style (p < 0.001). In this way, the highest anxiety was related to the children of permissive parents, and the most minor anxiety was associated with the authoritarian parents (p < 0.001). The findings of this research indicate that there is a significant difference between the perceived parenting styles in terms of the level of children's anxiety. Therefore, considering the importance of parenting styles on children's psychological characteristics, It is recommended to educate parents about the importance of their parenting style on their children's health.

Changes in health, lifestyle, and wellbeing of children with type 1 diabetes and their parents during the pandemic

ObjectiveThe COVID-19 pandemic restrictions have substantially affected people’s health and rapidly changed their daily routines. This is a prospective study that investigated the impact of the pandemic on primary school children with Type 1 diabetes and their parents during the first lockdown in Kuwait.MethodsA questionnaire battery related to mental health, well-being, and lifestyle was administered at baseline in Summer 2019 (face-to-face, at a diabetes outpatient clinic) and at follow-up during lockdown in Summer 2020 (via telephone, in adherence with COVID-19 restrictions). Data were collected for 70 dyads with children aged 9–12 years.ResultsSignificant differences were found in most scores for both children and parents. Their mental health worsened to a higher level of depression, anxiety, stress, and a poor level of wellbeing. The average scores on the follow-up tests fell within a clinical range on these measures. Significant differences in their lifestyle, compared to before the lockdown, included decreased levels of physical activity and lower healthy core nutritional intake.ConclusionsOur findings indicate that the COVID-19 lockdown has had a significant psychological and possibly physiological impact on children with Type 1 diabetes and their parents. We conclude that there is a need for mental health support services focusing on these groups. Although full lockdown restrictions will have stopped in the past year, post-pandemic stressors may be expected to continue to adversely affect this cohort.

The status of reproductive Health Indicators in Iran, Compared to the Sustainable Development Goals of the World Health Organization

Background and Objectives: Health indicators such maternal and child mortality rates are social indicators that are used to measure the development of each country. This study aims to investigate the status of maternal and child health indicators and total fertility rate in the last 10 years in Iran compared to the sustainable development goals (SDG) of the World Health Organization (WHO). Methods: This is a systematic review study. A search was first conducted to find studies related to the study objectives in Iran from 2012 to 2022 in online databases of SID, IranDoc, Web of Science, PubMed, Scopus and Google Scholar, using the keywords: Health, fertility, mothers, children. The results of the studies were compared with the SDG indicators of the WHO. Results: The initial search yielded 162 articles. After removing duplicates and screening the studies based on the inclusion criteria, finally 20 articles were selected for the review. The status of SDG indicators in Iran, except for neonatal mortality rate and low birth weight, was in accordance with the SDGs of the WHO until 2030. Conclusion: In the last ten years, the status of most SDG indicators in Iran has been favorable. However, the attention should be paid to the factors affecting neonatal mortality rate and low birth weight to reduce their rates and improve the country’s health status.

Obstetric violence and associated factors among women who gave birth at public hospitals in Addis Ababa city administration, Ethiopia

BackgroundObstetric violence during labor and delivery is one of the main reasons that women do not seek care from health caregivers in health facilities. Developing respectful maternity care services for women is the most important approach to ensure better newborn and maternal outcomes.ObjectiveThis study aimed to assess the magnitude of obstetric violence and associated factors among women who gave birth at public hospitals in Addis Adaba city administration, Ethiopia.MethodsAn institution-based cross-sectional study was carried out among 409 mothers who had given birth at two public hospitals (Gandhi Memorial Hospital and Abebech Gobena Mothers and Children's Health Hospital) in Addis Ababa, Ethiopia, from 1 to 30 May 2023. A systematic sampling method was applied and data were collected using a structured face-to-face interview questionnaire and entered into EpiData 3.1. The data were analyzed using Statistical Package for Social Science version 25. Bi-variable and multivariate analyses were performed. Statistical significance was declared at a P-value &amp;lt;0.05.ResultsIn total, 318 mothers [77.8% with a 95% CI (73.64–81.96)] had experienced obstetric violence in the study settings. Being more educated [Adjusted Odds Ratio (AOR) = 6.43; 95% CI 2.92–14.17], having ≥4 antenatal care contacts (AOR = 3.59; 95% CI 1.91–6.75), being multiparous (AOR = 2.65; 95% CI 1.32–5.32), induction of labor (AOR = 3.39; 95% CI 1.69–6.79), vaginal delivery (AOR = 0.25; 95% CI 0.11–0.62), and female birth attendants AOR = 2.42, 95% CI (1.31–4.47) were significantly associated with obstetric violence.ConclusionMore than three-fourths of the participants experienced obstetric violence. Thus, stakeholders need to develop interventions by taking all risk factors of obstetric violence into account.

Growth factor dysregulation and placental dysfunction

The article is devoted to the study of angiogenic and antiangiogenic vascular growth factors in placental dysfunction, which is of great importance in obstetrics and perinatology. The study of growth factors as predictors of the development of placental dysfunction makes it possible to determine in advance the development of many obstetric pathologies, including preeclampsia and fetal growth retardation, which is of great practical importance. The authors conducted an immunological study of pregnant women with placental dysfunction and pregnant women with a physiological pregnancy. Purpose of the study: to study serum growth factors in women with placental dysfunction. We examined 47 pregnant women with a gestation period of 26-40 weeks, with a diagnosis of placental dysfunction, who were under observation in the obstetric department of the city maternity complex No. 3 of the city of Tashkent. The control group consisted of 35 women with a physiological pregnancy. All women underwent an immunological blood test: cellular and humoral immunity, as well as cytokines (VEGF-A, PlGF, sFlt-1, sFlt-1/PlGF) were studied. Based on the results obtained, the authors suggest that an increased level of soluble sFlt-1 and a simultaneous decrease in the levels of VEGF-A and PlGF in pregnant women at 26-40 weeks of gestation may portend the development of pregnancy complications, including preeclampsia and fetal growth restriction, and increase the risk of premature birth. Ddelivery due to impaired placental blood flow and oxygen deficiency for the fetus, lead to deterioration of microcirculation, and insufficient levels of VEGF-A and PlGF can contribute to vascular endothelial dysfunction, which can also contribute to the development of preeclampsia. The studied angiogenic and antiangiogenic vascular growth factors are important indicators and can serve as markers for predicting pregnancy complications for active medical intervention in maintaining the health of both mother and child.

Parental awareness and dental health behavior of children with congenital heart disease, with diabetes mellitus, or undergoing anti-cancer treatment, compared to healthy children

IntroductionChildren with chronic diseases tend to experience a considerably higher burden of oral disease compared to their healthy peers. Low awareness of the impact of systemic diseases on oral health, lack of motivation, and discomfort may render the maintenance of good oral hygiene challenging. We conducted a study of four groups of parents: of children with congenital heart disease (CHD), with diabetes mellitus type 1 (DM), and undergoing anti-cancer treatment (ACT); and a control group of healthy children (C). We aimed to compare between the groups, parental attitudes and knowledge of their children's oral health, and their reports of their children's dental habits.MethodsParents who arrived with their children for routine check-ups at three main clinics: cardiology, endocrinology, and hematology-oncology were asked to respond to a questionnaire regarding their children's oral and dental health.ResultsA total of 287 questionnaires were collected from 76 parents of children with CHD, 100 parents of children with DM, 50 parents of children undergoing ACT, and 61 parents who comprised group C. Compared to the CHD and DM groups, the ACT group demonstrated significantly more awareness of the importance of maintaining oral and dental health following diagnosis of their children's medical condition. Mothers’ education was found to correlate with dental health knowledge. Most children in the DM and C groups had previous dental examinations, compared to only half in the CHD and ACT groups. A higher proportion of the children in the C than the other groups brushed teeth twice daily. The groups were similar in their consumption of sugary drinks, and of sweets and snacks. The children's specialist physicians were the main source of information on oral health, especially in the ACT group.ConclusionsAlthough most of the parents reported awareness to the oral health aspects of their children's disease, only part of them reported that their children visited dentists, and brushed their teeth twice daily. For the parents of children with CHD, DM, and ACT, their children's treating specialists were the primary source of information regarding oral health. This highlights the importance of clear and continuous communication between pediatric specialists and dentists.

Benefits of Pet Therapy for Children and Young Adults

Abstract: With the development of psychology, the mental health of children is paid more attention than before. Reducing attachment to parents and anxiety are common mental issues in children. People need to focus on the mental health of the children. There have been several studies about the function of pets and how they positively or negatively support adults' mental condition. With the increasing number of pets owned, pets play an important role in several families. Pets play an essential role in affecting children's mental health. Pet therapy is an example of how pets impact the mental condition of children. This research focuses on how pets can work in pet therapy to help children reduce mental stress and how pets in their daily lives can help young adults and children perform better social development. The research reviews several previous study papers about pets' influence on children's mental and social development. The research finds that pet therapy can help children with physical health and disabled children reduce their mental stress from the environment and society. In their daily lives, children in families with pets benefit from socio-emotional development and get social support from pets.

Autism spectrum disorder (ASD) presentations among referrals to a child and adolescent mental health service (CAMHS) inpatient unit in Ireland.

This retrospective chart review aimed to identify the intersection between young people with Autism Spectrum Disorder (ASD)'s needs and CAMHS inpatient service needs. A retrospective chart review was conducted on all referrals to a CAMHS inpatient unit over three years (n = 352). Referrals which specified a formal diagnosis or suspected diagnosis of ASD were identified (n = 111), and basic demographic data were collected. Young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Findings highlight the lack of a clear care pathway for young people with co-occurring autism or suspected autism and complex mental health problems.

Interpersonal Relationship Between Parents and Its Impact on Mental Health of Children

The family plays an important role in the development of a person as an active participant in the life of society. When a child is born and grows up in a family, the system of relationships in the family that has been developing for years has an impact on the child's psychology. They are influenced by the interpersonal relationships of adults in the family with each other and with their children, i.e. communication, behavior, and attitude toward the child. This effect ultimately affects the child's way of understanding the world, his attitude toward the environment, and even his way of thinking. It would be wrong to consider this effect as negative or positive in the same direction. Because under certain conditions, a child's susceptibility to family influence can have different results depending on how he reacts to these influences. If the educational influence exerted by adults can be compared with existing social norms, the child will most likely follow the model that is considered positive for him. But life experience and observations show that the educational power of the family, especially in the child's preschool age, is high, and during this period the influence of adults in the family on the child can be of primary importance. Therefore, we have sufficient grounds to speak about a direct connection between personality traits and even the formation of a way of thinking and methods of educational influence in the family. Keywords: interpersonal relationship, parents, mental health of children, development

Parental Gender Stereotypes and Student Well‐Being in China

ABSTRACTA prominent gender stereotype claims that “boys are better at learning mathematics than girls.” Confronted with such a parental attitude, how does this affect the well‐being of 11‐ to 18‐year‐old students in Chinese middle schools? Although well‐being has often been shown to be not much gender‐diverse, the intergenerational consequences of such stereotypes are not well studied. Expecting too much from boys and too little from girls might damage self‐esteem among school kids. Using large survey data covering districts all over China reveals that one‐quarter of the parents agree with the math stereotype. It is shown that this has strong detrimental consequences for the offspring's well‐being. Students are strongly more depressed, feeling blue, unhappy, not enjoying life, and sad with no male–female differences, whereas parental education does not matter for this transfer. Various robustness tests including other than math stereotypes and an IV analysis confirm the findings. Moderating such effects, which is in line with societal objectives in many countries, not only supports gender equality but also strengthens the mental health of children.

Spatial Heterogeneity and association between the survey-based Women’s Empowerment Index (SWPER) and unmet need for birth spacing in sub-Saharan Africa

BackgroundUnmet need for birth spacing can significantly impact maternal and child health outcomes, leading to unintended or mistimed births, neonatal mortality, pregnancy loss, induced abortions, small-sized births, and malnutrition. Considering the role of women empowerment in women’s sexual and reproductive health, we examined the association between the survey-based women's empowerment index (SWPER) and unmet need for spacing in sub-Saharan Africa (SSA).MethodsWe used data from the Demographic and Health Surveys of 21 in SSA conducted between 2015 and 2021. In this study, the unit of analysis was women of reproductive age (15 to 49 years) who were married or living together and required family planning during the survey period. Multilevel logistic regression was fitted to examine the association between SWPER and the unmet need for spacing. The results were presented using adjusted odds ratios (AORs) with 95% confidence intervals (CIs).ResultsThe hotspot countries for unmet need for birth spacing were Angola, Benin, Liberia, Mauritania, and Sierra Leone. The findings showed that with the empowerment indicators, women with high attitude to violence (disagreement or rejection of violence) (AOR = 0.95; 95% CI 0.91, 0.99), and women with high decision-making (AOR = 0.90; 95% CI 0.85, 0.95) exhibited lower odds of unmet spacing need relative to women with low attitude to violence and those with low decision making. Women with high autonomy (AOR = 1.32; 95% CI 1.25, 1.39) were more likely to experience unmet need for spacing compared to those with low autonomy. ConclusionUnmet need for spacing has been linked to indices of women's empowerment such as attitudes toward violence, independence, and decision-making. Organizations such as UNICEF, UNFPA, and the Bill & Melinda Gates Foundation should consider incorporating SWPER indicators when planning interventions to address the high unmet need for spacing among women in SSA. Additionally, various governments and aid organizations must give women's empowerment a high priority as a tactical intervention strategy to increase access to contraception in the countries considered in this study. These programmes would contribute to attaining SDGs 3.1 and 3.7.

Prospective analysis of sex differences and factors associated with suicidal thoughts and behaviours in young people from the MILESTONE Italian sample

Suicide is a significant leading cause of death among young people, particularly those struggling with mental disorders. The present study utilised data from 230 young people (aged 16–18 years) undergoing a transitional care process from Child and Adolescent Mental Health Services to Adult Mental Health Services within the MILESTONE European project (2014–2019), a longitudinal cluster randomised controlled trial. The objectives of this study were to monitor temporal patterns of general health and social functioning over two years, to detect sex differences, and to identify factors associated with Suicidal Thoughts and Behaviours (STB) at the first and last time points. The results demonstrate a decrease in STB over the two-year follow-up period among all participants. Females exhibited a higher prevalence of STB across all time points, whereas males only exhibited STB at the nine-month follow-up. The most influential factors associated with STB were previous suicide attempts and mood disorders at baseline, and mood disorders and relational problems at the end of follow-up. These findings emphasise the importance of monitoring STB and informing young people undergoing a transitional care period about its key risk factors. Moreover, sex differences in STB suggest the need for different preventive strategies for males and females.

Exploring the Association Between Floods and Diarrhea among Under-five Children in Rural India.

Flood is one of the major public health concerns increasing the risk of childhood diarrhea. This study aims to explore the association of floods with diarrhea among under-five children in rural India. A cross-sectional study was carried out using large-scale nationally representative data from the National Family Health Survey-5. The Central Water Commission reports between the years 2018 and 2020 were used to group all the districts as non-flood-affected districts or flood-affected districts. Bivariate and multivariate logistic regression models were employed to assess the association of floods with childhood diarrhea. The prevalence of diarrhea was higher among children exposed to three consecutive floods during the year 2019-21 than those children not exposed to flood. Children exposed to flood three times between the year 2018-19 to 2020-21 were associated with a 34% higher likelihood of developing diarrhea than those children exposed to flood one or two times. Our study suggests that community health workers should target mothers belonging to the poor wealth quintile, young mothers, and mothers with young infants and more children to receive child health related counseling in flood-prone areas.

State Minimum Wage and Mental Health Among Children and Adolescents

Mental health disorders are increasing for children and adolescents in the US, with those in poverty having especially high rates. More evidence is needed about the association between economic policies, such as the minimum wage, and children's mental health. To test the association between minimum wages and the mental health of children and adolescents. This repeated cross-sectional, population-based US study used data from 2001 to 2022. Participants included state-representative, stratified random samples of children from the National Survey of Children's Health and adolescents from the Youth Risk Behavior Surveillance System. Data analysis was performed from January 2023 to August 2024. State minimum wage policies. A total of 15 outcomes reported by caregivers or adolescents from survey data were evaluated: depression, anxiety, attention deficit disorder and/or attention-deficit/hyperactivity disorder, behavior disorders, mood symptoms, gastrointestinal symptoms, considered and attempted suicide, any unmet health care and mental health care, alcohol and marijuana use, physical fights, school absenteeism, and paid employment. The associations between minimum wage policies and mental health were tested using 2-way fixed-effects models, lifetime minimum wage models, and difference-in-differences models with event studies, all with state, year, and birth cohort fixed effects. Additional controls included individual-level demographics and state-level health insurance and welfare policies. Analyses included 239 534 children (aged 3-17 years; 117 111 girls [48.9%]) from the 2016 to 2022 National Survey of Children's Health, and 1 453 043 adolescents (aged 12-18 years; 711 380 girls [49.0%]) from the 2001 to 2021 Youth Risk Behavior Surveillance System. Across diverse modeling approaches, increases in minimum wages were not associated with clear, consistent improvements in mental health. For example, in 2-way fixed-effects models, a $1 increase in the minimum wage was not associated with changes in rates of depression (0.06 percentage points [pp]; 95% CI, -0.11 to 0.23 pp; P = .48), unmet mental health care (0.13 pp; 95% CI, -0.04 to 0.30 pp; P = .14), or attempted suicide (-0.17 pp; 95% CI, -0.47 to 0.13 pp; P = .26). There also were no clear improvements when stratifying by household income, parental education, race and ethnicity, nativity, or urbanicity. In this repeated cross-sectional study, changes in minimum wage policies over the past 2 decades were not accompanied by clear improvements in children's and adolescents' mental health. More evidence is needed on policy approaches to improve the mental well-being of children, particularly those from economically disadvantaged families.

Child and adolescent sleep disturbances and psychopathology in a mental health clinic sample

IntroductionChildren and adolescents treated in specialty mental health services are more likely to have sleep disturbances than those without mental health problems. Few studies have investigated the relationship between sleep and psychopathology in broad clinical samples of children. We examined the relationship between sleep disturbance and age on internalizing and externalizing psychopathology in a sample who sought treatment at children's mental health centers.MethodsSecondary data analyses were completed on a sample of children (N = 13,472; aged 4 to 18; 55% male) from 39 children's mental health agencies in Ontario, Canada, who completed a semi-structured assessment, the interRAI Children and Youth Mental Health (ChYMH). A split-half sample approach was utilized (S1 n = 6,773, S2 n = 6,699). Hierarchical regressions examined the effects of sleep disturbances (i.e., difficulty falling asleep, staying asleep, night waking, bedtime resistance, falling asleep during the day) on internalizing and externalizing symptoms, above and beyond established child- (i.e., age, sex, sensory sensitivity, pain) and family-level variables (family functioning, caregiver distress, parenting strengths). Age was tested as a moderator for sleep disturbances on both outcome variables.ResultsOverall, 6.7% of children had clinically significant sleep disturbance scores (≥10 out of 16) on the interRAI ChYMH. In both samples, sleep disturbances predicted internalizing (S1 ΔR2 = 10%, S2 ΔR2 = 10%) and externalizing symptoms (S1 ΔR2 = 2%, S2 ΔR2 = 1%), above and beyond child and family variables. Age moderated the relationship between sleep disturbances and internalizing symptoms (S1 ß = 0.07; S2 ß = 0.07; ΔR2 = 0.004 in both samples), but not externalizing symptoms; sleep disturbance was more strongly related to internalizing symptoms amongst adolescents (ß = 0.98) than children (ß = 0.62).DiscussionThe relationship between sleep and internalizing symptoms appears to change as children move through development. Further, sleep was a stronger predictor of internalizing problems in adolescents than children, suggesting an additional focus of clinician efforts in this age group. These findings strengthen the importance of routine assessment of sleep, as is done with the interRAI ChYMH.

The role of physical activity, diet, and stress management in maternal and infant health during pregnancy

Introduction and aim of the study: During pregnancy, significant physiological, hormonal and circulatory changes occur that affect both the health of the mother and the child. Therefore, it is important for the mother to maintain physical activity, a healthy diet, and reduce stress to prevent complications and health problems for the mother and the child. Material and Methods: The Pubmed database was searched. The criteria for qualifying the article for the review were the following keywords: pregnancy, exercise, rehabilitation, nutrition during pregnancy, postpartum depression, atopy, stress, asthma. 30 articles from 2002-2023 were analyzed. Description of the state of knowledge: Regular physical activity during pregnancy brings many benefits such as reducing the risk of complications during childbirth, postpartum depression and helps to maintain a healthy body weight. Diet also has an impact on the health of both mother and baby. It should be balanced, providing the necessary nutrients and taking into account the mother's caloric needs. It is very important to reduce stress due to its negative impact on the mother and child. Summary: Physical activity and a healthy diet directly affect the course of pregnancy and the health of the fetus and baby. Exercise prevents pregnancy complications and other diseases, and maternal nutritional status is critical for fetal growth. During pregnancy, women are exposed to stress, which can be the cause of chronic mental disorders. Depression is the most common mental illness that occurs during pregnancy, which is influenced by various factors. In addition, maternal stress has a negative impact on the child's health, potentially increasing the risk of a number of atopic and non-atopic diseases.