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PubMedDate not supplied

Body mass index growth in a sample of U.S. children: repeated measures data analysis of the Minneapolis Children's Blood Pressure Study.

Longitudinal assessments of the body mass index (BMI) in children and adolescents are limited. The purpose of the study was to describe the growth patterns of the BMI in children and young adults. Black and White children of Minneapolis Children's Blood Pressure Study (MCBPS) were 6 to 9 years old at entry and were followed for 12 years at 19 separate visits. Those with at least five visits (n = 1,302) were included for analysis, using non-linear mixed effects models in conjunction with the Gompertz curve. The growth patterns of four sex-ethnic groups were different at three levels: starting level (SL) (kg/m(2)), asymptote level (AL) (kg/m(2)), and peak growth age (PGA) (in years). In this context, SL is the average BMI level at age 6, AL is the average BMI level when growth diminishes, and PGA is the average age at which the rate of growth in the BMI peaks. The SL (16.3 +/- 0.1) for White males was significantly greater than SL in the other three sex-ethnic groups, among which there were no significant differences. There was a significant ethnic difference in AL between Black females (25.5 +/- 0.3) and White females (24.4 +/- 0.2) and a marginally significant difference in AL between Black females and Black males (24.4 +/- 0.3). For PGA, only sex differences were significant: Black females reached the peak at the earliest age at (11.5 +/- 0.1) years, followed by White females (11.7 +/- 0.1), Black males (12.6 +/- 0.1), and White males (12.8 +/- 0.1).

Adolescent↗
PubMed2004

Prefrontal activation due to Stroop interference increases during development--an event-related fNIRS study.

Although it is well known that executive processes supported by the frontal lobe develop during childhood and adolescence, only one functional imaging study has used the Stroop task to investigate the relationship between frontal lobe function and cognition from a developmental point of view. Hence, we measured brain activation in the lateral prefrontal cortex of children with functional near-infrared imaging during an event-related, color-word matching Stroop task and compared results with a previous study, conducted with the same paradigm in adults. In children, the Stroop task elicited significant brain activation in the left lateral prefrontal cortex comparable to adults. However, the hemodynamic response occurred later in children than adults. Individual brain activation due to Stroop interference varied much more in children than adults, which was paralleled by a higher behavioral variance in children. Data suggest that children differed in their individual cognitive development independent of their chronological age more than adults. Brain activation due to Stroop interference increased with age in the dorsolateral prefrontal cortex in correlation with an improvement of behavioral performance. In conclusion, our results indicate that neuromaturational processes regarding resolution of Stroop interference may depend on increased ability to recruit frontal neural resources.

Adolescent↗
PubMed1988

The role of the priming fluid in the metabolic response to cardiopulmonary bypass in children of less than 15 kg body weight undergoing open-heart surgery.

The major metabolic response to open-heart surgery using cardiopulmonary bypass has been shown in adults to be modified by the components of the pump priming fluid. This effect is likely to be more significant in children. Data on 29 children less than 15 kg body weight are presented. Patients were randomised to receive a prime containing one of three crystalloid priming fluids: 100% Hartmann's (H), 50% Hartmann's + 50% 5%-Dextrose (HD), or 100% Plasmalyte 148 (P). The remainder of the prime was CPD stored blood and the prime was buffered with sodium bicarbonate. Severe hyperglycaemia 22.4 +/- 1.3 mmol/l occurred during bypass in the HD group but moderate hyperglycaemia occurred in the other prime groups. Hyperlactataemia occurred in all prime groups during bypass and was highest in the H prime group at 3.9 +/- 0.4 mmol/l. These changes in intermediary metabolites were only partly explained by the crystalloid components of the priming fluid. A subsiduary study revealed the important contribution of CPD stored blood to those intermediary metabolite concentrations. Therefore, the well recognised changes in intermediary metabolites as components of the metabolic response to surgery, namely hyperglycaemia and hyperlactataemia were augmented by the composition of the priming fluids. In addition, CPD stored blood and the sodium bicarbonate buffer increased the sodium concentration of the prime to hypernatraemic levels in both the H and P groups which caused an increase in sodium concentration during bypass. Therefore important changes during bypass occur as a direct result of the individual components of the priming fluid. These changes may result in osmolal flux, hyperglycaemia and hyperlactataemia, all of which have been reported to be potentially harmful.

Blood Glucose↗
PubMed1990

Anthropometric data of children for non-specialist users.

In a pilot study, 33 anthropometric variables were measured on 633 children aged 0-5.5 years. The variables where chosen on the basis of international standards and on the results of preliminary analysis of accidents. Methodical aspects of this pilot study are presented in this paper, followed by two applications: anthropometric aspects of current regulations for cribs, playpens and toys; anthropometric aspects in the selection of wheelchairs for children. The paper concludes with a discussion on how to present anthropometric data for non-special users.

Anthropometry↗
PubMed2006

Margarine and butter consumption, eczema and allergic sensitization in children. The LISA birth cohort study.

It has been hypothesized that margarine intake is associated with allergic diseases. However, the epidemiological evidence in children is limited. The aim of the present study was to assess the relationship between dietary intake of margarine and butter with eczema and allergic sensitization in 2-yr-old children. Data of 2582 children at the age of 2 yr with complete information on exposure to diet and allergic outcome were analyzed in a German prospective birth cohort study (LISA). Margarine and butter intake were estimated from a semiquantitative food frequency questionnaire about general fat use at home combined with questions on the child's spread intake. Multiple logistic regression analysis was applied comparing predominant margarine and predominant butter intake with consumption of both butter and margarine. Predominant margarine intake was positively associated with lifetime prevalence of symptomatic eczema (aOR: 1.71; 95% CI: 1.12-2.61) and doctor-diagnosed eczema (aOR: 2.10; 95% CI: 1.36-3.25) and allergic sensitization against inhalant allergens (aOR: 2.10; 95% CI: 1.01-4.41) at the age of 2 yr. No statistically significant associations were found for butter intake. Stratification for parental history of atopic diseases indicated that children at high risk of atopic diseases have higher effect estimates for margarine intake compared to children without parental history of atopic diseases. Stratification for sex also showed higher effect estimates in boys. Children with predominant margarine consumption had an increased risk for eczema and allergic sensitization, while butter intake was no predictor for allergic diseases. However, we could not determine whether margarine is a causal risk factor or whether other lifestyle factors have influenced this association.

Butter↗
PubMed2005

Community-acquired pneumonia in children: quantifying the burden on patients and their families including decrease in quality of life.

OBJECTIVES: Childhood respiratory infections have an important impact on society and are a frequent cause of physician visits, consumption of antibiotics and over-the-counter drugs, work loss, and reduction of quality of life. The aim of this study was to assess the burden of community-acquired pneumonia (CAP) on children and their families, including quantification of expenses and decrease in quality of life. METHODS: Patients <3 years old with pneumonia were enrolled in 3 sites in southern Israel: pediatric wards, the pediatric emergency department, and a primary health clinic. In the primary health clinic, the diagnosis was based on clinical judgment, and in the hospital the diagnosis was based on the World Health Organization Standardization of Interpretation of Chest Radiographs for the diagnosis of CAP in children. Data regarding the children's medical history and various aspects of direct and indirect burden were gathered every 2 to 3 days during the 29 days of follow-up. The patients' parents were asked to give the names of 2 healthy children who could serve as controls from among the child's friends, neighbors, or day care center attendees. RESULTS: Two-hundred thirteen children with pneumonia were enrolled: 34 (16.0%) in the pediatric wards, 73 (34.2%) in the pediatric emergency department, and 106 (49.8%) in the primary pediatric clinic. The control group consisted of 99 children. During the 29 follow-up days, hospitalized children had the most severe and prolonged symptoms, followed in decreasing order by children seen at the emergency department, primary health clinic, and controls: The mean +/- standard deviation (SD) of febrile days was 4.9 +/- 2.8, 4.8 +/- 3.1, 3.3 +/- 2.5, and 1.4 +/- 3.3, respectively (statistically significant between any patient group and the control group). The mean duration of respiratory distress +/- SD was 3.8 +/- 5.6, 2.8 +/- 4.4, 2.2 +/- 4.4, and 0.4 +/- 1.8 days, respectively (statistically significant between any patient group and the control group). The median duration of nonroutine days as judged by the parents was 13, 8, 7, and 0, respectively. The mean number of workdays lost by working mothers +/- SD was 4.2 +/- 4.8, 2.0 +/- 2.6, 1.7 +/- 1.9, and 0.2 +/- 0.9, respectively (between any patient group and the control group). The quality-of-life-questionnaire analysis reveals statistically significant differences with regard to all 11 questions asked between any of the patient groups and the control group. There was a clear trend toward decreasing quality of life from the control group to the primary health clinic, pediatric emergency department, and pediatric wards groups. CONCLUSIONS: CAP in children causes a significant burden on both patients and their families, including substantial expenses, loss of routine, and decrease in quality of life.

Caregivers↗
PubMed1991

Social environment and vulnerability of low birth weight children: a social-epidemiological perspective.

This study examined the impact of low birth weight on children's health and assessed the influence of the social environment on various aspects of health in low birth weight and normal birth weight children. Data on 8661 children aged 2 through 11 from the 1981 Child Health Supplement of the National Health Interview Survey provided strong evidence for two major conclusions: (1) Low birth weight children in high-risk social environments are at increased for poor health outcomes compared with comparable normal birth weight children. This vulnerability was found across all age groups, suggesting that the effects of low birth weight are long-lasting. The poor health outcomes for low birth weight children in high-risk social environments were found for all seven aspects of child health status studied: excessive bed days, restricted-activity days, and school-loss days; school failure, low school-ranking, behavior problems, and maternal perception of child health status as fair/poor. (2) The mechanism of risk was complex and differed by birth weight group. Whereas certain combinations of individual risk factors protected normal birth weight children from several adverse outcomes, none for low birth weight children were identified. However, low birth weight children in low- or moderate-risk social environments were not at greater risk for poor outcomes compared with comparable normal birth weight children. This study underscores the importance of a healthy social environment for children who are already at high risk for poor health outcomes by virtue of being low birth weight.

Age Factors↗
PubMed2006

Neurobehavioral function in children with low blood lead concentrations.

Debate continues as to whether low blood lead level, even below 5 microg/dl, impairs neurodevelopmental function in children. This study assessed the association between neurodevelopmental performance and lead exposure below 5 microg/dl in Korean children. Data were collected from 61 children, aged 7-16 years with a mean blood lead level of 2.9 microg/dl, who participated with their mothers. Neurodevelopmental function was measured with computer-based neurobehavioral tests. The analyzed data included children's performances on five neurobehavioral tests as the dependent variables, and children's blood lead level, sex, age, and mother's performance as the four independent variables. For simple reaction time and digit span, which, respectively reflect attention and short-term memory, there was a small and significant association between the children's neurodevelopmental performance and their blood lead levels (p=0.05, 0.08, respectively). Our study suggests that low blood lead below 5 microg/dl can influence children's neurobehavioral performance.

Adolescent↗
PubMedDate not supplied

Non-word repetition and grammatical morphology: normative data for children in their final year of primary school.

It is likely that tests of phonological short-term memory (non-word repetition) and grammatical morphology (past tense, third-person singular) are clinical markers for specific language impairment (SLI). The study provides normative data on three specific tests covering the aforementioned areas for 100 children attending the final year of primary schooling (10-11 year olds). Data from typically developing age controls can be used to provide a benchmark against which to compare the ability of language-impaired children. This is particularly important given that the transition from primary to secondary schooling is a key stage in a child's education.

Analysis of Variance↗
PubMed1992

[Acquired peripheral facial palsy in children. Current data illustrated by 66 recent personal cases].

The authors observed 66 cases of peripheral facial palsy (PFP) in children during a 5-year period (1986-1990). Bell's palsy (idiopathic facial paralysis) occurred in 26 children (39.3%), 1 month to 14.5 years old, with a complete recovery in 95% of the cases; a surgical decompression was carried out in 2 cases. The PFP was related to otitis in 16 cases (24.2%): acute otitis media (6), mastitis (4), serous otitis (5), cholesteatoma (1); the treatment was medical and surgical in all cases with complete recovery in 15 cases. In 15 cases the PFP was secondary to trauma (13) or surgery (2); complete spontaneous recovery occurred in 11 cases, and partial recovery following surgical treatment in 2 cases. A viral origin was retained in 6 cases: herpes zoster (3), mumps (1), echovirus (1), herpes (1); the recovery was complete in 4 cases, partial in 2 cases. In 3 cases the PFP was related to a rare cause: lymphoma, metabolic acidosis, Melkerson-Rosenthal syndrome. Bell's palsy remains the main cause of PFP in childhood; other etiologies can be ruled out by the case history, a careful physical examination, and a limited number of laboratory and/or X-ray studies; medical treatment, in particular prednisone, does not seem to have an effect upon the rate of recovery which is spontaneously high; similarly there is no evidence that surgical decompression really modifies the rate of recovery so that the authors suggest that it should be reserved to the complete forms with no clinical and electrical evidence of recovery after 3 weeks.

Adolescent↗
PubMed1984

Articulation skills of Spanish-speaking Mexican-American children: normative data.

Articulation tests are frequently used to assess articulation skills and velopharyngeal competence. Five hundred Spanish speaking Mexican-American children age tour to eight years were administered the Templin-Darley Screening Test of Articulation, the Iowa Pressure Articulation Test and all consonant items of the Templin-Darley Diagnostic Test. Normative data are presented.

Child↗
PubMed2003

[Conservative treatment of femoral fractures in children in data from the Orthopedic Clinic of the 2nd Medical Faculty of Charles University].

PURPOSE OF THE STUDY: Conservative therapy is the method of choice for treating femoral fractures in younger children all over the world. At the Department of Orthopedic Surgery of the Second Faculty of Medicine, Charles University in Prague, this approach has had a long tradition and has only partly been replaced by other, more recent methods. It is not always necessary to abandon well-established and reliable techniques because of new achievements and this is demonstrated by the results of our study. MATERIAL: In a period of 22 years, 112 boys and 97 girls were treated by Bryant's traction and 62 boys and 46 girls by Weber's traction. The former was used in children younger than 5 years, weighing less than 20 kg. The latter was applied in patients between 5 and 10 years of age whose body mass was between 20 to 35 kg. METHODS: Bryant's traction, used in the younger age category, offered the advantage of easy application without total anesthesia. Both legs were suspended in an apparatus that keeps the patient's pelvis slightly elevated above the bed level. Counter traction was provided by the weight of the suspended pelvis. In Weber's traction, used in children aged 5 to 10 years, a Kirschner's wire was inserted in the distal metaphysis of each femur in the frontal plane. The ends of each wire were attached to a metal U-shaped spreader. This apparatus holds the legs at right angles both in the knees and hips. Each patient was examined by X-ray at 1 week to check the correction of displacement and at 3 weeks to check callus development. All the patients were immobilized in a plaster cast spica for a period of 6 to 8 weeks after injury and each child was also shortly hospitalized for cast removal and early physical therapy. RESULTS: Fractures in the middle of the diaphysis with an oblique fracture line were most frequent. These and long spiral fractures responded well to these two methods in almost all cases. In transverse fractures, which are less common, when an angular dislocation persisted it was tolerated owing to the subsequent remodelation. The most serious complication was a shortening of the leg involved, which often occurred with the use of Bryant's traction. The shortening was found in 80% of the patients shortly after the fracture had healed. A low body mass of the child was generally responsible for failure to stretch the femur to its full length. In children treated by Weber's traction, the shortening was observed in 55% immediately after fracture healing. On examination at 1 and 3 weeks, its presence was markedly lower, occurring in 25% and 17% of the children, respectively. Lengthening was found only occasionally on examination in adolescence or adulthood, but this may have been due to other causes. Excessive movement of the child in bed, usually when the parents came to visit, sometimes interfered with good correction of the displacement. DISCUSSION: Bryant's traction was used in our department for conservative treatment even in very young children. The plaster cast spica was applied primarily to non-displaced fractures. Pavlík's harness, recommended by Rockwood and Stannard, was used in pediatric injuries only occasionally. When conservative treatment was indicated in older children, Weber's traction was applied. The Göteborg traction described by Havránek was not used. The shortening of the leg treated was the most frequent complication, but our results were not in agreement with the data reported by Stahelim, who described a greater and more frequent shortening in children older than our patients. In our study, younger children suffered from leg shortening more often, as was also reported by Náhoda and Stryhal. The subsequent lengthening was found only occasionally; the average values of 2.6 cm and 2.3 cm in younger and older children, respectively, as reported by Náhoda and Stryhal, were not recorded. When lengthening was observed, its value was always lower. A 30 degrees rotational deviation, observed by Verbeek in one third of his patients, was not seen in our children. Pseudoarthrosis or infection were absent in our population and a literature search showed that, when treated conservatively, femoral fractures were not associated with these complications. CONCLUSIONS: Well-established methods of conservative treatment of femoral fractures in children were evaluated with the objective to advocate their importance for today's orthopedic surgery. Although the children treated by these methods are confined to bed for a longer period than when more recent techniques are used, they may avoid many of the complications that accompany these new approaches.

Child↗
PubMed2001

Media-based behavioural treatments for behavioural disorders in children.

BACKGROUND: Prevalence studies show that behaviour problems in children are quite common (10-15% in preschoolers). These problems may manifest as, for example anxiety, sadness, over-activity and tantrums. Some studies have shown that these problems can be persistent, and that they lead to a range of problems in adolescence and adulthood. Many approaches are used to address behavioural problems such as medication, or more usually, psychological treatments either directly with the child and/or his/her family. Behavioural interventions have been shown to be highly effective but access to these treatments is limited due to factors such as time and expense. Presenting the information parents need in order to manage these behaviour problems in booklet or other media-based format would reduce the cost and thus increase access to these interventions. In the adult population it seems that media-based interventions such as these can be moderately effective. Given that the cost of media-based treatment is so low it is useful to know how effective they are when given to parents. It was hypothesised that media-based treatments would be less effective than conventional psychological treatments and that efficacy would improve with increasing amounts of therapist intervention. OBJECTIVES: To review the effects of media-based behavioural therapies (definitions below), for any young person with a behavioural disorder (however diagnosed) compared to standard care and no treatment controls. SEARCH STRATEGY: A range of electronic databases were systematically searched using a specified search strategy. Individual journals of interest were hand-searched where necessary, references in all selected trials were checked for other trials and, where it was thought to be of possible use, individual authors were contacted for additional information. SELECTION CRITERIA: Randomised controlled trials of behavioural media-based treatments for behaviour problems in children. DATA COLLECTION AND ANALYSIS: Abstracts and titles of studies identified from searches of electronic databases were read to determine whether they met the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by the reviewer and queries were resolved by discussion with an independent rater. Data were analysed using Revman. MAIN RESULTS: In general, media-based therapies for behavioural disorders in children had a moderate effect when compared with both no-treatment controls and with standard care. Significant improvements were often made with the addition of up to 2 hours of therapist time. REVIEWER'S CONCLUSIONS: These formats of delivering behavioural interventions for carers of children are possibly worth considering in clinical practice. For straightforward cases media-based interventions may be enough to make clinically significant changes in a child's behaviour, and reduce the amount of time primary care workers have to devote to each case. Consequently this would increase the number of families who could possibly benefit from this type of intervention. Media-based therapies would therefore appear to have both clinical and economic implications as regards the treatment of children with behavioural problems.

Caregivers↗
PubMed2005

Active commuting to and from school and BMI in elementary school children-preliminary data.

BACKGROUND: United States National Health Objectives include increasing the proportion of trips made by walking to and from school for children who live within 1.6 km to 50%. The purpose of this objective is to increase the level of physical activity among children. However, the impact of walking, bicycling or skating (active commuting) to and from school on the prevalence of overweight is unknown. METHODS: Body mass index (BMI) was measured for 320 children (age 10.2+/-0.7 years) in September. Over 5 months, an active commuting index (SI) and daily physical activity were estimated via questionnaire. In April, BMI and body fat were measured. RESULTS: A significant positive association was found between April BMI and SI adjusting for September BMI (partial r=0.03, P<0.05). Positive associations were found between SI and physical activity before school (r=0.17, P<0.05) and daily moderate intensity physical activity (r=0.13, P<0.05). There were no significant association between SI and BF (P>0.05). CONCLUSIONS: This preliminary data suggests that active commuting does not appear to provide sufficient amounts of physical activity to attenuate BMI; however, it may contribute to the attainment of physical activity recommendations. Future research is needed to objectively measure the impact of active commuting on the prevalence of overweight.

Adipose Tissue↗
PubMed2004

Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5-7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS).

OBJECTIVES: To identify the major risk factors of overweight and obesity in prepubertal children. DESIGN: Cross-sectional study. SETTING: In all, 32 primary schools in Kiel (248 000 inhabitants), northwest Germany. SUBJECTS: A total of 2631 5-7-y-old German children and their parents. MAIN OUTCOME MEASURES: Weight status, socio-economic status (SES), parental overweight, dietary intake, activity, inactivity and further determinants (birth weight, breast feeding, nutritional status of siblings) of the children. RESULTS: The prevalence of overweight (>/=90th BMI percentile of reference) was 9.2% in boys and 11.2% in girls, respectively. Considered univariately, family-, environment- and development-related determinants showed some relations to overweight and obesity. In multivariate analyses parental overweight, a low SES as well as a high birth weight were the strongest independent risk factors of overweight and obesity in children. Additionally, there were sex-specific risk factors: parental smoking and single households were risk factors in boys, whereas a low activity was associated with obesity in girls. Birth weight was associated with obesity, but not with overweight. The prevalence of obesity reached 29.2% in boys and 33.4% in girls with all the three main risk factors. CONCLUSIONS: Overweight families of low SES have the highest risk of overweight and obese children. Future prevention programmes must also take into account sex-specific risk factors.

Analysis of Variance↗
PubMed1998

Validity and accuracy of interview and diary data on children's medical utilisation in The Netherlands.

STUDY OBJECTIVE: To assess the validity and accuracy of children's medical utilisation estimates from a health interview and diary and the possible consequences for morbidity estimates. The influence of recall bias and respondent characteristics on the reporting levels was also investigated. DESIGN: Validity study, with the medical record of the general practitioner (GP) as gold standard. In a health interview and three week diary estimates of medical utilisation of children were asked and compared with a GP's medical record. SETTING: General community and primary care centre in the Netherlands. PARTICIPANTS: Parents of 1,805 children and 161 GPs. MAIN RESULTS: The sensitivity of the interview (0.84) is higher than the diary (0.72), while specificity and kappa are higher in the diary (0.96; 0.64) than in the interview (0.91; 0.5-8). Recall bias, expressed as telescoping and heaping, is present in the interview data. Prevalence estimates of all morbidity are much higher in the interview, except for skin problems. Compared with a parental diary more consultations are reported exclusively by the GP for children from ethnic minorities (OR 1.6), jobless (OR 2.3), and less educated mothers (OR 2.6). CONCLUSIONS: Estimates of medical utilisation rates of children are critically influenced by the method of data collection used. Interviews are prone to introduce recall bias, while diaries should only be used in populations with an adequate level of literacy. It is recommended that medical records are used, as they produce most consistent estimates.

Child↗
PubMed2026

Adolescents' Growing Sensitivity to Psychosocial Stressors: Evidence From Two Decades of Health Behaviour in School-aged Children (HBSC) Data in the Nordic Countries.

PURPOSE: We tested a perception-based explanation for rising psychosomatic complaints among adolescents in the Nordic countries. Specifically, we examined whether adolescents have become more sensitive to psychosocial stressors, reflected in stronger associations between stressors and psychosomatic complaints in 2022 than in 2002. METHODS: Data were drawn from the 2002 to 2022 waves of the Health Behaviour in School-aged Children survey among 15-year-olds in five Nordic countries (N = 7,263 in 2002 and 6,739 in 2022). Psychosomatic complaints were examined in relation to stressors in the following three domains: interpersonal relationships, school-related strain, and body- and activity-related factors. Moderated regression analyses tested whether associations between stressors and complaints differed between survey years. Sex and perceived family finances were included as covariates. RESULTS: Four of five psychosocial stressors showed stronger associations with psychosomatic complaints in 2022 than in 2002. Perceived poor family finances, although less prevalent in 2022, were more strongly related to complaints. Girls consistently reported higher levels of psychosomatic complaints, and the association between school pressure and complaints was stronger among girls. DISCUSSION: Although several psychosocial stressors declined in prevalence, their associations with psychosomatic complaints strengthened over time. These findings suggest that rising complaints may reflect changes in how psychosocial stressors are linked to adolescents' psychosomatic symptoms, rather than increases in exposure to those stressors. This shift highlights the importance of considering how adolescents interpret and respond to everyday stress when addressing population trends in mental health.

Humans↗