Implementation of resilience training programmes in children and adolescents: value and barriers

Abstract Background Emotional distress increasingly represents a major burden in children and adolescents (C&A), especially in conflict zones where its prevalence is estimated to reach 70%. Resilience training programmes (RTPs) are interventions that seek to enhance resilience in individuals or groups pursuing mental distress prevention. Literature suggests RTPs be particularly effective in C&A; however, their effectiveness and value for public health are still unclear. Methods A scoping review was performed in order to summarize evidence regarding the implementation and effectiveness of RTPs in children and adolescents. A search string has been built according to the PICO model and launched on PubMed, PsycInfo, Academia databases. Additional references were identified by a hand-search in Google Scholar. Studies included were narratively summarized according to topics that emerged. Results 18 articles were finally included in the review. Main issues were 1) RTPs seem to be more effective in adolescents rather than in children; 2) COVID-19 pandemic has raised the attention towards RTPs in C&A; 3) beyond conflict zones their implementation is increasingly recognized in supporting C&A management of daily stressors and traumas also in C&A with disabilities; 4) school is identified as the key setting for RTPs; 5) the high heterogeneity in RTPs approaches, contexts and study samples limits a conclusive effectiveness assessment. Conclusions Our findings highlighted how RTPs are increasingly recognized as a tool to improve C&A cognitive and behavioral functioning and resilience to external stressors, getting greater interest in the COVID-19 pandemic. Despite relevant theoretical support and promising study results, RTPs still lack strong evidence supporting their embracement by policymakers and effective implementation in public health policy. In order to not miss this chance, more efforts are needed in strengthening RTPs conceptualization and cost-effectiveness studies. Key messages • RTPs are a promising tool to enhance the resilience of children and adolescents gaining increasing interest due to the COVID-19 pandemic. • More studies are needed to provide a strong evidence base that supports their acknowledgment by policymakers and their implementation in public health policies.


Background:
The health and development of school-age children is a contemporary topic of various health policies and programs, which has become even more of a focus in critical situations such as the COVID-19 pandemic. The study aims to assess the prevalence of school-age children's participation in fights and bullying in Serbia, and to examine the relevance of students' socio-demographic characteristics and perceptions of school and relations with other students and professors for participation in fights and bullying.

Methods:
A secondary analysis of the original data of the 2017 HBSC study is performed on 3267 students in a nationally representative sample of primary and high schools in Serbia. Predictors of taking part in fights and taking part in bullying were examined by using univariate and multivariate logistic regression.

Results:
The main results show that 50.8% of boys and 17.1% of girls have taken part in fights, while 17.7% boys and 10.4% of girls have taken part in bullying. Students who felt a large and very large burden of school obligations were 1.43 times more likely to participate in bullying at least once, while they were 1.38 and 2.12 times more likely to participate in multiple fights and 4.04, 1.24, and 2.78 times more likely to participate multiple times in bullying. Fights among school-age children are significantly positively associated with living with relatives/ legal guardians and poor quality of life.

Conclusions:
The prevalence of participating in at least one fight/bullying is higher than in multiple fights/bullying. These associations suggest a necessity to enhance the monitoring and control of peer behavior among school-age children. The findings of the study imply key enablers of protection, such as building relationships based on team spirit and work, friendly behavior, empathy, and help, which should be included in the value system of school and family activities in programs to combat fights and bullying in school-age children.

Key messages:
In Serbia, every second boy and every fifth girl participated in fights, while less than every fifth boy and every tenth girl participated in bullying. Study results can inform school and healthcare actors' efforts to improve school-age children's development and health capacity for life.

Background:
Early childcare has been linked to child development in some countries. The aim of this study is to evaluate the impact of early childcare in the French context, where children can attend different types of childcare facilities prior to age 3 when they enter kindergarten, and development at age 3.5 years. Methods: 10,683 children from the ELFE French national birth cohort were classified into 4 groups depending on their main type of childcare between birth and age three: childminder (n = 5,014), centre-based childcare (n = 2,583), informal childcare (n = 777) and parents only (n = 2,465). Children's development was measured with the short form of the Child Development Inventory (CDI) via parents-reports at age 3.5 years. The CDI score was transformed into a Development Quotient (DQ) taking into account the child's age, and global developmental delay was defined as DQ < 90. Missing data was imputed by Fully Conditional Multiple Imputation with 10 imputations. Multinomial analyses were carried out adjusted by Inverse Probability Weighting based on Propensity Scores calculated using main selection and confounding variables.

Results:
Compared to children who were cared for by parents only, children who were cared for by a childminder or in a centrebased childcare had a higher DQ (103.0 and 104.8 respectively) as well as a lower likelihood of global developmental delay (propensity-score weighted OR = 0.84, [95% CI 0.70-1.01] and propensity-score weighted OR = 0.54, [95% CI 0.44-0.66]) respectively.

Conclusions:
In the French context, early centre-based childcare attendance is significantly associated with a lower risk of global child delay. Policies should make centre-based childcare more accessible to a broader number of children.

Key messages:
Early childcare type is linked to child development in France. Children in centre-based childhood had a lower likelihood of developmental delay compared to those looked after by parents only.

Background:
Emotional distress increasingly represents a major burden in children and adolescents (C&A), especially in conflict zones where its prevalence is estimated to reach 70%. Resilience training programmes (RTPs) are interventions that seek to enhance resilience in individuals or groups pursuing mental distress prevention. Literature suggests RTPs be particularly effective in C&A; however, their effectiveness and value for public health are still unclear.

Methods:
A scoping review was performed in order to summarize evidence regarding the implementation and effectiveness of RTPs in children and adolescents. A search string has been built according to the PICO model and launched on PubMed, PsycInfo, Academia databases. Additional references were identified by a hand-search in Google Scholar. Studies included were narratively summarized according to topics that emerged.

Results:
18 articles were finally included in the review. Main issues were 1) RTPs seem to be more effective in adolescents rather than in children; 2) COVID-19 pandemic has raised the attention towards RTPs in C&A; 3) beyond conflict zones their implementation is increasingly recognized in supporting C&A management of daily stressors and traumas also in C&A with disabilities; 4) school is identified as the key setting for RTPs; 5) the high heterogeneity in RTPs approaches, contexts and study samples limits a conclusive effectiveness assessment.

Conclusions:
Our findings highlighted how RTPs are increasingly recognized as a tool to improve C&A cognitive and behavioral functioning and resilience to external stressors, getting greater interest in the COVID-19 pandemic. Despite relevant theoretical support and promising study results, RTPs still lack strong evidence supporting their embracement by policymakers and effective implementation in public health policy. In order to not miss this chance, more efforts are needed in strengthening RTPs conceptualization and cost-effectiveness studies.

Background:
Trust is a key component of a socially sustainable society, and is typically divided into general trust (referring to trust in other people) and institutional trust (referring to trust in the public institutions of society). Trust tends to be developed and formed early in life. While a plethora of research has reported positive links between trust and health in adults, the aim of this study was to examine the associations between general and institutional trust and emotional difficulties in mid and late adolescence.

Methods:
Data were derived from the Swedish cohort study Futura01, using information collected amongst 3622 grade 9 students (15-16 years, t1) who were followed-up two years later (17-18 years, t2). General and institutional trust was measured by indices based on five items each at both t1 and at t2 (range 1-4). Emotional difficulties were measured by the Strengths and Difficulties Questionnaire (SDQ) subscale at both t1 and at t2 (range 0-10). Control variables included family type and cash margin at t1 and upper secondary school program (academic vs. vocational) at t2. Linear regressions were performed using the first difference (FD) approach, analysing the change in emotional difficulties (t2-t1) regressed on the change in general and in institutional trust (t2-t1), respectively.

Results:
Analyses simultaneously adjusting for change in both dimensions of trust showed inverse associations between the change in general trust and the change in emotional difficulties (b = -0.21, 95% CI -0.39, -0.04) and between the change in institutional trust and the change in emotional difficulties (b = -0.22, 95% CI -0.35, -0.09).

Conclusions:
Increases in general and in institutional trust between ages 15-16 and 17-18 years were associated with a corresponding decrease in emotional difficulties. The findings suggest that trust is a social determinant of emotional difficulties in adolescents. Endeavours to enhance trust in this age group are relevant.

Key messages:
Changes in trust were inversely associated with changes in emotional difficulties in adolescents.
The findings indicate that efforts to reinforce trust in adolescents are relevant.

Background:
Through this study, we aimed to test the association between the exposure to metals measured in indoor dust and metabolic outcomes among children living in areas with environmental exposure to metals.

Methods:
The project ''Health impacts of environmental exposure to airborne pollutants in the sites of Brescia and Taranto, Italy: increase knowledge to address preventive intervention of local and global relevance'' (ISEIA) enrolled 130 children aged 6 to 13 years (51.5% females) resident from pregnancy in highly industrialized areas of the Brescia province, Northern Italy. Metabolic outcomes including BMI, fasting blood glucose and blood creatinine were measured. The concentration of a mixture of 10 metals in indoor dust was determined through an X-ray fluorescence portable analyzer (p-XRF). Linear regressions and Weighted Quantile Sum (WQS) regression were applied to test for the association between metal exposure and metabolic outcomes. All models were adjusted for age, gender, socio-economic status and area of residence.

Results:
A significant association was observed between Cd and blood creatinine (b = 0.01; 95%CI = 0.001, 0.02; p-value = 0.028) when considering each individual metal separately in the model. WQS regression showed a positive significant association between the mixture of metals and fasting glucose (b = 0.87; 95%CI 0.14, 1.61; p-value = 0.023) identifying Mn, Cr and Cu as the elements with the higher weights, while a marginally significant association was found between the metal mixture and blood creatinine (b = 0.01; 95%CI = -0.001, 0.02; p-value = 0.075) where Cd and Ti showed the highest weight.

Conclusions:
We assessed the potential association between exposure to metals in indoor household dust and blood glucose and creatinine. Our results contribute to clarifying the role of metal exposure in the burden of non-communicable diseases