In China, there are an estimated 41 million left-behind children (LBC). The objective of this study was to examine the mental health of current-left-behind children (current-LBC) and previous-left-behind children (previous-LBC) as compared to never-left-behind children (never-LBC), while considering factors like parent-child communication. Children were recruited from schools in rural areas of Anhui province in eastern China. Participants completed a questionnaire focusing on migration status, mental health, and parent-child communication, measured with the validated Strengths and Difficulties Questionnaire (SDQ) and Parent–Adolescent Communication Scale (PACS). Full data were available for 1251 current-, 473 previous-, and 268 never-LBC in Anhui province. After adjusting for all confounding variables, the results showed that both current and previous parental migration was associated with significantly higher mental health difficulties, including aspects of emotional symptoms, conduct problems, hyperactivity, and total difficulties. Additionally, we found that difficulties communicating with parents were strongly associated with the presence of greater total difficulties in children. Parental migration has an independent, long-lasting negative effect on children. Poor parent-child communication is strongly associated with children’s mental health. These results indicate that parent–child communication is important for the development of children, and interventions are needed to improve migrant parents’ understanding and communication skills with their children.

Background The overuse of antibiotics is recognised as a major contributor to antimicrobial resistance globally. Levels of antimicrobial resistance in China are among the highest in the world. This study aimed to develop and trial a replicable model to reduce antibiotic consumption in general hospitals in Zhejiang province, China. Methods The project was a multicentre before-and-after study that involved a three-stage training programme, conducted in all 202 general hospitals of Zhejiang province, China, from January, 2012, to December, 2017. The threestage process comprised: (1) raising awareness of antimicrobial resistance among all directors of the hospitals and of infection control departments through workshops to discuss appropriate management strategies for antimicrobial resistance; (2) workshops to improve cooperation across departments, including all clinical, microbiology, IT, and pharmacy departments; and (3) training of all doctors and pharmacists in infection diagnosis and treatment through teleconferencing. Doctors who failed the post-course examination were prevented from prescribing any antibiotics for a fixed period. In addition, annual unannounced random surveillance was carried out by an expert team supported by the Center for Antibacterial Surveillance of Zhejiang province. Annual reports were fed back to each hospital. Routine data on antibiotic prescriptions (number, type, and antibiotic use density) were collected from hospital information systems before the intervention and on an annual basis thereafter. The primary outcome measure was the difference in proportions of antibiotics prescribed at baseline (2012) and after 5 years (2017). Findings Data were obtained from 197 general hospitals (five hospitals were excluded owing to missing data). Between 2012 and 2017, antibiotic prescription decreased in outpatients from 21•1% to 14•1%, in emergency patients from 40•4% to 35•4%, and in inpatients from 63•5% to 53•8%. The percentage of antibiotic prescriptions that were given by intravenous antibiotic infusions decreased from 37•7% to 24•8% in outpatients, and from 59•0% to 53•7% in emergency patients. The percentage of inpatients receiving more than one antibiotic decreased from 25•7% to 16•7%, and the cumulative defined daily doses (DDDs) per 100 inpatient days decreased from 58•4 to 50•9. The cost of antibiotics as a proportion of all drugs prescribed decreased from 18•5% to 15•6%. Interpretation The project demonstrates that raising awareness and an education programme combined with surveillance can reduce antibiotic use in general hospitals. More work needs to be done to evaluate and promote the model.