COVID-19 Vaccine Hesitancy Among People Living with HIV: A Systematic Review and Meta-Analysis.

Vaccine hesitancy is one of the top 10 threats to global health, which affects the prevalence and fatality of vaccine-preventable diseases over the world. During the COVID-19 pandemic, people living with HIV (PLWH) may have higher risks of infection, more serious complications, and worse prognosis without the protection of the COVID-19 vaccine. A systematic review and meta-analysis aiming to evaluate the prevalence of COVID-19 vaccine hesitancy among PLWH was conducted using PubMed, Embase, and Web of Science databases for studies published between January 1, 2020, and August 31, 2022. The pooled prevalence with a corresponding 95%CI of COVID-19 vaccine hesitancy among PLWH was reported. Subgroup analysis was conducted to explore variation in prevalence across different categories. 23 studies with a total of 19,922 PLWH were included in this study. The prevalence of COVID-19 vaccine hesitancy among PLWH was 34.0%, and the influencing factors included male, influenza vaccination experience, and a CD4 count of more than 200 cells/mm3. Subgroup analysis did not identify significant causes of heterogeneity but showed that the prevalence of COVID-19 vaccine hesitancy among PLWH varies by study period, region, and race. Although all PLWH are recommended to receive the COVID-19 vaccine, a large proportion of them remain hesitant to be vaccinated. Therefore, governments and relevant institutions should take specific measures to encourage and promote vaccination to improve the coverage of the COVID-19 vaccine among PLWH.

Artificial intelligence performance in detecting lymphoma from medical imaging: a systematic review and meta-analysis.

BACKGROUND: Accurate diagnosis and early treatment are essential in the fight against lymphatic cancer. The application of artificial intelligence (AI) in the field of medical imaging shows great potential, but the diagnostic accuracy of lymphoma is unclear. This study was done to systematically review and meta-analyse researches concerning the diagnostic performance of AI in detecting lymphoma using medical imaging for the first time. METHODS: Searches were conducted in Medline, Embase, IEEE and Cochrane up to December 2023. Data extraction and assessment of the included study quality were independently conducted by two investigators. Studies that reported the diagnostic performance of an AI model/s for the early detection of lymphoma using medical imaging were included in the systemic review. We extracted the binary diagnostic accuracy data to obtain the outcomes of interest: sensitivity (SE), specificity (SP), and Area Under the Curve (AUC). The study was registered with the PROSPERO, CRD42022383386. RESULTS: Thirty studies were included in the systematic review, sixteen of which were meta-analyzed with a pooled sensitivity of 87% (95%CI 83-91%), specificity of 94% (92-96%), and AUC of 97% (95-98%). Satisfactory diagnostic performance was observed in subgroup analyses based on algorithms types (machine learning versus deep learning, and whether transfer learning was applied), sample size (≤ 200 or >  200), clinicians versus AI models and geographical distribution of institutions (Asia versus non-Asia). CONCLUSIONS: Even if possible overestimation and further studies with a better standards for application of AI algorithms in lymphoma detection are needed, we suggest the AI may be useful in lymphoma diagnosis.

HIV testing and related factors among 50 years and older MSM in China: results from a cross-sectional study.

ABSTRACTHIV prevalence has increased continuously, and the age groups most afflicted by the epidemic have also shifted to people aged above 50 years. Informed by the theory of HBM, we aimed to investigate related factors associated with regular HIV testing behavior. Cross-sectional data were collected using online questionnaire from geosocial networking (GSN) mobile application (apps) for MSM during May 2020 (N = 1259). Data were analyzed by univariate and multivariate logistic regression. Around 62.0% (n = 781) had received HIV testing before. Participants being divorced/widowed (AOR = 1.5,95%CI:1.1-2.0), being aware of HIV/AIDS-related knowledge (AOR = 1.8,95%CI:1.4-2.3), having disclosed sexual orientation (AOR = 1.9,95%CI:1.5-2.5), ever had sexually transmitted infections symptoms (STIs)before (AOR = 2.4,95%CI:1.8-3.2), having had≥2 sexual partners (AOR = 1.8,95%CI:1.4-2.3) and with high self-efficacy (AOR = 1.1,95%CI:1.0-1.1) were more likely to receive HIV testing. Findings suggest that many Chinses MSM aged 50 and above have not been tested for HIV. Interventions for promoting HIV testing should focus on expanding scales of HIV/STIs screening, providing HIV/AIDS-related knowledge, creating a more supportive social environment and improving self-efficacy of HIV testing.

HIV-related stigma, depression and suicidal ideation among HIV-positive MSM in China: a moderated mediation model.

BACKGROUND: As the HIV epidemic among MSM in China continues, Chinese men who have sex with men (MSM) face various mental health difficulties, including suicide ideation, depression, and stigma. The current study aims to assess the mechanisms between HIV-related stigma, depression, and suicidal ideation among MSM in China. METHODS: This national cross-sectional study was completed on the geosocial networking application (GSN) app, Blued, from December 2020 to March 2021. We used the HIV Stigma Scale and the Center for Epidemiologic Studies Depression Scale (CES-D10) to measure HIV stigma and depression, respectively. Suicidal ideation was measured by the suicidal ideation-related item. Descriptive analyses, logistic regression, and structural equation modeling (SEM) were used for data analysis. RESULTS: A total of 244 HIV-positive MSM were included in the analysis. The mediation model revealed that the direct pathway of perceived HIV-related stigma on suicidal ideation was significant (standardized pathway coefficient = 0.07), and the indirect pathway of perceived HIV-related stigma on suicidal ideation via depression was also significant (standardized pathway coefficient = 0.04). There was a partial mediating effect of depression in the association between perceived HIV-related stigma and suicidal ideation. CONCLUSIONS: Our study found that both perceived HIV-related stigma and depression were associated with suicidal ideation among HIV-positive MSM in China, and that depression could serve as a mediator between HIV-related stigma and suicidal ideation. Targeted interventions regarding HIV-related stigma and depression should be taken into account to reduce suicidal ideation among HIV-positive MSM in China.

Unassisted Clinicians Versus Deep Learning-Assisted Clinicians in Image-Based Cancer Diagnostics: Systematic Review With Meta-analysis.

BACKGROUND: A number of publications have demonstrated that deep learning (DL) algorithms matched or outperformed clinicians in image-based cancer diagnostics, but these algorithms are frequently considered as opponents rather than partners. Despite the clinicians-in-the-loop DL approach having great potential, no study has systematically quantified the diagnostic accuracy of clinicians with and without the assistance of DL in image-based cancer identification. OBJECTIVE: We systematically quantified the diagnostic accuracy of clinicians with and without the assistance of DL in image-based cancer identification. METHODS: PubMed, Embase, IEEEXplore, and the Cochrane Library were searched for studies published between January 1, 2012, and December 7, 2021. Any type of study design was permitted that focused on comparing unassisted clinicians and DL-assisted clinicians in cancer identification using medical imaging. Studies using medical waveform-data graphics material and those investigating image segmentation rather than classification were excluded. Studies providing binary diagnostic accuracy data and contingency tables were included for further meta-analysis. Two subgroups were defined and analyzed, including cancer type and imaging modality. RESULTS: In total, 9796 studies were identified, of which 48 were deemed eligible for systematic review. Twenty-five of these studies made comparisons between unassisted clinicians and DL-assisted clinicians and provided sufficient data for statistical synthesis. We found a pooled sensitivity of 83% (95% CI 80%-86%) for unassisted clinicians and 88% (95% CI 86%-90%) for DL-assisted clinicians. Pooled specificity was 86% (95% CI 83%-88%) for unassisted clinicians and 88% (95% CI 85%-90%) for DL-assisted clinicians. The pooled sensitivity and specificity values for DL-assisted clinicians were higher than for unassisted clinicians, at ratios of 1.07 (95% CI 1.05-1.09) and 1.03 (95% CI 1.02-1.05), respectively. Similar diagnostic performance by DL-assisted clinicians was also observed across the predefined subgroups. CONCLUSIONS: The diagnostic performance of DL-assisted clinicians appears better than unassisted clinicians in image-based cancer identification. However, caution should be exercised, because the evidence provided in the reviewed studies does not cover all the minutiae involved in real-world clinical practice. Combining qualitative insights from clinical practice with data-science approaches may improve DL-assisted practice, although further research is required. TRIAL REGISTRATION: PROSPERO CRD42021281372; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=281372.

Correction: Unassisted Clinicians Versus Deep Learning-Assisted Clinicians in Image-Based Cancer Diagnostics: Systematic Review With Meta-analysis.

[This corrects the article DOI: 10.2196/43832.].

Willingness to human papillomavirus (HPV) vaccination and influencing factors among male and female university students in China.

This study compared the willingness to receive human papillomavirus (HPV) vaccination and the influencing factors between male and female university students who had never been vaccinated against HPV in China. University students were recruited from seven universities in China. A self-administered questionnaire was used to collect information about demographic characteristics, willingness to HPV vaccination, and possible influencing factors including demographics, knowledge, and attitude toward HPV vaccination. The χ2 test was used to test the difference between males and females' knowledge and attitudes to HPV vaccination. Multivariate logistic regression was employed to detect the factors associated with willingness to HPV vaccination. A total of 7335 university students participated in the survey (3570 males and 3765 females). Over 70% of the participants had previously received sex education and knowledge. The average age of sexual debut was 17.5 years old. More male students reported acceptance of premarital sex than female students did (χ2 = 708.458, p < 0.001). Female students had better knowledge and attitudes to HPV in general, while male students perceived a higher chance of being infected by HPV compared with female students (χ2 = 6.047, p = 0.014). The level of knowledge (male: adjusted odds ratio [AOR] = 1.935, 95% confidence interval [CI]:1.516-2.470; female: AOR = 1.227, 95% CI: 1.055-1.428) and receiving sex education (male: AOR = 1.414, 95% CI: 1.109-1.804; female: AOR = 1.289, 95% CI: 1.064-1.562) were indicators of the HPV vaccination willingness for both genders. For male students, those who had ever inoculated optional self-paid vaccines were more likely to receive the HPV vaccine than those who had not (AOR = 1.567, 95% CI: 1.242-1.977). Female students were more willing to be vaccinated against HPV, if they had higher living expenses (AOR = 1.395 and 3.717, 95% CI: 1.071-1.426 and 1.776-7.752), relatives or friends had certain cancer (AOR = 1.290, 95% CI: 1.095-1.518), ever had sexual experiences (AOR = 2.628, 95% CI: 1.788-3.863), and had ever consulted on HPV vaccination issues (AOR = 1.612, 95% CI: 1.367-1.901). In China, more active education should be provided to improve university students' knowledge and attitudes on HPV and HPV vaccination. Including HPV vaccine uptake for both males and females at recommended ages in National Immunization Program would be the most cost-effective way to prevent HPV infection.

Effect of an IMB Model-Based Education on the Acceptability of HPV Vaccination Among College Girls in Mainland China: A Cluster RCT.

OBJECTIVE: Despite the fact that the human papillomavirus vaccine (HPVV) has been approved in mainland China since 2016, there is a lack of inoculation among Chinese college women. This multi-center, online interventional RCT based on the information-motivation-behavioral skills (IMB) model intended to investigate if the intervention may improve human papillomavirus vaccine acceptance and awareness among target women. METHODS: Participants were selected from comprehensive universities and allocated to 1 of 2 groups: intervention or control. After the baseline survey, participants in the intervention group were given 10-minute online IMB model-based education every day for 7 days. Self-administered questionnaire surveys on Human papillomavirus knowledge, HPVV acceptability, and IMB construct toward HPV vaccination were performed at pre- and post-intervention. RESULTS: The baseline survey was completed by 3739 female university students from the intervention (n = 1936) and control groups (n = 1803) between February and April 2020. The average score of students on 11 HPV-related questions was 5.225 ± 2.739, and only 32.07% (1199/3739) of them showed a willingness to be vaccinated against HPV. After the intervention, the intervention group had a higher willingness to vaccinate themselves and encourage their friends to get the HPVV compared to the control group (40.39% vs 31.56%, 82.67 vs 73.18%, P < .001), and the difference in knowledge scores between the 2 groups was significant (7.917 ± 1.840 vs 5.590 ± 2.859, P < .001). In addition, 8 students in the intervention group self-reported receiving HPVV during the research period. CONCLUSIONS: This IMB model-based intervention showed positive effects on the participants' knowledge, motivation, and perceived objective skills toward HPV vaccination and has the potential to improve the vaccination among Chinese college women.

COVID-19 vaccine hesitancy among different population groups in China: a national multicenter online survey.

BACKGROUND: COVID-19 vaccine has been available in China since the beginning of the 2021, however, certain numbers of people are reluctant for some reasons to vaccinate. The high vaccine coverage is crucial for controlling disease transmission, however, the vaccine hesitancy might be a barrier to the establishment of sufficient herd immunization. This study aims to investigate the prevalence of the COVID-19 vaccine hesitancy among different population groups, and explore common barriers and facilitators to vaccination decisions. METHODS: The current survey was performed among Chinese students, public health professionals, medical workers and general population from January to March 2021 from seven cities in China. The questionnaire contained sociodemographic information, concerns about infection with COVID-19, general vaccination behaviors and attitudes, the General Vaccine Hesitancy Scale, the COVID-19 Vaccine Hesitancy Scale and other potential factors. Univariate analysis was conducted by chi-squared test, and variables significant at P < 0.10 were then included in a multivariable regression model. RESULTS: The prevalence of COVID-19 vaccine hesitancy was 15.6% in our study, and 23.9% of students, 21.2% of the general population, 13.1% of medical workers, and 10.4% of public health professionals had vaccine hesitancy. The results of multivariate analysis indicated that participants who had received negative information of COVID-19 vaccine (OR: 1.563, 95% CI: 1.229-1.986) and who had doubts about the information source (OR: 2.157, 95% CI: 1.697-2.742) were more likely to have vaccine hesitancy. While those who needed transparent information about COVID-19 vaccine (OR: 0.722, 95% CI: 0.535-0.973) and who would get COVID-19 vaccine if doctors recommended (OR: 0.176, 95% CI: 0.132-0.234) were less likely to have COVID-19 vaccine hesitancy. CONCLUSIONS: Given recommendations from medical workers about vaccination can motivate people to accept COVID-19 vaccination, appropriate training in knowledge about vaccines and communication skills are necessary for them to increase public's willingness of vaccination. Reducing the spread of misinformation and disseminating facts in a timely and accurate way will likely reduce vaccine hesitancy. Moreover, to establish suitable communication strategies and information exchange platforms between the government and the public and a warning system on infodemic would be helpful to improve public's confidence in vaccination.

Psychometric validation of a chinese version of COVID-19 vaccine hesitancy scale: a cross-sectional study.

BACKGROUND: COVID-19 vaccines have been administered in many countries; however, a sufficient vaccine coverage rate is not guaranteed due to vaccine hesitancy. To improve the uptake rate of COVID-19 vaccine, it is essential to evaluate the rate of vaccine hesitancy and explore relevant factors in different populations. An urgent need is to measure COVID-19 vaccine hesitancy among different population groups, hence a validated scale for measuring COVID-19 vaccine hesitancy is necessary. The present study aims to validate the COVID-19 vaccine hesitancy scale among different populations in China and to provide a scale measuring COVID-19 vaccine hesitancy with satisfactory reliability and validity. METHODS: Self-reported survey data were collected from different populations in China from January to March 2021. Based on the Parent Attitudes about Childhood Vaccines scale, 15 items were adapted to evaluate the COVID-19 vaccine hesitancy. Exploratory and confirmatory factor analysis were utilized to identify internal constructs of the COVID-19 vaccine hesitancy scale among two randomly split subsets of the overall sample. Reliability was analyzed with the internal consistency, composite reliability, and the test-retest reliability, and validity was analyzed with the criterion validity, convergent validity, and discriminant validity. RESULTS: A total of 4227 participants completed the survey, with 62.8% being medical workers, 17.8% being students, 10.3% being general population, and 9.1% being public health professionals. The exploratory factor analysis revealed a three-factor structure that explain 50.371% of the total variance. The confirmatory factor analysis showed that models consisting of three dimensions constructed in different populations had good or acceptable fit (CFI ranged from 0.902 to 0.929, RMSEA ranged from 0.061 to 0.069, and TLI ranged from 0.874 to 0.912). The Cronbach's α for the total scale and the three subscales was 0.756, 0.813, 0.774 and 0.705, respectively. Moreover, the COVID-19 vaccine hesitancy scale had adequate test-retest reliability, criterion validity, convergent validity, and discriminant validity. CONCLUSIONS: The COVID-19 vaccine hesitancy scale is a valid and reliable scale for identifying COVID-19 vaccine hesitancy among different population groups in China. Given the serious consequences of COVID-19 vaccine hesitancy, future studies should validate it across regions and time to better understand the application of the COVID-19 vaccine hesitancy scale.

An Internet-Based Education Program for Human Papillomavirus Vaccination Among Female College Students in Mainland China: Application of the Information-Motivation-Behavioral Skills Model in a Cluster Randomized Trial.

BACKGROUND: Patients diagnosed with cervical cancer in the last 2 decades were mainly young females. Human papillomavirus (HPV) vaccination is the most radical way to prevent HPV infection and cervical cancer. However, most female college students in mainland China have not yet been vaccinated, and their relevant knowledge is limited. Theory-based education delivered via the internet is a potentially accessible and useful way to promote HPV vaccination among this population. OBJECTIVE: This 3-month follow-up study intended to identify the feasibility and efficacy of an information-motivation-behavioral skills (IMB) model-based online intervention for promoting awareness and willingness regarding HPV vaccination among female college students. METHODS: A 7-day online HPV education program for female college students in mainland China was developed using a cluster randomized trial design. Recruitment and questionnaire surveys were performed online without face-to-face contact. SPSS 23.0 was used for statistical analysis. The chi-square test and t test were used to compare differences in qualitative and continuous variables between intervention and control groups. The generalized estimating equation was used to test the effectiveness of the intervention with a consideration of the time factor. RESULTS: Among 3867 participants, 102 had been vaccinated against HPV before the study (vaccination rate of 2.6%). A total of 3484 participants were followed up after the baseline survey, with no statistical difference in the loss rate between the intervention and control groups during the intervention and follow-up periods. At different follow-up time points, HPV-related knowledge, and the motivation, behavioral skills, and willingness regarding HPV vaccination were higher in the intervention group than in the control group. HPV-related knowledge was statistically different between the 2 groups, while the motivation, behavioral skills, and willingness regarding HPV vaccination only showed statistical differences right after the intervention, reaching a peak right after the intervention and then gradually reducing over time. Furthermore, there was no statistical difference in the HPV vaccination rate between the 2 groups. CONCLUSIONS: IMB model-based online education could be a promising way to increase the HPV vaccination rate and reduce the burden of HPV infection and cervical cancer among high-risk female college students in China. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900025476; http://www.chictr.org.cn/showprojen.aspx? proj=42672. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-DOI:10.1186/s12889-019-7903-x.

[Mental Health Status and Its Influencing Factors among College Students during the Epidemic of Coronavirus Disease 2019:A Multi-center Cross-sectional Study].

Objective To measure the prevalence of mental health symptoms and identify the associated factors among college students at the beginning of coronavirus disease 2019(COVID-19)outbreak in China. Methods We carried out a multi-center cross-sectional study via snowball sampling and convenience sampling of the college students in different areas of China.The rates of self-reported depression,anxiety,and stress and post-traumatic stress disorder(PTSD)were assessed via the 21-item Depression-Anxiety-Stress Scale(DASS-21)and the 6-item Impact of Event Scale-Revised(IES-6),respectively.Covariates included sociodemographic characteristics,health-related data,and information of the social environment.Data pertaining to mental health service seeking were also collected.Multivariate Logistic regression analyses were performed to identify the risk factors. Results A total of 3641 valid questionnaires were collected from college students.At the beginning of the COVID-19 outbreak,535(14.69%)students had negative emotions,among which 402(11.04%),381(10.49%),and 171(4.90%)students had the symptoms of depression,anxiety,and stress,respectively.Meanwhile,1245(34.19%)college students had PTSD.Among the risk factors identified,male gender was associated with a lower likelihood of reporting depression symptoms(AOR=0.755,P=0.037],and medical students were at higher risk of depression and stress symptoms than liberal arts students(AOR=1.497,P=0.003;AOR=1.494,P=0.045).Family support was associated with lower risks of negative emotions and PTSD in college students(AOR=0.918,P<0.001;AOR=0.913,P<0.001;AOR=0.899,P<0.001;AOR=0.971,P=0.021). Conclusions College students were more sensitive to public health emergencies,and the incidence of negative emotions and PTSD was significantly higher than that before the outbreak of COVID-19.More attention should be paid to female college students who were more likely to develop negative emotions.We should strengthen positive and proper propaganda via mass media and help college students understand the situation and impact of COVID-19.Furthermore,we should enhance family support for college students.The government and relevant agencies need to provide appropriate mental health services to the students under similar circumstances to avoid the deterioration of their mental well-being.

Willingness to Accept Human Papillomavirus Vaccination and its Influencing Factors Using Information-Motivation-Behavior Skills Model: A Cross-Sectional Study of Female College Freshmen in Mainland China.

BACKGROUND: This study aimed to assess the awareness and attitudes toward human papillomavirus (HPV) vaccination among female college freshmen and explore their willingness and associated factors to receive the HPV vaccine based on the information-motivation-behavior skills (IMB) model. METHODS: From February 21 to April 30, 2020, a cross-sectional survey was conducted among female freshmen in seven colleges in mainland China. Socio-demographic characteristics, health-related awareness, knowledge of HPV, motivation, and behavioral skills toward HPV vaccination were assessed using questionnaires. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors of willingness to receive the HPV vaccine in the next 6 months. RESULTS: Among the 3867 students invited to participate in this study, 102 (2.64%) reported having taken the HPV vaccine. Among the unvaccinated participants, 59.89% had previously heard of HPV, and 32.08% were willing to take the HPV vaccine in the next 6 months. Willingness to get the HPV vaccine was associated with sexual experience(s) (AOR = 1.96, 95% CI: 1.25-3.08), family or friends with cancer (AOR = 1.24, 95% CI: 1.04-1.48), having heard of HPV (AOR = 1.23, 95% CI: 1.03-1.47), and having actively searched for or having consulted on issues concerning HPV vaccine (AOR = 1.22, 95% CI: 1.02-1.45). In the dimensions of the IMB model, "perceived susceptibility" (AOR = 1.20, 95% CI: 1.09-1.31), "perceived severity" (AOR = 1.24, 95% CI: 1.11-1.39), "subjective norms" (AOR = 2.09, 95% CI: 1.75-2.49), and "self-efficacy" (AOR: 2.95, 95% CI: 2.44-3.58) were positively associated with HPV vaccination acceptance, while "perceived barriers" (AOR = .60, 95% CI: .52-.69) negatively affected intention to get HPV vaccination. CONCLUSION: HPV vaccination rates and willingness to receive the HPV vaccine in the next 6 months were found to be poor among female college freshmen in mainland China. Having a positive attitude toward HPV vaccination, creating vaccine-friendly social norms, and removing related barriers are important measures to promote HPV immunization.

The impacts of coping style and perceived social support on the mental health of undergraduate students during the early phases of the COVID-19 pandemic in China: a multicenter survey.

BACKGROUND: An increasing number of undergraduate students in China have been reported to have psychological problems. In response to the COVID-19 pandemic, a series of preventive and control measures were implemented, which undoubtedly worsened their psychological health. Coping style and social support were probably important factors that affected the psychological well-being of undergraduate students during the pandemic. This study aimed to explore the effects of coping style and perceived social support on the psychological well-being of college students and relevant risk factors. METHODS: This cross-sectional study was performed in February and March of 2020 by distributing an online questionnaire among undergraduate students from seven geographical regions across China. The questionnaire included sociodemographic information; the 21-item Depression, Anxiety and Stress Scale (DASS-21); the Perceived Social Support Scale (PSSS); and the Simplified Coping Style Questionnaire (SCSQ). For the analyses, t-tests, one-way analysis of variance (ANOVA), the Kruskal-Wallis test and multiple linear regression were utilized. The level of significance was set at P < 0.05. RESULTS: Among 3113 college students, the rates of anxiety, depression and stress symptoms were 13.3, 15.4 and 6.8%, respectively. Increased rates of current smoking and drinking (5.5 and 25.2%, respectively) among undergraduates were identified. The results indicated that the PSSS subscales and SCSQ subscales were significantly associated with DASS-21 scores (P < 0.001). Multiple linear regression analysis showed that active coping style and family support were protective factors while passive coping style could aggravate psychological problems among participants (P < 0.001). CONCLUSIONS: A remarkable number of college students adopted passive coping strategies to cope with negative feelings, such as smoking and drinking, which were detrimental to their mental health. In contrast, active coping strategies helped improve their psychological well-being. Moreover, family support was particularly important for maintaining their mental health and ameliorating mental health challenges in this major health crisis. Consequently, suitable psychointervention, routine screening for risk behaviors, and provision of further social support are needed for undergraduate students in the COVID-19 pandemic or other emergency public health events.

[Status of Human Papillomavirus Vaccination and Knowledge,Attitudes, and Influencing Factors towards Human Papillomavirus and Its Vaccines among University Students in Western China].

Objective To investigate the knowledge about human papillomavirus(HPV)and its vaccines,HPV vaccination status,and vaccination willingness among the freshmen majoring in liberal arts,sciences,and medicine in western China,so as to provide evidence-based suggestions for health education among university students and to increase their vaccination. Methods By convenience sampling,stratified sampling,and cluster sampling,an online questionnaire survey was conducted among freshmen in a comprehensive university in Chengdu.The differences among the groups were compared by χ2 test,and non-conditional logistic regression was performed to analyze the influencing factors of willingness to vaccination. Results A total of 881 participants were included in this study,including 419 males and 462 females.The vaccination rate of females was 3.5%(16/462).Of all the university students,59.1%,67.5%,and 56.3% had heard of HPV,HPV-related diseases,and HPV vaccines,respectively,and only 10.4%,10.6%,and 27.8% knew "HPV infection usually does not cause symptoms","HPV infection is usually transient and mostly spontaneous regressive",and "HPV infection is very common".Females and medical students had more related knowledge than males and non-medical students(P=0.035,P=0.021).Of all the university students,65.7% were willing to be vaccinated against HPV.The high cost of vaccination(50.8%),worry about the side effects adverse reaction(46.3%),and lack of sexual life(43.4%)were the main reasons for the reluctance to be vaccinated.Gender,education background of parents,history of self-financed vaccination,attitude towards premarital sexual behavior,history of sexual behavior,and knowledge of HPV were the influencing factors of vaccination willingness. Conclusions The freshmen had a low rate of HPV vaccination and limited detailed knowledge about HPV and its vaccines.Health education campaign is urgently called for among university students regarding HPV infection as well as the safety,effectiveness,and side effects of HPV vaccines.More attention should be paid to the health education of male and non-medical students.

The risk of Helicobacter pylori infection for adverse pregnancy outcomes: A systematic review and meta-analysis.

OBJECTIVE: To estimate the current evidence regarding the association between Helicobacter pylori infection during pregnancy and adverse pregnancy outcomes. MATERIALS AND METHODS: A systematic literature search for relevant publications was conducted using PubMed, EMBASE, Cochrane Library, and Web of science databases through November 17th, 2018. The pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were selected as the effect size. Subgroup analysis and sensitivity analysis were performed. RESULTS: Thirty-one studies with a total of 22 845 participants were identified. There was significant association of H pylori infection with preeclampsia (OR: 2.51; 95% CI: 1.88-3.34; P < 0.001), fetal growth restriction (OR: 2.28; 95% CI: 1.21-4.32; P = 0.01), gestational diabetes mellitus (OR: 2.03; 95% CI: 1.56-2.64; P < 0.001), spontaneous abortion (OR: 1.50; 95% CI: 1.05-2.14; P = 0.024), and birth defect (OR: 1.63; 95% CI: 1.05-2.54; P = 0.03). Sensitivity analysis showed the significant association between H pylori infection and low birthweight (OR: 1.59; 95% CI: 1.05-2.40; P = 0.03). CONCLUSION: The present meta-analysis offers proof to support that H pylori infection during pregnancy can increase the risk on adverse pregnancy outcomes. Screening and treating for H pylori infection before pregnancy should be taken into account.

Interventions to improve human papillomavirus vaccination among Chinese female college students: study protocol for a randomized controlled trial.

BACKGROUND: While the HPV vaccines have been approved by the US FDA since 2006, in recent years an increasing number of women are living with cervical cancer globally. Among them, Chinese women have a higher cervical cancer incidence and mortality rate than the global average, with mortality rates being almost twice the global average. However, the current approach of HPV vaccination in China is not satisfactory given the high disease burden of cervical cancer. The current study is a randomized controlled trial designed to identify the barriers and facilitators of HPV vaccination among Chinese female students. This study will also test a health intervention measure via a popular form of new media in order to improve the HPV vaccine uptake under the framework of Information-Motivation-Behavioral skill Model (IMB). METHODS: This investigation is a multicenter, school-based, prospective, randomized, parallel group, double-blind, blank-controlled trial involving a 7-day education intervention with a further 6-month follow-up. We will enroll at least 3360 participants older than 18 years. The enrolled participants will be randomly divided into two groups (1:1 ratio). The intervention group will be offered a 7-day mobile health education, and participants in both groups will fill out 4 questionnaires at the baseline, 1 month, 3 months and 6 months after the intervention. The primary outcome is the difference in HPV vaccination or reservation for the HPV vaccine between the intervention and control groups. Secondary outcomes will include the comparison of (1) knowledge, attitudes, motivation, beliefs and behavioral skill about HPV and cervical cancer prevention, and (2) the willingness to uptake HPV vaccination. DISCUSSION: This study will examine the theory-based intervention in improving HPV vaccination among Chinese female college students. We will conduct the randomized controlled trial to provide scientific evidence on the potential effect of the IMB theory-based intervention. Findings from this study will contribute to a growing research field which assesses the effectiveness of mobile-based, school-targeted and theoretically guided interventions for promoting HPV vaccination in adolescents. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900025476; Registered on 27 August 2019.

Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing.

BACKGROUND: Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident. AIM: The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population. METHODS: This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling. RESULTS: Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data. CONCLUSION: The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.

Characteristics and influencing factors of anticipated HIV stigma among HIV-negative/unknown MSM in China: A regression mixture model.

BACKGROUND: Anticipated HIV stigma among men who have sex with men's (MSM) has a severe negative effect on their physical and mental health wellbeing and hence requires specific attention. The current study aims to identify the characteristics and the psychosocial influencing factors of anticipated HIV stigma in MSM using regression mixture model (RMM) and to determine the cut-off point of the seven-item Anticipated HIV Stigma Questionnaire (AHSQ) using the receiver operating characteristic (ROC) analysis. METHODS: A cross-sectional study was conducted among HIV-negative/unknown MSM from Blued online platform in China from December 16th, 2020 to March 1st, 2021, enrolling 1394 participants. Data were collected on demographic characteristics, perceived social support, anticipated HIV stigma, depressive symptoms, and HIV knowledge. Latent profile analysis was performed to identify different profiles of anticipated HIV stigma level. Chi-square test, analysis of variance, and RMM analysis were conducted to explore the influencing factors in different profiles. ROC analyses were carried out to identify the cut-off value of anticipated stigma. RESULTS: Among the participants, three profiles of anticipated stigma were identified: "low anticipated HIV stigma" (12.0%), "moderate anticipated HIV stigma" (52.1%), and "severe anticipated HIV stigma" (35.9%). RMM analysis showed that higher income and higher levels of knowledge were positively associated with moderate anticipated HIV stigma, whereas full-time job and social support were negatively associated with moderate anticipated HIV stigma; higher income, depressive symptoms, and knowledge were positively associated with severe anticipated HIV stigma, whereas minor ethnicity and social support were negatively associated with severe anticipated HIV stigma. ROC curve of the AHSQ showed that the optimal cut-off value of ≥16 could indicate positive anticipated HIV stigma. CONCLUSION: The study focuses on the level of anticipated HIV stigma and its psycho-socio influencing factors among HIV-negative/unknown MSM. It provides evidence for implementing relevant psychological interventions to HIV-negative/unknown MSM.

The incidence of urinary incontinence in Chinese hypertensive women and the relationship between hypertension and urinary incontinence.

OBJECTIVES: To determine the incidence of UI (urinary incontinence) and its subtypes in hypertensive women and examine the association between hypertension and new-onset UI. STUDY DESIGN: We conducted a cohort study on women aged ≥20 years in six regions of China. This cohort study was carried out from 2014 to 2016 at baseline, with follow-up completed in 2018. Information on sociodemographic characteristics, physiological and health behaviours were collected. We calculated the standardized person-year incidence of UI in hypertensive women, and used logistic regression to evaluate the association between hypertension and UI and its subtypes. RESULTS: The standardized incidence of UI, stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) in hypertensive women was 32.2, 21.9, 4.1, and 6.1 per 1000 person-years. Compared with normotensive women, the unadjusted and adjusted OR (odd ratio) for UI in hypertensive women was 2.62 (95 % confidence interval [CI], 2.16-3.18) and 1.70 (95 % CI, 1.14-2.53), respectively; The unadjusted and adjusted OR for SUI in women with hypertension was 2.44 (95 % CI, 1.92-3.09) and 2.60 (95 % CI, 1.68-4.04), respectively; The unadjusted and adjusted OR for UUI in women with hypertension was 2.80 (95 % CI, 1.79-4.37) and 0.54 (95 % CI, 0.13-3.66), respectively; The unadjusted and adjusted OR for MUI in women with hypertension was 2.49 (95 % CI, 1.92-3.09) and 0.60 (95 % CI, 0.19-1.91), respectively. CONCLUSIONS: The incidence of UI in hypertensive women was 32.2/1000 person-years. Hypertension was an independent risk factor for new-onset UI and SUI in Chinese adult women.