Association between obesity and fracture risk in Chinese women above 50 years of age: a prospective cohort study.

BACKGROUND: Fractures present serious health challenges for older adults, including premature mortality and reduced quality of life. Obesity has become significantly prevalent in China. However, the association between obesity and fractures remains unclear. This study aimed to assess the association between obesity and fractures among Chinese women above 50 years of age. METHODS: A prospective cohort study was designed based on the China Health and Nutrition Survey, using data from 1997 to 2015. The average follow-up duration was seven years. Trained investigators measured body mass index (BMI) and waist circumference (WC) at baseline. Obesity was defined according to World Health Organization recommendations. Waist-to-height ratio (W-HtR) was calculated, with 0.5 as the cutoff value. Onset of fractures, self-reported by the participants during the follow-up period, was the primary outcome. Cox hazard regression models were used to assess the association between BMI, WC, W-HtR and subsequent risk of fracture. A sensitivity analysis was conducted by multiple imputation of missing data on the variables at baseline. RESULTS: A total of 2,641 women aged ≥ 50 years were involved in the study. In all the models, no significant association existed between BMI and fracture risk. However, women with WC ≥ 88 cm had significantly higher risk of fracture than those with WC < 80 cm according to both the unadjusted (HR = 1.744, 95% CI: 1.173-2.591) and adjusted models (HR = 1.796, 95% CI: 1.196-2.695). In addition, W-HtR and fracture risk were positively associated according to both the unadjusted (HR = 1.798, 95% CI: 1.230-2.627) and adjusted models (HR = 1.772, 95% CI: 1.209-2.599). Results of the sensitivity analysis were consistent with those of the above analyses. CONCLUSIONS: Abdominal obesity increased the risk of all-cause fractures in Chinese women ≥ 50 years old. Intervention strategies and measures to prevent or address abdominal obesity would be helpful to decrease the fracture incidence.

Development and Reliability and Validity Analysis of the Knowledge,Attitude, and Practice Evaluation Scale for Teachers' Early Childhood Sex Education.

Objective To develop the knowledge,attitude,and practice evaluation scale for teachers' early childhood sex education and analyze the reliability and validity of the scale,providing evaluation tools for the research on teachers' early childhood sex education. Methods On the basis of relevant guidelines,publications,and the theory of knowledge,attitude,and practice,a preliminary pool of items for the scale was formed by group discussions.The scale was drafted after two rounds of Delphi expert consultation.In May 2023,stratified cluster sampling was conducted,and 535 preschool teachers from Changshou District,Chongqing were selected for a survey.Cronbach's α coefficient,split-half reliability,exploratory factor analysis,and content validity were adopted to assess the reliability and validity of the scale. Results An evaluation scale for teachers' early childhood sex education was formulated,involving 27 items in 3 dimensions of knowledge,attitude,and practice.The total Cronbach's α coefficient of the scale was 0.875,and that of the knowledge,attitude,and practice dimensions were 0.902,0.743,and 0.879,respectively.The total split-half reliability of the scale was 0.937,and that of the knowledge,attitude,and practice dimensions were 0.934,0.821,and 0.912,respectively.The content validity of the scale was good,with a factor loading range of 0.500-0.836 and a cumulative variance contribution rate of 61.57.The average score of teachers' knowledge,attitude,and practice in sex education was 72.85±7.13,with a good rate of 70.84%. Conclusions The developed scale for evaluating teacher's early childhood sex education demonstrates good reliability and validity,and it can be used to evaluate the teachers' knowledge,attitude,and practice in early childhood sex education.The evaluation results indicate that teachers have low levels of knowledge,attitude,and practice in sex education,and relevant departments need to carry out training on the sex education for young children.

[Current Situation and Influencing Factors of Kindergarten Teachers' Participation in Training for Preschool Sex Education].

Objective To understand the current situation and influencing factors of kindergarten teachers' participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future. Methods A multi-stage stratified cluster sampling method was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowledge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city. Results Among the 461 teachers,43.0% had participated in lectures/courses/training activities related to preschool sex education;99.1% hoped to participate in lectures/courses/training activities related to preschool sex education;82.6% learned about child sexual knowledge through school education;75.5% expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor (OR=0.57,95%CI=0.37-0.87,P=0.008),high monthly income (OR=3.52,95%CI=1.13-9.30,P=0.011),more ways to know about sex education knowledge (OR=2.87,95%CI=1.76-4.70,P<0.001),and social support (OR=1.58,95%CI=1.04-2.38, P=0.030) were promoting factors for teachers to participate in the training for preschool sex education. Conclusion The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers' participation in the training for preschool sex education.

Global and regional burden estimation of HIV-associated non-Hodgkin's lymphoma: a meta-analysis and modelling analysis protocol.

INTRODUCTION: HIV infection is one of the complex aetiologies of non-Hodgkin's lymphoma (NHL). However, the contribution of HIV to burden of NHL across time and region has not yet been comprehensively reported and quantified. Thus, this study aims to evaluate the relative risk of NHL in individuals with HIV infection compared with those without by performing a comprehensive meta-analysis. Additionally, we intend to further estimate quantitatively the degree of HIV contributing to burden of NHL using population attributable fraction (PAF) modelling analysis. METHODS AND ANALYSIS: This study will screen a mass of records searched from four electronic databases (PubMed, Embase, Cochrane Library and Web of Science). The main outcomes are specific effect values and corresponding 95% CIs for NHL among population with HIV infection compared with those without to quantify the association between HIV infection and NHL. After quality assessment and data extraction, we will undertake a meta-analysis to calculate the pooled risk ratio (RR). Furthermore, PAF calculation based on pooled RR combines with number of age-specific disability-adjusted life year (DALY) and HIV prevalence data (aged ≥15 years old) from 1990 to 2019, at global, regional and country levels. We will calculate the PAF, HIV-associated DALY number and age-standardised rate to quantify the burden of HIV-associated NHL. ETHICS AND DISSEMINATION: This study is based on published articles; thus, the ethic approval is not essential. In addition, we intend to publish the results on peer-reviewed journals for more discussion. We believe that research on estimating global burden of NHL can provide valuable insights for developing targeted prevention and control strategies, thereby achieving significant benefits. PROSPERO REGISTRATION NUMBER: CRD 42023404150.

Estimates of the global burden of non-Hodgkin lymphoma attributable to HIV: a population attributable modeling study.

Background: Human immunodeficiency virus (HIV) significantly increases the risk of non-Hodgkin lymphoma (NHL) development, yet the population-level impact on NHL burden is unquantified. We aim to quantify this association and estimate the global burden of HIV-associated NHL. Methods: In this meta-analysis, we searched five databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus) from database inception up to September 13, 2023, identifying cohort, case-control, or cross-sectional studies with an effective control group to assess NHL risk among individuals with HIV infection, with two authors extracting summary data from reports. Global and regional HIV-associated population attributable fraction (PAF) and NHL disease burden were calculated based on the pooled risk ratio (RR). HIV prevalence and NHL incidence were obtained from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Trends in NHL incidence due to HIV were assessed using age-standardised incidence rate (ASIR) and estimated annual percentage change (EAPC). This study was registered with PROSPERO (CRD42023404150). Findings: Out of 14,929 literature sources, 39 articles met our inclusion criteria. The risk of NHL was significantly increased in the population living with HIV (pooled RR 23.51, 95% CI 17.62-31.37; I2 = 100%, p < 0.0001), without publication bias. Globally, 6.92% (95% CI 2.18%-11.57%) of NHL new cases in 2019 were attributable to HIV infection (30,503, 95% CI 9585-52,209), which marked a more than three-fold increase from 1990 (8340, 95% CI 3346-13,799). The UNAIDS region of Eastern and Southern Africa was the highest affected region, with 44.46% (95% CI 19.62%-58.57%) of NHL new cases attributed to HIV infection. The Eastern Europe and Central Asia region experienced the highest increase in ASIR of NHL due to HIV in the past thirty years, wherein the EAPC was 8.74% (95% CI 7.66%-9.84%), from 2010 to 2019. Interpretation: People with HIV infection face a significantly increased risk of NHL. Targeted prevention and control policies are especially crucial for countries in Eastern and Southern Africa, Eastern Europe and Central Asia, to achieve the UNAIDS's '90-90-90' Fast-Track targets. Limited studies across diverse regions and heterogeneity between research have hindered precise estimations for specific periods and regions. Funding: Sichuan Provincial People's Hospital, Chengdu, China; Health Care for Cadres of Sichuan Province, Chengdu, China; Science and Technology Department of Sichuan Province, Chengdu, China.

The Practice and Willingness of Women Towards Opportunistic Screening for Breast and Cervical Cancers in Sichuan Province, China: A Cross-Sectional Study.

Purpose: To understand the practices and willingness of Chinese women to undergo opportunistic screening for breast cancer (BC) and cervical cancer (CC). Patients and Methods: From July to August 2021, a cross-sectional study of 1446 women from six cities in Sichuan Province, China, was conducted. A questionnaire was used to investigate practices, willingness, and barriers to opportunistic screening for BC and CC. Furthermore, potential factors for opportunistic screening willingness were analyzed using the chi-squared test and logistic regression. Results: During their lifetime, 312 (21.6%) and 388 (26.8%) women had undergone opportunistic screening for BC and CC, respectively. There were 1069 (73.9%) women willing to accept physician-recommended screening during a medical visit, while 835 (57.7%) were willing to have a voluntary screening at a healthcare institution. The main barriers to reluctance to participate in physician-recommended and voluntary screenings were "no symptoms; hence, no need for screening" and "unwillingness or difficulty in paying screening cost". Ethnic minorities, lower education levels, and menopause were inversely associated, whereas awareness of the screening methods and eligibility for screening were positively associated with physician-recommended and voluntary screenings (P < 0.05). Furthermore, awareness of "two-cancers" screening was positively associated with physician-recommended screening (P < 0.05). Conclusion: BC and CC opportunistic screening rates in Sichuan Province were low. The willingness to undergo physician-recommended screening was high, while that towards individual initiative screening was low. Public health education should be strengthened to increase cancer prevention awareness and knowledge of cancer screening, especially for women with low education, ethnic minorities, and post-menopause, for whom tailored interventions are suggested. In addition, novel ways of sharing screening costs need to be explored.

Psychological Resilience May Be Related to Students' Responses to Victims of School Bullying: A Cross-Sectional Study of Chinese Grade 3-5 Primary School Students.

BACKGROUND: School bullying is a major public health problem with a large impact on children's health. There is an increasing number of cases of school bullying reported in China. Studies have shown that the health consequences of different ways of responding to school bullying may be quite different and that psychological resilience is also closely related to aggressive behaviors. However, there has been little research on whether individuals with different psychological resilience levels respond differently. OBJECTIVE: To explore the relationship between responses to school bullying and psychological resilience, which may provide new ideas and strategies to better prevent and intervene in school bullying. METHODS: A random sample of 5425 primary school students aged 7-14 years were recruited in Luzhou, China. All students completed a questionnaire anonymously. The statistical significance of differences between groups was tested using the χ2 test or t test. Binary logistic regression was conducted to explore the relationship between responses and psychological resilience. RESULTS: Over two-thirds of primary school students in this study reported experiencing bullying in the past year. The rate of positive responses among victims was 69.10% (2596/3757, 95% CI: 67.62~70.58%). There was a positive relationship between psychological resilience and positive responses. This relationship was observed for all victims (OR = 1.605, 95% CI: 1.254~2.055), especially male victims (OR = 2.300, 95% CI: 1.624~3.259). CONCLUSIONS: There was a positive relationship between primary school bullying responses and psychological resilience among victims, with differences by sex. Therefore, increasing students' level of psychological resilience, possibly by improving their responses, is important for preventing school bullying. Meanwhile, effective interventions for school bullying should be developed from multiple perspectives, particularly sex, bullying roles, and psychological resilience.

[Mental health status among middle school students in Wenchuan earthquake region].

OBJECTIVE: To investigate mental health status among middle school students in Wenchuan earthquake region three months after the earthquake. METHODS: 38 classes of 3 middle schools in the disaster region were selected and 1966 students were invited to participate the investigation. The post-traumatic stress disorder (PTSD) checklist-civilian version was used to screen positive PTSD, and the perceived social support scale (PSSS) was used to evaluate the level of perceived social support. RESULTS: 1958 valid questionnaires were selected. The general positive rate of PTSD was 78.29% (1533/1958). PTSD prevalence of the girls was 82.30%(851/1034), higher than that of the boys (73.92% (683/924), chi(2) = 20.22, P < 0.01); the rate of the minority students was 80.27% (1375/1713), higher than that of the Han students (64.98% (154/237), chi(2) = 28.75, P < 0.01); the rate of the rural students was 83.52% (872/1044), higher than that of the urban students (72.43% (662/914), chi(2) = 35.37, P < 0.01); the rate of those who were injured in the quake was 90.38% (94/104), higher than that of the uninjured (77.66% (1439/1853), chi(2) = 9.40, P < 0.01). The level of perceived social support and family support of the subjects was high while outside family support was average. The medians of the score were 21, 60 and 39, respectively. The severity of PTSD was negatively correlated with perceived social support, and perceived support within and outside family (r values were -0.191, -0.130 and -0.190 respectively, all P values < 0.01). CONCLUSION: The incidence rate of PTSD is high among the middle school students in disaster region. The symptoms and severity of PTSD are different in the middle school students with different characteristics. Moreover, the more perceived social support they obtain, the better health status they keep.

[Relationship between post-traumatic stress disorder and perceived social support among middle school students in Wenchuan earthquake-stricken].

OBJECTIVE: To explore the relationship between post-traumatic stress disorder (PTSD) and perceived social support (PSS) ability among middle school students in earthquake-stricken areas after the Wenchuan earthquake accident. METHODS: A total of 1966 students from three secondary schools of Wenchuan earthquake-stricken areas were evaluated by PTSD Checklist-Civilian Version (PCL-C) and Perceived Social Support Scale (PSSS). RESULTS: The overall incidence rate of PTSD was 78.3%, with severe PTSD as 24.38%. Significant differences on the incidence rates of PTSD were found among the students who were in different PSS levels (P < 0.05) and significant negative correlation existed between the levels of severity on PTSD and PSS (gamma = -0.226, P < 0.05). Significant differences on PTSD incidence rates were found among those students who were from different families or out-family PSS levels (P = 0.009, P < 0.05). Significant negative correlation existed between the severity of PTSD and family or out-family PSS level (gamma = -0.176, P < 0.05, gamma = -0.214, P < 0.05). CONCLUSION: Relationships between the incidence rate, severity of PTSD and PSS levels existed among the middle school students in Wenchuan earthquake-stricken areas, with higher PSS, lower incidence rate and lighter severity of PTSD. Psychological intervention for earthquake-stricken students should be carried out.