The relationship between cumulative ecological risk and health risk behaviors among Chinese adolescents.

OBJECTIVES: To explore the relationship between cumulative ecological risk and individual risky behavior and multiple forms of aggregated behaviors among adolescents, and examine the gender differences. METHODS: A large-scale, nationally representative, and students-based investigation was conducted in rural and urban areas of eight provinces in China from October to December 2021. A total of 22 868 adolescents with an average age of 14.64 years completely standardized questionnaire in which the sociodemographic characteristics, socio-ecological risk factors and risky behaviors were used to analyze. RESULTS: Of included students, 48.4% encountered the high level of social-ecological risk. The prevalence of breakfast intake not daily, alcohol use (AU), smoking, physical inactivity, prolonged screen time (ST) on weekdays and weekends, suicidal ideation, suicidal plan, suicidal attempt, and non-suicidal self-injury (NSSI) was 41.0%, 11.9%, 3.4%, 61.9%, 15.1%, 51.1%, 27.7%, 13.9%, 6.5% and 27.0% respectively. 22.2% of participants engaged in high-risk behaviors. All were significantly influences of increased cumulative ecological risk on individual behavior and low-risk clustering behaviors separately. The odds ratio of breakfast intake not daily, AU, smoking, physical inactivity, prolonged ST in weekday and weekend, suicidal ideation, suicidal plan, suicidal attempt, and NSSI for the adjusted model in low versus high level of cumulative ecological risk was respectively significant in both boy and girls, and the ratio of odds ratios (ROR) was separately 0.95 (p = 0.228), 0.67 (p < 0.001), 0.44 (p < 0.001), 0.60 (p < 0.001), 0.78 (p = 0.001), 0.83 (p = 0.001), 0.80 (p = 0.001), 0.83 (p = 0.022), 0.71 (p = 0.005), 0.75 (p = 0.001). Girls encountering a high level of cumulative ecological risk were more likely to engage in multiple forms of clustering risky behaviors than boys (RORs: 0.77, p = 0.001). CONCLUSIONS: Research and effective inventions at the social-ecological environment, based on the view of cumulative risk, are needed to promote the healthy development of behaviors in adolescence, and pay more attention to decreasing the occurrence of risky behaviours in girls than boys.

Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study.

PURPOSE: The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy. METHODS: This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis. RESULTS: Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the "early onset" group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the "late onset" group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the "persistent onset" group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106). CONCLUSIONS: PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890).

Association of parent-child relationship quality and problematic mobile phone use with non-suicidal self-injury among adolescents.

BACKGROUND: Non-suicidal self-injury behavior (NSSI) is a common mental health threat among adolescents. Poor parent-child relationship (PCR) and problematic mobile phone use (PMPU) are risk factors for NSSI. We aimed to explore the impact of PCR quality, PMPU, and their interaction effects on NSSI among adolescents in China, as well as the sex difference. METHOD: A survey was conducted among school students in 4 provinces in China between 2017 and 2018. The study included 14,500 valid participants. The students' general demographic characteristics was collected, and further data on PCR quality, PMPU, and NSSI were obtained through self-rated questionnaire. Chi-square test, binomial logistic regression models, and the Andersson Excel were used for data analysis. RESULTS: The 12-month prevalence of NSSI was 27.3%. Lower PCR quality and PMPU were significantly associated with NSSI, respectively. The low PCR + yes PMPU group had the greatest association with NSSI, followed by the high PCR + yes PMPU group, low PCR + no PMPU group. Moreover, in low father-child relationship + yes PMPU group, females had a higher risk of NSSI than males; in high mother-child relationship + yes PMPU group, females had a higher risk of NSSI than males. Additive interaction analysis indicated that mother-child relationship quality and PMPU were associated with increased risks of NSSI, in the subgroup of males. CONCLUSIONS: The findings underline the importance of simultaneously studying the quality of PCR and PMPU for a comprehensive understanding of NSSI behavior, and especially highlights the significance of maternal relationship quality.

Relationship between chronotype and mental behavioural health among adolescents: a cross-sectional study based on the social ecological system.

BACKGROUND: Health risk behaviors (HRBs) is a kind of phenomenon behavior that often occurs in adolescence, and also often appears in clusters. Previous studies suggested an association between social ecological risk factors (SERFs) and HRBs. This study explored 1) whether chronotype moderates the risk of HRBs associated with SERFs and 2) whether mental health is a mediator in this relationship. METHODS: Adolescents were recruited from 39 junior or senior schools (three cities, 13 schools per city) using a multistage cluster sampling method conducted between October, 2020 and June, 2021. The Social Ecological System, Morningness-Eveningness Questionnaire, Brief Instrument on Psychological Health Youths, and Youth Risk Behavior Surveillance questionnaires were used to measure the SERFs, chronotype, mental health and HRBs. Latent category analysis was used to explore the clustering mode of HRBs. The primary exposure was SERFs, and the primary outcome was HRBs; chronotype was a moderator, and mental health was a mediator. The multivariable logistic regression model was used to determine the relationship between SERFs and chronotype and mental behavioral health status. Mediation moderate analysis using the PROCESS method was used to explore the relationship between these variables. Sensitivity analysis was conducted to evaluate the robustness of the model. RESULTS: In total, 17,800 individuals were initially enrolled. After excluding 947 individuals with invalid questionnaires, 16,853 participants were finally included in the analysis. The mean age of participants was 15.33 ± 1.08 years. After adjusting for covariates, multivariable logistic regression found that high levels of SERFs (odds ratio [OR] = 10.10, 95% confidence interval [CI]: 8.88-11.43, P < 0.01), intermediate chronotype (OR = 5.24, 95% CI: 4.57-6.01, P < 0.01), and eveningness (OR = 1.83, 95% CI: 1.64-2.05, P < 0.01) were associated with higher HRBs frequency. This study also assessed the interaction between chronotype, SERFs and HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01) and mental health (OR = 18.46, 95% CI: 13.16-25.88, P < 0.01). The moderated mediation analyses examined the relationship between chronotype, SERFs, mental health and HRBs. CONCLUSIONS: SERFs may be important variables in measuring the effect of the adolescent psychosocial environment on HRBs; this effect is mediated by mental health and moderated by chronotype.

Moderating effects of smoking and drinking on the relationship between biological rhythm and psychological health and gender differences among adolescents.

OBJECTIVES: To determine whether smoking and drinking moderate the correlation between biological rhythm and mental health and the role of gender differences in these moderating effects. METHODS: Adolescents from three cities, all twelve middle schools (N = 7,986), named Shenzhen, Nanchang and Shenyang in China, were asked to complete a standardized questionnaire including the details of biological rhythm, psychological health, and the status of smoking and drinking. The PROCESS program was used to analyze whether smoking and drinking moderated the relationship between biological rhythm and psychological health. RESULTS: The analyses revealed poorer psychological health and greater likelihood of smoking and drinking in participants with higher scores for biological rhythm disorder (P < 0.001). Specifically, smoking and drinking accelerated the relationship between biological rhythm and psychological health in the total sample (B = 0.05, P < 0.05; B = 0.06, P < 0.001) and only the subgroup of girls (B = 0.09, P < 0.05; B = 0.12, P < 0.001), respectively. CONCLUSIONS: As the findings suggest, attention should be given to smoking, drinking and gender-specific approaches employed to alleviate the psychological disorders of adolescents with biological rhythm disorders.

Gender-based differences in interaction effects between childhood maltreatment and problematic mobile phone use on college students' depression and anxiety symptoms.

BACKGROUND: Childhood maltreatment and problematic mobile phone use are risk factors for depression and anxiety symptoms among college students. However, how the interaction between the two factors affects depression and anxiety has yet to be validated. This study aimed to investigate the independent and interaction effects of childhood maltreatment and problematic mobile phone use on depression and anxiety among college students and explored gender-based differences in these associations. METHOD: A cross-sectional study was conducted from October to December 2019. We collected data from 7623 students at two colleges in Hefei and Anqing cities in Anhui Province, China. Multinomial logistic regression models were performed to explore the associations of childhood maltreatment and problematic mobile phone use with depression and anxiety symptoms and their interaction effects on depression and anxiety symptoms. RESULTS: Childhood maltreatment and problematic mobile phone use were significantly associated with increased risk of depression and anxiety symptoms (P < 0.001). Moreover, following adjustments for covariates, there was a multiplicative interaction between childhood maltreatment and problematic mobile phone use on depression and anxiety symptoms (P < 0.001). Gender-based differences were also observed in the associations. For instance, depression was more common in males and male students with childhood maltreatment were at higher risk of depression-only symptoms. CONCLUSION: Focusing on childhood maltreatment and problematic mobile phone use could facilitate a reduction in the occurrence of depression and anxiety symptoms in college students. Furthermore, it is necessary to develop gender-targeted intervention strategies.

Role of polygenic risk scores in the association between chronotype and health risk behaviors.

BACKGROUND: This study explores the association between chronotypes and adolescent health risk behaviors (HRBs) by testing how genetic background moderates these associations and clarifies the influence of chronotypes and polygenic risk score (PRS) on adolescent HRBs. METHODS: Using VOS-viewer software to select the corresponding data, this study used knowledge domain mapping to identify and develop the research direction with respect to adolescent risk factor type. Next, DNA samples from 264 students were collected for low-depth whole-genome sequencing. The sequencing detected HRB risk loci, 49 single nucleotide polymorphisms based to significant SNP. Subsequently, PRSs were assessed and divided into low, moderate, and high genetic risk according to the tertiles and chronotypes and interaction models were constructed to evaluate the association of interaction effect and clustering of adolescent HRBs. The chronotypes and the association between CLOCK-PRS and HRBs were examined to explore the association between chronotypes and mental health and circadian CLOCK-PRS and HRBs. RESULTS: Four prominent areas were displayed by clustering information fields in network and density visualization modes in VOS-viewer. The total score of evening chronotypes correlated with high-level clustering of HRBs in adolescents, co-occurrence, and mental health, and the difference was statistically significant. After controlling covariates, the results remained consistent. Three-way interactions between chronotype, age, and mental health were observed, and the differences were statistically significant. CLOCK-PRS was constructed to identify genetic susceptibility to the clustering of HRBs. The interaction of evening chronotypes and high genetic risk CLOCK-PRS was positively correlated with high-level clustering of HRBs and HRB co-occurrence in adolescents, and the difference was statistically significant. The interaction between the sub-dimensions of evening chronotypes and the high genetic CLOCK-PRS risk correlated with the outcome of the clustering of HRBs and HRB co-occurrence. CONCLUSIONS: The interaction of PRS and chronotype and the HRBs in adolescents appear to have an association, and the three-way interaction between the CLOCK-PRS, chronotype, and mental health plays important roles for HRBs in adolescents.

[Clinical Study of Peripherally Inserted Central Catheter-Related Thrombosis and Its Influence on the Blood Flow Status of the Inserted Veins in Cancer Patients].

Objective: To investigate the clinical features of peripherally inserted central catheter (PICC)-related thrombosis (PICCRT) within 2 weeks after PICC placement in cancer patients and its dynamic influence on the blood flow status of veins inserted with catheter, and to provide support for implementing thrombosis prevention and control measures. Methods: Between May 2019 and July 2020, patients who had solid tumors and who had PICC were prospectively enrolled at West China Hospital, Sichuan University. Scheduled color Doppler imaging was performed to examine the status of PICCRT formation at 8 points of time, with the first one conducted one day before the insertion of PICC and the other 7 completed within 2 weeks after the insertion of PICC. Then, based on whether patients had PICCRT, the patients were divided into two groups, a non-PICCRT group and a PICCRT group. The PICCRT group was further divided into two subgroups, an asymptomatic PICCRT group and a symptomatic PICCRT group, according to whether the patients had thrombosis-related symptoms and signs. Comparisons were made to study the incidence of PICCRT and the vascular diameter and the blood flow velocity in the veins inserted with catheters at different points of time in the patients of different groups. Results: Among 173 cancer patients in the cohort, 126 (72.8%) developed PICCRT, all of which occurred within 1 week after PICC insertion. There were 95 cases of asymptomatic PICCRT and 31 cases of symptomatic PICCRT. Before and after PICC insertion, the vascular diameter of both the asymptomatic and symptomatic PICCRT groups was significantly smaller than that of the non-PICCRT group and the blood flow velocity was significantly slower than that of the non-PICCRT group, with the difference continuing to increase with the prolongation of catheter indwelling time. Conclusion: Inserting catheters in veins with bigger vascular diameter and faster blood flow velocity may help reduce the incidence of PICCRT. The first week post catheter insertion is the key intervention period for the prevention of PICCRT.

[Association between patterns of adverse childhood experiences, screen time and non-suicidal self-injury behaviors among middle school students].

OBJECTIVE: The aim of this paper is to understand the relationship between patterns of adverse childhood experiences(ACEs), screen time and non-suicidal self-injury behaviors(NSSI) among middle school students. METHODS: Stratified cluster sampling method was used to select 14 500 middle school students(7347 boys and 7153 girls; 7247 junior high school students and 7253 senior high school students; 7619 urban students and 6881 rural students) from Shenzhen, Guiyang, Nanchang and Zhengzhou Cities. Questionnaire surveys were conducted using the child abuse questionnaire, household dysfunction questionnaire, non-suicidal self-injury behavior questionnaire and screen time items. The latent class analysis was used to evaluate the ACEs exposure patterns, and multivariable logistic regressions was used to analyze the association between patterns of ACEs, screen time levels and their combined effects with NSSI. RESULTS: Latent class analysis indicated four distinct patterns of ACE exposure: highly ACEs group(6.3%), highly abuse and neglect group(21.4%), lowly ACEs group(26.8%), highly neglect group(45.5%). Those in highly ACEs(OR=4.65, 95%CI 3.73-5.80), highly abuse and neglect(OR=3.43, 95%CI 2.91-4.06) and highly neglect(OR=1.31, 95%CI 1.11-1.55) group had significantly higher risk of NSSI compared with those in lowly ACEs group(P<0.001). In study days(OR=1.72, 95%CI 1.42-2.08) and weekends(OR=1.42, 95%CI 1.27-1.60), high screen time were associated with increased rate of NSSI(P<0.01). There showed a trend toward increased risk of NSSI with increasing ACEs exposure and screen time level(P<0.05). CONCLUSION: High ACEs exposure patterns and high screen time are associated with increased rate of NSSI. Reducing ACEs exposure and controlling screen time is beneficial to the prevention and control of NSSI in middle school students.

A model for predicting acute and chronic fatigue in Chinese nurses.

AIM: To explore a model designed to examine direct and indirect effects of variables on acute and chronic fatigue. BACKGROUND: Although influencing factors for fatigue have been studied extensively, direct and indirect effects of predictors for acute and chronic fatigue remain poorly understood. Therefore, we proposed an original prediction model for acute and chronic fatigue in Chinese nurses based on previous studies. DESIGN: Cross-sectional, descriptive, correlational design. METHODS: We used a multi-stage sampling process to finally include 581 nurses working in the general hospitals in Chengdu, China. Data were collected between November 2007-March 2008 by using questionnaires. A path analysis was applied to test the fit of the hypothesized model and analysis of variance. RESULTS: The final model fits the data well. A total of 44·8% of variance in acute fatigue was directly and indirectly explained by job demand, job control, support at work, exposure to hazards in work environments and sleep quality, and only indirectly influenced by intershift recovery and shift work. Moreover, 61·5% of total chronic fatigue was directly and indirectly accounted for by anxiety, depression, job dissatisfaction, intershift recovery, and acute fatigue, and only indirectly influenced by job control, support at work, exposure to hazards in work environments, shift work, and sleep quality. CONCLUSION: Acute and chronic fatigue is affected by different factors and nurse managers should generate specific interventions to decrease them.

Public perceptions on the application of artificial intelligence in healthcare: a qualitative meta-synthesis.

OBJECTIVES: Medical artificial intelligence (AI) has been used widely applied in clinical field due to its convenience and innovation. However, several policy and regulatory issues such as credibility, sharing of responsibility and ethics have raised concerns in the use of AI. It is therefore necessary to understand the general public's views on medical AI. Here, a meta-synthesis was conducted to analyse and summarise the public's understanding of the application of AI in the healthcare field, to provide recommendations for future use and management of AI in medical practice. DESIGN: This was a meta-synthesis of qualitative studies. METHOD: A search was performed on the following databases to identify studies published in English and Chinese: MEDLINE, CINAHL, Web of science, Cochrane library, Embase, PsycINFO, CNKI, Wanfang and VIP. The search was conducted from database inception to 25 December 2021. The meta-aggregation approach of JBI was used to summarise findings from qualitative studies, focusing on the public's perception of the application of AI in healthcare. RESULTS: Of the 5128 studies screened, 12 met the inclusion criteria, hence were incorporated into analysis. Three synthesised findings were used as the basis of our conclusions, including advantages of medical AI from the public's perspective, ethical and legal concerns about medical AI from the public's perspective, and public suggestions on the application of AI in medical field. CONCLUSION: Results showed that the public acknowledges the unique advantages and convenience of medical AI. Meanwhile, several concerns about the application of medical AI were observed, most of which involve ethical and legal issues. The standard application and reasonable supervision of medical AI is key to ensuring its effective utilisation. Based on the public's perspective, this analysis provides insights and suggestions for health managers on how to implement and apply medical AI smoothly, while ensuring safety in healthcare practice. PROSPERO REGISTRATION NUMBER: CRD42022315033.

The impact of problematic mobile phone use and the number of close friends on depression and anxiety symptoms among college students.

Background: Psychological problems often occur in college students, with the most common ones being depression and anxiety symptoms. Exploring the risk factors that influence depression and anxiety symptoms in college students is essential to promote their physical and mental health. Objective: This study aimed to investigate the independent and interaction effects of problematic mobile phone use (PMPU) and the number of close friends (NCFs) on depression and anxiety symptoms and the comorbidity of these symptoms among college students. Methods: A cross-sectional survey was conducted in Huainan, Anhui Province, and Suzhou, Jiangsu Province in China from October to December 2022. Data from 7,617 college students were collected. The Patient Health Questionnaire and Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety symptoms. The PMPU data were collected by the Mobile Phone Addiction Type Scale. Multinomial logistic regression models were performed to examine the associations of PMPU and NCFs with depression and anxiety symptoms and their interaction effects. Results: PMPU and lack of close friends significantly increased the risk of depression and anxiety symptoms and the comorbidity of these symptoms in college students (p < 0.001). In addition, the effects of PMPU and lack of close friends on depression and anxiety symptoms in college students were interactive (p < 0.001). No significant sex differences were found. Conclusion: PMPU and lack of close friends are important risk factors for depression, anxiety, and the comorbidity of these symptoms in college students in China.

Comparison of adverse childhood experience analytic approaches and associations with emotional and behavioral problems: A nationwide study among Chinese middle school students.

BACKGROUND: Adverse childhood experiences (ACEs) are demonstrated to be strongly associated with many health related problems, which have aroused extensive public attention. But the variety of analytic approaches of ACEs has limited researchers to differentiate those approaches across the outcomes. METHODS: A total of 22,686 middle school students were surveyed, and their ACEs and health related behaviors were collected. Four different analytic approaches were used to compare the effects of ACEs on four outcomes (non-suicidal self-injury, suicidal ideation, depression and anxiety symptoms). Logistic regression models were applied to verify the associations of adversities and four outcomes. R2 and the areas under the Receiver Operator Characteristic (ROC) curve were computed to compare the effects of four approaches. RESULTS: It was suggested that four measures of ACEs were significantly associated with all the outcomes in both the unadjusted and adjusted models (Ps all <0.05). R2 and areas under ROC curve showed that the contributions of four analytical approaches to different outcomes were diverse in this study. ACEs were more impactive to girls than to boys. CONCLUSION: ACEs are profound influencing factors of emotional and behavioral problems among middle school students. The selection of analytic approaches of ACEs depends on the need of research, and our study contributes to the choice of suitable analytic methods for future research of ACEs.

Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences.

PURPOSE: Adolescents exposed to adverse childhood experiences (ACEs) are at increased risk for health-compromising behaviors. However, few studies have investigated how ACEs correlate with patterns of health risk behaviors (HRBs) during adolescence, a crucial developmental period. The aim was to extend the current knowledge about the relationship between ACEs and HRB patterns among adolescents, and to explore gender differences. METHODS: A multi-centered population-based survey was conducted in 24 middle schools in three provinces across China between 2020 and 2021. A total of 16,853 adolescents effectively completed anonymous questionnaires covering exposure to eight ACE categories and 11 HRBs. Clusters were identified using latent class analysis. Logistic regression models were utilized to test the association between them. RESULTS: There were four classes of HRB patterns: "Low all" (58.35%), "Unhealthy lifestyle" (18.23%), "Self-harm" (18.42%), and "High all" (5.0%). There were significant differences between HRB patterns in terms of the different numbers and types of ACEs in three logistic regression models. Specifically, compared to "Low all," different types of ACEs were positively associated with the three other HRB patterns, and there were significant trends toward increase in the three latent classes of HRBs with higher ACEs. In general, females with ACEs had a higher risk of "High all" except sexual abuse than males. CONCLUSION: Our study comprehensively considers the association between ACEs and aggregation categories of HRBs. The results support efforts to improve clinical healthcare, and future work may explore protective factors based on individual, family, and peer education to mitigate the negative trajectory of ACEs.

Population attributable fractions of adverse childhood experiences for emotional problems and self-harming behaviors among middle school students in China.

The population attributable fractions of health outcomes attributed to adverse childhood experiences (ACEs) among Chinese middle school students is unknown. Of all the 22,868 middle school students, 29.8 % had exposure to four or more ACEs. Findings showed a graded relationship between ACE scores and those adverse outcomes. The PAFs of six outcomes attributed to experiencing ≥ 4 ACEs ranged from 23.1 % to 44.2 %. The results emphasized the significance of preventive interventions to alleviate the negative legacies of ACEs.

Co-occurrence patterns of adverse childhood experiences and their associations with non-suicidal self-injury and suicidal behaviors and gender difference among middle school students: A three-city survey in China.

BACKGROUND: Previous research has found increasing evidence of adverse childhood experiences (ACEs) leading to non-suicidal self-injury (NSSI) and suicidal behaviors. Most studies have focused on a certain type or timing of ACEs or the patterns of multiple types; however, few of them have examined the patterns of ACEs combined types and timing and the gender differences in the association between ACEs and self-harming behaviors. METHODS: A cross-sectional survey was conducted in three Chinese cities from November 2020 to May 2021. We asked 16,853 middle school students to anonymously complete a questionnaire to provide the details of their own ACEs and NSSI or suicidal behaviors. RESULTS: Latent class analysis identified four classes: high ACEs (10 %), high abuse/neglect (20.3 %), moderate ACEs (26.7 %) and low ACEs (43 %). Logistic regression models demonstrated that students in the high ACEs, high abuse/neglect and moderate ACEs subgroups were more likely to engage in NSSI and suicidal behaviors than students with low ACEs. Compared with boys, girls had a higher probability of engaging in NSSI and suicidal behaviors when exposed to the same level of ACEs. CONCLUSION: Co-occurrence of ACEs is associated with high risk of NSSI and suicidal behaviors. Our findings recognized the most dangerous patterns and latent class membership, which supply the evidence for policy makers to adopt preventive measures to protect high-risk individuals. Strategies to relieve the impact of ACEs, especially on girls, need to be considered comprehensively. LIMITATIONS: The study was limited by cross-sectional design, as causality could not be confirmed. In addition, because our survey was retrospective, potential recall bias can not be ignored.

Fear of disease progression among breast cancer patients in China: a meta-analysis of studies using the fear of progression questionnaire short form.

Background: Fear of disease progression (FoP) is among the most prevalent and major psychological burdens breast cancer patients encounter. Excessive FoP may result in serious adverse effects for patients. FoP in breast cancer patients has gained attention recently; however, its prevalence in China is unknown. Objectives: This meta-analysis and systematic review aimed to assess the overall FoP among Chinese breast cancer patients to make recommendations for treatment and care. Methods: Systematic search databases included PubMed, EMbase, The Cohrane Library, Web of Science, CINAHL, PsycINFO and 4 Chinese databases (Wan Fang Data, CBM, VIP and CNKI). The retrieval time ranged from the database's establishment to March 20, 2023. After two researchers independently evaluated the literature, retrieved information, and assessed the risk of bias for the included literature, Stata 15.1 software was used to conduct a meta-analysis. Results: A total of 37 moderate or high-quality studies involving 9,689 breast cancer patients were included. Meta-analysis showed that the pooled mean score of FoP for Chinese breast cancer patients was 33.84 [95% CI (31.91, 35.77)], prediction interval (21.57 ~ 46.11). The subgroup study found that FoP levels varied among breast cancer patients of different regions, ages, educational levels, marital statuses, residences, illness stages, and disease statuses. Conclusion: Breast cancer patients have higher FoP scores. Healthcare workers should be concerned. We expect that more relevant research will be undertaken and more effective interventions will be developed. Patients can manage their illness and improve their quality of life by reducing their fears. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023408914.

Childhood maltreatment and depressive symptoms among Chinese college students: A moderated mediation model of adult attachment styles and physical activity.

BACKGROUND: Previous research has investigated the independent effects of childhood maltreatment, adult attachment, and physical activity, on depressive symptoms. However, explanatory mechanisms linking childhood maltreatment to current depressive symptoms are poorly understood. This study investigated the mediating role of adult attachment between childhood maltreatment and depressive symptoms among college students and explored the moderating effect of physical activity in the mediating pathway. METHODS: The data for the present study were gathered in three waves with 6-month lags. A total of 3662 Chinese college students completed anonymous questionnaires concerning demographic variables, childhood maltreatment, and depressive symptoms in Wave 1, adult attachment and physical activity in Wave 2, and depressive symptoms in Wave 3. RESULTS: Childhood maltreatment and adult attachment were significantly associated with depressive symptoms, identifying a mediating role of adult attachment in the relationship between childhood maltreatment and depressive symptoms, and a moderating role of physical activity between attachment anxiety and depressive symptoms in the mediating pathway. LIMITATIONS: This study utilized self-reported questionnaires for data collection purposes, which could constitute key study limitations. CONCLUSIONS: These findings highlight the need to consider early stress factors (childhood maltreatment), social psychological factors (adult attachment), and potential protective factors (physical activity) simultaneously when evaluating the occurrence and development of depressive symptoms.

Associations of Childhood Maltreatment With Suicidal Behavior Among Chinese Adolescents: Does It Differ Based on Gender and Biological Rhythm?

Background: The impact of biological rhythm disorder (BRD) on the association of childhood maltreatment (CM) and suicidal behavior in adolescents remains unclear. CM increases the risk of suicidal ideation (SI), suicidal planning (SP), and suicidal attempts (SAs). There is less investigation on gender differences in CM's effects on suicidal behavior. It is unknown whether the impacts vary with different levels of BRD. Aims: To identify gender differences in CM's effects on suicidal behavior and to investigate these impacts at different levels of BRD. Method: The analysis is based on data from 7,986 adolescents recruited from three cities in China between October and December 2019. All participants, aged 14.7 ± 2 years, filled out standard questionnaires involving CM, BRD, and suicidal behavior. Results: A total of 22.9, 10.8, and 4.7% of the adolescents reported SI/SP/SAs in the past year. Girls are more likely to engage in SI and SP when exposed to the highest level of CM; boys are more likely to engage in SAs than girls. A significant relationship between moderate levels of CM and SI/SP/SAs was only observed in girls exposed to low BRD. Moderate CM is only significantly associated with SI in boys exposed to low BRD. The percentage of low-BRD adolescents who experienced high CM was 31.4%, whereas 58% of high-BRD adolescents experienced high CM in SI. Adolescents with high BRD were more likely to experience high levels of CM in SP and SAs. Conclusions: Adolescents at high risk of suicidal behavior in relation to CM should be targeted accordingly. Improving biological rhythm in adolescents who experience CM could help prevent them from engaging in suicidal behavior.

Associations of Non-suicidal Self-Injury and Psychological Symptoms With Suicide Attempt in Adolescents: Are There Any Gender Differences?

Background: Psychological symptoms and non-suicidal self-injury (NSSI) are independently associated with suicide attempts (SA). Yet, no study has tested the interaction effects between NSSI and psychological symptoms on SA in community adolescent populations, or examined whether the interaction varies by gender. We sought to examine the interaction effects of NSSI and psychological symptoms on SA in adolescents and explore gender differences. Methods: A school-based health survey in 3 provinces in China was conducted between 2013-2014. 14,820 students aged 10-20 years completed standard questionnaires, to record the details of various psychological symptoms, SA and NSSI. Results: Psychological symptoms and NSSI were independently associated with a higher likelihood of SA in both boys and girls (p < 0.001). Adolescents with psychological, conduct or social adaptation symptoms without concurrent NSSI, were twice as likely to report SA (corresponding RORs were 1.80, 1.80 and 2.16, respectively; p < 0.01) than those who reported NSSI. Male adolescents with psychological, emotional, conduct or social adaptation symptoms had a higher risk of SA in the non-NSSI group than the NSSI group (corresponding RORs were 2.85, 2.26, 2.30 and 3.01 respectively; p < 0.01). While in girls, only adolescents with social adaptation symptoms had a higher risk of SA in the non-NSSI group than NSSI group (corresponding RORs was 1.71, p < 0.05). In the non-NSSI group, boys reporting psychological symptoms exhibited a higher likelihood of a SA than their female counterparts. Conclusion: Psychological symptoms and NSSI are independently associated with an increased risk of SA in adolescents. However, to some extent, NSSI may reduce the risk of SA among individuals with psychological symptoms, especially in boys.