Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis.

BACKGROUND: Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE: To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD: We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS: We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION: SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.

Maternal periconceptional environmental exposure and offspring with congenital heart disease: a case-control study in Guangzhou, China.

BACKGROUND: Congenital heart defects (CHDs) are a major global health problem, yet their crucial environmental risk factors are still unclear. We aimed to explore the associations between maternal periconceptional environmental exposures and all CHDs, isolated and multiple CHDs and CHDs subtypes. METHOD: A case-control study including 675 infants with CHDs and 1545 healthy controls was conducted. Participating mothers who delivered in Guangzhou from October 2019 to November 2021 were recruited. To examine the independent associations between maternal periconceptional environmental exposure and offspring with CHDs, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression model. RESULTS: Maternal exposure to living near main roads [adjusted OR (aOR) = 1.94, 95% CI = 1.06-3.56] and housing renovation (aOR = 1.94, 95% CI = 1.03-3.67) during the periconceptional period were positively related to a greater risk of all CHDs, similar results were also found in isolated CHDs rather than multiple CHDs. Additionally, living near main roads was positively associated with secundum atrial septal defect/patent foramen ovale (aOR = 2.65, 95% CI = 1.03-6.81) and housing renovation was strongly positively associated with ventricular septal defect (aOR = 5.08, 95% CI = 2.05-12.60). However, no association was observed between incense burning and family relationships and all CHDs, isolated and multiple CHDs and CHDs subtypes. CONCLUSION: Living near main roads and housing renovation during the periconceptional period are significantly associated with the increased risks for all CHDs and isolated CHDs. Further study is needed to extend sample size to explore the effects of time and frequency of burning incense and family relationships on CHDs in offspring.

A global systematic review and meta-analysis of prevalence of repeat induced abortion and correlated risk factors.

As a significant public health problem, repeat-induced abortion is a challenge to women's sexual and reproductive health. Despite many studies in this area, they lack consensus regarding risk factors for repeat-induced abortion. A global systematic review was conducted to analyze prevalence of repeat-induced abortion among women worldwide and determine correlated risk factors. Three electronic databases were systematically searched. Data on prevalence of repeat-induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach. Sixty-five (which were published between 1972 and 2021) of 3,706 articles were included, consisting of a total of 535,308 participants from 25 countries. The overall pooled prevalence of repeat-induced abortion was 31.3 percent (95 percent CI 25.7 percent, 36.9 percent). Of 57 exposures extracted, 33 factors were significantly correlated with repeat induced abortion, comprising 14 individual demographic factors (i.e. age, education, marriage, etc.), three reproductive history-related factors (i.e. parity, age at sexual debut, and time since sexual debut), five contraception-related factors (i.e. contraceptive use at sexual debut, attitude toward contraceptive use, etc.), four abortion-related factors (i.e. age at the index abortion, previous abortion at the index abortion, etc.), and seven sexual partner-related factors (i.e. multiple sexual partners, sexual partner's age, etc.). The study findings highlight the problem of repeat-induced abortion worldwide and suggest the need for government and civil society in each country to increase efforts to reduce the alarming risk of repeat-induced abortion among women and improve their sexual and reproductive health.

Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study.

Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.

The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave.

BACKGROUND: There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. METHODS: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. RESULTS: Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSIONS: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

Dietary Zinc, Copper, and Selenium Intake and High-Risk Human Papillomavirus Infection among American Women: Data from NHANES 2011-2016.

Studies have shown that the micronutrients, zinc (Zn), copper (Cu), and selenium (Se) are associated with the HPV-associated cervical cancer, yet between dietary Zn/Cu/Se intake and high-risk HPV (hrHPV) infection remain unclear. We obtained publicly available data in the present cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) performed between 2011 and 2016. Dietary Zn, Cu, and Se intakes were assessed from two 24-h diet recalls. A total of 4628 female with the age of 18-59 years were included in this secondary analysis. Comparing the highest with the lowest quartiles of Zn intake, the adjusted odds ratio (aOR) for hrHPV infection was 0.72 (95% CI, 0.54-0.98). The aOR upon comparison of the quartile three with the lowest quartile of Cu intake was 0.67 (95% CI, 0.50-0.90). Whereas no significant association was found between intakes of Se and hrHPV infection in multivariate analysis. Moreover, compared with those below the Recommended Dietary Allowance (RDA), hrHPV infection risk was significantly decreased among women who met the RDA for Cu (aOR: 0.74; 95% CI = 0.60-0.92), but not for Zn and Se. In conclusion, high dietary Zn and moderate copper intakes were independently and negatively associated with hrHPV infection in addition to Se.

Perceived Discrimination and Relationship Satisfaction Among Same-Sex Couples: The Role of Dyadic Stress and Sex.

Based on the fact that most research drawn from the minority stress theory on the association between minority stress and relationship satisfaction has focused on an individual perspective rather than a dyadic perspective, and the limited evidence of the systemic transactional model (STM) explore the topics of same-sex couples. This study aims to combine both theories to examine the association between perceived discrimination and relationship satisfaction among lesbian, gay, and bisexual (LGB) people on both partners and test the potential mediating role of dyadic stress and sex difference in this association. Using an actor-partner interdependence mediation model (APIMeM), we analyzed data including a sample of 241 LGB couples (133 female and 108 male same-sex dyads). Results showed that perceived discrimination had no direct actor-partner effects on relationship satisfaction. APIMeM revealed significant indirect partner effects from perceived discrimination on both individuals' and their partners' relationship satisfaction through the partner's dyadic stress. Additionally, the effect of personal dyadic stress on a partner's relationship satisfaction was stronger for women compared to men. These findings demonstrated the utility of the minority stress theory and STM framework for understanding the risk of stressors in damaging LGBs' romantic relationships. Couple interventions should integrate knowledge from a dyadic perspective with attention to sex differences.

Eight-year experience of maternal death surveillance in Morocco: qualitative study of stakeholders' views at a subnational level.

BACKGROUND: Since 2009, Morocco has been implementing the Maternal Death Surveillance System (MDSS). The results obtained indicate significant regional variations in terms of implementation stage, completeness of maternal death reporting, and information use for action. The objective of this research is to better understand the contextual factors involved in the implementation process and use of MDSS, with a focus on the facilitators and barriers, as experienced by stakeholders in health regions.  METHODS: Evaluation research was conducted in 2017 based on a descriptive qualitative study using semi-structured in-depth interviews, in four out of the twelve health regions of Morocco. A total of thirty-one in-depth interviews were held with members of regional committees of maternal death reviews (RC-MDR) and other key informant staff. Interviews focused on participants' views and their experiences with the MDSS since the introduction in 2009. We conducted thematic analysis relied on inductive and deductive approaches. Applying the Consolidated Framework for Implementation Research guided data analysis and reporting findings.  FINDINGS: Engaging leadership at all health system levels, regular training of district and regional MDSS coordinators and supportive supervision at a national level were the most important MDSS implementation facilitators. Reported barriers were essentially related to the review system: Irregular review meetings, blame culture, high turn-over of RC-MDR members, lack of analytical capacity to inform the review process and formulate recommendations, finally limited accountability for recommendation follow-up. While financial incentives boosted MDSS adoption, they were nonetheless a substantial barrier to its sustainability. CONCLUSIONS: The MDSS is a complex process that requires taking numerous steps, including the commitment of multiple stakeholders with varying roles as well as information sharing across health system levels. Contextual factors that influence MDSS implementation at the sub-national level are to be considered. Horizontal and vertical communication about MDSS goals and feedback is crucial to strengthen stakeholders' commitment, hence improving quality and use of MDSS. Furthermore, health regions should place emphasis on making high-quality recommendations in partnerships between the regional management teams, RC-MDR members and external stakeholders.

Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: a scoping review.

OBJECTIVES: The COVID-19 pandemic has exposed and exacerbated existing socioeconomic and health disparities, including disparities in sexual health and well-being. While there have been several reviews published on COVID-19 and population health disparities generally-including some with attention to HIV-none has focused on sexual health (ie, STI care, female sexual health, sexual behaviour). We have conducted a scoping review focused on sexual health (excluding reproductive health (RH), intimate partner violence (IPV) and gender-based violence (GBV)) in the COVID-19 era, examining sexual behaviours and sexual health outcomes. METHODS: A scoping review, compiling both peer-reviewed and grey literature, focused on sexual health (excluding RH, IPV and GBV) and COVID-19 was conducted on 15 September 2020. Multiple bibliographical databases were searched. Study selection conformed to Joanna Briggs Institute (JBI) Reviewers' Manual 2015 Methodology for JBI Scoping Reviews. We only included English-language original studies. RESULTS: We found that men who have sex with men may be moving back toward pre-pandemic levels of sexual activity, and that STI and HIV testing rates seem to have decreased. There was minimal focus on outcomes such as the economic impact on sexual health (excluding RH, IPV and GBV) and STI care, especially STI care of marginalised populations. In terms of population groups, there was limited focus on sex workers or on women, especially women's sexual behaviour and mental health. We noticed limited use of qualitative techniques. Very few studies were in low/middle-income countries (LMICs). CONCLUSIONS: Sexual health research is critical during a global infectious disease pandemic and our review of studies suggested notable research gaps. Researchers can focus efforts on LMICs and under-researched topics within sexual health and explore the use of qualitative techniques and interventions where appropriate.

Women's cancers in China: a spatio-temporal epidemiology analysis.

BACKGROUND: Women's cancers, represented by breast and gynecologic cancers, are emerging as a significant threat to women's health, while previous studies paid little attention to the spatial distribution of women's cancers. This study aims to conduct a spatio-temporal epidemiology analysis on breast, cervical and ovarian cancers in China, thus visualizing and comparing their epidemiologic trends and spatio-temporal changing patterns. METHODS: Data on the incidence and mortality of women's cancers between January 2010 and December 2015 were obtained from the National Cancer Registry Annual Report. Linear tests and bar charts were used to visualize and compare the epidemiologic trends. Two complementary spatial statistics (Moran's I statistics and Kulldorff's space-time scan statistics) were adopted to identify the spatial-temporal clusters. RESULTS: The results showed that the incidence and mortality of breast cancer displayed slow upward trends, while that of cervical cancer increase dramatically, and the mortality of ovarian cancer also showed a fast increasing trend. Significant differences were detected in incidence and mortality of breast, cervical and ovarian cancer across east, central and west China. The average incidence of breast cancer displayed a high-high cluster feature in part of north and east China, and the opposite traits occurred in southwest China. In the meantime, the average incidence and mortality of cervical cancer in central China revealed a high-high cluster feature, and that of ovarian cancer in northern China displayed a high-high cluster feature. Besides, the anomalous clusters were also detected based on the space-time scan statistics. CONCLUSION: Regional differences were detected in the distribution of women's cancers in China. An effective response requires a package of coordinated actions that vary across localities regarding the spatio-temporal epidemics and local conditions.

Prevalence and risk factors for repeat induced abortion among Chinese women: a systematic review and meta-analysis.

OBJECTIVES: Repeat induced abortion is a significant public health problem in China. International knowledge about repeat induced abortion and its associated risk factors in Chinese women is scarce, and existing studies are hard to access for international scholars because most are published in Chinese. A systematic review was conducted to analyse the prevalence of repeat induced abortion among Chinese women and determine correlated risk factors. METHODS: Seven electronic databases were systematically searched. Data on the prevalence of repeat induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach. RESULTS: Of 2458 articles retrieved from seven databases, 21 were included in the study. The overall pooled prevalence of repeat induced abortion was 43.1% (95% confidence interval 36.7%, 49.5%). Of 25 exposures extracted, 15 factors were significantly correlated with repeat induced abortion, comprising seven individual demographic factors (i.e., age, education, employment, migrant status, parity, unhealthy lifestyle habits and region of residence), four reproductive health- and contraception-related factors (i.e., age at sexual debut, history of sexual activity, contraceptive knowledge and having a regular sexual life) and four sexual partner-related factors (i.e., multiple sexual partners, age of sexual partner, educational level of sexual partner and cohabitation with sexual partner). CONCLUSION: The study findings highlight the problem of repeat induced abortion in China and suggest the need for government and civil society to increase efforts to reduce the alarming risks of repeat induced abortion in Chinese women and make them and their sexual partners more aware and protective of their sexual and reproductive health.

External and Internal Validation of a Computer Assisted Diagnostic Model for Detecting Multi-Organ Mass Lesions in CT images.

Objective We developed a universal lesion detector (ULDor) which showed good performance in in-lab experiments. The study aims to evaluate the performance and its ability to generalize in clinical setting via both external and internal validation. Methods The ULDor system consists of a convolutional neural network (CNN) trained on around 80K lesion annotations from about 12K CT studies in the DeepLesion dataset and 5 other public organ-specific datasets. During the validation process, the test sets include two parts: the external validation dataset which was comprised of 164 sets of non-contrasted chest and upper abdomen CT scans from a comprehensive hospital, and the internal validation dataset which was comprised of 187 sets of low-dose helical CT scans from the National Lung Screening Trial (NLST). We ran the model on the two test sets to output lesion detection. Three board-certified radiologists read the CT scans and verified the detection results of ULDor. We used positive predictive value (PPV) and sensitivity to evaluate the performance of the model in detecting space-occupying lesions at all extra-pulmonary organs visualized on CT images, including liver, kidney, pancreas, adrenal, spleen, esophagus, thyroid, lymph nodes, body wall, thoracic spine, etc. Results In the external validation, the lesion-level PPV and sensitivity of the model were 57.9% and 67.0%, respectively. On average, the model detected 2.1 findings per set, and among them, 0.9 were false positives. ULDor worked well for detecting liver lesions, with a PPV of 78.9% and a sensitivity of 92.7%, followed by kidney, with a PPV of 70.0% and a sensitivity of 58.3%. In internal validation with NLST test set, ULDor obtained a PPV of 75.3% and a sensitivity of 52.0% despite the relatively high noise level of soft tissue on images. Conclusions The performance tests of ULDor with the external real-world data have shown its high effectiveness in multiple-purposed detection for lesions in certain organs. With further optimisation and iterative upgrades, ULDor may be well suited for extensive application to external data.

Diagnostic Performance of Acoustic Radiation Force Impulse Elastography for the Differentiation of Benign and Malignant Superficial Lymph Nodes: A Meta-analysis.

To estimate the diagnostic performance of acoustic radiation force impulse elastography in distinguishing between benign and malignant superficial lymph nodes, relevant articles published before October 31, 2018, in China and other countries were used. Conclusively, a total of 18 articles were analyzed. Sixteen studies used Virtual Touch tissue quantification (Siemens Healthineers, Erlangen, Germany), and 4 studies used Virtual Touch tissue imaging (Siemens Healthineers). After a meta-analysis, it was found that acoustic radiation force impulse elastography is an efficient method for detecting superficial lymph nodes. In addition, if the cutoff value for the shear wave velocity were less than 2.85 m/s, the summary sensitivity would increase, and the heterogeneity would be reduced.

Association between nonmedical use of opioids or sedatives and suicidal behavior among Chinese adolescents: An analysis of sex differences.

OBJECTIVE: The rising rate of suicidal behavior among adolescents is a growing concern, and sex differences may induce differential exposure to prescription drug misuse or suicidal behavior. We estimated, among Chinese adolescents, (1) the prevalence of nonmedical use of prescription drugs, suicidal ideation and suicide attempts; (2) whether nonmedical use of prescription drugs was independently associated with suicidal ideation and suicide attempts; and (3) whether there were sex differences in the associations. METHODS: This was a secondary analysis of the data drawn from the 2015 National School-based Chinese Adolescents Health Survey. A total of 94,911 students completed questionnaires and qualified for our survey (response rate: 93.7%). All analyses were conducted separately for boys and girls. RESULTS: There were significant sex differences in the prevalence of opioid or sedative misuse, and the sources and reasons for nonmedical use of prescription drugs ( p < 0.05). The prevalence of suicidal ideation or suicide attempts was significantly higher in girls than in boys (suicidal ideation: 17.9% among girls vs 14.1% among boys; suicide attempts: 3.5% among girls vs 2.7% among boys). Among girls, frequent use of opioids was associated with an increased risk of suicidal ideation (adjusted odds ratio = 1.84, 95% confidence interval = [1.57, 2.17]) and suicide attempts (adjusted odds ratio = 2.96, 95% confidence interval = [2.34, 3.74]), and frequent use of sedatives was also positively associated with suicidal ideation (adjusted odds ratio = 2.23, 95% confidence interval = [1.91, 2.60]) and suicide attempts (adjusted odds ratio = 4.02, 95% confidence interval = [3.25, 4.99]). These associations were also statistically significant in boys, but the magnitudes of adjusted odds ratios for the associations between frequent use of opioids and sedatives and suicidal behavior were greater in girls than boys. CONCLUSION: There exist significant sex differences in the prevalence rates of nonmedical use of prescription drugs and suicidal behavior, and the child's sex plays a role in the association between nonmedical use of prescription drugs and suicidal behavior. The significant sex differences found above may provide a basis for early identification of adolescents at high risk of suicidal behavior.

Association between body weight status and suicidal ideation among Chinese adolescents: the moderating role of the child's sex.

PURPOSE: Suicidality (ranging from suicidal ideation to suicidal attempts and completed suicide) is a major and preventable public health concern, and body weight is considered a modifiable factor which might be helpful to the early risk assessment of suicidal ideation. This study aimed to comprehensively evaluate the association of body weight status with suicidal ideation across sex among Chinese adolescents. METHODS: Data were drawn from the 2015 National School-based Chinese Adolescents Health Survey, and 54,640 students' questionnaires were completed and qualified for the survey. Body mass index z scores were calculated and categorized into four levels: underweight (less than the 5th percentile for sex and age), normal weight (between the 5th and 85th percentile), overweight (between the 85th and 95th percentile), and obese (above the 95th percentile). RESULTS: Of the total sample, 47.3% (25,852) were boys. The weighted prevalence of suicidal ideation among Chinese adolescents is 15.7% (14.6% in boys and 17.3% in girls). After adjusting for demographics, smoking, drinking, and depressive symptoms, our final multivariate logistic regression models demonstrated that only boys identified as underweight (Adjusted odds ratio [AOR] = 1.23, 95% CI = 1.06-1.44) or obese (AOR = 1.19, 95% CI = 1.02-1.38) were at a higher risk of suicidal ideation. Additionally, the association between weight status and suicidal ideation among boys might be moderated by academic pressure, smoking, and depressive symptoms. CONCLUSIONS: There was a significant J-shaped association between relative body weight and suicidal ideation in boys. The child's sex should be taken into consideration when developing interventions against unhealthy weight and suicidal ideation.

Association between weekday sleep duration and nonmedical use of prescription drug among adolescents: the role of academic performance.

Nonmedical use of prescription drug (NMUPD) among adolescents has increased substantially over the last 2 decades, and evidence suggests that sleep duration may impact upon drug use and academic performance. This study aimed to estimate the prevalence of sleep duration, NMUPD, and academic performance among Chinese adolescents, to test the independent associations of sleep duration with NMUPD, and to investigate whether these associations vary by academic performance. Data were from the 2015 School-based Chinese Adolescents Health Survey using a multi-stage, stratified-cluster, random-sampling method to collect information from 162,601 high school students [mean age (SD) =15.2 (1.9) years; 47.4% were male] from 42 cities in China. The weighted prevalence of sleeping ≤ 5 h/weekday was 1.1% (95% CI, 1.0-1.1%), and the weighted prevalence of sleeping > 9 h/weekday was 7.6% (95% CI 7.4-7.7%). After adjusting for significant covariates and academic performance, the results showed that compared with those with 7-9 h/weekday sleep duration, students reporting ≤5 h/weekday were more likely to misuse opioids (AOR = 2.12, 95% CI 1.73-2.59), sedatives (AOR = 2.00, 95% CI 1.65-2.42), and any prescription drug use (AOR = 1.89, 95% CI 1.60-2.23); students with>9 h/weekday sleep duration were also at a higher risk of opioids use, sedative use, and any prescription drug misuse; the U-shaped association of sleep duration with NMUPD was found. Moreover, there exist significant associations between weekday sleep duration and NMUPD among Chinese adolescents, and academic performance plays a moderating role in the aforementioned associations. The efforts to prevent NMUPD should be focused on adolescents who report abnormal sleep duration or poor academic performance.

Contraceptive practices among unmarried women in China, 1982-2017: systematic review and meta-analysis.

OBJECTIVE: Premarital sexual practices and contraceptive prevalence rate (CPR) among unmarried women in China remain unclear. We conducted a systematic review and meta-analysis to estimate CPR and analyse contraceptive methods used by unmarried women between 1982 and 2017. METHODS: Wanfang, The China National Knowledge Infrastructure Database, MEDLINE, PubMed and Web of Science were systematically searched. Data on CPR and use of major contraceptive methods were extracted and pooled using a DerSimonian-Laird random effects model. RESULTS: Of 188 articles retrieved from five databases, 22 studies met our inclusion criteria. Overall CPR based on a random effects meta-analysis was 32.2% (95% confidence interval [CI] 24.7%, 39.8%). Pooled rates of contraceptive use were 61.4% (95% CI 47.9%, 74.9%) for condoms, 25.9% (95% CI 14.5%, 37.4%) for pills, 19.8% (95% CI 8.9%, 30.8%) for the rhythm method and 25.4% (95% CI 14.2%, 36.7%) for the withdrawal method. CONCLUSIONS: The sexual and reproductive health situation of unmarried women in China seems to have improved little since the 1990s. Our findings may help to optimise reproductive health care programmes and thereby reduce the alarming rates of unplanned pregnancies and abortions among unmarried women in China.

Contraception determinants in youths of Sierra Leone are largely behavioral.

BACKGROUND: Sexual initiation occurs early in Sierra Leone. This study aims to analyze the determinants of condom and/or contraceptive use among a representative sample of young persons (10 to 24 years) in Sierra Leone. METHODS: This is a secondary analysis of data from a study conducted to monitor the implementation of a UNFPA package of interventions directed to improve SRH in young people of Sierra Leone. This assessment was conducted in 2016 at the end of the Ebola outbreak. In consequence, determinants linked to healthy lifestyle behaviors and UNFPA interventions were explored in addition to the usual determinants: socio demographic and sexual lifestyle. This study is a household quantitative survey with open ended questions used to illustrate and complete the analysis. RESULTS: A total of 1409 young people were interviewed: of these, 216 boys and 381 girls were sexually active. Those who were pregnant or wished for pregnancy were excluded, leaving 194 boys and 268 girls for the analysis of determinants. The proportion of young people using neither condom nor other contraception at their last sexual intercourse in the whole sample was 40.5% and there was no statistically significant difference between boys and girls (42.3 vs 39.2; P = 0.504). Determinants were assessed and, after multivariable analysis, results differed between boys and girls and showed the importance of behavioral aspects. Four determinants were common to boys and girls: literacy, distance, negotiation capacity and hand washing. However, the distance factor for girls was to the health facility and for boys it was to school. Three more determinants remained in the boy's model: sleeping under a bednet, number of sexual partners and knowledge of contraceptive methods. Opinions about condoms and contraception revealed important barriers; opposition to contraceptive use was the main reason for non-use for both boys and girls, while lack of access was an important reason for boys. CONCLUSION: There is a need to reach out to the 40% of young people who are sexually active and neither pregnant nor with pregnancy desire, and are not using condom or contraception.

A qualitative exploration of perceptions and experiences of contraceptive use, abortion and post-abortion family planning services (PAFP) in three provinces in China.

BACKGROUND: The INPAC project aims to evaluate the effectiveness of integrated post-abortion family planning (PAFP) services into existing hospital based abortion services in China. A qualitative study was conducted in three provinces to contribute to developing effective PAFP services through understanding influences on contraceptive use, experiences of abortion and existing PAFP, and their effect on future contraceptive practices from the perspective of users, in the context of social and institutional change. METHODS: Twenty-nine in-depth interviews (IDIs) were undertaken with women who had experienced abortion between 1 and 6 months prior to interview, recruited from three urban and two rural facilities in each province. Thirteen IDIs were also conducted with male partners. Six focus group discussions (FGDs) were carried out with community members from different social groups, including unmarried and married women and men, urban residents and rural-to-urban migrants. RESULTS: Social networks and norms are important in shaping attitudes and behaviour towards abortion and contraception. Widespread concerns were expressed about side-effects, reliability and effects on future fertility of some modern contraceptives. The combination of limited information and choices and a lack of person-centred counselling in PAFP with anxieties about side effects underlies the widespread use of unreliable methods. Gendered power relations significantly influence contraceptive (non)use, with several examples illustrating women's relative lack of power to decide on a method, particularly in the case of condoms. Although the availability of contraceptive information from respected providers can offer impetus for individual behaviour change, social distance from providers reduces opportunities for clients to discuss their difficulties regarding contraceptive use; particularly, but not exclusively for young, unmarried clients. CONCLUSIONS: Increased access to non-commercial, reliable information on contraceptive methods is needed. PAFP services must go beyond simple information provision to ensure that providers take a more person-centred approach, which considers the most appropriate method for individual clients and probes for the underlying influences on contraceptive (non)use. More sensitive reflection on gender norms and relationships is required during counselling and, where women choose this, efforts should be made to include their male partners. Specific attention to provider positionality and skills for counselling young, unmarried clients is needed.

Post-abortion family planning counselling practice among abortion service providers in China: a nationwide cross-sectional study.

OBJECTIVE: To assess the practice of post-abortion family planning (PAFP) counselling among Chinese abortion service providers, and identify the influencing factors. METHODS: A cross-sectional questionnaire survey was conducted between July and September 2013 among abortion services providers in 30 provinces in China. Univariate and multivariable logistic regression analyses were used to identify the factors that influenced PAFP counselling. RESULTS: 94% of the 579 service providers responded to the questionnaire in the survey. The median age was 39 years (range 20-72), and 95% were females. 92% providers showed a positive attitude and had promoted the PAFP counselling services; however, only 57% spent more than 10 min for it. The overall knowledge on PAFP was limited to the participants. After adjusting for potential confounding factors: providers from the middle region (compared with 'east region', ORadj = 3.33, 95% CI: 2.12-5.21) conducted more PAFP counseling; providers with more knowledge (ORadj = 2.08, 95% CI: 1.38-3.15) provided more counseling; and compared with 'middle school and below', providers with higher education gave more counseling [ORadj(95% CI)] for 'college', 'university' and 'master/doctor' [1.99 (1.01,3.92), 2.32 (1.22,4.40) and 2.34 (1.06,5.17), respectively]. CONCLUSIONS: The majority of providers could provide PAFP counselling to women undergone an abortion, but some of them had insufficient time to make it available. Education, knowledge about fertility and reproductive health and residence region were the main factors influencing the practice. Training of health providers and integrating family planning as a part of abortion services are essential to provide adequate PAFP to abortion seekers, thereby reducing the risk of unintended pregnancy.