The Fertility Status of the Married People Living with HIV/AIDS in China.

In order to analyze the fertility status of the married people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLHA) of reproductive age in China, a sample of married PLHAs aged 22-45 in China is selected by using a stratified cluster sampling method. All participants are face-to-face interviewed with a structured questionnaire. Among them, the fertility status and its influencing factors of 366 PLHAs are statistically analyzed. Experimental results show that married PLHA of reproductive age in China has a high proportion of having children. The fertility status and fertility intention of females are higher than that of males. The proportion of unwanted pregnancies after the HIV + diagnosis of females is high.

Cognitive bias toward the Internet: The causes of adolescents' Internet addiction under parents' self-affirmation consciousness.

The Internet plays a crucial part in the adolescent life. However, as a product of modernization, the Internet has brought a lifestyle different from that of our parents who tend to regard excessive exposure to the Internet as a manifestation of the adolescent Internet addiction. The cognitive bias against the Internet seem to have been arisen among the parents. Under the theoretical framework of self-efficacy and empathy, this study adopts PLS-SEM to analyze the contributing factors of the adolescent Internet addiction from the perspective of self-affirmation consciousness of parents. The result demonstrates that self-affirmation consciousness has a significant positive effect on the empathy process; the empathy process and self-affirmation have a significant positive effect on cognitive bias; and the empathy process acts as a mediator between self-affirmation and cognitive bias. To sum up, through the investigation of the causes of adolescent Internet addiction, this study explores the formation process of parents' cognitive bias toward the Internet under the influence of self-affirmation consciousness, verifying the practical effects of empathy in the process of promoting rational thinking of parents toward the Internet and adolescent Internet use, and at the same time promoting the harmonious development of parent-child relationships to a certain extent.

Prevalence and factors associated with fertility desire among people living with HIV: A systematic review and meta-analysis.

BACKGROUND: The fertility desire of people living with HIV (PLHIV) has been rising in the past decade. However, there are many studies among which the association remains controversial between the fertility desire of HIV-infected persons and antiretroviral therapy (ART), sex, marital status, and educational level. METHODS: We performed a literature search of these meta-analyses in PubMed, the Cochrane Library, Web of Science and ScienceDirect in November 2019. We also reviewed references of eligible studies to complement the search. We used pooled odds ratios (ORs) and 95% confidence intervals (CIs) with a random-effects model and a fixed-effects model to estimate the association between fertility desire among PLHIV and ART, sex, age, marital status, educational level, and number of children. Subgroups with I square values (I2) and sensitivity analyses were performed to assess the heterogeneity and the stability of the overall ORs, respectively. We evaluated publication bias using Egger's test and a visual inspection of the symmetry in funnel plots. RESULTS: In these meta-analyses 50 articles were included with 22,367 subjects. The pooled prevalence of fertility desire among PLHIV was estimated to be 42.04%. The pooled analyses showed that the fertility desire of PLHIV is associated with ART (OR = 1.11, 95% CI:1.00-1.23, P = 0.043), sex (OR = 1.51, 95% CI:1.10-2.09), age (OR = 2.65, 95% CI:2.24-3.14), marital status (OR = 1.34, 95% CI:1.08-1.66), educational level (OR = 0.85, 95% CI:0.73-1.00, P = 0.047) and the number of children (OR = 3.99, 95% CI:3.06-5.20). PLHIV who are on ART, are male, are younger than 30, are married/cohabiting, have received a secondary education or above, and are childless have a higher prevalence of fertility desire. The two factors of age and the number of children, in particular demonstrated a strong significant association with fertility desire. We found moderate heterogeneity in the meta-analyses of age and educational level and high heterogeneity in the meta-analyses of sex, marital status and number of children. Publication bias was detected in the meta-analyses of the association of fertility with sex and educational level. CONCLUSION: This study demonstrates that the prevalence of fertility desire among HIV-infected people is 42.04%, and the fertility desire among PLHIV is associated with ART experience, sex, age, marital status, the number of children, and educational level. Since a majority of PLHIV are of reproductive age, it is necessary to support PLHIV in terms of their needs regarding reproductive decision-making. Through counseling and reproductive health care, further measures to prevent the horizontal and vertical transmission of HIV should be taken.

[The role and mechanism of endoplasmic reticulum stress key factor PREK in myoblast apoptosis under stress loading].

PURPOSE: This study was aimed to figure out the way that cyclic-stretch influenced the apoptosis of myoblasts and evaluate the importance of PERK and its possible mechanism involved. METHODS: L6 rat myoblasts were cultured in vitro and mechanical stimulation model was constructed successfully. The myoblasts were imposed tension for 0, 2, 6, 12 and 24 hours respectively by multi-channel cell stress loading system. The force value was 15% cell deformation and the frequency was 10 cycles/min. Each cycle was consisted of stretch for 3 seconds and relaxation for 3 seconds, and the group without tension was used as the control group. The apoptotic myoblasts were dyed by DAPI and observed through fluorescence microscopy to detect the apoptosis rate; the mRNA levels of PERK and CHOP in different groups were detected by real-time PCR and protein levels of PERK and p-PERK in different groups were detected by Western blot. PERK inhibitor was used to clear the role of PERK in apoptosis induced by cyclic-stretch and clarify the relationship between the endoplasmic reticulum stress and apoptosis induced by cyclic-stretch. SPSS 17.0 software package was used to analyze the data statistically. RESULTS: DAPI nuclear stain showed that cyclical tensile stress can induce apoptosis in vitro cultured myoblast. Apoptosis rate showed a trend of rising gradually over time, peaked at 24 h. After dealt with the inhibitor of PERK, the apoptosis rate of the 24 h group under the cyclic stretch showed no difference compared with the control. The results of real- time PCR showed that the mRNA of CHOP was increased with the extension loading time, while the mRNA of PERK showed no difference compared with the control. Western blot results showed that the protein level of p-PERK was increased with the extension of loading time, while the expression of PERK showed no difference compared with the control group. When PERK inhibitor added, the mRNA level of CHOP along with the protein expression level of p-PERK showed no significant difference compared to the control. CONCLUSIONS: PERK signaling pathway is involved in the apoptosis of myoblasts induced by cyclic stretch, and the possible mechanism may be closely related to the phosphorylation of PERK.

Individual and family level factors associated with physical and mental health-related quality of life among people living with HIV in rural China.

BACKGROUND: One of the major challenges faced by people living with HIV (PLH) is the compromised quality of life due to the negative impact of HIV on their health. HIV/AIDS control effort should go beyond laboratory and lay more emphasis on improving the health-related quality of life (HRQoL) for PLH. The objective of this study is to evaluate the physical and mental HRQoL of PLH in rural China, and explore the relationship between HRQoL and individual- and family-level factors. METHODS: A cross-sectional study was conducted among 522 PLH in Anhui, China. Participant's sociodemographic characteristics, family status, and HIV-related factors were collected. Physical health summary score (PHS) and mental health summary score (MHS) of quality of life were measured. Multiple linear regressions were conducted to estimate the association of the individual- and family-level factors with MHS and PHS. RESULTS: Male were more likely to report a higher level of PHS and MHS than female (ß = 0.123, P = 0.009; ß = 0.150, P = 0.002). Age was significantly negatively associated with the PHS (ß = - 0.232, P<0.001) when other variables were controlled. Family size remained negatively correlated with PHS (ß = - 0.105, P = 0.021). Family annual income was significantly positively associated with PHS and MHS (ß = 0.126, P = 0.003; ß = 0.135, P = 0.002). CONCLUSIONS: Future intervention should be carefully tailored to the specific needs of sub-populations (such as female and older PLH) considering their physical and mental HRQoL conditions. More attention and care should be provided to PLH with left-behind children in the family.

Changes in behavioral outcomes among children affected by HIV: Results of a randomized controlled trial in China.

This study assessed the effects of a multilevel intervention on HIV-affected children's negative behaviors. A total of 536 children aged 6-18 years from 475 HIV-affected families in Anhui, China, participated in the randomized controlled trial. A significant overall intervention effect on reducing negative behaviors was observed at 18-month follow-up, and the effect remained at 24-month follow-up. The intervention showed greater effects for children aged 13-18 years than those aged 6-12 years. Study findings suggest that a multilevel intervention approach could be beneficial for reducing negative behavior in HIV-affected children. Age-specific programs should be considered to maximize the intervention effects.

Analysis of the quality of life and its related factors among children aged 4-5 years old in rural areas of Anhui Province / 中国学校卫生

Objective@#To understand the status and related factors of quality of life (QOL) among children aged 4-5 years old in rural areas of Anhui Province, and to provide a reference for improving the quality of life among children in rural areas.@*Methods@#A total of 4 457 preschool children aged 4-5 years old were selected from rural areas in five counties of Anhui Province by cluster sampling method. Parents of children were surveyed using the Pediatric Quality of Life Inventory Measurement Models 4.0.@*Results@#The total QOL score of children aged 4-5 years old in rural areas of Anhui Province was (79.44±12.51). The scores of emotional function, school performance and psychosocial summary were higher in left-behind children than that in non-left-behind children(t=2.99, 3.51, 3.22, P<0.05). Multivariate Logistic regression analysis showed that the older children (OR=0.82, 95%CI=0.71-0.95) and the bigger size of households (OR=0.85, 95%CI=0.73-0.98) were positively associated with quality of life of children, while the higher father’s educational level(OR=1.40, 95%CI=1.21-1.62), the lower father’s income, mothers doing housework or unemployment and children suffering from illness in the past two weeks (OR=1.76, 95%CI=1.50-2.06) were negatively associated with quality of life of children(P<0.05).@*Conclusion@#The quality of life of children aged 4-5 year old in rural areas of Anhui Province is relatively low. The children’s age, the father’s education level, the father’s annual income, the mother’s occupation, the size of households, and children suffering from illness in the past two weeks were the related factors that affectchildren’s quality of life.

Behavioral Problems Reported by Adolescents and Parents from HIV Affected Families in China.

This study examined the influence of various factors on the behavioral problems of adolescents affected by HIV while considering the agreement between adolescent and parent reports on problem behaviors. A total of 136 families each with one parent living with HIV (PLH) and one child aged 13-18 were included. Structural equation modeling was used to explore relationships between selected family measures and adolescent's problem behaviors. The correlation between the PLH and adolescent-reported behavioral problem measures was low (ß = 0.11). PLH-reported adolescent problem behaviors were negatively related to PLH-reported parental bonding (ß = -0.39), family routines (ß = -0.26), and positively associated with family conflict (ß = 0.21). Adolescent-reported family participation was associated with self-reported problem behaviors (ß = -0.35). Our study reported discrete perceptions of adolescent problem behaviors from parents' and adolescents' points of view. Future intervention efforts should emphasize family contextual factors to improve behavioral outcomes in adolescents affected by HIV.

Prevention of mother-to-child transmission of HIV services in China: A conversation between healthcare professionals and migrant women with HIV.

In China, the access to prevention of mother-to-child transmission (PMTCT) of HIV services is particularly low among migrant population, which remains a challenge in the fight against HIV/AIDS. The study is aimed to investigate the PMTCT continuum for migrant women with HIV (MWHIV) and to identify barriers and potential strategies to improve the service delivery. The study started with a first round of focus group discussions with 20 healthcare professionals to map out the local PMTCT service cascade, followed by in-depth interviews with 20 recently delivered MWHIV to explore their perceived barriers along each step of the cascade, and a final round of focus groups with healthcare professionals to identify potential strategies to improve the PMTCT continuum. Lack of knowledge of antenatal care, stigma and discrimination in healthcare settings, inadequate provider-patient communication were major barriers hindering the PMTCT service utilization. Potential strategies to enhance the PMTCT uptake included broaden publicity to the general population and using mobile phone application for health education. The issues of HIV designated hospital and integration of postpartum and neonatal care were also discussed. The study allowed the healthcare professionals to recognize the service gaps along the PMTCT continuum and identified potential solutions for service improvement.

Gender Differences in Depressive Symptoms Among HIV-Positive Concordant and Discordant Heterosexual Couples in China.

HIV seropositive individuals and their heterosexual partners/spouses, either seropositive or seronegative, are facing several mental health challenges. The objective of this study was to examine gender differences in depressive symptoms among HIV-positive concordant and HIV-discordant couples. We identified heterosexual couples from participants of a randomized controlled trial conducted in Anhui province, China. A total of 265 couples, comprising 129 HIV+ male/HIV- female couples, 98 HIV- male/HIV+ female couples, and 38 HIV-positive concordant couples, were included in the analyses. We collected data using the computer-assisted personal interview method. We used a linear mixed-effects regression model to assess whether gender differences in depressive symptoms varied across couple types. HIV-positive women reported a significantly higher level of depressive symptoms than their partners/spouses. HIV-positive women with HIV-positive partners had higher depressive symptoms than those with HIV-negative partners, whereas HIV-positive men reported similar levels of depressive symptoms regardless of their partners' serostatus. Among the concordant couples, those with the highest annual family income showed the greatest gender differences in depressive symptoms. We suggest that family interventions should be gender- and couple-type specific and that mental health counseling is warranted not only for HIV-positive women but also for HIV-negative women in an HIV-affected relationship.

Efficacy of a multilevel intervention on the mental health of people living with HIV and their family members in rural China.

OBJECTIVE: HIV has a profound impact on infected individuals and their families. This study evaluated the efficacy of an intervention aimed at improving the mental health of people living with HIV (PLH) and their family members. METHOD: A randomized controlled trial of 475 PLH and 522 family members was conducted in Anhui, China. The intervention comprised activities at individual, family, and community levels. The study outcomes, which included depressive symptoms and coping with illness for the PLH and depressive symptoms and caregiver burden for the family members, were assessed at baseline and at 6-, 12-, 18-, and 24-month follow-up. We used a mixed-effects regression model with village- and participant-level random effects to assess the intervention effect on the improvement of outcome measures. RESULTS: Relative to the control condition, the PLH and family members of the intervention group reported a significant reduction in depressive symptoms. The largest difference in depressive symptoms was observed at 6 months for the PLH and at 12 months for family members. Decreases in perceived caregiver burden over time were observed for family members in both conditions; however, the group difference did not reach statistical significance. Significant intervention effect on the coping with illness was reported by the PLH. CONCLUSIONS: The study highlights the importance of empowering families affected by HIV to confront the challenges together rather than individually. It may be optimal for future programs to include both PLH and their family members to maximize intervention effects through strengthening interactions and support within a family. (PsycINFO Database Record

Spousal role and caregiver burden in HIV affected families in Anhui Province, China.

This study examined the burden experienced by various roles of family caregivers of people living with HIV (PLH), in particular spouses vs. non-spouses. A total of 475 family members of PLH were recruited from Anhui Province, China. Participants responded to a survey using the Computer Assisted Personal Interview method. The assessment collected data on demographic characteristics and their perceived caregiver burden, which was compared between spouses and non-spouses. Multiple regression models were built to identify factors associated with caregiver burden. About 64.4% of our study participants were female and the mean age was 42.1 years. Among various relationships to PLH, almost half reported being a spouse. Spouses reported significantly higher caregiver burden than non-spouses. In addition, older age and lower family income were significantly associated with higher level of caregiver burden. Among the subsample of spouses, significantly higher level of caregiver burden was identified among wives. Future studies should give special consideration to address the needs of female spouses in order to reduce their caregiver burden.

Post-traumatic Stress Disorder Symptoms Among People Living with HIV/AIDS in Rural China.

Among people living with HIV/AIDS (PLHA), the occurrence of post-traumatic stress disorder (PTSD) symptoms associated with HIV diagnosis is a common problem. This study examined HIV diagnosis-related PTSD symptoms and its associated factors among PLHA in rural China. We used baseline data from a randomized controlled trial conducted in Anhui Province, China. Surveys of 522 PLHA were conducted via computer-assisted personal interview method. PTSD symptoms were measured based on re-experiencing, avoidance and arousal of the day of HIV diagnosis. Association between PTSD symptoms and demographic characteristics, physical and social functioning were assessed by multiple regression analysis and structural equation modeling. Social functioning exhibited a direct association with HIV diagnosis-related PTSD symptoms, and also mediated the association between PTSD symptoms and age, family income, and physical functioning. The study findings underscore the importance of developing interventions that alleviate PTSD symptoms and improve social functioning among PLHA in rural China.

Gendered aspects of perceived and internalized HIV-related stigma in China.

Although studies have demonstrated that females experience more HIV-related stigma than males do, questions remain regarding the different dimensions of the stigma (i.e., perceived versus internalized) in China. The present study investigated gender differences in perceived and internalized HIV-related stigma, taking into account the potential influence of education. The study was conducted between October 2011 and March 2013. A total of 522 people living with HIV (PLH) were recruited from Anhui Province, China. The PLH participated in a survey using the Computer Assisted Personal Interview (CAPI) method. The gender differences in perceived and internalized HIV-related stigma were calculated with and without stratifying by education level. Female participants had significantly less education than the male participants. No significant difference was observed between females and males with respect to perceived stigma. However, females reported significantly higher internalized stigma than males did (p < .001). When socio-demographic characteristics were controlled, the gender difference in internalized stigma remained significant among educated participants (p = .038). The findings suggested that gender differences in HIV-related stigma were primarily found for internalized stigma. Heightened intervention efforts are encouraged to reduce internalized HIV-related stigma, particularly among female PLH in China and other regions with similar gender dynamics.

Perceived Bonding by Parents Living with HIV and Their Adolescent Children.

This study examined the associations between parent and adolescent reports of bonding within families and the relationships among reported parental bonding, family conflict and adolescent stress. A total of 118 families from Anhui, China, were recruited for this study. Two family-level bonding scores were constructed: the average of and difference between parent and adolescent bonding scores. Study results indicated that the difference between parent and adolescent bonding reports was associated with higher levels of adolescent daily stress. A negative association was observed between average family-level bonding and the level of parent-reported conflict. Our findings highlight the importance of combining data from both parents and adolescents when studying issues related to family wellbeing.

[Factors influencing the quality of life of 104 children with phenylketonuria in Anhui Province, China].

OBJECTIVE: To investigate the factors influencing the quality of life (QOL) of children with phenylketonuria (PKU) in Anhui Province, China. METHODS: A total of 104 PKU children who were diagnosed and treated in three major maternal and child health hospitals in Anhui Province were enrolled as study subjects. The PedsQL™ 4.0 Generic Core Scales were used to evaluate the quality of life of these children. The multivariate logistic regression analysis was used to evaluate the factors influencing the QOL. RESULTS: The 104 PKU children had significantly lower overall QOL score and scores on the subscales of physiological functioning, emotional functioning, and social functioning than the general school-age children (P<0.01). They also had a significantly lower score on the physiological domain consisting of emotional functioning, social functioning, and role functioning than the general school-age children (P<0.01). The multivariate logistic regression analysis showed that an older age (≥4 years) of PKU children was the risk factor for poor QOL (OR=8.569, P<0.01), and guardians' engagement at enterprises or institutions was the protective factor for QOL (OR=0.206, P<0.05). CONCLUSIONS: PKU children have a low level of QOL, and age and guardians' occupation are factors influencing the QOL.

Community Disclosure by People Living With HIV in Rural China.

The decision to disclose HIV serostatus is a complex and a challenging task because of potential stigma, blame, and fear associated with HIV infection. Despite continued research on HIV disclosure, literature on HIV disclosure to community is still scarce. The purpose of the study is to describe patterns of HIV status disclosure to community members in a sample of HIV-infected men and women in rural China. This study used the baseline data of a randomized controlled intervention trial for HIV-affected families in China. The data was collected between late 2011 to early 2013. In addition to demographic and HIV-related clinical characteristics, we collected the extent of HIV disclosure to members within the community. We first calculated descriptive statistics and frequencies to describe the demographics of the sample. We then compared the extents of HIV disclosure to different community members. We performed chi-square tests to determine whether the demographic and socioeconomic variables were associated with the extent of HIV disclosure to community. A total of 522 PLH were included in the study. The results show that age and family income are associated with the extent of disclosure of HIV status to members within the community, including neighbor, village leaders, people in the village, and coworkers. More disclosures were found among older age groups. People with less family income tend to disclose more to the community than those with higher family income. There is a need to explore the association of HIV disclosure to the community to help realize the public health and personal implications of disclosure. Our results underscore the potential benefits of age and socioeconomic status-specific interventions in the efforts to dispel barriers to HIV status disclosure to the community.

Antiretroviral Therapy Initiation Following Policy Changes: Observations From China.

China's HIV/AIDS treatment policies have been evolving over the preceding decade. This study describes patterns of antiretroviral therapy (ART) initiation for a sample of people living with HIV/AIDS (PLHIV) in rural Anhui, China, where most PLHIV were infected via paid plasma donation during the 1990s. A total of 481 PLHIV who were receiving ART were included in our analyses. Times between HIV diagnosis and the initiation of ART were examined relative to the time points when major ART-related policies changed in China. More than half (53%) of PLHIV who had been diagnosed by 2003 received ART within 6 months, whereas 93% of PLHIV who had been diagnosed in 2010 or later received ART within 6 months. The study results provide additional support that the "Four Frees and One Care" policy in 2003 and the relaxation of ART eligibility in 2010 have facilitated the initiation of treatment for PLHIV in China.

Exploring Coping and Social Support with Gender and Education Among People Living with HIV in China.

Social support promotes positive coping strategies among people living with HIV (PLH); however, little is known about the various aspects of social support and their distinct effects on coping. The present study investigates the specific links between coping and perceived social support with respect to gender and education among PLH. A total of 522 PLH in Anhui, China, participated in an assessment that collected data on demographics, perceived tangible and emotional support, and cognitive and behavioral coping. The assessment was conducted using the computer-assisted personal interviewing method. The data were analyzed using linear mixed models. Emotional support was significantly associated with both cognitive and behavioral coping. Tangible support was significantly associated with behavioral coping but not with emotional coping. Women reported significantly lower levels of emotional support, cognitive coping, and behavioral coping than men did. Significant associations between tangible support and coping were found only among illiterate males. Women living with HIV are in greater need of social support and coping strategies. Future interventions should be gender specific, with targeted support for women with lower education levels to enhance their coping strategies.

Clinical role of circulating miR-223 as a novel biomarker in early diagnosis of cancer patients.

BACKGROUND: Current diagnostic procedures of cancers are invasive and non-specific. MicroRNAs (miRNAs) have become promising molecular markers for gastric cancer (GC) predication. However, there have been inconsistencies in the literature regarding the suitability of circulating miRNAs for early detection of cancers. METHODS: We performed a comprehensive meta-analysis to integrate an evaluation index for diagnostic accuracy of miR-223 in diagnosing cancer patients. Furthermore, we conducted an independent validation set of 50 gastric cancer patients and 50 healthy controls comparing miR-223 expression. We also analyzed miR-223 expression in vitro. RESULTS: A total of 11 studies met the inclusion criteria and therefore included in this meta-analysis. We found that miR-223 yielded a pooled area under ROC curve (AUC) of 0.89 (sensitivity: 81%, specificity: 84%) in discriminating cancer from controls. In our validation test, plasma miR-223 levels in GC patients were significantly higher than that in healthy controls (P<0.01). ROC curve analysis showed that AUC was 0.812 with a sensitivity of 70% and specificity of 80%. Moreover, the expression trend of miR-223 in plasma samples was in accordance with that of tissue and cell samples. CONCLUSION: Current evidences suggested that plasma miR-223 could be a reliable and non-invasive biomarker for cancer diagnosis. Further large-scale prospective studies are necessary to validate their potential applicability in human cancer diagnosis.