Outpatient depression current care expenditure changes in Liaoning Province from 2015 to 2020: a study based on the "system of health accounts 2011".

Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the "System of Health Accounts 2011" (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations. Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal-Wallis H test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM). Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015-2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees' health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure. Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication.

Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV.

Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.

The association between prenatal psychosocial factors and autism spectrum disorder in offspring at 3 years: a prospective cohort study.

PURPOSE: Few studies of risk factors for autism spectrum disorder (ASD) have been prospective in design or investigated the role of psychosocial factors measured during pregnancy. We aimed to investigate associations between prenatal psychosocial factors and risk of ASD in offspring, as part of a multicenter prospective cohort study of more than 2000 mother-child pairs. METHODS: Nulliparous women aged 18-35 years, living in Pennsylvania, USA, were interviewed during pregnancy and multiple times postpartum over the course of a 3-year period. There were 2388 mothers who completed the Screen for Social Interaction Toddler Version (SSI-T), a measure of risk of ASD, when their child was 3-years old. Multivariable logistic regression models were used to investigate the associations between prenatal psychosocial factors-including total scores on three scales (social-support, stress and depression), trouble paying for basic needs, mental illness diagnosis and use of antidepressants-and risk of ASD in offspring at the age of 3-years, controlling for relevant confounding variables. RESULTS: There were 102 children (4.3%) who were scored as at-risk of ASD at 3-years. Prenatal psychosocial factors that were significantly associated with risk of ASD in the adjusted models were lower social-support (p < 0.001); stress (p = 0.003): depression (< 0.001), trouble paying for basic needs (p = 0.012), mental illness diagnosis (p = 0.016), and use of antidepressants (p < 0.001). CONCLUSION: These findings suggest that maternal experience of adverse psychosocial factors during pregnancy may be important intrauterine exposures related to the pathogenesis of ASD.

Betel quid use is associated with anemia among both men and women in Matlab, Bangladesh.

Anemia accounts for 8.8% of total disability burden worldwide. Betel quid use among pregnant women has been found to increase anemia risk. Betel quid is prepared by wrapping the betel (or areca) nut, with spices and other additions, in betel or tobacco leaf and it is chewed or placed in the mouth. We explored the association between betel quid use and anemia among men and non-pregnant women. We collected data from a random sample of women and their husbands in Matlab, Bangladesh. Participants reported their current betel quid use and individual characteristics. We assessed hemoglobin (a biomarker of anemia) with a hemoglobinometer and soluble transferrin receptor (a biomarker of iron deficiency) and C-reactive protein (a biomarker of inflammation) in dried blood spots via enzyme immunoassay. We estimated logistic regression models to evaluate the association between betel quid use and anemia and structural equation models (SEM) to evaluate mediating roles of iron deficiency and elevated inflammation. A total of 1133 participants (390 men and 743 non-pregnant women) were included. After controlling for important confounders, any betel quid use was positively associated with anemia among men (OR: 1.80; 95% CI: 1.12, 2.89). Among women, betel quid use was associated with anemia only among the most frequent users (OR: 1.62; 95% CI: 1.03, 2.53). SEM did not reveal indirect paths through inflammation or iron deficiency. Betel quid use may contribute to the burden of anemia among adults in Bangladesh. Our findings suggest the burden of disease attributed to betel quid use has been underestimated.

Helping first-time mothers establish and maintain breastfeeding: Access to someone who can provide breastfeeding advice is an important factor.

BACKGROUND AND AIMS: First-time mothers often need help with breastfeeding and may feel isolated and uncertain about whom they can turn to for help with breastfeeding challenges. Exploration of whether access to breastfeeding advice helps new mothers initiate and continue breastfeeding is necessary. This study investigated the associations between ease of access to breastfeeding advice for first-time mothers and breastfeeding initiation and duration. METHODS: This was a prospective, longitudinal cohort study of 3,006 women who delivered their first child in Pennsylvania, USA; with prenatal and postpartum interviews. At 1-month postpartum participants reported the extent to which they had access to "Someone to give you advice about breastfeeding if you needed it", via a 5-point scale ranging from "none of the time" to "all of the time". RESULTS: There were 132 women (4.4%) who reported that they had access to someone to give them advice about breastfeeding "none of the time"; 697 (23.3%) reported access "a little of the time" or "some of the time"; and 2,167 (72.3%) reported access "most of the time" or "all of the time". While the majority of the new mothers were breastfeeding at 1-month postpartum (72.5%), less than half were still breastfeeding at 6-months postpartum (44.5%). The higher the level of access to advice about breastfeeding the more likely women were to establish breastfeeding by 1-month postpartum and to still be breastfeeding at 6-months. CONCLUSIONS: For first-time mothers, ease of access to someone who can give them advice about breastfeeding facilitates breastfeeding establishment and continuation.

English as a foreign language writing anxiety and its relationship with self-esteem and mobile phone addiction among Chinese medical students-A structural equation model analysis.

Medical students in China and other non-English speaking countries are susceptible to English as a Foreign Language (EFL) writing anxiety. English writing is not only a vital component tested for admission to postgraduate and doctoral programs, but it is also critical for the publication of academic papers. Although there is mounting evidence indicating relationships between anxiety, self-esteem and mobile phone addiction, pathways between these three constructs within a structural equation model have not yet been examined. Furthermore, there has been a dearth of studies exploring EFL writing anxiety, from which medical students in China as well as other non-English speaking countries are prone to suffer. The study was to assess EFL writing anxiety among Chinese medical students and to examine the relationships between EFL writing anxiety, self-esteem, and mobile phone addiction, with an aim to offer empirical evidence for effective preventive or intervention measures to alleviate EFL writing anxiety. Cross-sectional data were obtained from 1,238 medical students in China, with the administration of a self-administered questionnaire comprising the Second Language Writing Anxiety Inventory (SLWAI), the Rosenberg Self Esteem Scale (RSES) and the Mobile Phone Addiction Tendency Scale (MPATS). The results indicated that both self-esteem and mobile phone addiction exerted significant direct effects on EFL writing anxiety. Self-esteem also had a significant indirect effect on EFL writing anxiety via the mediating role of mobile phone addiction. The path coefficients of self-esteem on EFL writing anxiety were significantly reduced when mobile phone addiction was modeled as a mediator. Efforts to alleviate EFL writing anxiety among medical students may benefit from enhancing self-esteem and establishing a healthy relationship with mobile phones.

Timing of hospital admission at first childbirth: A prospective cohort study.

BACKGROUND AND AIMS: It is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women's labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress. METHODS: This was a cohort study of 1,656 primiparous women aged 18-35 years with singleton pregnancies who began labor spontaneously at home and delivered at 52 hospitals in Pennsylvania, USA. Women who were admitted before their contractions had become regular and ≤ 5-minutes apart (early admits) were compared to those who were admitted after (later admits). Multivariable logistic regression models were used to assess associations between timing of hospital admission and active labor status on admission (cervical dilation 6-10 cm), oxytocin augmentation, epidural analgesia and cesarean birth. RESULTS: Nearly two-thirds of the participants (65.3%) were later admits. These women had labored for a longer time period before admission (median, interquartile range [IQR] 5 hours (3-12 hours)) than the early admits (median, (IQR) 2 hours (1-8 hours), p < 0.001); were more likely to be in active labor on admission (adjusted OR [aOR] 3.78, 95% CI 2.47-5.81); and were less likely to experience labor augmentation with oxytocin (aOR 0.44, 95% CI 0.35-0.55); epidural analgesia (aOR 0.52, 95% CI 0.38-0.72); and cesarean birth (aOR 0.66, 95% CI 0.50-0.88). CONCLUSIONS: Among primiparous women, those who labor at home until their contractions have become regular and ≤ 5-minutes apart are more likely to be in active labor on hospital admission and less likely to experience oxytocin augmentation, epidural analgesia and cesarean birth.

Mindfulness for mediating the relationship between self-control and alexithymia among Chinese medical students: A structural equation modeling analysis.

Backgrounds: Medical students are prone to experience alexithymia due to academic work overload, which could increase the prevalence of mental illness such as anxiety and depression. The purpose of our study was to estimate the levels of alexithymia and to explore the relationships between alexithymia, self-control, and mindfulness among medical students. Materials and methods: From March 18th, 2021 to April 9th, 2021, a cross-sectional study with stratified sampling was carried out in China Medical University, Liaoning Province, China. A total of 1,013 medical students participated in this study. The questionnaires pertaining to the Toronto Alexithymia Scale (TAS-26), the Five Facet Mindfulness Questionnaire (FFMQ), and the Self-control Scale (SCS) were used to assess the levels of alexithymia, mindfulness and self-control. We used Hierarchical Multiple Regression (HMR) and structural equation modeling to explore the mediating role of mindfulness between self-control and alexithymia. Results: The mean score of alexithymia in medical students was 69.39 ± 9.9. After controlling for confounders, males were more likely to experience alexithymia. Self-control, acting with awareness, describing, and observing in mindfulness were negatively associated with alexithymia (P < 0.01). Mindfulness mediated the relationship between self-control and alexithymia (a*b = -0.06, BCa 95% CI: -0.09 to -0.031, Percentile 95% CI: -0.089 to -0.031). Conclusion: Chinese medical students experienced high levels of alexithymia. Self-control could directly attenuate alexithymia for medical students and indirectly affect alexithymia through the mediating path of mindfulness. Initiatives for self-control ability enhancement should be provided to medical students to combat alexithymia. And interventions on mindfulness training should be developed to prevent from alexithymia and promote their mental health.

Exploring the Association Between Resilience and Quality of Life Among Glaucoma Patients: Sleep Disturbance as a Mediating Factor.

Background: Patients with glaucoma may experience many symptoms such as blindness, which seriously affect their quality of life (QoL). Resilience is playing a vital role in enhancing the QoL and well-being of patients with chronic diseases. In addition, sleep disturbance is common in patients with glaucoma, leading to a decline in their QoL. However, there is a dearth of research on whether sleep disturbance plays a mediating role between resilience and QoL among glaucoma patients. Objective: The aim of this study is to explore the role of sleep disturbance in the relationship between resilience and QoL among glaucoma patients. Methods: From July to December 2019, a cross-sectional survey was conducted on 215 glaucoma patients in an ophthalmic hospital in Liaoning Province. Hierarchical multiple regression (HMR) analyses and structural equation modeling (SEM) were conducted to examine the factors related to QoL and to test the hypothesis that sleep disturbance mediates the relationship between resilience and QoL among glaucoma patients. Results: The average QoL score among glaucoma patients was 43.85 ± 14.97 as reported by the Glaucoma Quality of Life-15 (GQL-15) scale, where a higher scores indicating a poorer QoL. Resilience was found to be linked with a lower QoL score (P < 0.01), while sleep disturbance was associated with a higher QoL score (P < 0.01). When sleep disturbance was included in the model as partial mediator, the path coefficients for the association between resilience and QoL score was significantly decreased (a*b = -0.1, BCa95% CI: -0.154∼-0.045). Conclusion: Findings of this study reflected that QoL among glaucoma patients in China was poor. Resilience was found to be an important positive factor, which could result in the improvement of QoL. Furthermore, sleep disturbance mediated the relationship between resilience and QoL among patients with glaucoma, thereby reducing the positive impact of resilience on QoL in glaucoma patients. Efforts to improve QoL among glaucoma patients may benefit from interventions that enhance the levels of resilience and promote healthy sleep.

Associations Between Human Papillomavirus Vaccine Decisions and Exposure to Vaccine Information in Social Media.

PURPOSE: Exposure to different types of vaccine information in social media can result in parents making disparate vaccine decisions, including not following national guidelines for human papillomavirus (HPV) vaccination. We sought to characterize parents' exposure to and engagement with information about HPV vaccination in social media, and the associations between exposure to such information and vaccine decisions for their adolescent children. METHODS: In 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents who use social media. The survey assessed whether parents have seen information in favor, against, or mixed about HPV vaccination. Multivariable logistic regressions assessed correlates of vaccine decisions, including HPV vaccine initiation, delay, and refusal. RESULTS: Sixty-one percent of parents reported that their children have initiated HPV vaccination. Over one-third of parents (37%) reported seeing HPV vaccine information on social media, which was either in favor (20%), against (5%), or a mix (12%). Parents exposed to information in favor were more likely than those who saw no information to have initiated HPV vaccination (OR = 1.74, 95% CI:1.24, 2.44). Parents exposed to information against vaccination were more likely to have delayed (OR = 3.29, 95% CI:1.66, 6.51) or refused (OR = 4.72, 95% CI:2.35, 9.50) HPV vaccination. Exposure to mixed information was also significantly associated with vaccine delay and refusal. DISCUSSION: Our findings suggest that the type of information seen on social media regarding HPV vaccination may influence the decisions parents make about vaccinating their children. Efforts should be sought to increase online information in favor of HPV vaccination and combat vaccine misinformation in social media.

Cesarean Section and Child Development at 3 Years: A Prospective Cohort Study of First Births in Pennsylvania.

OBJECTIVES: The rising cesarean birth rate globally has led to increasing concern about long-term unintended consequences, with particular focus on child neurodevelopmental outcomes. This study investigated the association between cesarean birth and early child neurodevelopment, measured at 3 years of age. METHODS: This was a large multicenter longitudinal prospective cohort study of first-time mothers and their offspring in Pennsylvania. Mothers completed adapted versions of two measures of child development at 36- months postpartum: the modified Parents' Evaluation of Developmental Status (M-PEDS) and a shortened Ages and Stages Questionnaire (S-ASQ). Logistic regression models were used to assess the association between mode of delivery and delayed child development, controlling for confounding variables. RESULTS: There were 695 (29.3%) children born by cesarean delivery and 1676 (70.7) born vaginally. Children born by cesarean had increased odds of scoring as developmentally delayed on both measures of child development: the M-PEDS (8.9% cesarean and 5.1% vaginal, adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI] = 1.11-2.24)) and the S-ASQ (6.3% cesarean and 3.3% vaginal, aOR = 1.66, 95% CI = 1.09-2.54). Additional factors associated with developmental delay were male sex, and the maternal factors of high pre-pregnancy body mass index, thyroid disorder, and diabetes. CONCLUSION: In this large prospective cohort study of first-time mothers and their offspring, cesarean delivery was found to be associated with an elevated risk of delayed child development at age 3 years. This analysis highlights the importance of continued research to understand the impact of cesarean delivery on child development.

Maternal use of acetaminophen during pregnancy and neurobehavioral problems in offspring at 3 years: A prospective cohort study.

BACKGROUND: Acetaminophen is one of the most commonly used drugs during pregnancy globally. Recent studies have reported associations between prenatal exposure to acetaminophen and neurobehavioral problems in children, including attention-deficit hyperactivity disorders. Little research has investigated these associations in preschool-age children or the potential confounding effects of prenatal stress. The purpose of this study was to examine associations between prenatal acetaminophen exposure and offspring neurobehavioral problems at the age of 3 years, with a focus on the potentially confounding effects of prenatal stress. METHODS: We used data from the First Baby Study, a prospective cohort study conducted in Pennsylvania, USA, with 2,423 mother-child pairs. Women reported medication use and completed a prenatal stress inventory during their third trimester. Child behavioral problems were measured at the age of 3 years, using the 7 syndrome scale scores from the Child Behavior Checklist (CBCL) for ages 1 ½ to 5. RESULTS: There were 1,011 women (41.7%) who reported using acetaminophen during pregnancy. Children who were exposed to acetaminophen during pregnancy scored significantly higher on 3 of the 7 CBCL syndrome scales: withdrawn, sleep problems and attention problems. Scores on all 7 of the CBCL syndrome scales were significantly associated with prenatal stress. After adjustment for prenatal stress and other confounders, 2 syndrome scales remained significantly higher in children exposed to acetaminophen: sleep problems (aOR = 1.23, 95% CI = 1.01-1.51) and attention problems (aOR = 1.21, 95% CI = 1.01-1.45). CONCLUSIONS: These findings corroborate previous studies reporting associations between prenatal exposure to acetaminophen and attention problems in offspring and also show an association with sleep problems at age 3 years. Because use of acetaminophen during pregnancy is common, these results are of public health concern and suggest caution in the use of medications containing acetaminophen during pregnancy.

Family Functioning and Optimism as Protective Factors of Life Satisfaction Among Stroke Patients During the COVID-19 Epidemic in Shenyang, China.

The coronavirus disease-19 (COVID-19) pandemic may result in detrimental consequences for stroke patient's wellbeing. Family functioning and optimism could help stroke patients cope with crises leading to possible improvements in life satisfaction. This study aims to explore the protective effects of family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic in China. This study was designed as a cross-sectional survey. A total of 207 stroke inpatients who were receiving pharmacotherapy and rehabilitation in general public hospital of Liaoning province during the COVID-19 pandemic in China were consecutive selected and interviewed by online questionnaires via the WeChat platform effectively from April 8 to 30, 2020. The scales included: Satisfaction with Life Scale (SWLS), Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale and Revised Life Orientation Test (LOT-R). Hierarchical multiple regression (HMR) analysis was conducted to test the associated factors of life satisfaction. Stroke patient's life satisfaction was at a high level (Mean = 26.46, SD = 6.23) during the pandemic. Stroke patient's residence, duration of stroke, stroke type, and community shut down measures were the strong predictors of life satisfaction. Family functioning and optimism increased life satisfaction among stroke patients. This study contributes to the research on the association between family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic. Interventions that improve family functioning and enhance optimism should be provided in order to elevate life satisfaction for stroke patients.

Panic, Psycho-Behavioral Responses, and Risk Perception in the Earliest Stage of the COVID-19 Pandemic in China.

Background: Coronavirus Disease-19 (COVID-19), a rising global pandemic, has triggered psychological crises among the public. Panic, a severe symptom of mental disorders, is increasing in the public in China and it is urgent to provide research for intervention development. Objectives: This study aimed to assess the prevalence of public panic in China during the earliest stage of the COVID-19 pandemic and to explore the associated psychological behavioral responses and public's risk perception of the pandemic. Methods: A cross-sectional study using a web-based survey with convenience sampling was conducted with 2,484 participants nationally from February 11 to February 24, 2020 in China. A self-developed questionnaire was applied to assess the prevalence of public panic and its associated factors. Multivariable logistic regression analysis was applied to assess the risk and protective factors of public panic. Results: There were 23.39% (581/2,484) of the participants who reported experiencing panic during the earliest stage of the COVID-19 pandemic. Taking temperature repeatedly, being nervous in a crowd, being suspicious of infection in the family, being worried about the future, and worries about high infectivity of the COVID-19, lack of effective therapies, and wide impact of the COVID-19 pandemic increased the odds of public panic. Whereas, avoiding gatherings during holidays was negatively associated with the odds of public panic. Conclusions: Psycho-behavioral responses were closely associated with public panic during the earliest stage of the COVID-19 pandemic in China. Defusing excessive health-related worries, the guidance of appropriate self-protective behaviors, strengthening of health education in communities, and available treatment for mental disorders should be adopted to monitor the psychological responses and to guide the behaviors of the public.

Covid-19 vaccine acceptance and associated factors among pregnant women in Pennsylvania 2020.

Data on factors associated with vaccine acceptance among pregnant women are critical to the rapid scale up of interventions to improve vaccine uptake. When COVID-19 vaccines were still in the testing phases of research, we surveyed pregnant women accessing prenatal care at an academic medical institution in Central Pennsylvania, United States to examine factors associated with vaccine acceptance. Willingness to receive a COVID-19 vaccine once a vaccine became available was asked as part of an ongoing study on the COVID-19 pandemic and pregnancy (n = 196). Overall, 65% of women reported they would be willing or somewhat willing to receive the COVID-19 vaccine. Women who had received an influenza vaccine within the past year were more likely to be willing to receive the COVID-19 vaccine than women who had never received an influenza vaccine or those who received it over one year ago (aOR 4.82; 95% CI 2.17, 10.72). Similarly, women who were employed full-time were more willing to receive the COVID-19 vaccine than women who were not employed full time (aOR 2.22; 95% CI 1.02, 4.81), and women who reported feeling overloaded were more willing to receive the COVID-19 vaccine than women who did not feel overloaded (aOR 2.18; 95% CI 1.02, 4.68). Our findings support the need to increase vaccination education among pregnant women before vaccines are rolled out, especially those who have not received an influenza vaccine within the past year. Improved understanding of willingness to vaccinate among pregnant women will improve future pandemic responses and current vaccination efforts.

Paternal Education and Its Impact on Breastfeeding Initiation and Duration: An Understudied and Often Overlooked Factor in U.S. Breastfeeding Practices.

Objective: The primary objective was to determine the role that paternal education level plays in the initiation and duration of breastfeeding for their infants. Materials and Methods: As part of a prospective cohort study, primiparous women, aged 18-35 years, living in Pennsylvania, were enrolled and interviewed during pregnancy (N = 3,006) and at 1 and 6 months postpartum. Logistic regression models were used to evaluate the associations between paternal education level and breastfeeding initiation and duration, controlling for maternal education level and other covariates-including marital/relationship status, household poverty level, maternal age, race/ethnicity, smoking, attending breastfeeding class during pregnancy, mode of delivery, gestational age, and plans to return to work ≤2 months after delivery. Results: Information on both paternal and maternal education levels and breastfeeding outcomes was available for 2,839 couples. Most of the women reported that they planned to breastfeed (92.5%); 92.0% initiated breastfeeding; and 49.5% of those who initiated breastfeeding were still breastfeeding by 6 months postpartum. Paternal education level was independently associated with breastfeeding initiation and duration in both regression models-the higher the level of education of the father, the more likely breastfeeding was initiated and the mother was still breastfeeding at 6 months postpartum, even after controlling for maternal education level and other relevant covariates. Conclusions: In this large prospective cohort study of first-time mothers and their newborns, paternal education level was independently associated with breastfeeding initiation and duration. These findings highlight the importance of including the father in prenatal breastfeeding education initiatives.

Anxiety and its relationship with sleep disturbance and problematic smartphone use among Chinese medical students during COVID-19 home confinement - A structural equation model analysis.

BACKGROUND: The majority of medical students in China have experienced home confinement and a reliance on online resources to study medicine since the outbreak of COVID-19. More time spent studying online during the COVID-19 pandemic may be a potential risk factor for problematic smartphone use, since smartphones have become the most commonly used device for accessing the internet. The objective of the present study was to explore the association between anxiety, smartphone problematic use and sleep disturbance among medical students during the enforced COVID-19 home confinement. METHODS: Altogether, 666 medical students validly answered a self-administered questionnaire, which included the Chinese version of the Generalized Anxiety Disorder scale, Smartphone addiction scale - short version, and the PROMIS Sleep Disturbance scale (short form). Hierarchical multiple regression analyses were employed to explore the associated factors of anxiety. Structural equation modeling was conducted to test hypothesized associations. RESULTS: Anxiety was significantly associated with problematic smartphone use and sleep disturbance among medical students during the COVID-19 pandemic. Problematic smartphone use not only directly affected anxiety, but also exerted a significant indirect effect on anxiety via sleep disturbance. A significant decrease of the path coefficient of problematic smartphone use on anxiety (from ß=0.53 to ß=0.22, P<0.01) was observed with sleep disturbance being modeled as a mediator. LIMITATIONS: Limitations include its cross-sectional design and samples recruited from only one medical school. CONCLUSIONS: The detrimental impact of problematic smartphone use and the importance of sleep health on mitigating anxiety should be highlighted and incorporated into medical education.

'If not for this support, I would have left the treatment!': Qualitative study exploring the role of social support on medication adherence among pulmonary tuberculosis patients in Western India.

Social support has been identified as a significant factor in addressing treatment barriers and facilitating treatment adherence. Using a descriptive design, this qualitative study aims at sharing personal feelings and social support-related experiences among pulmonary tuberculosis (TB) patients in Western India. A semi-structured interview guide was designed, and thirty-seven in-depth interviews were conducted. Descriptive thematic analysis was employed for reporting the themes and the results. The participants highlighted diverse social support experiences like empathy, compassion, trust, neglect, tangible aid, strained relationships with in-laws, health provider's support, strength, and motivation which influences their treatment adherent behaviour. Contrasting differences of social support experiences among adherent and non-adherent TB patients were also reported. The study has important ramifications for developing patient-centric social support intervention strategies, TB policy, and practice. The study has shown, 'if not for this support', patients would have left the treatment, and it is mainly because this debilitating disease robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered. However, we resonate that addressing social support is not the only way, and TB elimination overall will require an optimal mix of enhanced biomedical, social, economic, and policy interventions.

Machine learning based suicide prediction and development of suicide vulnerability index for US counties.

Suicide is a growing public health concern in the United States. A detailed understanding and prediction of suicide patterns can significantly boost targeted suicide control and prevention efforts. In this article we look at the suicide trends and geographical distribution of suicides and then develop a machine learning based US county-level suicide prediction model, using publicly available data for the 10-year period from 2010-2019. Analysis of the trends and geographical distribution of suicides revealed that nearly 25% of the total counties experienced at least a 10% increase in suicides from 2010 to 2019, with about 12% of total counties exhibiting an increase of at least 50%. An eXtreme Gradient Boosting (XGBoost) based machine learning model was used with 17 unique features for each of the 3140 counties in the US to predict suicides with an R2 value of 0.98. Using the SHapley Additive exPlanations (SHAP) values, the importance of all the 17 features used in the prediction model training set were identified. County level features, namely Total Population, % African American Population, % White Population, Median Age and % Female Population were found to be the top 5 important features that significantly affected prediction results. The top five important features based on SHAP values were then used to create a Suicide Vulnerability Index (SVI) for US Counties. This newly developed SVI has the potential to detect US counties vulnerable to high suicide rates and can aid targeted suicide control and prevention efforts, thereby making it a valuable tool in an informed decision-making process.

Factors Associated with Adolescent Pregnancy in Sub-Saharan Africa during the COVID-19 Pandemic: A Review of Socioeconomic Influences and Essential Interventions.

Objective: A literature review was conducted to analyze the impact of COVID-19 on documented preexisting determinants of adolescent pregnancy in sub-Saharan Africa such as poverty, inequitable gender norms, low access to education, and reproductive health services. Methods: The terms "sub-Saharan Africa," "Gender Norms," "Poverty," and "Adolescent Pregnancy" were used to search the literature for preexisting determinants of adolescent pregnancy in academic and grey literature. "COVID-19" was added to investigate the potential consequences of the pandemic. The literature revealed similar experiences in adolescent girls during the Ebola outbreak, which lead to the analysis of government and healthcare official responses to previous epidemics. Results: The literature review revealed that the relationship between identified micro (inequitable gender norms, transactional sex, sexual and gender-based violence, early marriage, and menstruation) and macro (poverty, education, and healthcare) factors contributing to adolescent pregnancy were exacerbated by the COVID-19 pandemic. Conclusion: Three realistic targets including, expanding and communicating available reproductive health resources, prioritizing the role of women in the economy, and ensuring return to school should be included as part of current COVID-19 mitigation programs. Additionally, these interventions should be incorporated in future public health preparedness plans to reduce the risk of adolescent pregnancy during public health emergencies.