Decision tree-Markov model of perinatal depression screening: a cost-utility analysis.

Background: Perinatal depression affects the physical and mental health of pregnant women. It also has a negative effect on children, families, and society, and the incidence is high. We constructed a cost-utility analysis model for perinatal depression screening in China and evaluated the model from the perspective of health economics. Methods: We constructed a Markov model that was consistent with the screening strategy for perinatal depression in China, and two screening strategies (screening and non-screening) were constructed. Each strategy was set as a cycle of 3 months, corresponding to the first trimester, second trimester, third trimester, and postpartum. The state outcome parameters required for the model were obtained based on data from the National Prospective Cohort Study on the Mental Health of Chinese Pregnant Women from August 2015 to October 2016. The cost parameters were obtained from a field investigation on costs and screening effects conducted in maternal and child health care institutions in 2020. The cost-utility ratio and incremental cost-utility ratio of different screening strategies were obtained by multiplicative analysis to evaluate the health economic value of the two screening strategies. Finally, deterministic and probabilistic sensitivity analyses were conducted on the uncertain parameters in the model to explore the sensitivity factors that affected the selection of screening strategies. Results: The cost-utility analysis showed that the per capita cost of the screening strategy was 129.54 yuan, 0.85 quality-adjusted life years (QALYs) could be obtained, and the average cost per QALY gained was 152.17 yuan. In the non-screening (routine health care) group, the average cost was 171.80 CNY per person, 0.84 QALYs could be obtained, and the average cost per QALY gained was 205.05 CNY. Using one gross domestic product per capita in 2021 as the willingness to pay threshold, the incremental cost-utility ratio of screening versus no screening (routine health care) was about -3,126.77 yuan, which was lower than one gross domestic product per capita. Therefore, the screening strategy was more cost-effective than no screening (routine health care). Sensitivity analysis was performed by adjusting the parameters in the model, and the results were stable and consistent, which did not affect the choice of the optimal strategy. Conclusion: Compared with no screening (routine health care), the recommended perinatal depression screening strategy in China is cost-effective. In the future, it is necessary to continue to standardize screening and explore different screening modalities and tools suitable for specific regions.

Factor structure and longitudinal invariance for the Chinese Mainland version of the Edinburgh postnatal depression scale during pregnancy.

BACKGROUND: There are inconsistent results on the Edinburgh Postnatal Depression Scale's (EPDS) factor structure and longitudinal invariance among different cultures. Furthermore, limited relevant studies in Chinese pregnant women exist. PURPOSE: To test the factor structure of the Chinese Mainland EPDS during pregnancy and conduct longitudinal invariance analyses. METHODS: A national multi-centre cohort study was conducted among 1207 pregnant women selected consecutively by convenience sampling from five hospitals in Zhuhai, Taiyuan, Haidian, Changchun, and Shenzhen in China between August 2015 and October 2016. Depression was measured by the EPDS during gestational weeks 10-13, 15-18, 23-25, 30-32 and 36-37, respectively.s RESULTS: Three factors with eigenvalues nearly larger than 1.0 were optimal for the Chinese Mainland EPDS, labelled "anxiety," "anhedonia," and "depression," and contained items 3-5, 1-2, and 6-10, respectively. The confirmatory factor analysis results of standardized root mean square residual (SRMR) = 0.034, root mean square error of approximation (RMSEA) = 0.049, comparative fit index (CFI) = 0.968, Tucker-Lewis index (TLI) = 0.954, and χ2, p < 0.05 indicated good fit. For the longitudinal invariance tests, the configural invariance was met, with the CFI and TLI both higher than 0.90 and the RMSEA lower than 0.08 (CFI = 0.919, TLI = 0.908, and RMSEA = 0.034). The metric-, scalar-, and strict invariances were met. CONCLUSIONS: The three-factor model of the Chinese Mainland EPDS is invariant in pregnancy, suggesting stability and comparability in identifying the women screened positive at different points during pregnancy and making the scale feasible to screen prenatal depression and anxiety simultaneously.

The correlation between pregnancy-related low back pain and physical fitness evaluated by an index system of maternal physical fitness test.

To investigate incidence of pregnancy-related low back pain (LBP), evaluate physical fitness objectively during pregnancy and analyze the correlation between LBP and physical fitness of pregnant women, 180 pregnant women including 101 in mid-gestation (14-28 gestational weeks) and 79 in late-gestation (28-37 gestational weeks) were recruited and self-reported their LBP. The aerobic ability such as cardiorespiratory fitness and anaerobic ability including strength, endurance, speed, flexibility, and balance were evaluated by a novel materal physical fitness test system. The correlation between LBP and each component in physical fitness test system was analyzed in SPSS. As the results, 135 out of 180 participants (75% of total) had pregnancy-related LBP. Physical fitness of participants in late-gestation was significantly weaker including weaker back strength (p<0.05), less resistance band pullbacks in 30s (p<0.01), less stretching in sit-and-reach test (p<0.001), shorter duration in left legged blind balance test (p<0.05) and weaker bird dog balance(p<0.05) than those in mid-gestation. Correlation analysis indicated that LBP was negatively associated with standing heel raises in 20s (p<0.01) and standing glute kickbacks in 30s (left p<0.01, right p<0.05). Thus, it is concluded that LBP is in high prevalence throughout the entire pregnant course. The pregnant women are prone to have weakened strength of core muscle groups and poorer flexibility and balance along the pregnancy. In addition, their LBP was negatively correlated to strength of back muscle groups of lower limbs.

Exposure to ambient air pollution with depressive symptoms and anxiety symptoms among adolescents: A national population-based study in China.

BACKGROUND: Air pollution threatens adolescents' physical health and adversely affects adolescents' mental health. Previous studies mostly focused on the effects of air pollution on physical health, but there were few studies on the effects of air pollution on mental health. METHODS: We collected scores of depressive symptoms and anxiety symptoms from 15,331 adolescents from 43 schools in eleven provinces in September and November 2017. The data on air pollution comes from the China High Air Pollutants dataset, which included concentrations of particulate matter with diameters of ≤1.0 µm (PM1), diameters of ≤2.5 µm (PM2.5), and diameters of ≤10 µm (PM10), as well as nitrogen dioxide (NO2). The associations between air pollution and depressive and anxiety symptoms among adolescents were estimated using generalized linear mixed models. RESULTS: Depressive and anxiety symptoms among Chinese adolescents were 16% and 32%, respectively. In the adjusted model, an interquartile range (IQR) increase from PM2.5 was associated with the odds of anxiety symptoms [odds ratio (OR) = 1.01; 95% confidence interval (CI): 1.00, 1.01, P = 0.002]. Also, an IQR increase in PM10 was significantly associated with the odds of anxiety symptoms (OR = 1.01; 95% CI: 1.00, 1.01, P = 0.029). Compared with the lowest quartile, the adjusted OR of anxiety symptoms for the highest quartile of PM2.5 and PM10 were 1.29 (1.15, 1.44) and 1.23 (1.06, 1.42), respectively. In addition, the association between PM2.5 and depressive symptoms was significant. The robustness of the results was also confirmed by stratification and sensitivity analyses. CONCLUSIONS: Exposure values for airborne particulate matter were associated with depressive symptoms and anxiety symptoms in adolescents, particularly for PM2.5 and PM10 with anxiety symptoms among adolescents.

Effectiveness of mindfulness training on pregnancy stress and the hypothalamic-pituitary-adrenal axis in women in China: A multicenter randomized controlled trial.

Introduction: In the past two decades, mindfulness-based intervention programs have gradually become popular.Many studies have confirmed that these programs can effectively alleviate prenatal stress and negative emotion.The mindfulness-based stress-buffering hypothesis suggests that mindfulness training can induce changes in the levels of the cortisol secreted by the HPA axis, thereby reducing stress susceptibility. However, to date, only a few high-quality evidence-based medical studies have analyzed the effect of the mindfulness-based intervention in a maternal population.Thus, this study investigated the effects of a mindfulness-based psychosomatic intervention on pregnancy stress and the HYPERLINK "javascript:;" hypothalamic-pituitary-adrenal (HPA) axis of pregnant Chinese women. Methods: Women experiencing first-time pregnancy (n = 117) were randomly allocated to the intervention group or parallel active control group, and data were collected at baseline and post-intervention periods. The participants completed questionnaires regarding mindfulness and pregnancy stress. Saliva samples was collected at the time of waking up, and 30, 45, and 60 min after waking up for analyzing the salivary cortisol levels. We analyzed differences between the two groups and changes within the same group before and after the intervention. Results and discussion: A total of 95 participants completed the trial. Compared with the parallel active control group, the intervention group exhibited lower levels of stress after the intervention (P = 0.047). For HPA-axis-related indicators after the intervention, Delta value (P = 0.01) and AUCM value (P = 0.031) of the intervention group were significantly higher than that of the control group. Mindfulness-based interventions effectively reduced the level of pregnancy stress and adjusted the HPA axis function in pregnant women in China. Clinical Trial Registration: https://www.chictr.org.cn, identifier ChiCTR 2000033149.

Associations of greenness surrounding schools and self-reported depressive and anxiety symptoms in Chinese adolescents.

BACKGROUND: The effect of school-based greenness exposure on mental health among adolescents remains unclear. The study aimed to estimate the associations between school-based greenness and depressive and anxiety symptoms among adolescents and explore potential modifier and mediator between the associations. METHODS: A cross-sectional survey involving 15,559 adolescents was conducted in China. The Chinese version of the Center for Epidemiologic Studies Depression 9-Item Scale and the Generalized Anxiety Disorder 7-Item Scale were used to assess the depressive and anxiety symptoms among adolescents. The Normalized Difference Vegetation Index within a 400 m and 800 m zone surrounding schools was used to indicate the adolescents' exposure to greenness. We estimated daily concentrations of PM1.0, PM2.5, and NO2 from the China High Air Pollutants dataset. Multiple logistic regression models were used. RESULTS: Higher exposure to greenness surrounding schools was negatively associated with depressive (OR: 0.774, 95%CI: 0.685-0.875) and anxiety symptoms (0.740, 0.669-0.818). We observed stronger associations between greenness and depressive and anxiety symptoms among girls, lower age group (11-15 years), and adolescents born to parents with lower education levels. PM1.0 (proportion mediated estimates: 14.3 %; 95 % CI: 4.2 %, 24.5 %) and PM2.5 (10.5 %; 95 % CI: 3.0 %, 17.9 %) mediated the associations between greenness exposure and depressive symptoms. The number of days adolescents attended physical education classes per week mediated -22.8 % (95 % CI: -38.5 %, -7.1 %) and -9.7 % (95 % CI: -15.5 %, -3.8 %) of the effects of greenness on depressive and anxiety symptoms. CONCLUSIONS: Increasing the greenness and improving the environment surrounding schools is effective in promoting the mental health of adolescents.

Relationship between school bullying and mental health status of adolescent students in China: A nationwide cross-sectional study.

INTRODUCTION: School bullying, as a public health problem, has been linked to many emotional disorders. However, the overall status of school bullying among adolescent students in China is unknown. This nationwide study aimed to investigate school bullying in China and evaluate the relationships between school bullying and mental health status. METHODS: A total of 15, 415 middle and high school students were enrolled in this study through multistage stratified cluster random sampling. Multinomial logistic regression models were used to examine the association between school bullying and mental health status and the analysis was stratified by gender. RESULTS: Students were divided into four groups: 2.72%, bully/victims; 1.38%, bullies; 10.89%, victims; 85.01%, uninvolved. Compared with uninvolved students, students with anxiety symptoms, non-suicidal self-injury and suicide ideation had a higher risk of being involved in school bullying and were more likely to be bully/victims, bullies, and victims. Stratified analysis indicated that boys with anxiety symptoms and non-suicidal self-injury risks tended to be bullies, victims and bully/victims. However, for girls, bullying others or being bullied was related to anxiety symptoms and suicide ideation. CONCLUSION: Our study indicated that school bullying is still a health problem in the adolescent students of China, and is related to many mental health problems. Intervention programs are in urgent need to help the students involved in school bullying, both in terms of their mental and physical health.

Barriers to Adolescent Health Care in Maternal and Children's Healthcare Hospitals: Based on a National Survey in China.

PURPOSE: Adolescence is a critical period for physical and psychological development; therefore, health interventions at this phase may be especially beneficial. In this study, we aim to describe the distribution of the adolescent health care system in China and to compare the perceived barriers of running an adolescent clinic (AC) proposed by hospitals with corresponding government entities. METHODS: A nationwide online survey was launched by the National Health Commission of China in December 2015, among 116 Maternal and Children's Healthcare (MCH) hospitals located across 24 randomized selected provinces. The online survey included management questionnaires filled out by health administrators from local health commissions and service questionnaires filled out by adolescent care providers from MCH hospitals. RESULTS: Among the surveyed provinces, only 7% have special funding for adolescent health care, 13% have a supporting policy, 8% have guidelines/service standards, and 16% provide adolescent health care based in MCH hospitals. Among the 116 MCH hospitals investigated, 31 (27%) had a functioning AC and 15 (13%) used to have an AC. Compared with the MCH hospitals that never have an AC, those that previously had an AC were more likely to perceive demand as a barrier (odds ratio = 8.02; p value < .05) but less likely to perceive guidelines/service standards as a problem (odds ratio = .09; p value < .01). The perceptions of health administrators and adolescent health care providers differed markedly on demand and profits: both were ranked highly by supply side (health providers) but ranked low by the health administrators. CONCLUSIONS: This national survey, for the first time, presents a whole picture of adolescent health care in MCH hospital settings in China. Among the surveyed MCH hospitals, major areas of discordance between administrators and health care providers were barriers in demand and profits, which health administrators tend to overlook. A number of strategic priorities are proposed to best guide the development of the adolescent health care system in China, including improved linkage between health and education and community systems, comprehensive approaches move beyond sexual and reproductive education, as well as the workforce development and capacity-building.

Association of health-risk behaviors and depressive symptoms and anxiety symptoms: a school-based sample of Chinese adolescents.

Background Depressive symptoms and anxiety symptoms of adolescents not only affect youth but also have wide-ranging impacts on the health of adults. The study was carried out to determine the epidemiological characteristics of depressive symptoms and anxiety symptoms and the associations between the two and health-risk behaviors in Chinese adolescents. Methods Participants were recruited from the junior and senior high schools in China. Data were collected by self-designed questionnaires. The questionnaires included questions about demographic characteristics, depressive symptom scales, anxiety symptom scales and nine categories of health-risk behaviors. Descriptive analysis and binary logistic regression were performed by SPSS 21.0 software. Results There were 4.4% of the participants with depressive symptoms. Approximately 32.0% of the participants had anxiety symptoms. Girls and general senior school students were risk factors for depressive symptoms and anxiety symptoms. Multiple health-risk behaviors were associated with depressive symptoms and anxiety symptoms in Chinese adolescents. Conclusion Depressive symptoms and anxiety symptoms were prevalent in Chinese adolescents. Their distribution was affected by certain health-risk behaviors. Multiple health-risk behaviors were associated with depressive symptoms and anxiety symptoms in Chinese adolescents.

A preliminary cervical cancer screening cascade for eight provinces rural Chinese women: a descriptive analysis of cervical cancer screening cases in a 3-stage framework.

BACKGROUND: Cascade analysis is an effective method to analyze the processing data of an event, such as a provided service or a series of examinations. This study aimed to develop a primary cervical cancer screening cascade in China to promote the quality of the screening process. METHODS: We designed a cervical cancer screening cascade in China according to the program flow chart. It had three stages, each with two steps and one result. Data from 117,522 women aged 35 to 64 years in the Rural Cervical Cancer Surveillance Project from January 1, 2014, to December 31, 2014, were collected to analyze the main results of the cascade. The data and proportion are used to describe the follow-up of cervical cancer and pre-cancer detection rate. RESULTS: In 2014, 117,522 (80.94% of all cases reported by the Rural Cervical Cancer Surveillance Project) women aged 35 to 64 years had not received cervical cytology in the previous 3 years. The pre-cancer and cancer detection rates were 256.12/100,000 and 16.16/100,000, respectively. A total of 3031 cases failed to follow-up through the screening process, and 1189, 1555, and 287 cases were lost at cervical cytology, colposcopy, and histopathological screening stages, respectively. The estimated cases of pre-cancer and cancer cases would have been 544 and 34, respectively, and the estimated detection rates of pre-cancer and cancer would have been 462.89/100,000 and 28.93/100,000, respectively. CONCLUSION: In order to increase the detection rate of cervical cancer, cervical cancer screening staff should focus on increasing the rate of follow-up of those who are positive for cervical cancer screening (ie, those with positive cytology results), especially for the 40 to 44 years age range.

The role of depressive symptoms, anxiety symptoms, and school functioning in the association between peer victimization and internet addiction: A moderated mediation model.

BACKGROUND: Both peer victimization and internet addiction are common public health problems for children and adolescents. Several studies found an association between peer victimization and internet addiction, but the mechanism underlying this association remained unclear. This study aimed to determine the mechanisms underlying this association. METHODS: Data was extracted from an epidemiologic study involving middle and high school adolescents, in which 15,415 individuals (14.6 ±â€¯1.7 years) were recruited. The moderated mediation models were examined using SPSS PROCESS macro 2.16 software, in which the mediation variables were depressive symptoms and anxiety symptoms, and the moderation variable was school functioning. RESULTS: The total indirect effect of verbal victimization on internet addiction through depressive symptoms and anxiety symptoms was found to be 0.4531, which accounted for 63.7% of the total effect of verbal victimization on internet addiction. Depressive symptoms and anxiety symptoms totally mediated the association between relational victimization and internet addiction and the association between the physical victimization and internet addiction. There were gender differences in the mediating effects of depressive and anxiety symptoms on the association between peer victimization and internet addiction. The indirect effect of the three different types of peer victimization (physical, verbal, relational) on internet addiction became stronger as school functioning increased. LIMITATIONS: We included two mediators in one model, and the data used in this study was self-reported and cross-sectional. CONCLUSIONS: Depressive symptoms and anxiety symptoms mediate the association between peer victimization and internet addiction. Students who score higher in school functioning were more likely to develop internet addiction when they encounter peer victimization.

Global and Chinese perspectives on adolescent health and development / 中国学校卫生

Abstract@#Through a review of the current state and risks of adolescent health in the world and in China, the main health issues faced by adolescents are summarized. The importance of promoting adolescent health and the importance of effective adolescent health services are highlighted. The past 30 years important documents of international adolescent health and development have been sorted out. The history of the development of adolescent health care in China has been reviewed. It was pointed out that the health and development of adolescents has become a hot spot and focus of international attention, and it has received more and more attention in China. The adolescent health care has ushered in a new opportunity for development, which will help the health and development of adolescents in China.

Effect of estrogen on gene expression of fatty acid synthase in periosteum.

BACKGROUND: Estrogen deficiency contributes to postmenopausal osteoporosis. Periosteum might be a potential target of estrogen, but the underlying mechanism at gene level is far from being elucidated. The objective of this study was to investigate the correlation between estrogen and fatty acid synthase (FAS) expression in periosteum. METHODS: Human periosteum cells were cultured in vitro. Expressed genes in the substrated cDNA library were verified using semi-quantitative PCR and real-time PCR. The expression of FAS in periosteum of ovarectomized (OVX) SD rats was investigated. RESULTS: FAS gene was most significantly expressed in the subtracted cDNA library of periosteal cells screened by semi-quantitative PCR. Low FAS expression was verified by real-time PCR in the estrogen exposed human periosteum rather than in the control. The estradiol levels were (20.81 +/- 12.62) pg/ml, (19.64 +/- 4.35) pg/ml and (13.47 +/- 1.84) pg/ml in the sham group, the control, and the OVX group, respectively. The estradiol levels in the OVX group was significantly lower (P = 0.0386). The FAS gene expression in periosteum in the OVX group, sham group, and control group was 3.09 +/- 1.97, 1.33 +/- 0.47 and 1.51 +/- 1.32, respectively. The gene expression in the OVX group was significantly higher (P = 0.0372). CONCLUSION: Estrogen modulates FAS gene expression in in vitro human perisoteum as well as in in vivo rat periosteum.