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1.
Ecotoxicol Environ Saf ; 210: 111854, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33422839

RESUMO

OBJECTIVE: To explore the prospective correlation between serum metals before 24 weeks' gestation and gestational diabetes mellitus (GDM) or glucose in the late second trimester among southern Chinese pregnant women. METHODS: A total of 8169 pregnant women were included in our retrospective cohort study. Logistic regression was used to investigate the relationships between metals (Manganese [Mn], copper [Cu], lead [Pb], calcium [Ca], zinc [Zn], magnesium [Mg]) and GDM. Quantile regression was performed to detect the shifts and associations with metals and three time-points glucose distribution of oral glucose tolerance test (OGTT) focused on the 10th, 50th, and 90th percentiles. Weighted quantile sum (WQS) regression was used to explore the relationship of metal mixtures and GDM as well as glucose. RESULTS: Maternal serum concentrations of metals were assessed at mean 16.55 ± 2.92 weeks' gestation. Women with under weight might have 25% decreased risk of GDM for every 50% increase in Cu concentration within the safe limits. A 50% increase in Mn and Zn levels was related to a 0.051 µmol/L (95% CI: 0.033-0.070) and 0.059 µmol/L (95% CI: 0.040-0.079) increase in mean fasting plasma glucose of OGTT (OGTT0), respectively. The magnitude of association with Mn was smaller at the upper tail of OGTT0 distribution, while the magnitude of correlation with Zn was greater at the upper tail. However, there was a 0.012 mmol/L (95% CI: -0.017 to -0.008), 0.028 mmol/L (95% CI: -0.049 to -0.007), and 0.036 mmol/L (95% CI: -0.057 to -0.016) decrease in mean OGTT0 levels for every 50% increase in Pb, Ca, and Mg, respectively. The negative association of Pb, Ca, and Mg was greater at the lower tail of OGTT0 distribution. No significant relationship was observed in Cu and mean OGTT0 level (-0.010 mmol/L, 95% CI: -0.021 to 0.001), however, it showed a protective effect at the upper tail (-0.034 mmol/L, 95% CI: -0.049 to -0.017). No obvious correlation was found between metals and postprandial glucose levels (OGTT1 and OGTT2 from OGTT). The WQS index was significantly related to OGTT0 (P < 0.001). The contribution of Mn (80.19%) to metal mixture index was the highest related to OGTT0, followed by Cu (19.81%). CONCLUSIONS: Higher Mn and Zn but lower Pb, Ca, and Mg concentrations within a certain range before 24 weeks' gestation might prospectively impair fasting plasma glucose during pregnancy; a greater focus is required on Mn. It could provide early markers of metal for predicting later glucose and suggest implement intervention for pregnant women.


Assuntos
Glicemia/análise , Diabetes Gestacional/sangue , Metais/sangue , Adulto , Monitoramento Biológico , Biomarcadores/sangue , China/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Gravidez
2.
Artigo em Inglês | MEDLINE | ID: mdl-32865233

RESUMO

INTRODUCTION: This study aimed to evaluate the preterm birth and additional perinatal outcomes between spontaneous and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) dichorionic-diamnionic (DCDA) twin pregnancies. MATERIAL AND METHODS: This retrospective cohort study was conducted in a tertiary university-affiliated medical center. All women with DCDA twin pregnancies were considered for inclusion. The primary outcome of interest was preterm birth <37 weeks of gestation and secondary outcomes included spontaneous preterm birth, iatrogenic (induced) preterm birth, gestational diabetes mellitus, pregnancy-induced hypertensive disorder, preeclampsia, preterm premature rupture of membranes (PPROM), intrahepatic cholestasis of pregnancy, placenta previa, neonatal intensive care unit (NICU) admission, birthweight discordance, small for gestational age, neonatal respiratory distress syndrome, ventilator support, and perinatal death and/or severe morbidity. These outcomes were compared between IVF/ICSI and spontaneous twin pregnancies. Multivariable logistic regressions were used to adjust for confounders. General estimated equation models were used to address intertwin correlation. RESULTS: A total of 1297 twin pregnancies, including 213 spontaneous and 1084 IVF/ICSI DCDA pregnancies, met the inclusion criteria. Women with IVF/ICSI pregnancies were older and had higher body mass index, adherence with prenatal care and proportion of nulliparity. After adjustment for confounders, IVF/ICSI pregnancies were associated with a slight increase in preterm birth <37 weeks of gestation (adjusted odds ratio [aOR] 1.72; 95% CI 1.24-2.39), iatrogenic preterm birth <37 weeks of gestation (aOR 1.41; 95% CI 1.00-1.97) as well as NICU admission (aOR 1.34; 95% CI 1.00-1.80). IVF/ICSI pregnancies were associated with a decrease in PPROM (aOR 0.64; 95% CI 0.42-0.99). There were no differences between IVF/ICSI and spontaneous DCDA pregnancies in terms of spontaneous preterm birth, gestational diabetes mellitus, pregnancy-induced hypertensive disorder, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, birthweight discordance, small for gestational age, neonatal respiratory distress syndrome, ventilator support, and perinatal death and/or severe morbidity. CONCLUSIONS: IVF/ICSI DCDA twin pregnancies were associated with a slight increase in preterm birth <37 weeks of gestation, iatrogenic preterm birth <37 weeks of gestation, and NICU admission but with a decrease in PPROM. Other outcomes were comparable between IVF/ICSI and spontaneous DCDA twin pregnancies. Multicenter studies with adequate power remain warranted.

3.
BMC Pregnancy Childbirth ; 20(1): 465, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795269

RESUMO

BACKGROUND: Previous evidence has suggested that lower gestational vitamin D levels might increase the risks of adverse pregnancy and birth outcomes. The results remain inconsistent and require further exploration. METHODS: A total of 2814 Chinese mother-infant pairs were included in this retrospective cohort study. Serum concentrations of 25(OH)D were reviewed in early pregnancy (16.3 ± 2.3 weeks). Outcomes of maternal gestational diabetes mellitus (GDM), cesarean section, fetal distress, preterm birth, low birth weight (LBW), and macrosomia were extracted from the medical records. Cox regression analysis was used to explore these associations. RESULTS: In total, 19.3% of mothers were pregnant at an advanced age (≥35 years), and 40.3% of pregnant women had vitamin D deficiency (< 50 nmol/L). After adjusting for potential covariates, the hazard ratio (HR) (95% CI) per standard deviation (SD) increase of serum 25(OH)D concentrations was 0.86 (0.779, 0.951) for GDM, 0.844 (0.730, 0.976) for preterm birth, and 0.849 (0.726, 0.993) for LBW. Similar protective associations were found for GDM, cesarean section, and preterm birth for a better vitamin D status when compared with vitamin D deficiency. CONCLUSION: Higher early pregnancy vitamin D was associated with a lower risk of GDM, cesarean section, preterm birth, and LBW.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32256449

RESUMO

Objective: To explore the size and shape association of OGTT values with adverse pregnancy complications among women with gestational diabetes mellitus (GDM) in Southern Han Chinese population and further analyze their mediating effects with maternal age in outcomes. Methods: 6,861 women with GDM were included in the study. Logistic regression was used to identify the correlations between OGTT values and adverse pregnancy outcomes of GDM. Restricted cubic spline nested logistic regression was conducted to investigate potential non-linear and linear associations. Mediating effect among maternal age, OGTT and adverse outcomes were explored. Results: Women with GDM had a mean age of 31.83, and 24.49% had advanced maternal age (≥35 years). In logistic regression with adjustment, compared with lower OGTT0 (<5.1 mmol/L), GDM patients with higher OGTT0 (≥5.1 mmol/L) exhibited 1.891 (95% CI: 1.441-2.298, P < 0.001), 1.284 (1.078-1.529, P = 0.005), 1.285 (1.065-1.550, P = 0.009), and 1.302 (1.067-1.590, P = 0.010) times increased risk of hypertensive disorders of pregnancy (HDP), preterm, neonatal hyperbilirubinemia, and macrosomia, respectively. GDM patients with higher OGTT1 (≥10 mmol/L) had only found to exhibited 1.473-fold (1.162-1.867, P = 0.001) increasing risk of HDP than those with lower OGTT1 (<10 mmol/L). No adverse outcome was identified to associate with higher OGTT2 (≥8.5 mmol/L). Linear relationships (non-linear P > 0.05) were observed between OGTT0 and HDP, preterm, neonatal hyperbilirubinemia, and macrosomia in both maternal age groups (<35 and ≥35 years). Non-linear associations of OGTT1 with incidence of HDP, preterm, and neonatal hyperbilirubinemia were detected in GDM patients younger than 35 years (non-linear P = 0.037, P = 0.049, P = 0.039, respectively), rising more steeply at higher values. Similar non-linearity was noted for OGTT2 with HDP in older patients. All OGTT values had significant mediating effects on some special complications caused by higher age. Conclusion: Higher fasting plasma glucose was more strongly linked to adverse pregnancy outcomes among GDM patients. Both linearity and Non-linearity of associations between glucose and complications should be taken into account. A careful reconsideration of GDM with hierarchical and individualized management according to OGTT is needed.

5.
Front Endocrinol (Lausanne) ; 11: 611071, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33613448

RESUMO

Objective: Although research suggests a close association between maternal thyroid function and birth outcomes, no clear conclusion has been reached. We aimed to explore this potential association in a retrospective cohort study. Methods: This study included 8985 mother-child dyads. The maternal serum free tetraiodothyronine (FT4), thyroid-stimulating hormone (TSH), and thyroid peroxidase antibody (TPO Ab) concentrations and birth outcome data were reviewed from medical records. Subjects with TPO Ab concentrations of >34 and ≤34 IU/ml were classified into the TPO Ab positivity (+) and TPO Ab negativity (-) groups, respectively. Results: Compared with subjects in the normal group (0.1 ≤ TSH < 2.5 mIU/L and TPO Ab-), those with TSH concentrations of 2.5-4.0 mIU/L and TPO Ab- had a 0.65-fold lower risk of low birth weight (LBW). In contrast, those with TSH concentrations of >4.0 mIU/L, regardless of the TPO Ab status, had a 2.01-fold increased risk of LBW. Subclinical hypothyroidism, regardless of the TPO Ab status, was associated with a 1.94-fold higher risk of LBW when compared with that in subjects with euthyroidism and TPO Ab-. No other significant associations were observed. Conclusion: A maternal TSH concentration of 2.5-4.0 mIU/L was associated with a lower risk of LBW when combined with TPO Ab-, whereas subjects with a TSH concentration of >4.0 mIU/L had an increased risk of LBW. Subclinical hypothyroidism appears to be associated with a higher risk of LBW.

6.
Eur J Obstet Gynecol Reprod Biol ; 243: 97-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31678762

RESUMO

OBJECTIVE: No recommendations are available for gestational weight gain (GWG) in underweight women with twin pregnancies. We aimed to evaluate whether underweight women with twin pregnancies should gain more weight than normal-weight women in order to optimize perinatal outcomes. STUDY DESIGN: This retrospective cohort study compared the GWG and perinatal outcomes among normal-weight and underweight women who gave birth to viable twins between 2015 and 2018 at the Maternal and Child Health Hospital in Foshan, China. Gestational weight gain (GWG) was categorized as adequate or inadequate GWG, based on the US Institute of Medicine 2009 guidelines for normal-weight women (≥ 0.46 kg/week). The outcomes of interest included spontaneous preterm birth (sPTB) <37 weeks, <35 and <32 weeks, small for gestational age (SGA), gestational hypertensive disorder (GHD), gestational diabetes mellitus (GDM), birth weight discordance (BDW) ≥20%, neonatal intensive unit (NICU) admission and neonatal respiratory distress syndrome (NRDS). Propensity score matching (PSM, in a 1:1 ratio) was utilized to minimize the effects of confounders on the differences in the two cohorts. Multivariable logistic models were also used to verify the results from PSM analysis. RESULTS: There were 475 normal-weight and 111 underweight women included in the analysis. Our results suggested that the incidence of adequate GWG was comparable between underweight and normal-weight women (37.5% vs. 45.1%, P = 0.141). The prevalence of GDM was significantly lower among underweight women (9.9%) than among normal-weight women (20.4%) (P = 0.010). There was no evidence of differences in other perinatal outcomes between the two groups. 102 underweight women and 102 normal-weight women were included in PSM analyses. There was a lower incidence of GDM in underweight women than in normal-weight women, but the difference was not significant (9.8% vs. 18.6%, P = 0.071). No evidence of any differences in the other outcomes, including sPTB, GHD, BWD≥20%, SGA, NICU admission and NRDS, was found between the underweight and normal-weight women. Multivariable logistic regression models yielded similar results. CONCLUSIONS: For Chinese twin pregnant women with twin pregnancies, our data does provide evidence to suggest underweight women need to gain more weight than normal-weight women to optimize perinatal outcomes. Future studies with larger number of underweight women with twin gestations are warranted to establish an optimal range of GWG.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Ganho de Peso na Gestação , Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez de Gêmeos , Nascimento Prematuro/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Magreza/epidemiologia , Adulto , Peso ao Nascer , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Modelos Logísticos , Gravidez , Complicações na Gravidez , Pontuação de Propensão , Estudos Retrospectivos , Adulto Jovem
7.
Sci Rep ; 9(1): 12099, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31431662

RESUMO

This retrospective cohort study aimed to investigate the effect of placental location on birthweight discordance among diamniotic-dichorionic twin pregnancies. Medical records and sonographic reports of 978 diamniotic-dichorionic twin pregnancies delivered at Foshan Maternal and Fetal Health Hospital were reviewed. Pregnancies with congenital malformation, intrauterine death or placenta previa were excluded. The placental location for each twin was determined by last sonographic examination before delivery, and the pregnancies were grouped by different versus same placental location in each pregnancy. Maternal and fetal characteristics were summarized. The primary outcome of interest was birthweight discordance (BWD) ≥20%, and secondary outcomes included small for gestational age (SGA) as a binary outcome and mean value and absolute difference in birthweight as continuous outcomes. Student's t test and the chi-square test were used for univariate analyses, while multivariate regressions were used to adjust for confounders. General estimated equation (GEE) models were used to address the correlation between fetuses when assessing SGA. A total of 866 eligible subjects were included in the analysis. In total, 460 pregnancies had placentas with different locations, and 406 had placentas with same locations. The gestational age at delivery was slightly younger in the same placental location group than in the different placental location group (35.8 ± 0.1 vs. 36.1 ± 0.1 weeks, P = 0.067). Other maternal and fetal characteristics were comparable between the two study groups. There was no significant difference in BWD ≥20% (aOR = 1.06; 95% CI: 0.71-1.59) or SGA (aOR = 1.32; 95% CI: 0.76-2.28) between the same and different placental location groups. Neither the mean value nor the absolute difference in birth weight was associated with placental location combination (P = 0.478 and P = 0.162, respectively). In conclusion, discordant birthweight is not affected by same location of diamniotic-dichorionic placentas.


Assuntos
Peso ao Nascer/fisiologia , Doenças Fetais/diagnóstico por imagem , Placenta/diagnóstico por imagem , Gravidez de Gêmeos , Adulto , Âmnio/fisiologia , Córion/fisiologia , Feminino , Doenças Fetais/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Placenta/fisiopatologia , Gravidez , Resultado da Gravidez , Ultrassonografia Pré-Natal
8.
BMC Pregnancy Childbirth ; 19(1): 262, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340779

RESUMO

BACKGROUND: Gestational weight gain (GWG) has implications for perinatal outcomes, the guidelines for maternal weight gain, however, remain understudied among twin pregnancies. This study aimed to assess the associations between perinatal outcomes and GWG among twin pregnancies, based on the US institute of Medicine (IOM) 2009 guidelines. METHODS: A retrospective cohort study of pregnant women with viable twins ≥26 weeks of gestation, was conducted in Foshan, China, during July 2015 and June 2018. Maternal BMI was categorized based on Chinese standard and GWG was categorized as below, within and above the IOM 2009 recommendations. Underweight women were excluded for analysis. Perinatal outcomes were compared among these groups. To assess the independent impact of GWG on the perinatal outcomes, conventional multivariable regression and general estimated equation (GEE) were utilized for maternal outcomes and neonatal outcomes, respectively. RESULTS: A total of 645 mothers with twin pregnancies were included, of whom 15.0, 41.4 and 43.6% gained weight below, within and above guidelines, respectively. Compared to weight gain within guidelines, inadequate weight gain was associated with increased risks in spontaneous preterm birth < 37 weeks (aOR:3.55; 95% CI: 1.73-7.28) and < 35 weeks (aOR:2.63; 95% CI: 1.16-5.97). Women who gained weight above guidelines were more likely to have gestational hypertension disorder (aOR: 2.36; 95% CI: 1.32-4.21), pre-eclampsia (aOR: 2.59; 95% CI: 1.29-5.21) and have fetuses weighted >90th percentile and less likely to have fetuses weighted < 2500 g and < 1500 g. CONCLUSIONS: Maintenance of gestational weight gain within the normal range could decrease the risk of adverse perinatal outcomes. However, the causality between pre-eclampsia and gestational weight gain requires further investigations.


Assuntos
Ganho de Peso na Gestação , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos/estatística & dados numéricos , Adulto , China , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos
9.
Psychol Res Behav Manag ; 11: 607-615, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30573996

RESUMO

Background: Studies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents. Methods: We analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People's Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%). Results: After adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio =1.82, 95% CI=1.69-1.95) and suicide attempts (adjusted odds ratio =2.16, 95% CI=1.82-2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized ß estimate=0.009, 95% CI=0.007-0.012) and suicide attempts (standardized ß estimate=0.004, 95% CI=0.003-0.005). Conclusion: Poor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion.

10.
Artigo em Inglês | MEDLINE | ID: mdl-30445669

RESUMO

Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57⁻1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09⁻4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01⁻1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43⁻2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image.


Assuntos
Comportamento do Adolescente/psicologia , Índice de Massa Corporal , Minorias Sexuais e de Gênero/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Imagem Corporal , China , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Masculino , Psicologia do Adolescente , Fatores de Risco , Autorrelato , Tentativa de Suicídio/psicologia
11.
Psychiatry Res ; 269: 361-368, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30173042

RESUMO

Adolescence is a critical period for the onset of illicit drug use. This study aimed to estimate the prevalence of illicit drug use among Chinese adolescents, to assess the associations between different forms of childhood maltreatment and subsequent illicit drug use and to test whether the child's sex plays a moderating role in the associations. A secondary analysis was made of cross-sectional data collected from 10th to 12th graders from China who were sampled in the 2015 School-based Chinese Adolescents Health Survey. A total of 59,518 questionnaires were included in the final analysis. The prevalence estimates and logistic regression analyses were weighted to account for the complex survey design. If the interaction term (between childhood maltreatment and sex) was significantly associated with illicit drug use, we would perform stratification analyses across sex. Of the total sample, 45.2% were boys, and the mean (SD) age was 17.0 (0.9) years. The results of stratification analyses demonstrated that among boys, physical abuse and sexual abuse were independently associated with an increased risk of use during their lifetime of MDMA, methamphetamine, ketamine, and mephedrone; among girls, only emotional abuse and sexual abuse were associated with MDMA use, methamphetamine use, ketamine use, and mephedrone use.


Assuntos
Maus-Tratos Infantis/psicologia , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Criança , China , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Instituições Acadêmicas , Estudantes/psicologia , Inquéritos e Questionários
12.
BMJ Open ; 8(8): e020969, 2018 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-30093513

RESUMO

OBJECTIVES: Suicidality among sexual minority adolescents has generated worldwide concern in recent decades, and previous Western studies have demonstrated that sexual minority status is associated with adolescent suicidality. However, whether this association exists in Chinese adolescents remains largely unknown. This study aimed to estimate the associations between sexual minority status and suicidal behaviour among Chinese adolescents. DESIGN: Cross-sectional survey. SETTING: A total of 506 high schools in 7 provinces of China. PARTICIPANTS: A total of 150 822 students in grades 7-12 who completed the questionnaires (response rate of 95.9%) were included. MAIN OUTCOME MEASURES: Suicidal ideation and suicide attempts were used to measure suicidal behaviour, and sexual attraction (opposite sex, same sex or both sex) was used as a measure for sexual minority status. RESULTS: Of the 150 822 adolescents analysed, 4.1% self-reported as sexual minorities and 17.3% were unsure. Compared with heterosexual and unsure adolescents, same-sex romantic attraction (SSA) and both-sex romantic attraction (BSA) adolescents reported a higher prevalence of past-year suicidal ideation (SSA: 21.6% for males and 30.4% for females; BSA: 34.7% for males and 42.3% for females) and suicide attempts (SSA: 6.9% for males and 8.9% for females; BSA: 12.2% for males and 10.9% for females). After adjustment for covariates, SSA and BSA adolescents were more likely to have past-year suicidal ideation and suicide attempts than their heterosexual and unsure peers. BSA adolescents reported the highest risk of suicidal ideation (males: adjusted OR (AOR) 2.42, 95% CI 2.03 to 2.88; females: AOR 2.61, 95% CI 2.41 to 2.82) and suicide attempts (males: AOR 3.83, 95% CI 2.85 to 5.14; females: AOR 2.59, 95% CI 2.19 to 3.06). CONCLUSIONS: Our study suggested that Chinese sexual minority adolescents were at increased risk of suicidality, and those with BSA had an especially high risk in this population. These findings emphasised the urgent need to develop targeted interventions to effectively address suicide-related problems among Chinese sexual minority adolescents.


Assuntos
Minorias Sexuais e de Gênero/psicologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Prevalência , Fatores de Risco , Minorias Sexuais e de Gênero/estatística & dados numéricos , Tentativa de Suicídio/psicologia
13.
J Affect Disord ; 239: 85-92, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-29990667

RESUMO

BACKGROUND: Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships. METHODS: We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher-classmate relations. RESULTS: Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259-0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074-0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher-classmate relations. LIMITATIONS: Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design. CONCLUSIONS: Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents.


Assuntos
Comportamento do Adolescente/psicologia , Grupo com Ancestrais do Continente Asiático/psicologia , Minorias Sexuais e de Gênero/psicologia , Ideação Suicida , Adolescente , Bullying/estatística & dados numéricos , China/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Grupos Minoritários , Estudantes/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários
14.
J Affect Disord ; 235: 421-427, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29677607

RESUMO

BACKGROUND: Non-medical prescription opioid use (NMPOU) and childhood maltreatment are currently serious problems among adolescents worldwide, and childhood maltreatment may be associated with the increased rates of NMPOU. This study examined the specific associations between particular types of childhood maltreatment and lifetime NMPOU and assessed whether gender has a moderating effect on these associations. METHODS: A 3-stage, stratified cluster, randomized sampling method was used to collect data from 11,194 high school students in Chongqing. RESULT: The prevalence of the lifetime NMPOU among senior high school students in Chongqing was 7.7%. Physical abuse (AOR = 1.11, 95% CI = 1.07-1.14), emotional abuse (AOR = 1.05, 95% CI = 1.03-1.08), sexual abuse (AOR = 1.04, 95% CI = 1.01-1.07), physical neglect (AOR = 1.06, 95% CI = 1.04-1.09), and emotional neglect (AOR = 1.03, 95% CI = 1.02-1.04) were all positively associated with lifetime NMPOU. The moderating effects of gender on emotional abuse (P = 0.004) and sexual abuse (P = 0.019) were statistically significant in the adjusted model of lifetime NMPOU. According to the stratification analyses in which the male and female students were analyzed separately, female students who previously experienced emotional/sexual abuse had a higher prevalence of lifetime NMPOU. LIMITATIONS: The study sample only contained school students and cross-sectional design limited our ability to make causal inferences. CONCLUSION: Childhood maltreatment was positively associated with lifetime NMPOU, and gender had a moderating effect on the associations between childhood maltreatment and lifetime NMPOU. Early identification of and intervention for childhood maltreatment victims, particularly female victims, may help reduce the lifetime risk of NMPOU.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático/etnologia , Criança , Maus-Tratos Infantis/psicologia , China/epidemiologia , Estudos Transversais , Emoções , Feminino , Humanos , Masculino , Prevalência , Instituições Acadêmicas , Fatores Sexuais , Estudantes/psicologia , Adulto Jovem
15.
J Pediatr ; 196: 244-250.e1, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29526470

RESUMO

OBJECTIVES: To test, among older Chinese adolescents, the associations of childhood maltreatment with single and multiple suicide attempts and whether these associations vary in relation to the presence of sleep disturbance. STUDY DESIGN: We analyzed data collected from 10th to 12th graders from 7 randomly selected provinces of China in the 2015 School-based Chinese Adolescents Health Survey. There were 83 200 students who were invited to participate, and 75 715 students' questionnaires were completed and qualified for the survey. Adjusted multinomial logistic regression models were conducted to evaluate the associations of childhood maltreatment with suicide attempts. RESULTS: Compared with no suicide attempts, each type of adjusted childhood maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect, or emotional neglect) was associated with an increased risk of single and multiple suicide attempts (P < .05). The magnitude of the aORs in multiple suicide attempters was greater than those in single suicide attempters. Moreover, the adjusted interaction effects for a single suicide attempt between each type of childhood maltreatment and sleep disturbance were all statistically significant in the multivariable multinomial logistic regression models (P < .001). However, the adjusted interaction effects for multiple suicide attempts were not significant (P > .05). CONCLUSIONS: Maltreatment during one's childhood is associated with an increased risk of single and multiple suicide attempts among older Chinese adolescents. Sleep disturbances play a moderating role in these associations for a single suicide attempt.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Transtornos do Sono-Vigília/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Comportamento do Adolescente , Grupo com Ancestrais do Continente Asiático , Criança , China , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores de Risco , Transtornos do Sono-Vigília/psicologia , Estudantes/psicologia
16.
Drug Alcohol Depend ; 183: 169-175, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29268185

RESUMO

OBJECTIVE: The nonmedical use of prescription drugs (NMUPD) is attracting public attention. We aimed to explore the association between sexual attraction and NMUPD among Chinese adolescents. METHOD: A school-based survey was conducted in seven Chinese provinces, and a multi-stage stratified cluster sampling method was used in this study. A total of 150,822 students from seven Chinese provinces completed the questionnaire; the response rate was 95.93%. All data were collected between November 2014 and January 2015. RESULTS: Overall, 8.8%, 4.4%, and 2.2% of the students reported lifetime, past-year, and past-month NMUPD, respectively. Compared with heterosexual students (8.2%), sexual minority and unsure students were more likely to report lifetime NMUPD (14.4% and 10.0%, respectively; χ2 = 244.34, P < 0.001). In addition, sexual minority and unsure students were more likely to admit past-year and past-month use of NMUPD. After adjusting for social demographics and lifestyle covariates, sexual minority and unsure students were at an increased risk of lifetime NMUPD (adjusted odds ratio [AOR] = 1.68, 95% confidence interval [CI] = 1.54-1.83 and AOR = 1.33, 95% CI = 1.26-1.41, respectively). CONCLUSIONS: Our study suggested that sexual minority and unsure adolescents have a higher risk of NMUPD. Moreover, our study suggested that sexual minority and unsure students are more likely to both try and continue to use prescription drugs. Further studies focusing on the mechanism of substance abuse and appropriate interventions among sexual minority and unsure adolescents are warranted.


Assuntos
Comportamento do Adolescente/psicologia , Analgésicos Opioides/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/psicologia , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Analgésicos Opioides/administração & dosagem , China/epidemiologia , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Fatores de Risco , Estudantes/psicologia , Inquéritos e Questionários , Adulto Jovem
17.
BMJ Open ; 7(12): e017067, 2017 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-29282258

RESUMO

OBJECTIVES: Recent studies have suggested that sexual minorities are more likely to have poor sleep quality. This study aims to explore sleep quality among sexual minority adolescents and examines the association between sexual minority status and sleep quality. DESIGN: Cross-sectional survey. SETTING: A total of 506 high schools in seven Chinese provinces. PARTICIPANTS: A total of 150 822 students in grades 7-12 completed the questionnaires, and 123 459 students who reported being aware of their sexual orientation were included in analyses. MAIN OUTCOME MEASURES: The Pittsburgh Sleep Quality Index, sexual attraction and school bullying victimisation. RESULTS: Of the 123 459 students who were analysed, 5.00% self-reported as sexual minorities. Only 26.67% of sexual minority students slept 8 or more hours/day, which is less than their heterosexual peers (35.70%; χ2=130.04, P<0.001). Of the total sample, 22.41% of the students reported poor sleep quality, and this prevalence was significantly higher in sexual minority students than in heterosexual students (32.56% vs 21.87%; χ2=281.70, P<0.001). After controlling for social demographics, lifestyle and depressive symptoms, sexual minority students had higher odds of poor sleep quality (adjusted OR=1.41, 95% CI 1.31 to 1.51) than their heterosexual peers. The indirect effect of school bullying victimisation (standardised ß estimate=0.007, 95% CI 0.006 to 0.009) was significant, indicating that school bullying victimisation partially mediated the association between sexual minority status and sleep quality. CONCLUSIONS: Our study suggested that poor sleep quality was common in sexual minority adolescents, and more attention should be paid to sleep problems in this population. Conducting interventions to reduce school bullying behaviours is an important step to improving sleep quality in sexual minority adolescents. Further, studies are warranted that focus on the risk factors and mechanisms of and interventions for sleep problems in sexual minority adolescents.


Assuntos
Bullying/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Sono , Estudantes/estatística & dados numéricos , Adolescente , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Instituições Acadêmicas , Autorrelato
18.
J Affect Disord ; 208: 355-362, 2017 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-27810718

RESUMO

BACKGROUND: Suicidal ideation and attempts are still currently serious problems among adolescents worldwide, and there is evidence that sleep problem may be associated with increased rates of mental disorder. This study aimed to examine the associations between sleep duration and suicidal ideation and attempts among adolescents and to test whether depressive symptoms have moderating effects on the associations. METHODS: A 3-stage, stratified cluster, random sampling method was used to collect data from 20,130 high school students in southeast China. RESULTS: The weighted prevalence of short sleep among Chinese adolescents was 5.6% (95% CI, 5.3-6.0%), and the weighted prevalence of long sleep was 2.7% (95% CI, 2.5-3.0%). The final results demonstrated that short sleep was positively associated with suicidal ideation (AOR=2.28, 95% CI=1.96-2.66) and suicidal attempts (AOR=3.20, 95% CI=2.46-4.16), and long sleep was only significantly associated with suicidal attempts (AOR=2.47, 95% CI=1.70-3.58). Stratification analyses conducted separately for students with and without depressive symptoms demonstrated that depressive symptoms may have moderating effects on the associations between sleep duration and suicidality. LIMITATIONS: Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design. CONCLUSIONS: Sleep duration was associated with suicidal ideation and attempts, and the association between sleep duration and suicidal attempts was U-shaped. These findings support that proper treatments services with the potential to restore adolescent normal sleep would be helpful in preventing suicidality among adolescents.


Assuntos
Comportamento do Adolescente/psicologia , Grupo com Ancestrais do Continente Asiático/psicologia , Depressão/psicologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adolescente , China/epidemiologia , Estudos Transversais , Depressão/complicações , Feminino , Humanos , Masculino , Prevalência , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estudantes/psicologia
19.
Health Qual Life Outcomes ; 14(1): 125, 2016 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-27608683

RESUMO

BACKGROUND: The quality of life in patients receiving chronic hemodialysis is compromised despite of the substantial achievements in treatments. Quality of life in hemodialysis patients have been shown to be associated with decreased survival and increased hospitalization. Therefore, it is necessary to incorporate the managements of symptoms and patient self-perceived well-being as measurements of effective treatments for these patients. METHODS: A survey of symptom distress, quality of sleep and quality of life was performed in 301 maintenance hemodialysis patients using Dialysis Symptom Index, Short Form-36, and Pittsburgh Quality of Sleep Index table. Patients were recruited from five hospitals in Guangdong area of China by convenience sampling. RESULTS: The prevalence of various symptoms in maintenance hemodialysis patients was between 23.3 and 80.4 %. These patients had compromised sleep and poor quality of life. Moreover, poor quality of sleep and impaired quality of life were associated with high symptom burden of these patients. CONCLUSION: The patients receiving chronic hemodialysis generally have heavy symptom distress, which could contribute to the disturbed sleep and impaired quality of life of these patients. Measurements of clinical outcomes for hemodialysis patients should include the management of symptoms and morbidity. The ultimate goal of treatments is to improve patient self-perceived quality of life.


Assuntos
Qualidade de Vida , Diálise Renal/psicologia , Transtornos do Sono-Vigília/etiologia , Estresse Psicológico/etiologia , Adulto , Idoso , China , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Diálise Renal/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento
20.
PeerJ ; 4: e2169, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27478695

RESUMO

Background. Internal migration plays a significant role in China's HIV epidemic. However, few studies have directly compared migrant men who have sex with men (MSM) with local MSM with regard to HIV/sexually transmitted infections (STIs) risks. Methods. We conducted a study in Guangzhou, China, with the aim of understanding the differences in HIV/STIs risks between migrant MSM and local MSM. A cross-sectional study was conducted among 273 migrant MSM and 249 local MSM in Guangzhou, China. Their behavioral and serologic data on HIV/syphilis were collected and compared between the two groups. A multivariate logistic regression was used to estimate the associations between HIV/STIs risks and migratory status. Results. Migrant MSM, compared to local MSM, have higher odds of reporting unprotected anal intercourse (UAI) (OR = 1.4; 95% CI [0.9-2.0]) and having multiple homosexual partners (OR = 1.2; 95% CI [0.8-1.8]). A lower rate of condom use at homosexual debut was reported in migrant MSM than in local MSM (OR = 0.7; 95% CI [0.5-0.9]). Migrant MSM have less odds of reporting HIV/STIs testing in the previous 6 months relative to local MSM (OR = 0.5; 95% CI [0.4-0.8]). In addition, migrant MSM demonstrated a lower level of HIV knowledge than local MSM (OR = 0.4; 95% CI [0.2-0.8]). Conclusion. Migrant MSM are more likely to engage in sexual risk behaviors, report a lower level of HIV knowledge and have less access to HIV/STIs testing. Further comprehensive interventions targeting migrant MSM are urged.

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