Changes in fertility intention among married Chinese couples with two children during COVID-19: a cross-sectional study.

BACKGROUND: A three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention. AIM: To describe married couples' changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions. METHODS: An online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention. RESULTS: A total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples' intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention. CONCLUSIONS: During severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.

Barriers and facilitators of psychological help-seeking behaviors for perinatal women with depressive symptoms: A qualitative systematic review based on the Consolidated Framework for Implementation Research.

OBJECTIVE: To identify barriers and facilitators related to psychological help-seeking behaviors of perinatal depression from all related stakeholders (e.g., perinatal women, family members, mental health care providers, and policymakers). DESIGN: A literature search of six English-language databases (PubMed, Web of Science, Embase, PsycINFO, the Cochrane Library, CINAHL) and three Chinese-language databases (China National Knowledge Infrastructure, Wan Fang, Chinese Biomedical Literature Databases). Studies published in English or Chinese using qualitative or mixed methods to explore the psychological help-seeking behaviors of women with perinatal depression were included. Data extraction was synthesized for common themes based on the Consolidated Framework for Implementation Research. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise methodologic quality. PARTICIPANTS AND SETTINGS: Perinatal women with depression, mental health care providers (e.g., pediatricians/nurses, social workers, nurse-midwives, perinatal psychiatrists, community health workers, and administrators), partners and informal caregivers (e.g., community birth attendants, elderly mothers, and men of reproductive age) based in high, middle and low income countries. FINDINGS: Forty-three articles were included in this review and presented according to the Consolidated Framework for Implementation Research domains (in parentheses). The most common barriers to help seeking were stigma (individual characteristics), misconceptions (individual characteristics), cultural beliefs (inner setting), and lack of social support (outer setting). The most common facilitators were providing adequate support (outer setting) and perinatal health care professional training on how to detect, manage and discuss depression; establishing supportive relationships with mental health care providers; and eroding stigma (all three implementation processes). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This systematic review could serve as a reference framework for health authorities to develop diverse strategies for improving the psychological help-seeking behaviors of women with perinatal depression. More high-quality studies focused on the Consolidated Framework for Implementation Research characteristics of available interventions, and implementation processes are needed in future research.

Increasing Understanding and Perceived Confidence of Nurses Working in an Emergency Department in Assessing Patients at Risk of Violent Behavior.

PURPOSE: The aims of this quality improvement project were to improve understanding and perceived confidence in using a tool that assesses patients at risk of violence. PROJECT DESCRIPTION: The Brøset Violence Checklist is valid at assessing patients at risk of violence. Participants were given access to an e-learning module that demonstrated how to use the tool. Improvement in understanding and perceived confidence in using the tool were assessed preintervention and postintervention via an investigator-developed survey. Analysis of the data was conducted using descriptive statistics, and open-ended survey responses were analyzed using content analysis. OUTCOME: Participants did not demonstrate an increase in understanding and perceived confidence after introduction of the e-learning module. Nurses reported that the Brøset Violence Checklist was easy to use, clear, reliable, and accurate and could be used to standardize assessments of at-risk patients. CONCLUSION: Emergency department nursing staff were educated in use of a risk assessment tool for identifying patients at risk of violence. This supported the implementation and integration of the tool into emergency department workflow.

Risk Factors Associated with Intimate Partner Violence against Chinese Women: A Systematic Review.

BACKGROUND: The prevalence of intimate partner violence against women in China remains high. Understanding associated risk factors will help inform prevention. The purpose of this systematic review was to identify associated risk factors of intimate partner violence against women in mainland China. METHODS: Nine English and Chinese databases were searched from 1 August 2008-2 August 2022. Reference lists of relevant studies supplemented the initial results. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence was used to assess article quality. Study results were combined in a narrative synthesis. RESULTS: Nineteen eligible studies were identified. Examples of key intimate partner violence risk factors included: partner's low education or income, unhealthy habits (gambling), women's marital status, poor health or education, women's or partner's childhood abuse or witnessing thereof at home, or multiple children and husband dominance. CONCLUSIONS: Despite the significant changes in Chinese policies and the new law, IPV continues, and this review has highlighted vulnerable women who need identification and protection. Further study is needed of individual (e.g., psychological well-being), relationship/family, and society/cultural variables.

Prevalence and Correlates of Weight Stigma among Postpartum Women in China.

Weight stigma is linked to a variety of psychological and health problems. In the postpartum period, women may be more likely to experience weight-based discrimination because of their changing social roles, weight, and the new functions their bodies fulfill. However, few studies have explored the issue of postpartum women's weight stigma. Thus, to investigate the prevalence and correlates of weight stigma for postpartum women in China, we conducted a cross-sectional study of 507 postpartum women. Results showed that almost one quarter (21.1%) of postpartum women claimed to have experienced perceived weight stigma (PWS). Two thirds (66.1%) scored at the mean and 14.8% at the highest levels of weight bias internalization (WBI). During the postnatal period, the conditions of those most likely to report experiences of weight-based discrimination included low income [b = -0.203, p = 0.004], occupation as a worker [b = 0.921, p = 0.017] or farmer [b = 0.826, p = 0.033], stress [b = 0.044, p = 0.035], depression [b = 0.057, p = 0.021], and higher WBIS [b = 0.018, p = 0.002]. In addition, postpartum women who lived alone [b = 7.511, p = 0.048], were overweight or obese [b = 5.443, p = 0.000], and had higher PWS [b = 0.897, p = 0.004] and anxiety symptoms [b = 0.219, p = 0.011] had higher levels of internalized weight stigma. Findings from this study provide a foundation to better understand characteristics of postpartum women in China who are at risk for weight stigma.

Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China.

Background: Although many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China. Methods: We conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg). Results: Overall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP. Conclusions: This study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.

Influencing factors for placenta accreta in recent 5 years: a systematic review and meta-analysis.

OBJECTIVE: Assess influencing factors for placenta accreta in pregnant women documented in recent literature. METHODS: A systematic review and meta-analysis were conducted based on English- and Chinese-language articles published from January 2014 to June 2019. Articles were retrieved from the following Chinese databases, CNKI, Wanfang Data, China Science and Technology Journal Database, CBM and English databases, PubMed, Web of Science, the Cochrane Library and Embase. RESULTS: Eleven studies with 2,152,014 cases were included in the meta-analysis. The odds ratios of influencing factors were as follows: hypertension 2.51 (95% CI, 1.50-4.20), multifetal gestations 1.90 (95% CI, 1.26-2.88), male fetus 0.79 (95% CI, 0.74-0.84), and low socioeconomic status 0.51 (95% CI, 0.37-0.71). CONCLUSION: Evidence from English- and Chinese-language literature indicates that hypertension and multifetal gestations are risk factors for placenta accreta, while male fetus and low socioeconomic status are protective factors.

Frequency of basic public health services utilization by married female migrants in China: associations of social support, discrimination and sociodemographic factors.

BACKGROUND: Utilization of basic public health services (BPHS) allows for disease prevention and management and is an essential component for protecting health. Disparities in utilization exist between rural-to-urban migrants and their local counterparts in China. This study sought to determine the frequency of BPHS utilization and whether social support, discrimination, and sociodemographic features were risk factors for low BPHS utilization by Chinese female migrants. METHODS: Data were derived from a survey of female rural-to-urban migrants at nine work sites in Changsha, China. The association between social support, discrimination, sociodemographic factors and BPHS utilization was obtained using Chi-square and logistic regression analysis. RESULTS: Between December 2017 and April 2018, 307 female participants completed the survey. A total of 24.7% reported having had health education, 26.1% had breast and cervical cancer screening, 27.2% had established a health care record, and 40.9% had received basic contraceptive services. Two factors were associated with the reduced likelihood of BPHS utilization: Length of migration and health record establishment (OR = 0.53; 95% CI = 0.31, 0.92) and years of education and basic contraceptive service use (OR = 0.36; 95% CI = 0.20, 0.67). The remaining six factors were associated with an increased likelihood of BPHS utilization: Living circumstances and health record establishment (OR = 2.11; 95% CI = 1.17, 3.80), health education (OR = 2.71; 95% CI = 1.51, 4.87) and cancer screening (OR = 2.38; 95% CI = 1.30, 4.36). Utilization of social support was associated with health record establishment (OR = 1.24; 95% CI = 1.06, 1.44), basic contraceptive service use (OR = 1.21; 95% CI = 1.04, 1.42) and cancer screening (OR = 1.29; 95% CI = 1.10, 1.51). Objective social support was associated with health education utilization (OR = 1.15; 95% CI = 1.04, 1.26), while subjective social support was associated with basic contraceptive service use (OR = 1.11; 95% CI = 1.05, 1.18) and cancer screening (OR = 1.10; 95% CI = 1.02, 1.17). Family location was associated with basic contraceptive service use (OR = 1.96; 95% CI = 1.12, 3.44) and migration time in Changsha was associated with basic contraceptive service use (OR = 2.24; 95% CI = 1.18, 4.27). CONCLUSIONS: Overall, there was low utilization rate for four BPHS by Chinese female migrants, and social support appears to be an important factor in this setting. Government, community, and workplace education efforts for enhancing BPHS utilization among female rural-to-urban migrants are recommended.

Revising an Organizational Readiness Tool for Doctor of Nursing Practice Projects.

BACKGROUND: Students conducting doctor of nursing practice (DNP) projects can experience barriers that cause delays, frustration, and poor-quality projects. PROBLEM: For successful initiation and timely completion of quality projects, organizational readiness for change (ORC) evaluation is essential, yet ORC tools are not currently part of most DNP project requirements and curricula. APPROACH: The purpose of this project was to revise a reliable, validated ORC tool with 12 DNP student participants and evaluate its utility for DNP projects. OUTCOMES: Doctor of nursing practice students completed the revised Organizational Readiness for Knowledge Translation (OR4KT)-DNP tool and rated the tool as being high in acceptability, learning, and educational impact. Students who indicated that they had complications during project initiation scored lower than their peers on the OR4KT-DNP tool and scored higher on the student survey for utility. The OR4KT-DNP tool can serve as the foundation for a successful DNP project initiation.

Nurses' knowledge, attitudes, and behaviours related to pressure injury prevention: A large-scale cross-sectional survey in mainland China.

AIMS AND OBJECTIVES: To determine the level of and factors in nurses' knowledge, attitudes and behaviours towards pressure injury (PI) prevention. BACKGROUND: Although there has been a declining trend in global PI prevalence and hospital-acquired rates in recent years, this has not been the case in China. Evidence in the literature indicates the importance of nurses' knowledge, attitudes and behaviours for promoting PI prevention. DESIGN: Cross-sectional study. METHODS: A total of 1,806 nurses from 10 tertiary general hospitals in Hunan Province, China, participated in this study. Nurses' knowledge and attitudes were assessed using Pieper's Pressure Ulcer Knowledge Test and Attitude towards Pressure Ulcer Prevention Instrument, respectively, and behaviours were measured using a researcher self-designed questionnaire. Multiple logistic regression analysis determined factors affecting the nurses' PI-prevention knowledge, attitudes and behaviours. A STROBE checklist was used to report findings. RESULTS: Among all nurses involved in this study, 41.7% had insufficient PI-prevention knowledge, 46.6% had negative PI-prevention attitudes, and 21.8% had poor PI-prevention behaviour. Nurses with a bachelor's degree or above were more likely to have adequate PI-prevention knowledge. Increased PI-prevention training frequency increased the nurses' positive attitude scores for PI prevention; longer years of service and a higher number of PI-prevention trainings attended predicted better PI-prevention behaviours. CONCLUSION: Chinese nurses' PI-prevention knowledge and attitudes in this study were unsatisfactory, while their PI-prevention behaviour was acceptable. Increasing PI-prevention training frequency can help improve Chinese nurses' PI-prevention attitudes and further behaviour. Having a minimum of a bachelor degree may be beneficial to Chinese nurses' PI-prevention knowledge, but more evidence is needed. RELEVANCE TO CLINICAL PRACTICE: Chinese nurses have insufficient knowledge about PI-repositioning, inadequate practices in PI nutrition assessment, and low confidence in their personal competence regarding PI-prevention. The key solution for the above issues is to promote ongoing education and training based on strong clinical leadership.

The risk, perceived and actual, of developing type 2 diabetes mellitus for mothers of preschool children in urban China.

BACKGROUND: The perceived risk of developing type 2 diabetes mellitus (T2DM) can motivate individuals to adopt preventive health behaviors. Compared with fathers, mothers of young children often experience unique risk factors for developing T2DM: pregnancy-related weight gain, lifestyle changes related to child care, and the increased incidence of gestational diabetes mellitus. Understanding how actual risk factors affect the perceived risk of developing T2DM can foster effective diabetes prevention interventions for this population. The aims of this study were to describe the risk, perceived and actual, of developing T2DM and to explore the influencing factors of perceived risk for Chinese mothers of preschool children in China. METHODS: A multisite, cross-sectional survey was conducted and included 176 mothers (mean age of 31.19 years old) of preschool children (aged 3-7 years old) from four preschools in Changsha, the capital city of Hunan Province, China. The overall perceived risk of developing T2DM was measured by one item "Your own personal health risk is at almost no risk, slight risk, moderate risk or high risk from diabetes" from the Risk Perception Survey for Developing Diabetes (RPS-DD). PRS-DD and the Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CHINARISK) were used to assess perceived risk related worry, personal control, optimistic bias, and diabetes risk knowledge and actual risk of T2DM. Mothers also reported their height, weight, and waist circumference followed by the NIH protocol. Pearson correlation and stepwise multivariate linear regression were used to explore how the actual risk factors affected the perceived risk of developing diabetes (RPS-DD)). RESULTS: Nearly 90% of mothers perceived almost no/slight risk for developing diabetes. Nearly half of the mothers had parents or siblings with diabetes. Roughly 70% of the mothers did not eat five servings of fruits and vegetables per day, and more than 50% did not exercise at least 30 minutes a day. In the five stepwise multivariate linear regression models, young mothers (95% CI .400-1.311) and those with a family history of diabetes (95% CI -0.74- .000) were founded a higher overall perceived risk. Mothers who reported more sedentary time (95% CI -0.029- -0.008) and less physical activity had less personal control (95% CI -0.354- -0.046). Mothers with more sedentary time had more worries about developing T2DM(95% CI 0.008-0.035) . Mothers who were older (95% CI -0.440-0.055) or had more physical activities (95% CI 0.003-0.048) had more optimistic bias of not developing T2DM. Mothers who had a higher education level (95% CI .354-1.422) and a family history of diabetes (95% CI .029-2.231) had more diabetes risk knowledge of developing T2DM. CONCLUSION: This study found that Chinese mothers of preschool children in urban areas reported low perceived risk of developing T2DM, although they have actual risk factors. These women did not associate anthropometric, health history, or health behavior factors with the risk of developing T2DM. Anthropometrics and risk factors associated with behavioral risk factors may be the focus of diabetes prevention programs.

Acculturation, Inflammation, and Self-rated Health in Mexican American Immigrants.

This cross-sectional study examined the bio-behavioral pathways that may account for poorer self-rated health (SRH) among Mexican American immigrants compared to non-Hispanic whites in the U.S. The association between acculturation and SRH among Mexican American immigrants was also examined. The 2009-2010 National Health and Nutrition Examination Survey enrolled 592 Mexican American immigrants and 2391 U.S.-born, non-Hispanic whites. Predictor variables included Mexican American ethnicity and a validated Acculturation Index comprised of language spoken at home, interview language, and proportion of life residing in the U.S. The mediator variables were depressive symptoms and log10 transformed C-reactive protein. Compared to U.S.-born, non-Hispanic whites, Mexican American immigrants reported poorer SRH. Mexican American immigrant status was also indirectly associated with worse SRH via greater C- reactive protein. Among Mexican American immigrants, greater acculturation was associated with better SRH. Poorer SRH among Mexican American immigrants may be partially attributable to greater inflammation. However, Mexican American immigrants with higher levels of acculturation report better SRH.

The Relationship Between Self-Rated Health and Acculturation in Hispanic and Asian Adult Immigrants: A Systematic Review.

We systematically reviewed studies to identify the association between acculturation and self-rated health (SRH) and the impact of nativity and language use in Asian and Hispanic adult immigrants. Six electronic databases were searched. Data on nativity and limited English proficiency (LEP) was extracted and analyzed. Nine studies met review criteria. A positive association between acculturation and fair/poor SRH among Asians and Hispanics was found. For both Asians and Hispanics, six out of eight studies showed nativity and all three studies reporting LEP were associated with worse SRH compared to whites. Nativity and LEP were found to be risk factors for reporting worse SRH in Hispanics compared to Asians. The degree of association between nativity and LEP and worse SRH was found to vary by Asian and Hispanic subgroup. Further studies are needed to accurately assess the health status of these populations, which will be essential to eliminating disparities.