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Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German masters program. Eligible participants were students in the masters program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

To accelerate medical breakthroughs, the All of Us Research Program aims to collect data from over one million participants. This report outlines processes used to construct the All of Us Social Determinants of Health (SDOH) survey and presents the psychometric characteristics of SDOH survey measures in All of Us. A consensus process was used to select SDOH measures, prioritizing concepts validated in diverse populations and other national cohort surveys. Survey item non-response was calculated, and Cronbachs alpha was used to analyze psychometric properties of scales. Multivariable logistic regression models were used to examine associations between demographic categories and item non-response. Twenty-nine percent (N = 117,783) of eligible All of Us participants submitted SDOH survey data for these analyses. Most scales had less than 5% incalculable scores due to item non-response. Patterns of item non-response were seen by racial identity, educational attainment, income level, survey language, and age. Internal consistency reliability was greater than 0.80 for almost all scales and most demographic groups. The SDOH survey demonstrated good to excellent reliability across several measures and within multiple populations underrepresented in biomedical research. Bias due to survey non-response and item non-response will be monitored and addressed as the survey is fielded more completely.

The study investigates residents behavior towards reducing the use of single-use plastic (SUP), specifically in the context of food packaging. The widespread view holds that pro-environmental behavior (PB) results from a persons moral and rational deliberations. In reducing single-use plastic (SUP) consumption and waste, the relative roles of rationality and morality models in validating PB among rural and urban residents are not yet clear. In this empirical study, we compared the relative efficacy of two models for explaining peoples SUP reduction behavior: the theory of planned behavior (TPB; rationality) and the value belief norm (VBN; morality). We investigated Thailands rural (Sichang Island) and metropolitan (Nonthaburi city) areas. As a result, we surveyed people living on Sichang Island (n = 255) and in Nonthaburi city (n = 310). We employed structural equation modeling (SEM) for data analysis in this study. Findings showed that while morality better justified all the study participants SUP reduction behavior, rationality underpinned behaviors of rural residents, while morality better explained the actions of city residents. We discussed future theoretical development and a policy roadmap based on these findings.

Abstract Fibromyalgia (FM) is chronic, widespread musculoskeletal pain and accompanying fatigue, sleep disturbances, cognitive, psychological, and somatic symptoms. The aim of the study is to assess the psychometric properties of the Polish version of the 36-item WHODAS 2.0 in FM patients. This is a cross-sectional study involving 456 FM polish patients. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-item version, the Fibromyalgia Impact Questionnaire (FIQ) and Beck’s Depression Inventory (BDI) were used as an assessment tool in the study. The internal consistency of the 36-item WHODAS 2.0 was assessed using Cronbach’s alpha. Values ranging from 0.824 to 0.951 were obtained. The interclass correlation coefficients (ICC) were very high. Internal structure of the 36-item WHODAS 2.0 was checked with Confirmatory Factor Analysis (CFA). RMSEA = 0.069, CFI = 0.963, TLI = 0.96, SRMR = 0.081 proved exactness of original six-dimensional structure of WHODAS 2.0. External validity was assessed by correlating the 36-item WHODAS 2.0 scores with the scores of two previously validated tools: FIQ and BDI. Positive correlations were obtained between the 36-item WHODAS 2.0 and these tools. Based on the conducted research, it has been shown that the 36-item WHODAS 2.0 is a reliable and valid tool for assessing disability in individuals with FM in Poland.

Recent controversies have arisen regarding claims of uncritical positive regard and hype surrounding psychedelic drugs and their therapeutic potential. Criticisms have included that study designs and reporting styles bias positive over negative outcomes. The present study was motivated by a desire to address this alleged bias by intentionally focusing exclusively on negative outcomes, defined as self-perceived negative psychological responses lasting for at least 72 h after psychedelic use. A strong justification for this selective focus was that it might improve our ability to capture otherwise missed cases of negative response, enabling us to validate their existence and better examine their nature, as well as possible causes, which could inspire risk-mitigation strategies. Via advertisements posted on social media, individuals were recruited who reported experiencing negative psychological responses to psychedelics (defined as classic psychedelics plus MDMA) lasting for greater than 72 h since using. Volunteers were directed to an online questionnaire requiring quantitative and qualitative input. A key second phase of this study involved reviewing all of the submitted cases, identifying the most severe-e.g., where new psychiatric diagnoses were made or pre-existing symptoms made worse post psychedelic-use-and inviting these individuals to participate in a semi-structured interview with two members of our research team, during which participant experiences and backgrounds were examined in greater depth. Based on the content of these interviews, a brief summary of each case was compiled, and an explorative thematic analysis was used to identify salient and consistent themes and infer common causes. 32 individuals fully completed an onboarding questionnaire (56% male, 53%

In the present study, we examined the construct validity of scores on the Hebrew version of the Adolescent and Adult Time Inventory-Time Attitudes Scale (AATI-TA). The AATI-TA was translated into Hebrew by bilingual speakers, using the back-translation method. Participants included 452 young adults (Mage = 22.47, SDage = 1.98, 51.5% female). Several measures of psychological well-being were used to establish convergent validity, including scales assessing self-esteem, life satisfaction, and optimism, and depressive, anxiety, and somatic symptoms. Internal consistency estimates for AATI-TA scores were high and confirmatory factor analyses supported the six-factor structure. Correlational analyses indicated the expected relationships between time attitudes and measures of psychological well-being, providing convergent validity support for the AATI-TA scores. The findings of this study support the use of the Hebrew version of the AATI-TA in further studies about time attitudes.

Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Scale (ICS) is a psychometrically strong measure assessing employees' perceptions of the implementation climate. The present cross-sectional study aimed at providing a German translation and investigating its psychometric properties. The translation followed standard procedures for adapting psychometric instruments. German psychotherapists (N = 425) recruited online completed the ICS, the Evidence Based Practice Attitudes Scale (EBPAS-36D) and the Intention Scale for Providers (ISP). We conducted standard item and reliability analyses. Factorial validity was assessed by comparing an independent cluster model of Confirmatory Factorial Analysis (ICM-CFA), a Bifactor CFA, a Second-order CFA and an (Bifactor) Exploratory Structural Equation Model (ESEM). Measurement invariance was tested using multiple-group CFA and ESEM, convergent validity with correlation analysis between the ICS and the ISP subjective norms subscale (ISP-D-SN). The mean item difficulty was pi = .47, mean inter-item correlation r = .34, and mean item-total correlation ritc = .55. The total scale (ω = 0.91) and the subscales (ω = .79-.92) showed acceptable to high internal consistencies. The model fit indices were comparable and acceptable (Second-order CFA: RMSEA [90% CI] = .077 [.069; .085], SRMR = .078, CFI = .93). Multiple-group CFA and ESEM indicated scalar measurement invariance across gender and presence of a psychotherapy license. Psychotherapists in training reported higher educational support for EBP than licensed psychotherapists (T = 2.09, p = .037, d = 0.25). The expected high correlation between the ICS and the ISP-D-SN was found (r = .59, p

Extant research has demonstrated the positive intrapersonal effects of mindfulness training. However, the cognitive mechanisms underlying the effects of mindfulness training on interpersonal processes are less clear. Here, we combined a randomized control mindfulness training design with computational approach to moral decision-making and moral judgments. Participants were randomly assigned to a Training group (N = 32) who received an 8-week mindfulness training or a Control group (N = 26) who waited for the same period of time. Before and after the 8-week period, participants completed a moral decision-making task, where they made tradeoff between money for themselves and unpleasant electric shocks to another person, and a moral judgment task, where they evaluated the blameworthiness of someone else's choices in the same moral decision-making task. Trait mindfulness, as measured by the Five-Facet Mindfulness Questionnaire, significantly increased from the pre- to post-training session for the Training group, but not the Control group, demonstrating the effectiveness of the mindfulness manipulation. For the Control group, participants' moral preference in both the decision-making task and the judgment task declined over time, exhibiting a "slippery slope" effect. In contrast, for the Training group, mindfulness training prevented moral preferences from declining. Computational modeling revealed that mindfulness training specifically reduced the increase in the weights of money over time in both the decision-making and judgment tasks, thereby curbing the "slippery slope" effects. These findings provide a cognitive account of the prosocial effects of mindfulness training on moral decision-making and moral judgments.

Long-haul COVID-19, also called post-acute sequelae of SARS-CoV-2 (PASC), is a new illness caused by SARS-CoV-2 infection and characterized by the persistence of symptoms. The purpose of this cross-sectional study was to identify a distinct and significant temporal pattern of PASC symptoms (symptom type and onset) among a nationwide sample of PASC survivors (n = 5652). The sample was randomly sorted into two independent samples for exploratory (EFA) and confirmatory factor analyses (CFA). Five factors emerged from the EFA: (1) cold and flu-like symptoms, (2) change in smell and/or taste, (3) dyspnea and chest pain, (4) cognitive and visual problems, and (5) cardiac symptoms. The CFA had excellent model fit (x2 = 513.721, df = 207, p

The aim of this study was to assess whether adolescents following anorectal malformation repair have a decreased cardiorespiratory performance capacity and impaired motor skills. All eligible children treated for ARMs between 2000 and 2014 were invited to participate in a prospective study consisting of a clinical examination, evaluation of Bowel function and Quality of Life, spirometry, spiroergometry and assessment of the motor activity. The results were compared to a healthy age- and sex-matched control group. There was no statistically significant difference in height, weight, BMI, muscle mass or body fat percentage between the study and the control group. Nine out of 18 patients (50%) had an excellent functional outcome with a normal Bowel Function Score. Spirometry revealed no significant differences between ARM patients and controls, four patients showed a ventilation disorder. Spiroergometry revealed a significantly lower relative performance capacity and the overall rating of the motor activity test showed significantly decreased grades in ARM patients. ARM patients were affected by an impaired cardiopulmonary function and decreased motor abilities. Long-term examinations consisting of routine locomotor function evaluation and spiroergometry are advisable to detect impaired cardiopulmonary function and to prevent a progression of associated complications and related impaired quality of life.

Social interactions play an extremely important role in maintaining health and well-being. The COVID-19 pandemic and associated physical distancing measures, however, restricted the number of people one could physically interact with on a regular basis. A large percentage of social interactions moved online, resulting in reports of "Zoom fatigue," or exhaustion from virtual interactions. These reports focused on how online communication differs from in-person communication, but it is possible that when in-person interactions are restricted, virtual interactions may benefit mental health overall. In a survey conducted near the beginning of the COVID-19 pandemic (N2020 = 230), we found that having a greater number of virtual interaction partners was associated with better mental health. This relationship was statistically mediated by decreased loneliness and increased perceptions of social support. We replicated these findings during the pandemic 1 year later (N2021 = 256) and found that these effects held even after controlling for the amount of time people spent interacting online. Convergent with previous literature on social interactions, these findings suggest that virtual interactions may benefit overall mental health, particularly during physical distancing and other circumstances where opportunities to interact in-person with different people are limited.Open Science Framework repository: https://osf.io/6jsr2/ .

Child sleep disorders are increasingly prevalent and understanding early predictors of sleep problems, starting in utero, may meaningfully guide future prevention efforts. Here, we investigated whether prenatal exposure to maternal psychological stress is associated with increased sleep problems in toddlers. We also examined whether fetal brain connectivity has direct or indirect influence on this putative association. Pregnant women underwent fetal resting-state functional connectivity MRI and completed questionnaires on stress, worry, and negative affect. At 3-year follow-up, 64 mothers reported on child sleep problems, and in the subset that have reached 5-year follow-up, actigraphy data (N = 25) has also been obtained. We observe that higher maternal prenatal stress is associated with increased toddler sleep concerns, with actigraphy sleep metrics, and with decreased fetal cerebellar-insular connectivity. Specific mediating effects were not identified for the fetal brain regions examined. The search for underlying mechanisms of the link between maternal prenatal stress and child sleep problems should be continued and extended to other brain areas.

Therapeutic interventions have not yet been shown to demonstrate restorative effects for declining long-term memory (LTM) that affects many healthy older adults. We developed a virtual reality (VR) spatial wayfinding game (Labyrinth-VR) as a cognitive intervention with the hypothesis that it could improve detailed, high-fidelity LTM capability. Spatial navigation tasks have been used as a means to achieve environmental enrichment via exposure to and learning about novel and complex information. Engagement has been shown to enhance learning and has been linked to the vitality of the LTM system in the brain. In the current study, 48 older adults (mean age 68.7 ± 6.4 years) with average cognitive abilities for their age were randomly assigned to 12 h of computer game play over four weeks in either the Labyrinth-VR or placebo control game arms. Promptly before and after each participant's treatment regimen, high-fidelity LTM outcome measures were tested to assess mnemonic discrimination and other memory measures. The results showed a post-treatment gain in high-fidelity LTM capability for the Labyrinth-VR arm, relative to placebo, which reached the levels attained by younger adults in another experiment. This novel finding demonstrates generalization of benefits from the VR wayfinding game to important, and untrained, LTM capabilities. These cognitive results are discussed in the light of relevant research for hippocampal-dependent memory functions.

People with obstructive sleep apnea (OSA) often have psychological symptoms including depression and anxiety, which are commonly treated with anti-depression or anti-anxiety interventions. Psychological stress is a related symptom with different intervention targets that may also improve mental state, but this symptom is not well characterized in OSA. We therefore aimed to describe stress in relation to other psychological symptoms. We performed a prospective cross-sectional study of 103 people, 44 untreated OSA (mean ± s.d. age: 51.2 ± 13.9 years, female/male 13/31) and 57 healthy control participants (age: 46.3 ± 13.8 years, female/male 34/23). We measured stress (Perceived Stress Scale; PSS), excessive daytime sleepiness (Epworth Sleepiness Scale; ESS), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder; GAD-7). We compared group means with independent samples t-tests and calculated correlations between variables. Mean symptom levels were higher in OSA than control, including PSS (mean ± s.d.: OSA = 15.3 ± 6.9, control = 11.4 ± 5.5; P = 0.002), GAD-7 (OSA = 4.8 ± 5.0, control = 2.1 ± 3.9; P = 0.02), PHQ-9 (OSA = 6.9 ± 6.1, control = 2.6 ± 3.8; P = 0.003) and ESS (OSA = 8.1 ± 5.3, control = 5.0 ± 3.3; P = 0.03). Similar OSA-vs-control differences appeared in males, but females only showed significant differences in PHQ-9 and ESS, not PSS or GAD-7. PSS correlated strongly with GAD-7 and PHQ-9 across groups (R = 0.62-0.89), and moderately with ESS. Perceived stress is high in OSA, and closely related to anxiety and depressive symptoms. The findings support testing stress reduction in OSA.

Flossing, an important oral hygiene skill, is technique-sensitive and challenging for children with developing manual dexterity. GumChucks is a novel flossing device designed to assist children with proper flossing technique. The aim of this study was to assess the efficacy of the GumChucks flossing device compared to string floss (SF). We conducted a randomized trial with 40 children aged 4-15 years at the UCLA Children's Dental Center from January- April 2017. Participants were randomly assigned to either GumChucks or SF. Interdental plaque score (IPS) and gingival index (GI) were recorded at baseline and 4-week post-usage. Flossing speed and interdental plaque reduction were also determined immediately after first use. In addition, questionnaires were completed by children, parents and dentists. Overall, children flossed significantly faster (p

We identified the most popular electronic cigarette (EC) refill fluids using an Internet survey and local and online sales information, quantified their flavor chemicals, and evaluated cytotoxicities of the fluids and flavor chemicals. "Berries/Fruits/Citrus" was the most popular EC refill fluid flavor category. Twenty popular EC refill fluids were purchased from local shops, and the ingredient flavor chemicals were identified and quantified by gas chromatography-mass spectrometry. Total flavor chemical concentrations ranged from 0.6 to 27.9 mg/ml, and in 95% of the fluids, total flavor concentration was greater than nicotine concentration. The 20 most popular refill fluids contained 99 quantifiable flavor chemicals; each refill fluid contained 22 to 47 flavor chemicals, most being esters. Some chemicals were found frequently, and several were present in most products. At a 1% concentration, 80% of the refill fluids were cytotoxic in the MTT assay. Six pure standards of the flavor chemicals found at the highest concentrations in the two most cytotoxic refill fluids were effective in the MTT assay, and ethyl maltol, which was in over 50% of the products, was the most cytotoxic. These data show that the cytotoxicity of some popular refill fluids can be attributed to their high concentrations of flavor chemicals.

Patient reported health-related quality of life (QOL) is a major component of the overall well-being of cancer patients, with links to prognosis. In 6,420 lung cancer patients, we identified patient characteristics and genetic determinants of QOL. Patient responses from the SF-12 questionnaire was used to calculate normalized Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Further, we analyzed 218 single nucleotide polymorphisms (SNPs) in the p38 MAPK signaling pathway, a key mediator of response to cellular and environmental stress, as genetic determinants of QOL in a subset of the study population (N = 641). Trends among demographic factors for mean PCS and MCS included smoking status (PCS Ptrend

The aim of this study was to examine the relationship between visual field (VF) loss, vision-related quality of life (QoL) and glaucoma-related symptoms in a large cohort of primary open angle glaucoma (POAG) patients. POAG patients with or without VF defects or "glaucoma suspect" patients were considered eligible. QoL was assessed using the validated versions of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and glaucoma-related symptoms were assessed using the Glaucoma Symptom Scale (GSS). Patients were classified as having VF damage in one eye (VFD-1), both eyes (VFD-2), or neither eye (VFD-0). 3227 patients were enrolled and 2940 were eligible for the analysis. 13.4% of patients were classified in the VFD-0, 23.7% in the VFD-1, and 62.9% in the VFD-2 group. GSS visual symptoms domain (Func-4) and GSS non-visual symptoms domain (Symp-6) scores were similar for the VFD-0 and VFD-1 groups (p = 0.133 and p = 0.834 for Func-4 and Symp-6, respectively). VFD-0 group had higher scores than VFD-2 both in Func-4 (p

Prostate cancer (PC) is a frequent neoplasm among men. This study aimed to determine the awareness level of Lebanese men on PC in terms of knowledge, attitude, and practice (KAP). This was a cross-sectional online based survey, conducted on Lebanese men between April and December 2021. We collected data regarding socio-demographic characteristics, habits, and patient/family history of PC, and assessed the level of knowledge (27 items), attitudes (6 items) toward PC, and the level of practice related to the prostate exam and PSA test. We evaluated 844 responses. Only 4.6% of our participants demonstrated an adequate Knowledge level about PC. A greater score was achieved with participants of higher educational levels (p < 0.001) and those who had previously heard about PC (p = 0.002). Around 40% of responders displayed an adequate attitude toward PC. Higher educational level (p < 0.001), being informed by the physician and/or urologist about the PSA test (p < 0.001), having previously heard about PC (p = 0.001), being advised to be screened for PC (p = 0.006), and being employed (p = 0.007), improved attitude level toward PC. As for practice, PSA testing and prostate exam performance significantly increased with age, monthly income, being employed, history of prostate problems, being informed by a physician and/or urologist about the advantages and disadvantages of having the PSA test, and attitude towards PC. With unsatisfactory KAP levels toward PC, tailored awareness campaigns according to the identified predictors of PC KAP are needed in Lebanese men to prevent and alleviate their disease progression., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

A combination of multiple genetic and environmental factors appear to be required to trigger the onset of amyotrophic lateral sclerosis (ALS). Early life environmental exposures have been reported to be risk factors for a variety of adult-onset diseases, so we used data from an online international ALS case-control questionnaire to estimate whether any of these could be risk factors for the clinical onset of ALS. Responses were obtained from 1,049 people aged 40 years or more, 568 with ALS and 481 controls. People with ALS were more likely to have been born and lived longer in a country area than in a city area, to have younger parents, and to have lower educational attainment and fewer years of education. No ALS-control differences were found in sibling numbers, birth order, adult height, birth weight, parent smoking, Cesarean delivery, or age of starting smoking. In conclusion, early life events and conditions may be part of a group of polyenvironmental risk factors that act together with polygenetic variants to trigger the onset of ALS. Reducing exposure to adverse environmental factors in early life could help to lower the risk of later developing ALS., (© 2024. The Author(s).)

This study investigated the knowledge, attitude, and practice (KAP) concerning stone formation and recurrence among patients with urolithiasis treated at Ningbo Medical Centre Lihuili Hospital between August 19, 2023, and April 19, 2024. A total of 394 patients were included, among which 70.30% were males. The median scores for knowledge, attitude, and practice were 7 (6-8.25), 29 (26.75-31), and 21.5 (18-25), respectively, indicating good knowledge and attitude but suboptimal practice. Positive correlations were found between knowledge and attitude (r = 0.274, P < 0.001) and between attitude and practice (r = 0.126, P < 0.05). Logistic regression revealed that knowledge, education, and whether the patient experienced a new or recurrent stone were independent predictors of attitude. Attitude, education, body mass index (BMI), and daily water intake were independent predictors of practice. Structural equation modeling (SEM) showed that knowledge, family history, and education directly influenced attitude, while education also significantly impacted practice. Our findings highlight the need for targeted diet, hydration, and lifestyle education to enhance preventive practices among patients with urolithiasis., Competing Interests: Declarations Ethics approval and consent to participate The study was carried out after the protocol was approved by the Ningbo Medical Center LiHuiLi Hospital (2023 − 216). We confirm that all methods were performed in accordance with the relevant guidelines. All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, and informed consent was obtained from all participants. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Musicians create sound that is enjoyable to themselves and their audience, but this same sound also threatens their hearing health due to high sound pressure levels generated by their own and their fellow musicians' instruments. Here we seek to identify musicians' hearing health awareness in relation to their coping strategies. 370 professional and 401 amateur musicians in total responded to a questionnaire on hearing health, which included quantitative elements and open-ended questions. Findings reveal that musicians are generally aware of hearing health risks but also indicate a lack of discussion on that topic. However, inasmuch as respondents consider hearing protection as necessary, they articulate justified concerns about its potential impact on quality of performance and musical communication. In sum, musicians show literacy regarding their hearing health, but more guidance and training is needed to ensure effective protective measures., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

To address air pollution hazards effectively, it is crucial to understand the factors that influence residents' adoption of harm reduction measures. Existing studies often focus on passive defense and ignore active strategies such as air purifiers, dehumidifiers, anti-haze window screens, and air-purifying plants. This study adopted the Knowledge-Attitude-Behavior (KAB) model to explore the factors that influence residents to take proactive measures to prevent the impacts of air pollution. This cross-sectional study recruited 371 participants aged 25-64 years living in southern Taiwan. A one-shot online survey was conducted to examine demographic information, air pollution exposure experience, knowledge, risk perceptions, attitudes toward air pollution protective measures, perceived barriers and benefits, payment for protective measures, and actual engagement in protective actions. Structural equation modeling was used to examine the relationships among these factors. This study reveals that the adoption of these protective measures can be understood through three primary pathways. The first pathway linked knowledge to attitude toward behavior. Regarding the various protective measures, this study found that knowledge strongly influenced individuals' attitudes. This, in turn, influenced their likelihood of engaging in protective measures. The second pathway revealed the effect of risk perception on protective measures, with attitudes mediating this relationship. Perceived risk susceptibility and risk severity were linked to attitudes, which further influenced the adoption of protective measures. The third pathway emphasized the direct effects of perceived barriers on the adoption of protective measures. Individuals who perceived fewer barriers were more likely to adopt these measures. This study fills the gap in the understanding of the factors influencing residents' adoption of proactive air pollution protection measures. Moreover, this study underscores the importance of increasing public awareness and reducing barriers to promote individual actions for mitigating the negative effects of air pollution., Competing Interests: Declarations Ethics approval This study was approved by the Institutional Review Board for Humanities and Social Sciences Research at Academia Sinica (AS-IRB-HS-22029). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Conflict of interest The authors declare no conflicts of interest. The funders had no role in the design of the study; collection, analyses, or interpretation of data; writing of the manuscript; or decision to publish the results., (© 2024. The Author(s).)

The Revised Hearing Handicap Inventory-Screening (RHHI-S) is a robust 10-item Patient-Reported Outcome Measure (PROM) that can quantify impacts of hearing loss (HL). Employing a cross-sectional study, the psychometric properties of a cross-culturally adapted Kurdish version of RHHI-S (RHHI-S-CK) were investigated. According to the degrees of HL, 168 enrollees (64.3% male; mean-age 63.1 ± 12.6 years) were divided into three subgroups; that is, mild (n = 56; 67.9% male; mean-age 60 ± 12.5 years), moderate (n = 64; 60.9% male; mean-age 64.6 ± 12.5), & moderately-severe (n = 48; 64.6% male; mean-age 63.1 ± 12.6). The internal cohesion among the items was confirmed by Cronbach's alpha (0.94). Confirmatory factor analysis recognised structural validity when a strong unidimensional factor was extracted. Convergent validity was verified (P-value < 0.001) via Spearman's correlation between the scale and a subjective correlator (visual analogue scale). A large effect size (0.88) from Kruskal-Wallis & Dunn-Bonferroni post-hoc tests established the discrimination between different degrees of HL. Lastly, intraclass correlation coefficient (ICC) proved the external reliability of the adapted version of the tool (Test-retest ICC = 0.95). RHHI-S-CK is a robust PROM that can measure the impacts of HL in adults across all age ranges. Accordingly, RHHI-S-CK augmented the clinical and academic practice of the Kurdish medical community., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Approximately one billion women require family planning services worldwide, 842 million women are currently using modern contraceptives, and 80 million are using traditional contraceptive methods for family planning (FP). Health literacy (HL) can significantly make women aware of contraceptives for family planning. This study aims to assess the effectiveness of health education in determining perceptions and intended contraceptive use among university students in Pakistan. A pre-and post-approach with cross-sectional study design was conducted in the public sector University of Islamabad from July to December 2022. A self-administered and structured questionnaire comprising variables on knowledge level and intended contraceptive use was conducted among randomly selected students (n = 396). Survey respondents were given Health Education Intervention (HEI), which included a lecture regarding contraception use for family planning, and a posttest assessment was conducted on the same group of students. Statistical Package for Social Science (SPSS) version 24 was used for statistical data analysis. An Institutional Review Board (IRB) of the Health Services Academy (HSA) approved this study. A majority, 217 (55%), were female respondents. There was a significant difference in the overall mean score between pretest and posttest assessments after the intervention. Hence, the findings proved that this intervention successfully improved the knowledge and intention of the participants to use FP. Moreover, after the HEI, 99% of respondents had improved knowledge about family planning methods and the benefits of contraceptive use. Knowledge, perceived benefits, and intended use of contraceptives for FP were significantly improved after the HEI (P < 0.05). In the posttest, the most learned methods were intrauterine devices, injections, implants, and withdrawal. Most of the participants were already well aware of condoms and oral pills. The study concludes that health education is an effective intervention to improve the knowledge, perception, and intended contraceptive use among undergraduate university students regarding family planning., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

This research explored the link between teacher-student relationships and learning engagement, considering perceived social support as a mediator and academic self-efficacy as a moderator. A total of 930 college students completed the Academic Self-Efficacy Scale, Teacher-Student Relationships Questionnaire, Multidimensional Scale of Perceived Social Support, and College Student Learning Engagement Questionnaire. Mediating and moderating effects were investigated using SPSS19.0 and one of its process plugins 3.5. The findings indicated (1) teacher-student relationships positively predicted learning engagement; (2) perceived social support mediated the link between teacher-student relationships and learning engagement; and (3) academic self-efficacy moderated the initial phase of the pathway to the mediating role of perceived social support. Moreover, the mediating effect was more significant at elevated academic self-efficacy levels. Establishing harmonious relationships between teachers and students, nurturing students' confidence in their academic abilities , and expanding students' access to social support were essential to boosting the educational involvement of college students. The study findings will help educators enhance college students' engagement in learning and provide recommendations for educators to conduct educational and teaching activities., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Patients suffering from chronic kidney failure ultimately need kidney replacement therapies, such as hemodialysis. Adherence to treatment in these patients can play a central role in improving health levels and feelings of well-being. The aim of this study was to determine the psychometric properties of the Persian version of the modified version of the Greek Simplified Medication Adherence Questionnaire in hemodialysis patients. In a methodological study carried out in 2024, a sample of 411 hemodialysis patients was selected using a convenience sampling method. The GR-SMAQ-HD utilized in the study was translated, and its psychometric properties were evaluated through assessments of construct validity, including exploratory and confirmatory factor analysis, convergent validity, and divergent validity. Furthermore, the study examined the internal consistency of the scale to ensure its reliability. The mean age of the participants was 59.37 (SD = 12.99) years. The results of the tetrachoric correlation matrix with Varimax with Kaiser Normalization rotation using the first random dataset (n = 205) extracted three factors accounting for 74.4% of the variance comprising 8 items. The results of CFA showed that the data fit the model. As for construct reliability, Cronbach's alpha, CR, AIC, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability. In the overall population, the mean score for treatment Adherence was 5.61 (SD = 1.95, 95% CI 5.42, 5.80). Invariance analysis shows that the model has strong measurement invariance between sex ($ΔCFI= - 0.001, ΔRMSEA= - 0.004$). The findings affirm the appropriateness of employing the Persian iteration of the GR-SMAQ-HD as a dependable and valid instrument for assessing adherence to treatment in hemodialysis patients. GR-SMAQ-HD is crucial for ensuring that patients follow their prescribed treatment regimens effectively., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Artificial intelligence (AI) integration in healthcare has emerged as a transformative force, promising to enhance medical diagnosis, treatment, and overall healthcare delivery. Hence, this study investigates university students' perceptions of using AI in healthcare. A cross-sectional survey was conducted at two major universities using a paper-based questionnaire from September 2023 to November 2023. Participants' views regarding using artificial intelligence in healthcare were investigated using 25 items distributed across five domains. The Mann-Whitney U test was applied to compare variables. Two hundred seventy-nine (279) students completed the questionnaire. More than half of the participants (52%, n = 145) expressed their belief in AI's potential to reduce treatment errors. However, about (61.6%, n = 172) of participants fear the influence of AI that could prevent doctors from learning to make correct patient care judgments, and it was widely agreed (69%) that doctors should ultimately maintain final control over patient care. Participants with experience with AI, such as engaging with AI chatbots, significantly reported higher scores in both the "Benefits and Positivity Toward AI in Healthcare" and "Concerns and Fears" domains (p = 0.024) and (p = 0.026), respectively. The identified cautious optimism, concerns, and fears highlight the delicate balance required for successful AI integration. The findings emphasize the importance of addressing specific concerns, promoting positive experiences with AI, and establishing transparent communication channels. Insights from such research can guide the development of ethical frameworks, policies, and targeted interventions, fostering a harmonious integration of AI into the healthcare landscape in developing countries., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Anthropomorphism describes the tendency to endow objects with human characteristics, with some individuals being more inclined to do this than others. In an ambiguous environment, this phenomenon can offer guidance. This study investigates the relationship between self-reported attribution and evoked anthropomorphism when viewing house facades. Data was collected from three countries (Germany, Denmark, Canada; N = 305). Implicit house anthropomorphism was measured using the Global Vectors for Word Representation method. Explicit anthropomorphism was assessed using the Individual Differences in Anthropomorphism Questionnaire (IDAQ) and a specific House Anthropomorphism Score (EHAS). No significant relationship was found between implicit and explicit house anthropomorphism. Individual IDAQ scores were significantly associated with EHAS across all participants, regardless of country. Additionally, a high degree of agreement in explicit ratings between countries suggests that cultural differences are rather negligible. When objects are given human personality traits and people interact with them because emotions are triggered, it is important to understand which aspects elicit positive and reactive behaviors. In particular, houses, which have high psychological significance as objects of self-expression, might contribute to well-being, so research in this area can provide important knowledge for urban design and architecture., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Adults with cancer may perceive cannabis as beneficial for managing their cancer-related symptoms, but the evidence supporting its medical use is varied and inconclusive. This study characterized associations of cannabis use with cancer-related symptom trajectories. Participants were adults undergoing cancer treatment at the Stephenson Cancer Center (SCC; n = 218) in Oklahoma; they were 71% female, 10% minoritized race, and 45% had stage III or IV cancer. Participants completed surveys at baseline and 2-, 4-, and 6-months post-baseline. Assessments queried about cannabis use behavior, physical and psychological distress via the Rotterdam Symptoms Checklist (RSCL), respiratory symptoms via the American Thoracic Society Questionnaire (ATSQ), and quality of life indices (physical and social functioning, pain interference, sleep quality, fatigue) via the Patient Reported Outcomes Measurement Information System (PROMIS-29). Cannabis use status was categorized based on self-reported past 30-day cannabis use at each assessment as non-use [no use at any assessment], occasional-use [use at 1-2 assessments], or consistent-use [use at 3-4 assessments]. Longitudinal hierarchical linear modeling evaluated associations of cannabis use status with average symptoms and symptom trajectories across all four assessments. One-third (33%) of participants reported past 30-day cannabis use at ≥ 1 assessment. Participants who reported cannabis use (occasional-use and consistent-use) had more severe symptoms overall across assessments. While most cancer symptom trajectories did not differ by cannabis use status, participants who reported consistent cannabis use uniquely showed worsening physical function over time. Cannabis use was associated with greater cancer-related symptom severity over time., Competing Interests: Declarations Competing interests Kendzor and Businelle are inventors of the Insight Mobile Health Platform (not used or evaluated in the current study) and receive royalties for the external use of the platform outside of the University of Oklahoma Health Sciences Center. Kendzor is a member of the Scientific Advisory Board of Qnovia. Inc., which is a drug development company focused on inhaled therapies including prescription inhaled nicotine replacement therapy for smoking cessation (no medications provided or evaluated in the current study). Kendzor previously received medication (varenicline) at no cost from Pfizer to support a now completed pilot study (no medications provided or evaluated in the current study). The authors declare no competing interests., (© 2024. The Author(s).)

Male germ cell tumors (GCT) have excellent survival. Long-term sequelae in cancer survivors are an evolving field. We evaluated the risk of patients with GCT to develop primary hypogonadism and adherence to guideline-recommended therapy in a real-world cohort. Monocentric study at a tertiary cancer centre to evaluate treated GCT-patients (2001-2019). Post therapeutic male endocrine function, International Index of Erectile Function (IIEF)-5 and The aging males' symptoms rating scale (AMS) questionnaires were assessed. The overall response rates were low, with 44 of 402 contacted patients participating in the study. From these, 32(73%) underwent blood analysis, 42(95%) answered the IIEF-5 and 43(98%) the AMS. Latent hypogonadism (serum testosterone 8-12 nmol/l) was found in n = 9 (28%) and manifest hypogonadism (testosterone < 8 nmol/l) in n = 8 (25%). 50% (n = 21) indicated erectile dysfunction on IIEF-5 (cut off ≤ 21 pts.) and 62.8% (n = 27) reported symptomatic affection on AMS (cut off ≥ 27 pts.). Majority of tested patients revealed different degrees of hypogonadism. Standard instruments were able to detect gonadal damage in > 50%, which underscored the clinical need to evaluate endocrine function in cancer survivors. We further indicated the difficulties of today's research and provided starting points to assess barriers for study participations., Competing Interests: Competing interests CD has advisory roles for Janssen and IPSEN and has received travel compensation from Janssen, IPSEN and BayerB.H. has had advisory roles for ABX, AAA/Novartis, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Janssen R&D, Lightpoint Medical, Inc., and Pfizer; has received research funding from Astellas, Bristol Myers Squibb, AAA/Novartis, German Research Foundation, Janssen R&D, and Pfizer; and has received compensation for travel from Astellas, AstraZeneca, Bayer and Janssen R&D. A.H, MGvB, AI, MN, UK, LP declare no conflicts of interest.VG: receiving grant support, lecture fees, consulting fees, and travel support from AstraZeneca, BMS, Ipsen, and Pfizer, consulting fees and travel support from Bayer, grant support, lecture fees, and consulting fees from MSD, consulting fees from Roche, Eli Lilly, Onkowissen, and EUSA Pharma, consulting fees and lecture fees from Janssen– Cilag, PharmaMar, Merck Serono, and Eisai, lecture fees from Asklepios Clinic, Diakonie Clinic, Dortmund Hospital, andClinic of Oldenburg, and grant support and consulting fees from Novartis. Ethical approval This study protocol was reviewed and approved by the local ethics committee of University Duisburg-Essen (21-9860-BO) and conducted in accordance with the ethical standards of the Declaration of Helsinki. The participants provided informed written consent before participating in the study., (© 2024. The Author(s).)

The rapid change in information technology has made online or blended learning a new norm in higher education. However, the problem of low student engagement in online learning is becoming more prominent. This study explores how college students' proactive personality affects their online learning engagement through the mediating effects of positive emotions and learning motivation. A survey was conducted on college students (N = 1049), and the interrelationships among these variables were analyzed using structural equation modeling. The findings unveiled that: proactive personality positively predicts online learning engagement, positive emotions and learning motivation. Positive emotions and learning motivation significantly positively influence online learning engagement. Moreover, Positive emotions also exert a significant positive impact on learning motivation. In addition, the mediation of positive emotions and learning motivation further strengthened a significant positive correlation between proactive personality and online learning engagement. Implications for theory and practice, including the limitations, were discussed accordingly., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

This study investigates the relationship between risk and protective factors and suicidal ideation among teachers, a group often overlooked in suicide prevention efforts. Using the diathesis-stress model as a partial framework, the research explores how depression and anxiety, as risk factors, and emotional intelligence, resilience, and positive thoughts, as protective factors, influence suicidal ideation. A cross-sectional design was employed, involving 1,270 Spanish teachers (median age: 46, 70.2% female). Key measures included the Positive and Negative Suicidal Ideation scale (PANSI), the Brief Emotional Intelligence Scale (BEIS-10), the Brief Resilient Coping Scale (BRCS) for resilience, and the General Health Questionnaire (GHQ-12) for depression and anxiety. A network approach was used to examine the relationships between these variables. Results showed that depression had a stronger relationship with negative ideation than anxiety, while emotional intelligence and positive thoughts acted as protective factors. Positive ideation was negatively associated with depression and anxiety, and positively linked to emotional intelligence and resilience. Emotional intelligence emerged as the most critical protective factor. These findings provide valuable evidence to inform the development of emotional management and resilience-building programs aimed at enhancing teachers' mental health and performance, which could also indirectly benefit students., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

While Early Live Adversity (ELA) is a known risk factor for mental and physical diseases, the investigation into the mechanisms behind this connection is ongoing. In the present study, we investigated whether ELA blunts the relaxation response in healthy adults. Using a within-subjects design, we employed a paced breathing exercise (four seconds inhale, six seconds exhale) and a 360° nature video as relaxation interventions while measuring physiological relaxation using heart rate variability and subjective relaxation using the Relaxation State Questionnaire. A total of 103 participants (63.11% female; age mean  = 22.73 ± 3.43 years) completed the Parental Bonding Instrument and the Childhood Trauma Questionnaire to assess ELA retrospectively. For subjective relaxation, a blunted relaxation reaction was associated with lower scores of paternal care and higher scores of paternal overprotection, physical abuse, physical neglect, and emotional abuse. For heart rate variability emotional abuse in interaction with nicotine consumption was related to a blunted relaxation response. This indicates that experiencing ELA negatively affects the relaxation capability in a healthy sample and emphasizes the importance of assessing relaxation at a physiological and subjective level., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments., Competing Interests: Declarations Competing interests KK is a principal investigator on research projects that are sponsored by Mind Medicine (MindMed) Inc., and she is a paid member of the scientific advisory board of Clerkenwell Health. PH and EH declare that there is no conflict of interest., (© 2024. The Author(s).)

The mental health needs of young people in sub-Saharan African societies remain understudied. This study builds upon the everyday perspectives of young people in Gorongosa, a rural district in central Mozambique, to determine the frequency and severity of key mental health issues, identify significant risk and protective factors, and their associations with demographic factors and mental health predictors. This cross-sectional study gathered culturally and ecologically relevant variables, such as sociodemographic indicators and risk and protective factors. The Beck Depression Inventory-II (BDI-II), Self-Report Questionnaire (SRQ) and Nocturnal Intrusions after Traumatic Experiences Questionnaire (NITE) were used to determine the prevalence and severity of key mental health issues. A convenience sampling was used involving n = 794 young people of those (45.8%) were females and the mean age of all participants was 17.24 years (SD 2.9). To examine the results, univariate analysis, chi-square tests, binary logistic regression analyses and odds ratio were used. Risk factors were pervasive in households, communities, and schools. Mental health problems were commonly linked to severe depression (14.2%), anxiety-related disorders (39.3%), sleep disturbances (37.3%), and anxiety dreams (27.5%). Gender, age, and protective factors were associated with the frequency and severity of mental health outcomes, while living with both parents protected against the severity of anxiety-related disorders. Understanding the contextual mental health needs of young people in rural Mozambique is crucial for developing insights to craft and implement targeted public mental health interventions in resource-limited settings. Addressing mental health issues among young people necessitates a concentrated effort on understanding and managing the interplay of risks and protective factors within families, communities, and schools., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. Crown.)

Psychedelic-assisted therapy (PAT) with substances like psilocybin and MDMA has shown promise for conditions including depression and post-traumatic stress disorder. Psilocybin and MDMA may become approved medicines in the coming decade. This study assessed knowledge and attitudes regarding PAT among 879 U.S. healthcare professionals via anonymous online survey. Multivariable linear regression was used to identify predictors of openness to clinical use. Most participants (71.2%) were female and White (85.8%), with a mean (SD) age of 45.5 (12.7) years. Registered nurses (25.4%) and physicians (17.7%) comprised the largest professional groups. Respondents endorsed strong belief in therapeutic promise, and moderate openness to clinical use and support for legal access to both substances, with higher overall ratings for psilocybin compared to MDMA. Objective knowledge items revealed low knowledge of therapeutic uses, risks, and pharmacology. Primary concerns were lack of trained providers, financial cost, and potential contraindications. Prior psychedelic use, self-rated knowledge, younger age, and professional role predicted openness to clinical use of psilocybin and MDMA, with physicians reporting lower openness. As psychedelics continue to garner popular and scientific interest, results indicate a pressing need for additional formal training to provide balanced, evidence-based information from trusted sources., Competing Interests: Declarations Competing interests AGR is a paid scientific advisor to Innerwell and Otsuka Pharmaceutical Development & Commercialization, Inc. All the remaining authors declare no conflict of interest., (© 2024. The Author(s).)

Exams like the formative Progress Test Medizin can enhance their effectiveness by offering feedback beyond numerical scores. Content-based feedback, which encompasses relevant information from exam questions, can be valuable for students by offering them insight into their performance on the current exam, as well as serving as study aids and tools for revision. Our goal was to utilize Large Language Models (LLMs) in preparing content-based feedback for the Progress Test Medizin and evaluate their effectiveness in this task. We utilize two popular LLMs and conduct a comparative assessment by performing textual similarity on the generated outputs. Furthermore, we study via a survey how medical practitioners and medical educators assess the capabilities of LLMs and perceive the usage of LLMs for the task of generating content-based feedback for PTM exams. Our findings show that both examined LLMs performed similarly. Both have their own advantages and disadvantages. Our survey results indicate that one LLM produces slightly better outputs; however, this comes at a cost since it is a paid service, while the other is free to use. Overall, medical practitioners and educators who participated in the survey find the generated feedback relevant and useful, and they are open to using LLMs for such tasks in the future. We conclude that while the content-based feedback generated by the LLM may not be perfect, it nevertheless can be considered a valuable addition to the numerical feedback currently provided., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The choice of medical specialty for future doctors is a multidimensional issue, associated with many factors. This study aimed to explore the factors influencing the specialty choices of doctors entering the Polish healthcare system. A nationwide cross-sectional survey was conducted from May until August 2023. The data was gathered via an online nationwide survey among recent medical school graduates. We explored respondents' preferences regarding medical specialties (in two categories: surgical and non-surgical), and the factors that drive their choices. The U-Mann Whitney test was used to compare the distribution of 19 analysed factors, and the chi-squared test was used if a trend was not observed. 737 responses were collected, and 698 were included in the study. The respondents (60.5% female) preferred non-surgical specialties over surgical ones. The main factors influencing doctors' choices were remuneration, the ability to maintain work-life balance, interest in the medical field, the ability to start a private practice, skills possessed, and doctor-patient interactions. Doctors pursuing a career in surgical fields are driven by slightly different factors than those who chose a non-surgical specialty. The youngest generation values a healthy work-life balance, and their non-professional life remains crucial., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethical approval The research methodology was approved by the Bioethical Committee of Jagiellonian University (approval number: 1072.6120.215.2022)., (© 2024. The Author(s).)

Climate change and variability have threatened rainfed agriculture by affecting the livelihoods of rural communities in Ethiopia. The study area, Gassera District, is among the high-potential crop production areas of the Bale Zone and is severely impacted by recurrent droughts resulting from climate change. This study evaluated smallholder farmers' perceptions of significant climate change and its effects on food crop production across the agroecological zones of the Gassera District. A cross-sectional survey design was employed to collect data from 444 farm households via multistage random sampling techniques. Multiple linear regression (MLR) models were used for the data analysis. The results revealed that 98.5% of the interviewed farmers were aware of climate variability and that 51.6% understood its impact to a reasonable extent. However, over half of the farmers did not perceive climate change as the greatest threat to their livelihood. Most farmers experienced rain becoming more erratic, starting late, and ending early as medium climatic factors (60.4%, 68.1%, and 66.2%, respectively), affecting their crop production. The results revealed that rainfall had a negative and insignificant decreasing trend (2.92 mm/year). The annual mean temperature exhibited a positive and statistically significant increasing trend (Ρ < 0.01). Crop production is positively and linearly correlated with the amount of annual rainfall at the Ρ ≤ 0.05 level of significance. The findings revealed that the greatest crop yield loss was associated with lowland agroecology. The MLR results revealed that farmer agroecology, age, sex, and chemical use had substantial impacts on crop yield loss. We urge farmers to understand the long-term effects of climate change on their livelihoods., Competing Interests: Declarations Ethics approval and consent to participate The purpose of the study was clearly explained to household respondents and agricultural experts. The author declared that all the principles of anonymity and confidentiality, informed consent and voluntary participation, no harm to participants, and no invasion of privacy were implemented. Ethical approval for this study complies with national and Hawassa University postgraduate research guidelines and legislation. The ethical approval was also granted by the administration and advancement of the college research ethics sector and ethical committee. Consent to participants The data were collected from household respondents, local administrators, and district agricultural experts with their consent. Data collected from the BZFEDD and the GDARDO were requested formally through the official letter written by Hawassa University, College of Forestry and Natural Resources. The author declared that part of the Ph.D. thesis manuscript was original research work and acknowledged all sources of materials dearly. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

In recent years, nutrition has become increasingly important in treating and managing gestational diabetes mellitus. The Health Belief Model (HBM) is a conceptual framework in health behavior research used in some medical research. The present study aimed to evaluate the effect of glycemic index training based on the HBM on metabolic indicators and pregnant women's health-related quality of life. In this open-label, parallel-controlled randomized trial, 90 pregnant women from primary health centers in Iran were recruited and randomly assigned to either the intervention group or the control group, using a block randomization method with a block size of six. The intervention group underwent 12 weeks of nutritional education on the glycemic index and load of foodstuff. The control group only received routine health care. Valid and reliable questionnaires included demographic and prenatal information, physical activity, three days of food records, quality of life (SF-12), and HBM constructs. Fasting blood samples were taken at baseline and end of the study, to assess fasting blood glucose (FBS), fasting insulin, hs-CRP, and lipids. Eighty-four pregnant women with an age mean of 30.12 ± 4.35 completed 12 weeks of intervention. At baseline, there were no significant differences between groups in the HBM subscales (P > 0.05). However, within the intervention group, there was an increase in perceived susceptibilities (mean change 1.45 ± 4.21; P = 0.03) and cue to action (mean change: 1.22 ± 3.38; P = 0.02). In the adjusted model, the General Health subscale of Quality of Life showed a significant increase in the comparison between groups (mean change 13.69 ± 29.83 vs. 0.00 ± 29.58; P = 0.04). Additionally, the adjusted model revealed a notable difference between the groups in serum hs-CRP level, (mean change -0.877 ± 3.47 vs. -0.067 ± 3.40; P = 0.01) and triglyceride level (mean change - 55.24 ± 111.21 vs. 40.92 ± 142.01; P = 0.001). However, in the adjusted model, the total cholesterol levels increased between groups (mean change 22.75 ± 66.17 vs. 30.12 ± 61.33; P = 0.01) at the end of the study. There was no significant difference in glycemic indices (P > 0.05). Participation in a nutrition education program might positively impact nutritional beliefs, behaviors, and some biochemical indicators among pregnant women. Future studies with larger sample sizes and longer follow-ups are warranted.Trial registration number: IRCTID: IRCT20190227042858N1. Registration date: 2019-07-18., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethical approval and consent to participate The Ethics Committee of Jundishapur University of Medical Sciences reviewed and approved the study in compliance with the Declaration of Helsinki (IR.AJUMS.REC. 1397.600). After identifying the purpose of the study, each study participant provided their written informed consent., (© 2024. The Author(s).)

Owned dogs are often regarded as family members, best friends, or even as substitutes for children. These new roles and their effects on human well-being have received scientific attention, but little is known about how attributing such social functions to dogs might influence the caring behaviour of the owner, which in turn can impact canine welfare. Our online survey of Hungarian dog owners (N = 790) aimed to describe what owners appreciate the most and the least in their dogs and to investigate the relationship between the social and non-social functions of the dog, the characteristics of the owner and the dog, the management practices of the owner, as well as the dog's behaviour, including behaviour problems. We found that most owners appreciated petting and physical contact with their dog (97.6%), followed by 'unconditional love' (93.7%), the dog's beauty (88.4%), and walking with the dog (86.5%). The most frequently mentioned problems were socialisation issues (20.4%) and lack of time (15.9%). Regarding canine behaviour, jumping up (33.2%), chasing animals (28.5%), territoriality (26.7%), and overexcitement (20.9%) were common problems. Almost a quarter of owners rated their dogs as totally obedient and 30.6% as totally safe off-leash. We identified three profiles of dog owners based on the roles they attribute to their dogs. Dogs with both companionship and practical functions (31.1%) were perceived as more obedient and provided higher safety benefits to their owners than others. Dogs regarded as 'companion animals' (19.4%) spent less time with their owners and had older owners than others. Lastly, owners labelled as 'dog parents' (49.5%) were more likely to keep their dog indoors only than others. Importantly, the roles attributed to dogs were not associated with owner-reported canine behaviour problems. We concluded that while the functions humans attribute to dogs are multiple and appear to have direct implications for the dogs' daily lives, these variations in management practices do not necessarily seem to compromise their welfare., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

E-cigarette use is a growing public health concern, especially because of the potential health risks it poses. This study focuses on assessing e-cigarette dependence and the factors associated with it among Palestinian young adults. A cross-sectional survey was conducted from January to May 2023 among university students in the West Bank. A self-administered questionnaire was used to collect demographic data, knowledge, and attitudes regarding e-cigarettes. E-cigarette dependence was assessed using the Penn State Electronic Cigarette Dependence Index. The study included 386 university students who used e-cigarettes. Many of them started using e-cigarettes at a young age, and 54.7% were dual users of e-cigarettes and traditional tobacco. High levels of dependence were reported in 11.4% of participants, and moderate dependence in 28.8%. Several factors were identified through multivariate linear regression as significantly associated with e-cigarette dependence: a higher monthly allowance (β = 0.116, 95% CI: 0.128- 1.124, p = .014), having a father who uses tobacco (β = 0.095, 95% CI: 0.030- 1.638, p = .042), having a close friend who smokes traditional cigarettes (β = 0.095, 95% CI: 0.019- 1.667, p = .045), using e-cigarettes in areas where traditional smoking is prohibited (β = 0.175, 95% CI: 0.689-2.330, p < .001), using e-cigarettes to quit other forms of tobacco (β = 0.134, 95% CI: 0.434-2.314, p = .004), and a more negative attitude score (β = - 0.210, 95% CI: - 0.285- - 0.112, p < .001). The study revealed high levels of e-cigarettes dependence among the participants among young adults, with associated variables such as monthly allowance, attitudes, and age of e-cigarette initiation. Policymakers, educators, and healthcare professionals should collaborate to address e-cigarette dependence among young adults, taking into consideration social, environmental, and socioeconomic factors., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The implementation of home-care robots is sometimes unsuccessful. This study aimed to explore factors explaining people's willingness to use home-care robots, particularly among care recipients and caregivers. Surveys were conducted in Japan, Ireland, and Finland. The survey questionnaire comprised four categories (familiarity with robots, important points about home-care robots, functions expected from home-care robots, and ethically acceptable uses), with 48 items assessing users' willingness to use home-care robots. The responses from 525 Japanese, 163 Irish, and 170 Finnish respondents were analyzed to identify common and distinct factors influencing their willingness to use these robots. Common factors across the countries included "willingness to participate in research and development," "interest in robot-related news," and "having a positive impression of robots". The distinct factors for each country were: "convenience" in Japan; "notifying family members and support personnel when an unexpected change occurs in an older person" in Ireland; and "design" in Finland. Therefore, developers should determine potential users' willingness to participate in the research and development of home-care robots and consider a system that involves them in the development process., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Mpox is a zoonotic viral disease that presents significant public health challenges. Despite the pivotal role of healthcare workers, research on their knowledge and attitudes towards mpox is limited. This study aimed to assess healthcare workers' knowledge, awareness and attitude regarding mpox as well as associated factors at Rivers State University Teaching Hospital in Nigeria. A descriptive cross-sectional study design was employed, utilizing a 34-item semi-structured questionnaire. Knowledge levels were categorized as good (> 70% score), fair (50-69%), or poor (< 50%), while attitudes were classified as positive (> 70% score), moderate (50-69%), or negative (< 50%). Statistical analyses included independent sample T-test, One-way Analysis of Variance, and Chi-square tests. Among a total of 227 healthcare professionals, majority were females (59%) and singles (54.2%). Over 79% correctly identified mpox as a viral infection, while 59.9% recognized its potential transmission through a monkey bite. Overall, 22.5% demonstrated good knowledge. Majority (61.7%) acknowledged the potential of mpox as a worldwide pandemic, with 89% agreeing it could strain affected countries' healthcare systems. Healthcare workers exhibited moderate to positive attitudes towards mpox. Gender (Males, (p = 0.003), age (> 40 years (p = 0.008), years of experience (6-10 years; (p < 0.001), professional qualification (physicians, (p = 0.002), and previous mpox training (p < 0.001) significantly influenced knowledge levels, but no significant associations were found between demographic variables and attitudes. The study revealed a high level of awareness but low to fair knowledge among most participants. Healthcare professionals also demonstrated moderate to positive attitudes towards mpox. Factors such as gender, age, years of experience, professional qualification, and previous training on mpox influenced knowledge levels, but did not influence attitude in the study participants highlighting the importance of targeted educational interventions., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval and consent to participate Ethical clearance was obtained from Rivers State University Teaching Hospital Research Ethics Committee (RSUTHREC) with approval number RSUTHREC 24 − 13 before the research was conducted. Participant eligibility was assessed based on study inclusion criteria after which a written informed consent was obtained before enrolment into the study. The confidentiality of the information they gave was maintained. All methods were performed in accordance with the relevant guidelines and regulations., (© 2024. The Author(s).)

A family with a disabled child has major changes and challenges. The difficulties experienced by the whole family are of various natures and relate to emotional, psychological, caring, and financial problems. The aim of the study is to learn about the challenges and involvement of Polish families in caring for a disabled child in the home environment. A cross-sectional pilot study was conducted in a group of 103 parents of disabled children. The proprietary questionnaire and a standardized scale for the Generalized Self-Efficacy Survey (GSES) were used as a research tool. The material for the study was collected online, using Google Forms software, and statistically processed. Emotional contact with a disabled child turned out to be the most difficult aspect of care for almost half of the respondents (42.7%). The vast majority of respondents (75.7%) described the level of difficulty in caring for a disabled child as much higher than the level of difficulty in caring for a healthy child. Most parents (87%) spend between 10 and 20% of their family income on the treatment and rehabilitation of disabled children. A significant relationship was noted between the assessment of the family's economic situation and place of residence (χ 2 P = 27.32; p < 0.0001; Vc 0.51). Parents of children with disabilities who live in rural areas and have less education are less well off financially. The average GSES score was 24.54 and was in 4 sten. The biggest care challenge for parents of disabled children turned out to be emotional contact with the child. The GSES index for parents of children with disabilities is lower than the average values obtained in Polish studies, which translates into worse coping with problems., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

With the emergence of new strains of Covid-19, the adoption of preventive behaviors is still considered a requirement to control this disease. Therefore, considering the importance of social cognitive factors in adopting various types of preventive behaviors, the present study was conducted to design and psychometrically measure the social cognitive factors related to Covid-19 preventive behaviors. A cross-sectional study was conducted on 526 people ages 18 and over with multi-stage stratified, cluster and random sampling in Isfahan, Iran in 2022. The questionnaire was validated and formulated in three stages: designing, creating and reducing items. After collecting information and creating a bank of items, qualitative and quantitative methods were used to calculate the tool's validity. Data analysis was done in SPSS23 software at a significance level of less than 0.05. In the present study, the average age score of the participants was 39.16 ± 11.48. The results related to the construct validity in the exploratory part show that the five factors (Outcome expectations, self-efficacy, social support, self-regulation and barrier self-efficacy) obtained have a specific value higher than one and range from 1.376 to 9.343. Correlation between factors shows that all factors have a relatively high relationship with each other (P < 0.05). According to the exploratory factor analysis, the final questionnaire contains 29 items and 5 constructs from socio-cognitive theory. The results showed that the thematically and technically designed tool has been prepared in an appropriate way for each of the structures and can accurately measure the structures of outcome expectations, self-efficacy, social support, self-regulation and barrier self-efficacy to explain the preventive behaviors of Covid-19 to evaluate., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

This study aimed to assess the reliability and validity of a novel clinical tool for distributing rehabilitation patients (DRP) for measuring a population of rehabilitation patients based on first-hand data from the field survey in China. A multi-stage sampling scheme was used to select 2512 rehabilitation outpatients from 21 medical institutions in seven cities in China. The evaluation indicators of the DRP tool consisted of five clinical indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course. The evaluation of rehabilitation ways of the DRP tool mainly included outpatient rehabilitation treatment, admission to primary healthcare, admission to secondary hospitals, and admission to tertiary hospitals. The mean age of participants was 54.22 years (SD:17.91), and nearly half (48.68%) were male. The majority (70.15%) were diagnosed with orthopaedic disorders. The Cronbach's alpha (0.66), the Kendall test (Kendall coefficient = 0.86; P < 0.001), and the Kappa test (Kappa = 0.83; Agreement: 90.48%; P < 0.001) reflected acceptable consistency reliability for the indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course in DRP tool. The modified confirmatory factor analysis (CFA) showed the indexes of multiple dysfunctions (β = 0.31; 95%CI = 0.20-0.43), self-care ability (β = 0.99; 95%CI = 0.65-1.33), disease status (β = 0.11; 95%CI = 0.06-0.16), disease course (β = 0.15; 95%CI = 0.09-0.21), and vital signs (β = 0.15; 95%CI = 0.08-0.21) had significantly factor loadings on the rehabilitation ways. The modified CFA exhibited a satisfactory model fit (RMSEA = 0.03; CFI = 0.99; TLI = 0.95; SRMR = 0.01; AIC = 8268.51; BIC = 8373.43). This is the first study to develop a DRP tool using a relatively large sample from seven cities in China. The DRP tool had acceptable reliability and validity in measuring the rehabilitation ways of patients. Our findings provide a starting point for developing a practical tool in rehabilitation clinical practices and could provide advice on building more effective strategies and tools for other low-and middle-income countries that struggle with integrated healthcare., Competing Interests: Declarations Consent for publication Not applicable. Competing interests The authors declare no competing interests. Ethical approval and consent to participate Our studies were approved by the Second People’s Hospital of Shenzhen Ethical Review Board (approval number of studies: 2023-226-02PJ). Participants were informed of the nature and purpose of the study before providing written consent. All participants provided informed consent to participate in the study., (© 2024. The Author(s).)