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This article addresses the problem of estimating the population mean of variable y using information from multiple auxiliary variables in adaptive cluster sampling. We define a class of estimators based on p(>1) auxiliary variables x 1 , x 2 , ..... , x p , derive bias and mean squared error expressions up to order n−1, and determine optimal conditions for minimizing mean squared error. Our findings demonstrate that the proposed estimators outperform the multiple linear regression estimator. We also identify several existing estimators as members of this class, including those introduced by Dryver and Chao (2007), Chutiman and Kumphon (2008), Chutiman (2013), Chaudhry (2014), Chaudhry and Hanif (2015), and Yadav et al. (2016). Furthermore, we obtain the correct values of constants "a" and "b" for the Chaudhry and Hanif (2015) estimator, leading to an accurate expression for its minimum mean squared error. To assess the performance of these estimators, we conduct a simulation study. [ABSTRACT FROM AUTHOR]

Introduction: Bangladesh has made an intense effort to improve maternal healthcare facilities including facility delivery, but the number of home deliveries is still very high. Therefore, this study aims to find out district-wise prevalence and determine the individual and community-level predictors of home delivery among women in Bangladesh. Methods: Data were derived from the Multiple Indicator Cluster Survey (MICS) 2019, a nationwide cross-sectional survey in Bangladesh. A final sample of 9,166 (weighted) women who gave birth in the two years preceding the survey were included in this study. Considering the two-stage cluster sampling strategy adopted by MICS, we used multilevel (2-level) logistic regression analysis to find out the correlates of home delivery. Results: The overall weighted prevalence of home delivery was 46.41% (95% confidence interval [CI]: 45.39–47.43). The highest prevalence was observed in Bandarban district (84.58%), while the lowest was found in Meherpur district (6.95%). The intercept-only regression model demonstrates that the likelihood of women from various clusters having home delivery varied significantly (variance: 1.47, standard error [SE]: 0.117), indicating the applicability of multilevel regression modeling. The multilevel regression analysis showed that women with higher education, wealth status and ANC visit, and those aged >18 years at first marriage/union were associated with lower odds of delivering child at home compared to their counterparts. While women from age group of 35–49 years, whose last pregnancy was unintended were more likely to deliver child at home. In addition, those respondents belonging to a community that had higher wealth status, women's education level, and exposure to media showed lower odds of having delivery at home. Conclusions: The finding indicates that delivery at home is still high in Bangladesh. Targeted interventions to reduce home delivery are urgently needed in Bangladesh to tackle adversities during deliveries and save mothers from the consequences. [ABSTRACT FROM AUTHOR]

Background: The global population's aging has led to an increasing demand for long-term care (LTC), especially in developing countries like China. Comprehensive assessment of LTC service demands by including the time and cost analysis is crucial to inform the planning and financing of LTC resources, yet such research is lacking in China. Our research team has developed a quantitative index system of the medical and nursing services needs of older adults (QISMNSNE) based on the framework of Time-Driven Activity-Based Costing (TDABC), providing a valuable tool for measuring LTC service needs. This study aimed to assess the LTC service needs of older adults in China and the factors associated with such needs. Methods: A cross-sectional study was conducted in Changsha City, Hunan Province, China, from June 2021 to December 2022. A stratified multistage cluster sampling method was used to recruit 1,270 older adults from five nursing homes and three communities/streets in three regions of Changsha City. The LTC service needs were assessed by calculating the service time required from caregivers, nurses, and doctors and the total service time (min/d) using the QISMNSNE. Participants' disability, activities of daily living (ADLs), mental status and social involvement (MSSI), and sensory and communication (SC) were assessed using standard scales. Generalized linear regression models were used to analyze factors associated with LTC service needs. Results: The participants had an average age of 76.41 ± 8.38 years, with 43.7% being female. The median service time required from caregivers, nurses, and doctors was 53.34 min/d, 3.66 min/d, and 0.33 min/d, respectively, and the total service time was 83.31 min/d. The generalized linear regression model identified the following factors that were associated with higher total service time: aged 75–84 years, living in nursing homes, income over 5000 per month, ADLs, MSSI (9 ~ 40), SC, and having 3 ~ 4 kinds of geriatric comorbidity (P < 0.05). Conclusions: Older adults have a high need for LTC services, especially those provided by caregivers, indicating an urgent need to expand and improve LTC systems. The LTC service time needed is associated with multilevel factors encompassing socio-demographic, functional, and psychological aspects. This study offers preliminary insights into the needs, demands, and costs of LTC services for older adults and provides essential guidance for future planning and financing of LTC resources. [ABSTRACT FROM AUTHOR]

Many clinical trials involve partially clustered data, where some observations belong to a cluster and others can be considered independent. For example, neonatal trials may include infants from single or multiple births. Sample size and analysis methods for these trials have received limited attention. A simulation study was conducted to (1) assess whether existing power formulas based on generalized estimating equations (GEEs) provide an adequate approximation to the power achieved by mixed effects models, and (2) compare the performance of mixed models vs GEEs in estimating the effect of treatment on a continuous outcome. We considered clusters that exist prior to randomization with a maximum cluster size of 2, three methods of randomizing the clustered observations, and simulated datasets with uninformative cluster size and the sample size required to achieve 80% power according to GEE‐based formulas with an independence or exchangeable working correlation structure. The empirical power of the mixed model approach was close to the nominal level when sample size was calculated using the exchangeable GEE formula, but was often too high when the sample size was based on the independence GEE formula. The independence GEE always converged and performed well in all scenarios. Performance of the exchangeable GEE and mixed model was also acceptable under cluster randomization, though under‐coverage and inflated type I error rates could occur with other methods of randomization. Analysis of partially clustered trials using GEEs with an independence working correlation structure may be preferred to avoid the limitations of mixed models and exchangeable GEEs. [ABSTRACT FROM AUTHOR]

Background: The proliferation of instruments that define instrument-specific metrics impedes progress in comparative assessment across populations. This paper explores a method to extract a common metric from related but different instruments and transform the original measurements into scores with a standard unit of measurement. Methods: Existing data from four assessment instruments of child development, collected from three different samples of children, were used to create "equate clusters" of items that measure the same behaviour in (slightly) different ways. A probability model was formulated to identify best items and groups to serve as anchors linking the instruments, assuming that items in an anchoring or "active" equate cluster are psychometrically equivalent. Quantification and inspection of item characteristic curves were used to resolve which equate clusters should be active. We simulated the impact of various analytic choices. Results: Simulation confirmed the feasibility of creating a common metric from data collected with different instruments from respondent samples with different abilities. The method performed as expected in an application in early childhood development. Conclusions: The use of equate clusters is an intuitive and flexible way to establish a common metric across instruments and facilitates the transformation of measurements obtained to a standardized scale. Standardizing instrument scores to a common metric allows for population-level comparisons on a global scale. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic generated or accelerated healthcare changes, some of which persist thereafter (e.g., healthcare reorganisation, remote consultation). Such changes entail novel risks for patient safety. Methods: Aim To compare the characteristics of patient safety incidents with harm (PSIH) in primary care before the pandemic and at present. Design and setting Cross-sectional, comparative, observational study conducted within the entire Primary Care Service of the Madrid region with observations at two time points (2018 and 2021/2022). Participants Patients > 18 years of age with at least one consultation in the previous year. The necessary sample size was established at N1 = 2,000 for the first time point and N2 = 2,700 for the second. Sampling was performed by simple randomisation for the first group and by clusters followed by simple randomisation for the second. Main measurements Age, gender, presence of PSIH in the medical record, and characteristics of the PSIH, specifically avoidability, severity, place of occurrence, nature, and contributory factors. Triggers validated in primary care were employed to screen the patients' medical records and those containing any trigger were reviewed by three nurse-physician teams who underwent previous training. Analysis Comparative analysis using Fisher's exact test. Results: A total of 63 PSIHs and 25 PSIHs were found for the first and second samples, respectively. The comparison of the characteristics of PSIH before the pandemic and currently was: avoidable 62% vs. 52% (p = 0.47), mild 51% vs. 48% (p = 0.57), in the primary care setting 73% vs. 64% (p = 0.47), respectively. Although no statistically significant differences were observed globally in the nature of the incidents (p = 0.13), statistically significant differences were found for diagnostic errors, with pre-pandemic rates of 6% vs. 20% at present (p < 0.05). Finally, no significant differences were found in the contributory factors. Conclusions: No differences were found in the avoidability, severity, place of occurrence, or contributory factors of PSIHs before the pandemic and currently. In terms of the nature of these incidents, the outcomes revealed an increase in diagnostic errors (excluding diagnostic tests), which could be attributed to a greater frequency of remote consultations and a decrease in the longitudinality of care resulting from the shortage of professionals. [ABSTRACT FROM AUTHOR]

Introduction: According to career construction theory, middle school students are in a critical phase of growth and exploration that requires self-reflection on their interests, values, and aspirations. Career adaptability is a key indicator of career development for middle school students and a crucial ability for achieving career success. Research indicates that many Chinese middle school students face significant hurdles in their career development, including a lack of motivation, limited self-awareness, and unclear career trajectories. Objective: To address these challenges, it is imperative to explore the factors influencing career adaptability, with a particular focus on the role of parental and teacher autonomy support within the framework of self-determination theory. This study aims to explore the correlation between parental autonomy support (PAS), teacher autonomy support (TAS), core self-evaluations (CSE), and career adaptability (CA) among middle school students. Methodology: The longitudinal data for this study were collected from two middle schools in the Anhui province. Middle school students were recruited as research participants through a cluster sampling method. A total of 482 students were surveyed in three stages during a 1-year period, and a cross-lag model was employed to analyze the data. Results: (1) From T1 to T2, T1PAS predicted T2CS, T1CSE predicted T2CA, and T1CA predicted T2TA; (2) from T2 to T3, T2PAS predicted T3CS, T2CSE predicted T3CA, and T2TAS predicted T3PAS; (3) TAS did not predict CSE and CA over time; (4) T2CSE mediated the relationship between T1PAS and T3CA. Discussion: These findings suggest that autonomy support has a consistently positive influence on the career development of early adolescents. Valuing children's autonomy is beneficial for fostering positive self-evaluations and shaping their career trajectories. Conclusion: Autonomy support plays a pivotal role in enhancing middle school students' career adaptability and promoting career development by strengthening self-evaluations. Additionally, the effect of parental autonomy support is more stable than that of teacher autonomy support. [ABSTRACT FROM AUTHOR]

Clustering samples based on similarity remains a significant challenge, especially when the goal is to accurately capture the underlying data clusters of complex arbitrary shapes. Existing density-based clustering techniques are known to be best suited for capturing arbitrarily shaped clusters. However, a key limitation of these methods is the difficulty in automatically finding the optimal set of parameters adapted to dataset characteristics, which becomes even more challenging when the data contain inherent noise. In our recent work, we proposed a Differential Evolution-based DENsity CLUstEring (DE-DENCLUE) to optimise DENCLUE parameters. This study evaluates DE-DENCLUE for its robustness in finding accurate clusters in the presence of noise in the data. DE-DENCLUE performance is compared against three other density-based clustering algorithms—DPC based on weighted local density sequence and nearest neighbour assignment (DPCSA), Density-Based Spatial Clustering of Applications with Noise (DBSCAN), and Variable Kernel Density Estimation–based DENCLUE (VDENCLUE)—across several datasets (i.e., synthetic and real). The study has consistently shown superior results for DE-DENCLUE compared to other models for most datasets with different noise levels. Clustering quality metrics such as the Silhouette Index (SI), Davies–Bouldin Index (DBI), Adjusted Rand Index (ARI), and Adjusted Mutual Information (AMI) consistently show superior SI, ARI, and AMI values across most datasets at different noise levels. However, in some cases regarding DBI, the DPCSA performed better. In conclusion, the proposed method offers a reliable and noise-resilient clustering solution for complex datasets. [ABSTRACT FROM AUTHOR]

In few-shot fault diagnosis tasks in which the effective label samples are scarce, the existing semi-supervised learning (SSL)-based methods have obtained impressive results. However, in industry, some low-quality label samples are hidden in the collected dataset, which can cause a serious shift in model training and lead to the performance of SSL-based method degradation. To address this issue, the latest prototypical network-based SSL techniques are studied. However, most prototypical network-based scenarios consider that each sample has the same contribution to the class prototype, which ignores the impact of individual differences. This article proposes a new SSL method based on pseudo-labeling multi-screening for few-shot bearing fault diagnosis. In the proposed work, a pseudo-labeling multi-screening strategy is explored to accurately screen the pseudo-labeling for improving the generalization ability of the prototypical network. In addition, the AdaBoost adaptation-based weighted technique is employed to obtain accurate class prototypes by clustering multiple samples, improving the performance that deteriorated by low-quality samples. Specifically, the squeeze and excitation block technique is used to enhance the useful feature information and suppress non-useful feature information for extracting accuracy features. Finally, three well-known bearing datasets are selected to verify the effectiveness of the proposed method. The experiments illustrated that our method can receive better performance than that of the state-of-the-art methods. [ABSTRACT FROM AUTHOR]

Objectives: The digit ratio (2D:4D) is a possible marker of prenatal hormone exposure. The purpose of this study was to explore the relationships between digit ratio (2D:4D) and anthropometric indexes in Chinese children and adolescents. Methods: This study is a cross‐sectional study. A school‐based survey among 685 children and adolescents aged 8–15 years were conducted by stratified cluster sampling. The length of index finger (2D) and ring finger (4D) of the left hand, height, sitting height (ST), weight, chest circumference (CC), waist circumference (WC), hip circumference (HC), and abdominal skinfold thickness (AST) were measured. Pearson correlation and multivariate linear regression were used to analyze associations between 2D:4D and above indexes. Results: In girls, 2D:4D was positively related to WC, AST, waist‐to‐height (WHtR), waist‐to‐hip ratio (WHR) after adjusting for ages (p < 0.05). The WC, AST, WHtR, and WHR among girls with 2D:4D ≥ 1 were significantly higher than those among girls with 2D:4D < 1, respectively (p < 0.05). However, there was no correlations between digit ratio (2D:4D) and above anthropometric indexes in boys (p > 0.05). Conclusions: The 2D:4D was related to anthropometric indexes in girls, which suggests that the maternal prenatal hormone exposure might be related to the anthropometric indexes of their female offspring. [ABSTRACT FROM AUTHOR]

Objective This manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA). Design This manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP). Setting Ten VHA clinics Subjects 19 pain navigators, >200 primary care physicians, and over 1000 Veterans were involved in the PNP implementation Methods Data were generated within the VHA electronic health record (EHR) for the ongoing AIM-Back trial to describe PNP implementation for system-level findings in terms of number of visits, and type of care received Results Over a 3-year period, 9 of 10 clinics implemented the PNP within the context of the AIM-Back trial. The most frequent care recommended in the PNP included physical therapy, chiropractic, acupuncture, and yoga/tai chi. During follow-up at six-weeks, ∼50% of Veterans elected to receive a different care choice than what was initially prescribed. Notable variation across clinics was documented for PNP based on time to initiation of care and follow-up rates. Conclusions Implementation of the telehealth delivered PNP provides a nuanced understanding of the introduction of novel care programs within diverse clinical settings. These findings are most applicable to care programs that are delivered remotely and involve facilitation of existing care options. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to investigate the knowledge and attitudes of first-time pregnant women regarding hearing loss in infants, and to identify the key factors that influence their perceptions. Methods: After validating and ensuring the reliability of a well-structured questionnaire consisting of 15 items, it was distributed to a total of 400 pregnant women who were experiencing their first pregnancies. Utilizing a cluster sampling method, participants were selected from both public hospitals and private gynecologist offices across diverse geographic regions in Tehran, Iran. Participants were asked to respond on a three-point scale (No, Not Sure, Yes). The results were analyzed using both descriptive and analytic statistics. Results: The translated questionnaire exhibited suitable face validity, test–retest reliability, and internal consistency. Findings revealed the highest maternal knowledge for "newborns can be born with hearing loss "(77.5%) and the lowest knowledge score was observed for "delayed birth cry can lead to hearing loss" (23.8%). Regarding attitudes, 72.5% of mothers scored above the mean of 5.65 out of 6, indicating a preference for early diagnosis and intervention. Several factors, such as education level and the mother's city of residence, showed a significant correlation with certain knowledge and attitude-related questions. Notably, individuals receiving care at public hospitals showed greater knowledge compared to those visiting private clinics. Conclusions for Practice: Mothers play a crucial role in child health and need to have a thorough understanding of pediatric diseases in order to make informed decisions. One particular condition that mothers should be well-informed about is hearing loss, as it has a significant impact on language development. However, this study reveals that there are gaps in maternal knowledge when it comes to the specific causes of hearing loss. Significance: Multiple studies have been conducted so far, particularly among mothers that have examined individuals' attitudes and knowledge about newborn hearing loss and the factors that contribute to it. However, this study looks into Iranian mothers' attitudes regarding screening and hearing aids, as well as their awareness about hearing loss and its risk factors, and it compares these findings to earlier research. This study, consistent with prior research, highlights the importance of raising awareness about hearing loss, particularly among mothers in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: The Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4–7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren. Methods: Data from the UK National Diet and Nutrition Survey (2008–2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4–7 years, n = 835) was compared to the change in an unexposed control group (8–11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups. Results: Before UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions. Conclusions: This study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children's diet. [ABSTRACT FROM AUTHOR]

BACKGROUND: Teachers can face demanding and stressful working conditions. Classroom environments in elementary schools are dynamic and challenging, which can be mentally and emotionally exhausting for teachers. This study aimed to investigate the prevalence of psychological distress and identify associated factors among elementary school teachers. METHODS: This is an analytical, observational cross‐sectional study. The participants consisted of 450 teachers selected using the cluster sampling method from elementary schools of Tabriz, Iran. Multiple regression analysis was performed to examine the associations between teachers' psychological distress and potential factors. RESULTS: The study found a significant proportion of participants (54.2%) experiencing psychological distress. Multiple regression analysis revealed age, sex, work experience, school type, family income status, teachers' efficacy, emotional labor, and presenteeism were statistically associated with teachers' psychological distress. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: To address teachers' psychological distress, schools need to adopt policies that promote teacher well‐being and mental health support. CONCLUSION: The high prevalence of psychological distress among elementary school teachers raises concerns and highlights the need for attention. Schools and administrators must provide teachers with the resources and support they need to succeed in their roles. Interventions targeting the identified associated factors must be planned to improve the mental health of elementary school teachers and enhance their overall performance. [ABSTRACT FROM AUTHOR]

Galaxy clusters provide an avenue to expand our knowledge of cosmology and galaxy evolution. Because it is difficult to accurately measure the total mass of a large number of individual clusters, cluster samples are typically selected using an observable proxy for mass. Selection effects are therefore a key problem in understanding galaxy cluster statistics. We make use of the |$(2.8~\rm {Gpc})^3$| FLAMINGO hydrodynamical simulation to investigate how selection based on X-ray luminosity, thermal Sunyaev–Zeldovich effect or galaxy richness influences the halo mass distribution. We define our selection cuts based on the median value of the observable at a fixed mass and compare the resulting samples to a mass-selected sample. We find that all samples are skewed towards lower mass haloes. For X-ray luminosity and richness cuts below a critical value, scatter dominates over the trend with mass and the median mass becomes biased increasingly low with respect to a mass-selected sample. At |$z\le 0.5$|⁠ , observable cuts corresponding to median halo masses between |$M_\text{500c}=10^{14}$| and |$10^{15}~\rm {{\rm M}_{\odot }}$| give nearly unbiased median masses for all selection methods, but X-ray selection results in biased medians for higher masses. For cuts corresponding to median masses |$\lt 10^{14}$| at |$z\le 0.5$| and for all masses at |$z\ge 1$|⁠ , only Compton-Y selection yields nearly unbiased median masses. Importantly, even when the median mass is unbiased, the scatter is not because for each selection the sample is skewed towards lower masses than a mass-selected sample. Each selection leads to a different bias in secondary quantities like cool-core fraction, temperature, and gas fraction. [ABSTRACT FROM AUTHOR]

Research to date has rarely addressed the association between peer victimization in childhood and social networking addiction in adulthood, much less the internal mechanism underlying that association. By integrating the relational self-system processes model and the cognitive–behavioral model of pathological internet use, our study marked an initial effort to explore whether social anxiety and perceived loneliness independently and/or sequentially mediate the impact of peer victimization on social networking addiction. Using school-based random cluster sampling, we recruited 1,136 students at various colleges in eastern, central, and western China (mean age = 21.98 years, 56.2% women) to complete an online survey. The results confirmed social anxiety's single mediation effect, perceived loneliness's single mediation effect, and the serial mediation effect of social anxiety and perceived loneliness between peer victimization and social networking addiction. The findings suggest that certain psychopathological and cognitive factors mediate the effect of peer victimization in childhood on individuals' symptoms of social networking addiction in adulthood both independently and sequentially. Our research contributes to clarifying how interpersonal stressors lead to psychopathological symptoms, maladaptive cognitions, and, in turn, addictive behavior, which has important implications for theory, interventions, and future research. [ABSTRACT FROM AUTHOR]

Aim: To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation‐involved defects. Materials and Methods: Fifty‐seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non‐furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI‐clustering method was also applied. Results: In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p =.01) was detected in FI compared with NF; IL‐6, MMP‐3, MMP‐8, BMP‐2, SOST, EGF and TIMP‐1 levels were increased in the GCF of FI compared with NF. Conclusions: This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI‐based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects. [ABSTRACT FROM AUTHOR]

Little is known about the people who comprise the natural support networks of children in foster care and any barriers to their ability to provide social support. Based on interviews with the network members of 150 children entering foster care, four barriers (criminal history, child welfare history, domestic violence, and substance abuse) were submitted to a latent profile analysis. Two barrier profiles were identified: a lower-barrier profile (87%) and a higher-barrier profile (13%). These results suggest that barriers are common but not widespread across the networks of most children, with implications for what caseworkers can expect when working with families. [ABSTRACT FROM AUTHOR]

Despite having adverse physical and mental health outcomes, harsh disciplinary methods are commonly practiced all over the world. This study aims to measure the harsh disciplinary actions taken by parents and their association with child functioning in children, aged 7 to 14 years in Punjab, Pakistan. This study is based on secondary data obtained from the United Nations Children's Fund (UNICEF's) Multiple Indicator Cluster Survey, conducted in the Punjab province from 2017 to 2018. Parents/caregivers of 19,721 children were included in the analysis. Questionnaire-based interviews were conducted, and the data collection form included sociodemographic information, questions on different "Methods of Child Discipline" and the "Child functioning module." The data was analyzed using STATA 15.0. Multiple logistic regression analysis was conducted to calculate the adjusted odds ratio and 95% CI exploring the association between harsh disciplinary methods and child functioning. More than 50% of children were exposed to severe physical, psychological, and emotional disciplinary methods. Exposure to severe physical aggression was associated with increased difficulty in learning (2.60 [1.27, 5.31]), remembering (2.83 [1.47, 5.44]), controlling behavior (1.63 [1.21, 2.18]), anxiety (1.98 [1.25, 3.13]), depression (2.57 [1.57, 4.22]) and making friends (1.94 [1.01, 3.79]). Whereas moderate physical aggression and psychological aggression were associated with (1.48 [1.19, 1.84]) and 1.5 times (1.20, 1.84) increase in difficulty in controlling behavior, respectively. Nonviolent actions were associated with protective odds for self-care (0.33 [0.17, 0.65]), communication (0.51 [0.27, 0.96]), learning (0.56 [0.33, 0.95]), remembering (0.62 [0.39, 0.90]), concentration (0.50 [0.31, 0.80]), anxiety (0.60 [0.46, 0.79]) and depression (0.67 [0.49, 0.92]). Severe disciplinary methods are detrimental to the child's personal care, mental, social, emotional, and psychological well-being, whereas nonviolent actions are associated with positive child functioning. In a third-world country such as Pakistan, this topic is widely undiscovered and understudied, thus emphasizing the need for awareness and education of parents and healthcare providers. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic is a serious public health challenge that causes negative effects on adolescents. This study aims to investigate the mediating roles of individual, family and community resilience in the association between COVID‐19‐related stress and quality of life according to the socio‐ecological theory. The sample consists of 814 adolescents from high schools in Zhejiang province, China (mean age = 16.79 years; 51.11% girls), collected by a multi‐stage cluster random sampling. The multiple mediation model is performed by SPSS macro PROCESS. The results show that individual resilience (β = −0.017, 95% CI [−0.044, −0.003]), family resilience (β = −0.028, 95% CI [−0.058, −0.008]) and community resilience (β = −0.031, 95% CI [−0.062, −0.007]) partially mediate the relationship between COVID‐19‐related stress and life satisfaction. Moreover, individual resilience (β = −0.028, 95% CI [−0.056, −0.008]), family resilience (β = −0.017, 95% CI [−0.042, −0.002]) and community resilience (β = −0.033, 95% CI [−0.065, −0.007]) also partially mediate the relationship between COVID‐19‐related stress and subjective well‐being. This study not only elucidates the mediating roles of multidimensional resilience but also provides valuable insights into improving adolescent resilience across different systems. [ABSTRACT FROM AUTHOR]

The phases of high-entropy alloys (HEAs) are crucial to their material properties. Although meta-learning can recommend a desirable algorithm for materials designers, it does not utilize the optimal solution information of similar historical problems in the HEA field. To address this issue, a transferable meta-learning model (MTL-AMWO) based on an adaptive migration walrus optimizer is proposed to predict the phases of HEAs. Firstly, a transferable meta-learning algorithm frame is proposed, which consists of meta-learning based on adaptive migration walrus optimizer, balanced-relative density peaks clustering, and transfer strategy. Secondly, an adaptive migration walrus optimizer model is proposed, which adaptively migrates walruses according to the changes in the average fitness value of the population over multiple iterations. Thirdly, balanced-relative density peaks clustering is proposed to cluster the samples in the source and target domains into several clusters with similar distributions, respectively. Finally, the transfer strategy adopts the maximum mean discrepancy to find the most matching historical problem and transfer its optimal solution information to the target domain. The effectiveness of MTL-AMWO is validated on 986 samples from six datasets, including 323 quinary HEAs, 366 senary HEAs, and 297 septenary HEAs. The experimental results show that the MTL-AMWO achieves better performance than other algorithms. [ABSTRACT FROM AUTHOR]

Background: Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017–2018. Materials and Methods: A weighted population-based sample of 8759 ever-married reproductive-aged women (15–49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Results: Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Conclusions: Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: The dramatic increase in fast food consumption among students, particularly adolescents and children, over the past two decades reflects a significant shift in lifestyle, with nearly one-third of these young individuals consuming ready-made foods on a daily basis. Purpose: This study aims to evaluate the effect of an intervention based on the Theory of Planned Behavior (TPB) in reducing fast food consumption among high-school students. Methods: One hundred and sixty Iranian high-school students were randomly assigned to an intervention or control group in a pretest-posttest-follow-up field trial. The intervention comprised four, 45-min teaching sessions over 3 weeks. Fast food consumption beliefs and self-report practices were assessed at pretest, posttest, and follow-up using a validated scale. Data analysis included descriptive statistics analyses-tests and ANOVA tests. Results: Findings revealed a statistically significant difference in the posttest between experiment and control groups in the major components of fast food consumption including behavioral beliefs (t = 5.1, p < 0001), evaluation of behavioral outcomes (t = 5.3, p < 0001), normative beliefs (t = 2.3, p < 05), motivation to comply (t = 5.5, p < 0001), control beliefs (t = 4.4, p < 0001), perceived power (t = 3.3, p < 0001), and behavioral intention (t =.68, p < 0001). Similar results were obtained in the follow-up stage. Discussion: Results suggest a parent-teacher participation intervention effectively reduced fast food consumption among high-school students, impacting both cognitive and behavioral factors. This model offers potential for customization to promote healthy food intake in wider student populations and beyond the school setting. Translation to Health Education Practice: According to our findings, several suggestions can be addressed. First, considering the crucial role of parents and teachers in shaping healthy food habits, future studies should always consider them as a key component of the training intervention. Second, parents and teachers should be trained on how to best transfer and express their knowledge to children and adolescents with regard to their disapproval of fast food consumption. As our findings show, students can perceive this disapproval and change their own attitudes accordingly. Third, future studies are recommended to use multilevel interventions to prevent students from consuming fast food. For both students and parents, we suggest adding more professionally designed visual and graphical messages (e.g. Infographics) or short video clips into interventions that could effectively demonstrate the differences between beliefs related to the consumption of fast food and healthy foods. [ABSTRACT FROM AUTHOR]

Adolescence is a crucial period of growth and the best time to recognize, rebuild, and improve different psychological and social aspects of a person's life. Anxiety is one of the variables that affect a person's mental health. Also, there is a connection between parenting styles and mental health during adolescence. The purpose of this study was to determine the relationship between perceived parenting styles and anxiety of adolescents in Isfahan (Iran). This descriptive-analytical study was conducted with the participation of 197 teenagers in the age group of 12–18 years in Isfahan, Iran. The participants were selected by cluster random sampling. The Parenting Styles Questionnaire (PSQ) and March Children's Anxiety Questionnaire were used to collect information. Data were analyzed using descriptive and analytical statistics through SPSS 26. The mean and standard deviation of anxiety in adolescents were 45.96 and 16.51, respectively (at a low level). The participants evaluated their parenting style in order as permissive (32%), authoritative (24.9%), neglectful (21.8%), and authoritarian (21.3%). A significant difference was observed between the anxiety level of adolescents and their parenting style (p < 0.001). In this way, the highest anxiety was related to the children of permissive parents, and the most minor anxiety was associated with the authoritarian parents (p < 0.001). The findings of this research indicate that there is a significant difference between the perceived parenting styles in terms of the level of children's anxiety. Therefore, considering the importance of parenting styles on children's psychological characteristics, It is recommended to educate parents about the importance of their parenting style on their children's health. [ABSTRACT FROM AUTHOR]

Background and aims: Abortion influences the composition and size of population. Estimating the overall and type-specific abortion rates, the reasons to choose the abortion can be helpful in designing and implementing preventive intervention. Therefore, the present study was designed to determine the: (i) prevalence of abortion, (ii) attitude of married women of reproductive age towards abortion, and (iii) reasons for choosing abortion by married women of reproductive age in Qazvin province. Methods: A cross-sectional study was conducted between February and April 2023, and comprised married women of reproductive age (N = 1571) referred to urban and rural comprehensive health centers in five cities of Qazvin province. Utilizing multi-stage proportional sampling process, data for the survey (including demographic and fertility information, reasons for choosing abortion, and attitudes toward abortion) were collected online. Results: The lifetime prevalence of abortion was 18.6% (among the total sample). The past-year prevalence was 22.3% (among those who reported having had an abortion). Of those reporting having had an abortion, 73.6% reported it was their first one, and 65.1% reported it was non-spontaneous. Women's reasons for choosing abortion fell into one of three main clusters: (i) couple's behavior, health and relationship problems, (ii) fertility-related stressful experiences, and (iii) family economic situations. The main reported reason to choose abortion was a couple's behavior (e.g., drug use), health (e.g., physical disease, psychological problems), and relationship problems (e.g., sexual infidelity, divorce) explaining 27% of the variance. Also, pro-abortion attitude was the most important attitude towards non-spontaneous abortion explaining 26.33% of variance. The variables that increased the likelihood of non-spontaneous abortion included choosing a reason for abortion vs. having no reason (OR = 1.77, p = 0.05), having poor vs. good mental health (OR = 1.74, p = 0.03), having a pro-abortion attitude (OR = 1.09, p = 0.09), and having ≥ 3 children vs. having no children (OR = 0.53, p = 0.06). Conclusion: Women in high-risk groups for non-spontaneous abortion (i.e., those aged over 35 years, those married for more than five years, those with an infertility history, those with a lower number of children, those living in rural areas, and those having poor mental health status) should be assessed by primary healthcare services during preconception and have early prenatal counseling to help in decisions regarding abortion. [ABSTRACT FROM AUTHOR]

Background: Early Childhood Caries (ECC) is a highly prevalent disease among preschoolers in Sri Lanka, with stagnated prevalence over the decades. Therefore, it is important to determine the socio-behavioural associations of ECC among preschoolers to reduce the country's ECC burden. Methods: A cross-sectional study with a multistage cluster sampling technique was used to select 3 to 4 year-old preschoolers/mothers dyads in Gampaha district in 2019. Preschoolers who completed third birthday and had not completed fifth birthday on the day of data collection were selected. The dependent variable was the presence (dmft ≥ 1) or absence (dmft = 0) of ECC. Independent variables were sex, monthly family income, mother's educational and occupational status, child's birth order, family type, frequency of consumption of sweets and sweetened drinks, time of sweet consumption during the last 24 h, toothbrushing frequency, supervision of toothbrushing, dental visit, and maternal dental caries. A pre-tested validated questionnaire was used. Multiple logistic regression analysis was used. Results: Total of 1038 preschoolers were selected. There were 529 females (51.0%) and 509 males (49.0%). The prevalence of ECC was 56.3% (95% CI: 53.1–59.3). Consuming sweets between meals had a higher odds ratio than consuming sweets after main meals (OR = 1.72, 95% CI:1.25–2.35), consumption of sweets every day had a higher odds ratio than consumption of sweets several times a week or less (OR = 2.89, 95% CI: 2.02–4.13), consumption of sweetened drinks every day had a higher odds ratio than consumption of sweetened drinks several times a week or less (OR = 1.73, 95% CI: 1.07–2.79), and the presence of maternal caries had a higher odds ratio than the absence of maternal caries (OR = 1.74, 95% CI: 1.12–2.69). The use of adult fluoridated toothpaste than not using adult fluoridated toothpaste (OR = 0.64, 95% CI:0.48–0.85), tooth brushing twice per day than not brushing twice per day (OR = 0.67, 95% CI:0.51–0.89), and supervised toothbrushing than unsupervised toothbrushing (OR = 0.61, 95% CI: 0.41–0.93) was negatively associated with ECC. Conclusions: ECC is highly associated with sweet consumption and oral hygiene behaviours among preschoolers in Gampaha District. Interventions should focus on the oral health behaviours of preschoolers to reduce ECC burden. [ABSTRACT FROM AUTHOR]

Objective: To examine the process of how parental conflict and family functioning influence adolescents' socially adverse emotions (shyness and loneliness). Methods: Stratified cluster sampling was used to conduct a questionnaire survey among 1,100 junior high school students from three junior high schools in Beijing, Chongqing, and Shijiazhuang, China. Results: (1) The overall experience of adolescents' socially adverse emotions was at the moderate level; boys' experience of shyness and loneliness was significantly higher than that of girls; the experience of shyness and loneliness in the second grade was significantly higher than that in the first grade; (2) Parental conflict was significantly negatively correlated with family functioning and significantly positively correlated with adolescents' socially adverse emotions, while family functioning was significantly negatively correlated with adolescents' socially adverse emotions; (3) Family functioning partially mediates the relationship between parental conflict and adolescents' shyness and completely mediates the relationship between parental conflict and adolescents' loneliness. Conclusion: Compared to adolescents' shyness, family functioning plays a more important mediating role in the relationship between parental conflict and adolescents' loneliness. [ABSTRACT FROM AUTHOR]

Background: Oral health is so important for the adolescent age group that the World Health Organization has listed oral health as a lifelong prerequisite for maintaining public health; Therefore, this research was carried out with the aim of the effect of educational intervention based on self-efficacy theory on the promotion of behaviors related to oral health of adolescents through mobile application. Methods: In this clinical trial, 80 adolescents aged 13–15 years from Shushtar city were selected using a random cluster sampling method and assigned to either the test or control group. The data collection tools included a standard questionnaire for measuring Oral health behavior (awareness, attitude, behavior) and a standard questionnaire for measuring self-efficacy (self-efficacy in brushing teeth, self-efficacy in using dental floss, and self-efficacy in visiting the dentist), as well as demographic characteristics. Training was provided to the test group via a mobile application for 3 weeks. During the intervention, the control group did not receive any training. Questionnaires were distributed in both groups immediately after the intervention, as well as one month and three months post-intervention, and data were collected. In accordance with research ethics, at the end of the study, the educational content was provided to the control group. Collected data were analyzed using SPSS 22 software and Mann-Whitney and Friedman non-parametric tests. Results: The findings showed that the educational intervention through the mobile application was effective in improving the average scores of awareness, attitude, self-efficacy in brushing teeth, flossing, visiting the dentist, and the behavior of adolescents regarding oral health behaviors, and this statistical difference was significant compared to before the educational intervention (P < 0.05), while no change was observed in the control group (p > 0.05). Conclusion: Considering that adolescents aged 13–15 years are the age of starting behavioral habits, including oral health behaviors, and on the other hand, their interest in using technology and virtual spaces is high, it is suggested that part of the education of this age group should be designed and implemented in the platform of mobile application. Clinical Trial: Registration in Iran Clinical Trial Center with ID code (IRCT20200120046204N1) Date of.Registration: 2018-02-25. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the attitude of unmarried girls towards virginity, and its determinants, comparing three age cohorts (born in the 70s, 80s, and 90s) in the city of Tabriz in northwestern Iran. Methods: We conducted a cross-sectional survey among 700 girls residing in Tabriz in 2021 employing a population-based cluster sampling based on health clinics and households. We collected data using a pilot-tested instrument, which comprised socio-demographic questions, and statements to assess attitudes towards virginity and its importance, the meaning of virginity, ways of losing virginity, and perception of the hymen. The data was analyzed using SPSS, version 21. Analysis of variance and independent t-test was used for bivariate analysis and linear regression was used to identify the determinants of the attitude. A p value under 0.05 was considered statistically significant. Results: Only about one-third (35.2%) of unmarried girls considered preserving virginity as an important issue for girls before marriage in current days. About 27% were uncertain and about 38% believed it was unimportant. The importance of virginity (score range 7–35) was significantly greater for girls born in the 70s than for girls born in the 80s and 90s (p < 0.05). In the multivariate linear regression model, the determinants of the importance of virginity were older age, greater religious affiliation, living with both parents and lower consumption of the internet and social networks for sexual information. Conclusions: This study indicates significant shifts in sexual attitudes among young females which may have important implications for marriage age and the culturally and age-appropriate sexual health interventions of young people. [ABSTRACT FROM AUTHOR]

Objective To understand the intake of added sugars among primary school students, to analyze the sources and influencing factors of intake, and to propose improvement measures. [WTHZ]Methods [WTBZ]A stratified cluster sampling method was used to select 12,603 primary school students in Lianyungang as the research subjects. A food atlas-based questionnaire was used to investigate the intake of foods with added sugars and calculate daily intake of added sugars. [WTHZ]Results [WTBZ]The median added sugar intake of primary school students was 22.1 g/day, 45.7% of students consumed more than 25 g/day, and 21.7% of students consumed more than 50 g/day. Sugar-sweetened beverages, flavored yogurt, pastries and sweets were the four main sources of added sugar intake among primary school students (accounting for 38.3%, 24.0%, 14.1% and 12.1% respectively). Multiple linear regression analysis showed that boys, higher grade, higher BMI, and less sleep were associated with increased intake of added sugars. [WTHZ]Conclusions [WTBZ]The excessive intake of added sugar by primary school students in Lianyungang was quite prominent. On the one hand, nutrition education should be carried out to publicize the harm of excessive intake of added sugar. On the other hand, it isrecommended to include the added sugar content in the nutrition label to guide teenagers to choose healthy food. [ABSTRACT FROM AUTHOR]

Objective The primary objective of this study was to investigate the potential correlation between the presence of 22 metals in urine and the risk of developing gallstones in Bouyei population in qiannan region, ultimately aiming to furnish a scientific foundation for early preventative measures and targeted interventions. Methods From July 2018 to August 2019, a baseline survey was conducted among residents aged 30 to 79 years in Qiannan Bouyei and Miao Autonomous Prefecture using multistage stratified cluster sampling, including questionnaires, physical examination and ICP-MS to detect urine metal concentration. Urinary metal concentrations were divided into four groups (Q1, Q2, Q3, Q4), and binary logistic regression model was used to analyze the relationship between single metal and gallstone risk. At the same time, the dose-response relationship between metal concentration and gallstone risk was investigated by using restricted cubic splines. Results The gallstone detection rate of Bouyei population was 8.825%. After adjusting for covariates, binary logistic regression analysis revealed that in the male group, compared to the Q1 group, there was a positive association between gallstone risk and selenium in the Q2 group (OR=1.894, 95%CI: 1.046-3.431), Se in the Q3 group (OR=1.912, 95%CI: 1.053-3.472), and Fe in the Q3 group (OR=1.827, 95%CI: 1.040-3.210). In the female group, Al in the Q3 group (OR=1.460, 95%CI: 1.050-2.028) was positively associated with gallstone risk, while Na in the Q4 group (OR=0.654, 95%CI: 0.452-0.948) was negatively associated with gallstone risk, with a dose-response relationship observed. Conclusion There is a significant correlation between the concentration of certain metals in urine and the risk of gallstones. In the Bouyei female population in particular, urinary aluminum and urinary sodium concentrations have a significant impact on gallstone formation, providing possible directions for future prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: According to career construction theory, middle school students are in a critical phase of growth and exploration that requires self-reflection on their interests, values, and aspirations. Career adaptability is a key indicator of career development for middle school students and a crucial ability for achieving career success. Research indicates that many Chinese middle school students face significant hurdles in their career development, including a lack of motivation, limited self-awareness, and unclear career trajectories. Objective: To address these challenges, it is imperative to explore the factors influencing career adaptability, with a particular focus on the role of parental and teacher autonomy support within the framework of self-determination theory. This study aims to explore the correlation between parental autonomy support (PAS), teacher autonomy support (TAS), core self-evaluations (CSE), and career adaptability (CA) among middle school students. Methodology: The longitudinal data for this study were collected from two middle schools in the Anhui province. Middle school students were recruited as research participants through a cluster sampling method. A total of 482 students were surveyed in three stages during a 1-year period, and a cross-lag model was employed to analyze the data. Results: (1) From T1 to T2, T1PAS predicted T2CS, T1CSE predicted T2CA, and T1CA predicted T2TA; (2) from T2 to T3, T2PAS predicted T3CS, T2CSE predicted T3CA, and T2TAS predicted T3PAS; (3) TAS did not predict CSE and CA over time; (4) T2CSE mediated the relationship between T1PAS and T3CA. Discussion: These findings suggest that autonomy support has a consistently positive influence on the career development of early adolescents. Valuing children's autonomy is beneficial for fostering positive self-evaluations and shaping their career trajectories. Conclusion: Autonomy support plays a pivotal role in enhancing middle school students' career adaptability and promoting career development by strengthening self-evaluations. Additionally, the effect of parental autonomy support is more stable than that of teacher autonomy support. [ABSTRACT FROM AUTHOR]

Holistic development of school-going students has gained momentum. Developing countries need to equip students with skills to thrive in the contemporary world, yet research on this topic in Pakistan is limited. This study, therefore, examines students’ non-cognitive skills (i.e., social capabilities and life skills) using a sequential mixed-methods approach. The sample was selected through multi-stage cluster sampling technique. The quantitative sample comprised students (n=263) from eight schools. The qualitative sample of students (n=16), teachers (n=8), and school leaders (n=4) was purposively selected. The results revealed that students are socially capable and possess basic life skills. However, schools do not explicitly prioritise the development of social capabilities and life skills. As a result, the holistic development of students is generally a neglected aspect in Pakistan. Moreover, educational structures and the school system strongly predict students’ non-cognitive skills. This study has implications for policy, practice, and further research. [ABSTRACT FROM AUTHOR]

Background: The continuum of maternal health care ensures consistency in the delivery of care from pregnancy to the postnatal period. It recommends a minimum of 4 antenatal visits, skilled birth attendance, and 42 days of postnatal care. This approach helps reduce maternal deaths. The aim of this study was to estimate the proportion of women who had completed the different stages of the continuum of maternal health care (four antenatal visits, given birth under the care of qualified personnel, and received postnatal care within 42 days of delivery). Methods: This was a cross-sectional analytical study conducted in the five communes of Conakry, using a two-stage cluster sampling for data collection. Results were described using medians and percentages. The proportions of women in the continuum of care, and at the different stages of this continuum, have been weighted. Multivariate logistic regression was used to identify the factors associated with non-completion of the different stages of the maternal health care continuum among the women included in this study. Results: We found that 26.9% of women had completed all stages of the maternal health care continuum, while 73.1% had not. While 56.7% received four antenatal visits, only 29.5% delivered under the care of a qualified healthcare professional. Key factors associated with discontinuity were not attending school (AOR 1.825: 1.594-2.089), unemployment (AOR 4.588: 3.983-5.285), having two or more living children (AOR 1.890: 1.016-1.296), and not receiving a free Long-Lasting Insecticidal Net at the first Antenatal Care. Conclusion: Maternal care discontinuity is a major issue in Guinea. The country's Health Development Plan had set an expected level for maternal care which has not been met as of 2022. The completeness of care is influenced by various factors, including individual socio-demographic characteristics and factors related to the organization, availability, and quality of health services. To reduce maternal and child mortality rates, it is essential to improve interpersonal communication during antenatal care, ensure the availability of quality health services, and conduct a national study on maternal health service quality and maternal satisfaction. This will help establish a proper continuum of care for mothers and children. [ABSTRACT FROM AUTHOR]

Background: A variety of medicinal plants are used in traditional medicine in Lubumbashi for the management of hemorrhoidal diseases. However, no investigation has been conducted to gather the knowledge required for this type of management in the region. The present study was conducted to inventory the plants used in Lubumbashi to treat hemorrhoidal diseases and to relate their ethnomedical characteristics. Methods: This study was conducted between March 2022 and February 2023 by interviews using semi-structured questionnaire with households (n = 1520), herbalists (n = 25), and traditional healers: THs (n = 59). Results: The 1,604 respondents (sex ratio M/F = 0.9; mean age: 56 ± 3 years; experience: 12 ± 3 years) provided information on 100 taxa, 84 of which are used against internal hemorrhoids, Phyllanthus amarus being the most cited (Citation Index, CI: 0.76). Most of them are trees (38%) or shrubs (32%), belonging to 90 genera and 45 families dominated by the Fabaceae (10%) and Asteraceae (9%). They are indicated in 76 other pathologies, dominated by gastrointestinal disorders (GID), wounds and sexually transmitted infections (CI > 0.57). From these 100 taxa, 117 anti-hemorrhoidal formulations were derived, 11 of which combined more than one plant. In all these recipes, the leaf is the most commonly used part (> 60%) and the liniment (> 45%) is the most popular form of application. For the first time, this study reports 14 taxa as plants used in the treatment of hemorrhoids. Among these taxa, Ficus stuhlmannii, Ficus laurifolia, and Ocimum centraliafricanum are listed as medicinal plants for the first time. Khaya nyasica, and Syzygium cordatum, each with 11 uses, have the highest traditional medicinal value. Conclusion: The findings of this study indicate that a significant number of medicinal plants are used in traditional medicine in Lubumbashi for the treatment of hemorrhoidal diseases. Some of these plants are endemic to the biodiversity area, while others are shared with other cultures and regions. A series of pharmacological studies is currently underway with the objective of validating the anti-hemorrhoidal properties of these plants and in order to identify phytochemical compounds responsible of this activity. [ABSTRACT FROM AUTHOR]

This study explored the gamified experiences of Grade 8 students in MAPEH classroom using game elements of the mobile game, Mobile Legend, Bang! Bang! (MLBB) This study used qualitative research design, and cluster sampling was utilized. 40 students were invited to participate in a semi-structured interview to describe their experiences in the gamified classroom. The interview results were gathered, analyzed, and coded into main themes such as: gamified elements, positive experiences in gamified classroom, negative experiences in gamified classroom and suggestions for improvement. This study proved that the use of gamification in the classroom provided fun and interesting experiences as compared to traditional classroom. The participants mainly have positive experiences in the gamified classroom. They described gamification as motivating, fun, engaging, and interesting. Additionally, the study showed that gamification was effective in increasing motivation and engagement level of the students in the classroom. The study recommended teachers to adopt the game elements of MLBB in other subject areas and grade levels. [ABSTRACT FROM AUTHOR]

Background: Professional commitment of nursing students is closely related to the stability of the nursing team. Personality traits and metacognition may be related to professional commitment. We investigate the association between Big Five personality, metacognition, and professional commitment among nursing students, and further explore whether Big Five personality modifies the association between metacognition and professional commitment. Methods: From December 2023 to January 2024, a cross-sectional study was conducted among 3631 nursing students from 17 universities in China through the online platform Sojump.com by cluster sampling method and using the general information questionnaire, BFI-44 (Big Five Inventory 44) scale, metacognition scale and professional commitment scale to investigate their demographic data, personality traits, level of metacognition and level of professional commitment. Latent profile analysis was employed to identify optimal categories of personality traits. Multivariate logistic regression was used to analyze the association between the personality traits and professional commitment, as well as metacognition and professional commitment in all participants and participants with different personality traits subgroups, adjusting for potential covariates. Furthermore, the potential mediating role of metacognition between personality traits and professional commitment was also investigated. Results: Three distinct personality traits were identified: sensitive-negative personality (65.2%), ordinary personality (26.6%), and open-positive personality (8.2%). Compared with nursing students with sensitive-negative personality, nursing students with ordinary personality and open-positive personality were associated with professional commitment, respectively [OR (95% CI): 7.01 (5.99–8.20), 21.09 (15.43–28.83)]. The p value for trend of personality and professional commitment was < 0.001. Metacognition was associated with professional commitment [OR (95% CI): 5.95 (5.20–6.81); p < 0.001]. Personality traits could modify the association between metacognition and professional commitment (pinteraction = 0.009). The mediating role of metacognition between Big Five personality and professional commitment has also been verified. Conclusions: Personality traits and metacognition of nursing students need to be paid attention to, and interventions based on metacognition may help nursing students with different personality traits to improve their professional commitment level. [ABSTRACT FROM AUTHOR]

Background: While traditional medicine (TM) is employed by a significant portion of the global population for managing health issues, clinical guidelines and state recommendations often overlook this practice. The aim of this study was to describe the frequency of use of TM to control 3 metabolic risk factors (MRF): hypertension, hypercholesterolemia, and hyperglycaemia; and the sociodemographic, economic, and clinical characteristics associated with the use of TM. Methods: Cross-sectional descriptive study that analyses data obtained from a representative population survey in 2 health districts, one urban in the south of Quito and another in a forested rural area with diverse ethnic groups in Esmeraldas, Ecuador. We include 602 individuals with at least one MRF. We calculated the proportion of people reporting the regular use of TM (herbal or traditional remedy) to control their MRF and we assessed potential associations with sociodemographic, economic, and clinical characteristics with a multivariable logistic regression model. Results: In two very different sociocultural contexts in Ecuador we found that use of TM to control MRF was frequent (39.4% in Esmeraldas, 31.1% in Quito), frequently in combination with CM. There is a notable percentage of people, 33.9% in Esmeraldas and 39.0% in Quito, who did not take any treatment for their MRF, and the remainder used CM alone. In both settings, an individual's education lever was significantly associated with TM use. Whereas in Quito individuals with higher education more frequently treated their MRF with TM (aOR 2.04, 95% CI 1.03–3.90), in the rural, hard-to-reach context of Esmeraldas, it was more frequent among people with no formal schooling (aOR: 3.76; 95%CI 1.59–8.88), as well as those of younger age (aOR by year: 0.97; 95% CI 0.95–0.99) and afro ethnicity (aOR: 2.13; 95%CI 1.02–4.45). Conclusion: Traditional medicine is used by a significant proportion of the population in Ecuador, highlighting the need for a more accessible and intercultural healthcare approach. The health system should ensure access to the necessary information and resources for the management of their metabolic risk factors. [ABSTRACT FROM AUTHOR]

Background: Conduct disorder is a prevalent difficulty among children and adolescents, encompassing a range of mental and behavioral problems. The present study aimed to determine the association of developmental family functioning and conduct disorder signs with the mediating effect of cognitive emotion regulation in adolescents. Methods: The present descriptive-correlational study was conducted on 362 students aged 15-18 (16.70±0.92) in Tabriz, Iran in 2023. The study participants were chosen through multi-stage cluster sampling technique. Data collection was done using Cognitive Emotion Regulation Questionnaire (CERQ), Youth Self Report Questionnaire (YSRQ) and Developmental Family Functioning Assessment Scale Questionnaire (DFFAQ) and interviews. Data analysis was done through descriptive statistical methods and path analysis with SPSS version 23 and LISREL version 8.80. Results: Mean±SD of the studied variables were as follows: Attention and regulation (2.35±0.54), Logical thinking (1.96±0.49), Discipline (1.95±0.45), Catastrophizing (2.63±1.16), and Acceptance (2.75±1.24). The data analysis showed that the developmental family functioning had a significant association with negative (r=-0.21, P=0.0001) and positive strategies (r=0.32, P=0.0001) of cognitive emotion regulation. Also, negative (r=0.31, P=0.0001) and positive strategies (r=-0.44, P=0.0001) of cognitive emotion regulation had a statistically significant correlation with conduct disorder symptoms. Conclusion: Based on the results of the present study, developmental family functioning has a significant association with the symptoms of conduct disorder in adolescents due to the association between negative and positive strategies of cognitive emotion regulation. [ABSTRACT FROM AUTHOR]

To explore the mediating effect of sleep duration on the relationship between qi stagnation constitution and anxiety/depression in junior high school students. Methods From March 20 to March 31, 2020, a total of 10, 325 students from 6 junior high schools in Henan, Liaoning, Shaanxi, Shandong, and Fujian provinces were sampled by cluster sampling. Firstly, the general conditions ( age, gender, grade, hometown, whether they are an only child) and sleep duration were collected, and their qi stagnation constitution, depression and anxiety status were evaluated by using the Qi Stagnation Subscale in the "' TCM Constitution Classification and Judgment Scale", the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder ( GAD-7). Secondly, Spearman correlation analysis was used to explore the correlation between qi stagnation constitution, sleep duration, and anxiety/ depression. Then, linear regression analysis and mediating effect test were used to explore the relationship between qi stagnation constitution and anxiety/depression in junior high school students, and the mediating effect of sleep duration was analyzed, and the results were verified. Results (i) The detection rate of anxiety in non-only children was higher than that of only children (X1 = 11. 198, P = 0. 001) ； The detection rate of anxiety (f = 106. 967, P<0. 001) or depression (f = 84. 692, P<0. 001) was higher among senior students than those in lower grades, while those of girls with anxiety = 100.441, P<0.001) or depression (太2 = 71.418, P <0.001) were higher than those of boys. The detection rates of anxiety (太2 = 1 092. 298, P<0. 001) and depression (X1 = 866. 740, P<0. 001) in qi stagnation constitution students were higher than those of non-qi stagnation constitution students, and the detection rates of anxiety (χ2 = 1 076. 716, P<0. 001) and depression (太2 = 1 099. 725, P<0. 001) in students whose sleep duration less than 8 h were higher than those of whose sleep duration more than 8 h, and the shorter the sleep duration, the higher the detection rate. (ii) Qi stagnation constitution positively predicted anxiety/depression (β = 0.679, P<0.001;β = 0.718, P<0.001), and sleep duration had a negative predictive effect on anxiety/depression (β = -0.403, P<0. 001 ；β = -0. 439, P<0.001). ( iii) Sleep duration played a partial mediating role in the relationship between qi stagnation constitution and anxiety/depression in junior high school students, and the mediating effect accounted for 13. 40% and 13. 79% of the total effect, respectively. Conclusion Although qi stagnation constitution mainly affects anxiety/depression through direct effect, it can still be partially indirectly realized through the mediating variable of sleep duration, that is, the shorter the sleep duration, the higher the risk of anxiety/depression in junior high school students. Therefore, the mental health problems of junior high school students can be prevented and improved by regulating qi stagnation constitution and ensuring adequate sleep duration. [ABSTRACT FROM AUTHOR]

Bioradar systems, in general, refer to radar systems used for the detection of vital signs. These systems hold significant importance across various sectors, particularly in healthcare and surveillance, due to their capacity to provide contactless solutions for monitoring physiological functions. In these applications, the primary challenge lies in the presence of random body movements (BMs), which can significantly hinder the accurate detection of vital signs. To compensate the affected signal in a timely manner, portions of BM must be correctly identified. To address this challenge, this work proposes a solution based on the Density-Based Spatial Clustering of Applications with Noise (DBScan) algorithm to detect the occurrence of BM in radar signals. The main idea of this algorithm is to cluster the radar samples, aiming to differentiate between segments in which the subject is stable and segments in which the subject is moving. Using a dataset involving eight subjects, the proposed method successfully detects three types of body movements: chest movement, body rotation, and arm movement. The achieved results are promising, with F1 scores of 0.83, 0.73, and 0.8, respectively, for the detection of each specific movement type. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with suicidal ideation (SI) in adolescents and to explore the mediating role of depression and hopelessness in these predictive relationships. Method: Employing a cross-sectional research design, this study included adolescents aged 14 to 19 from Lorestan Province in Iran. A total of 623 middle-school students were selected through a multi-stage cluster sampling technique. Data were collected using a series of assessment tools, including the Depressive Symptom Index-Suicidality Subscale (DSI-SS), the Psychological Strain Questionnaire, the Hopelessness Scale, the Defeat Scale, and the Thwarted Belongingness Questionnaire. Structural Equation Modeling (SEM) in AMOS version 26 and SPSS version 26 was utilized to evaluate the proposed model. Results: The findings revealed that in the context of Iranian adolescents, defeat and psychological strains emerge as significant predictors of SI. Notably, hopelessness was found to mediate the relationship between psychological strains, defeat, and SI. Conclusion: These insights provide valuable knowledge for addressing the issue of SI in Iranian adolescents and may inform future prevention and intervention strategies. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the importance of maximizing program‐setting fit in scaling and spreading effective programs. However, in the context of hospital‐based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site‐initiated adaptations to STRIDE, a hospital‐based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States. Methods: STRIDE was implemented at eight hospitals in a stepped‐wedge cluster randomized trial. During the pre‐implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site‐level support calls and group‐based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications‐Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post‐implementation period. Results: A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (n = 13), patient eligibility criteria (n = 5), program enhancements (n = 3), staffing model (n = 2), and marketing and recruitment (n = 2). More than one‐half of adaptations were planned. Adaptations were common in both sustaining and non‐sustaining sites. Conclusions: Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation. [ABSTRACT FROM AUTHOR]

Background: The increasing incidence and prevalence of childhood overweight (OW) and obesity (OB) are major global health challenges. This study aimed to evaluate the effectiveness of a 2-year healthy lifestyle intervention program in reducing the incidence of OW and OB among schoolchildren aged 11–12 years in Vietnam. Methods: Study design: Randomized controlled trial. Participants and interventions: In total, 733 students participated in this study. Participants were included from four schools in Hanoi based on a random cluster sampling method. Students' health outcomes were assessed at baseline and after 2 years. Main outcomes: The primary outcomes were the incidence of OW and OB, and the secondary outcomes were the prevalence and remission of OW and OB. Generalized estimating equations (GEEs) were used to determine the outcomes and risk factors. Results: After the intervention, the prevalence of OW decreased by 9.24% in the intervention group and 3.01% in the control group. After adjustment for age and sex, the odds of overweight were 36.7% lower in the intervention group than in the control group (OR = 0.633; 95% CI: 0.434–0.925; P = 0.018). The incidence of OW was 1.31% in the intervention group compared with 5.33% in the control group. After adjustment for age and sex, the odds of incident overweight in the intervention group were 77.4% lower than in the control group (OR = 0.226; 95% CI: 0.063–0.813; P = 0.023). The proportion of patients who achieved OW remission was 41.22% in the intervention group and 28.68% in the control group. After adjustment for age and sex, the odds of OW remission of overweight were 2.219 times greater in the intervention group than in the control group (OR = 2.219; 95% CI: 1.220–4.036; P = 0.009). For most OB-related factors, there were no significant differences between the intervention and control groups. Conclusion: A multicomponent healthy lifestyle intervention was effective in reducing the incidence of OW; however, it had no significant effect on OB among children aged 11–12 years in Hanoi, Vietnam. Trial registration: Retrospectively registered number: UMIN000014992, 20/08/2023. [ABSTRACT FROM AUTHOR]

Background: Previous studies have indicated that social connectedness can serve as a protective buffer against negative outcomes associated with online victimization. However, the role of social connectedness between Internet gaming disorder and somatic symptoms is still unclear. This study aims to examine the mediating effect of social connectedness on the association between Internet gaming disorder and somatic symptoms. Methods: A cross-sectional design was utilized, using questionnaires for data collection and multi-stage stratified cluster sampling. The general demographic questionnaire, Nine-Item Internet Gaming Disorder Scale–Short Form, Social Connectedness Scale-Revised and Patient Health Questionnaire Physical Symptoms were used to collect data. We adopted Pearson's correlation analysis and the PROCESS Macro Model in regression analysis to explore the relationships among Internet gaming disorder, social connectedness and somatic symptoms. Results: Internet gaming disorder was positively correlated with somatic symptoms (r = 0.20, P < 0.001), while network (r=-0.08, P < 0.001) and real-life social connectedness (r=-0.31, P < 0.001) negatively affected somatic symptoms. The network social connectedness and the real-life social connectedness played a chain mediating role in the development of Internet gaming disorder to somatic symptoms [95%CI: 0.073, 0.088], explaining 45.25% of the total effect value. The difference of real-life social connectedness and network social connectedness played a partial mediating role between Internet gaming disorder and somatic symptoms [95% CI:0.050, 0.062], accounting for 31.28% of the total effect value. Conclusions: Real-life social connectedness, network social connectedness, and their disparity all mediated the relationship between Internet gaming disorder and somatic symptoms. Real-life social connectedness acted as a protective factor, while network social connectedness served as a risk factor. Encouraging offline activities and guiding teenagers to use the internet responsibly may help prevent and reduce physical symptoms linked to Internet gaming disorder. [ABSTRACT FROM AUTHOR]

Since it is impossible in practice to create a sampling frame for the population of forest trees, forest inventories have relied on indirect sampling methods. This indirect sampling uses two populations: the discrete populations of trees and the continuous population of points, from which trees are being sampled. Important works such as Mandallaz, Eriksson, and Stevens and Urquhart brought the fundamental elements in the formalization of the sampling of trees, by defining the duality principle that relates both populations. They led to the so-called continuous population approach where trees attributes are transformed into attribute density values. However, in these approaches, the trees quickly fade away despite being the target population, while their weight is calculated as the inverse of their inclusion probability. We explain how the generalized weight share method (GWSM) can be used to formalize the link between the two populations. GWSM allows to revisit previous concepts proposed to solve the question of how to produce estimations from tree-level attributes, under uniform random or more complex sampling designs. The principles of the method are explained, and its functioning is illustrated under a variety of points and trees sampling designs, including fixed-area, Bitterlich, and cluster sampling. [ABSTRACT FROM AUTHOR]

Objective: Attitudes toward aging (ATA) are among the most important determinants of well-being in old age. However, little research has examined factors contributing to their formation in middle-aged individuals. This study aimed to investigate predictors of attitudes toward aging among Iranian middle-aged individuals in 2022. Method: This study recruited 330 people with a mean age of 56.5 ± 5.6 using multistage cluster sampling. Data were collected using a three-part questionnaire, including demographic factors, an attitude toward aging questionnaire (AAQ), and a multidimensional scale of perceived social support (MSPSS). The obtained data were analyzed using SPSS (v.22) statistical software to conduct t-tests, ANOVA, Pearson correlation, and linear regression. Results: According to bivariate analysis, perceived social support (PSS), age, level of education, and perceived income adequacy (PIA) had a significant relation with the total ATA score (P < 0.05). According to regression analysis, family support (β = 0.288, P < 0.001), friend support (β = 0.188, P < 0.001), significant others support (β = 0.130, P = 0.04), age (β = 0.118, P = 0.002), and PIA (β = 0.290, P < 0.001) were the predictor factors of ATA and explained 41% of the variance. PSS and PIA were the predictors of all dimensions of ATA. Conclusion: The results highlight the role of potentially modifiable factors, such as PSS, PIA, and level of education, in shaping ATA. This requires interventions and policies that effectively promote social and financial support in middle-aged individuals. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Variation in forage composition decreases the accuracy of diets delivered to dairy cows. However, variability of forages can be managed using a renewal reward model (RRM) and genetic algorithm (GA) to optimize sampling and monitoring practices for farm conditions. Specifically, use of quality control charts to monitor forage composition can identify changes in composition for which adjustment in the formulated diet will result in a better match of the nutrients delivered to cows. The objectives of this study were (1) to assess the use of a clustering algorithm to estimate the mean time (d) the process is stable or in control (T Stable) and the magnitude of the change in forage composition between stable periods (Δ Forage) for corn silage and alfalfa-grass silage, which are input parameters for the RRM; (2) to compare optimized farm-specific sampling practices (number of samples, sampling interval, and control limits [Δ Limit ]) using previously proposed defaults and our estimates for the T Stable and Δ Forage input parameters; and (3) to conduct a simulation study to compare the number of recommended diet changes under the proposed sampling and monitoring protocols. We estimated the T Stable and Δ Forage parameters for corn silage NDF and starch and alfalfa-grass silage NDF and CP using a k-means clustering approach applied to forage samples collected from 8 farms, 3×/wk during a 16-wk period. We compared 4 sampling and monitoring protocols that resulted from the 2 methods for estimating T Stable and Δ Forage (default values and our proposed method) and either optimizing only the control limit or optimizing the control limits, the number of samples, and the number of days between sampling. We simulated the outcomes of implementing the optimized monitoring protocols using a quality control chart for corn silage and alfalfa-grass silage of each farm. Estimates of T ^ S t a b l e and Δ ^ F o r a g e from the k-means clustering analysis were, respectively, shorter and larger than previously proposed default values. In the simulated quality control monitoring, larger Δ ^ F o r a g e estimates increased the optimized Δ Limit , resulting in fewer detected shifts in composition of forages, a lower frequency of false alarms, and a lower quality control cost ($/d). Recommended diet reformulation intervals from the simulated quality control analysis were specific for the type of forage and farm management practices. The median of the diet reformulation intervals for all farms using our optimal protocols was 14 d (quartile [Q] 1 = 8, Q 3 = 26) for corn silage and 16 d (Q 1 = 8, Q 3 = 26) for alfalfa-grass silage. [ABSTRACT FROM AUTHOR]

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic threatened adolescents' mental health and livelihoods, which can worsen their non-suicidal self-injury (NSSI) behaviors. With the significant increase of total online time use, adolescents become more prone to problematic internet use (PIU). This study examined whether depression mediated the relationship between PIU and NSSI among adolescence during the COVID-19 outbreak. Constructed with a cross-sectional design during the COVID-19 outbreak in Taiwan, 1060 participants were drawn from junior high schools through stratified and cluster sampling, and completed a set of comprehensive surveys. The mediation model demonstrated a good fit to the data, GFI =.96, CFI =.97, NFI =.97, NNFI =.95, IFI =.97, and SRMR =.02. The overall fit of the mediational model was adequate. The path from PIU to depression, β =.41, p <.001, and the path from depression to NSSI, β =.40, p <.001, were both significant. Moreover, the effect of PIU to NSSI decreased from.23 (p <.001) to.05 (p =.099) when depression was incorporated into the analysis. Moreover, results in bootstrapping analysis displayed that the indirect effect (PIU on NSSI via depression) was statistically significant (p <.001) and the direct effect (PIU on NSSI) was statistically non-significant (p =.134). The full mediation model was confirmed. The findings of the structure equation modeling and bootstrap analysis showed that PIU significantly and positively predicted NSSI, and that depression fully mediated this relationship. [ABSTRACT FROM AUTHOR]