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Objectives: Assess student perceptions of health and disease during remote learning in the COVID-19 pandemic. Participants: Convenience sample of undergraduate students at a liberal arts university (n = 67). Methods: Survey administered across multiple sections of a required general education course in Spring 2020. Measures included Fear of COVID-19 Scale, Multidimensional Health Locus of Control, Perceived Health Competence, and COVID-19 perceived impact on students' communities and wellbeing. Results: Students reported relatively low levels of fear about COVID-19, not differing by number or severity of known cases or community impact (p = 0.67, 0.55, 0.11, respectively). Stress and mental health were priority concerns over infectious diseases. Students reported negatively affected emotional (70%) and interpersonal (67%) wellbeing; unexpectedly, over half of students reported positive impacts in [greater than or equal to] one wellness dimension. Conclusions: Student-identified concerns emphasized psychosocial wellbeing, suggesting additional need for mental health resources. Low perceived threat of infectious diseases may present barriers to COVID-19-related prevention behaviors.

This study tries to explore the relationship between prospective EFL teachers' locus of control and academic self-efficacy in Turkey. For the purpose of the study, the quantitative data of the research was collected through Multidimensional Locus of Control Scale developed by Levenson (1974) and adapted to Turkish by Kiral (2012). The scale, consisting of 24 items (6 point Likert type), simply examines the internal and the external locus of control of pre-service EFL teacher candidates. It measures (a) internal locus of control (8 items), (b) locus of control based on others (6 items), and (c) locus of control based on chance (5 items). The Cronbach Alpha coefficient for this scale is 0.77. As to the Academic Self-efficacy Scale, College Academic Self-Efficacy Scale was adapted from Owen & Froman (1988), consisting of 33 items measuring male and female ELT students' academic self-efficacy beliefs as a whole. The Cronbach Alpha coefficient for this scale is 0.83. The scale is a 5- point Likert scale ranging from 'very little' (1) 'quite a lot' (5). It is assumed that the higher the locus of control of EFL teachers, the higher level of academic self-efficacy is. At the end of the study, considering the results, some recommendations will be made for language instructors at these institutions.

A multiple regression analysis was performed to determine if self-esteem, social support, locus of control, or coping strategies could predict perceived stress in first-generation college students. All variables studied were found to predict stress, while self-esteem and emotional-support seeking coping added statistical significance to the prediction, p < 0.05. Results can be used to improve the college experience of first-generation college students.

Background: Internal health locus of control has been associated with positive health outcomes and behaviors. Understanding the mechanisms of this relationship are key to designing and implementing effective health behavior intervention programs. Purpose: The purpose was to examine whether self-efficacy and social support mediate the relationship between college students' health locus of control and the health behaviors of physical activity, fruit and vegetable intake, and dietary fat intake. Methods: Eight hundred thirty-eight college students at 2 public universities in the southeastern United States completed online surveys of health locus of control, physical activity, fruit and vegetable intake, and dietary fat and self-efficacy and social support of those behaviors from July to September 2013. Mediation was tested with product of coefficients approach. Results: Self-efficacy and social support mediated the relationship between health locus of control and physical activity behaviors and fruit and vegetable intake. Only self-efficacy was a mediator for dietary fat intake. Discussion: Internal health locus of control appears to exert its influence on health behaviors, at least partially, through self-efficacy and social support. Translation to Health Education Practice: By understanding the role of self-efficacy and social support, practitioners can develop and implement interventions that target improving locus of control for health behaviors.

Objective: Literature on participatory health care suggests that, though many patients desire basic information, a substantial number prefer a passive role. This variability is explored as a function of laypersons' beliefs about the nature of medical knowledge, referred to as epistemological beliefs, through the evaluation of a newly-developed instrument, the discipline-based epistemological beliefs scale-lay medical knowledge (DEBS-LMK). Design: Survey. Method: Items were developed to measure Schommer's hypothesized constructs of epistemological beliefs within a medical context: source, structure, and certainty of knowledge plus beliefs about acquiring knowledge - innate ability and speed of learning. Setting: Faculty, staff, and students ("n" = 367) from a Midwestern university provided complete responses to 63 medical epistemological beliefs items and the 18-item multidimensional locus of control scales (MHLOC). Results: Factor analysis confirmed the basic theoretical structure of the instrument. Scores on the DEBS-LMK were associated in predictable ways with MHLOC scales. Beliefs about doctors as omniscient authorities were associated with perceptions that powerful others are responsible for health status; in particular, beliefs that patients should be empowered to question and challenge their doctors predicted lower powerful others scores. Beliefs that medical knowledge depends on innate ability and quick learning predicted views that health status is due to chance factors, but beliefs in the need for quick learning were negatively associated with an internal health locus of control. Conclusions: Implications for research on information seeking and on interventions to improve patient/provider communication are discussed. (Contains 6 tables and 1 figure.)

Identifies the relationship of life adjustment after spinal cord injury with three components of locus of control (LOC): internality, chance, and powerful others. Internality was positively correlated with subjective well-being and powerful others was negatively correlated with health indicators. States that rehabilitation counseling will be enhanced by using LOC to predict risk for adverse outcomes. (Author/MKA)

Examined the psychometric properties of the Multidimensional Health Locus of Control (MHLC) Scales with chronic cigarette smokers (N=146). Results showed that health locus of control orientation was bidimensional, with domains defined by the Internal and Powerful Others measures. (Author/JAC)

Investigated measurement characteristics of the Multidimensional Health Locus of Control (MHLC) Scales when the scales are used with elementary school children. The MHLC scales were administered to 876 fourth, fifth, and sixth graders. Results from four analyses of data strongly support the reliability and factorial validity of the revised MHLC scales. (Author/NB)

Examined the psychometric properties of the Multidimensional Health Locus of Control (MHLC) Scales with alcoholic patients (N=100). The three MHLC Scales appear to measure largely independent dimensions of locus of control beliefs specifically related to health. Factor analyses suggest that the instrument is factorily valid. (Author/JAC)

Replicated a recent report of the factorial structure of the Multidimensional Health Locus of Control Scale, using rehabilitation patients. Analyses failed to validate the previously reported three-dimensional structure, which indicates a need for careful interpretation of this scale when used with certain populations. An alternative factor structure and possible future directions are proposed. (Author/BL)

Background: The use of Complementary and alternative medicine (CAM) in chronic liver disease (CLD) patients in Germany is unknown. This study investigated the frequency of CAM use and associated sociodemographic, clinical and personality factors in CLD patients in Germany. Methods: This is a cross-sectional multicenter study of CLD patients attending liver outpatient clinics of university hospitals in Halle(-Saale) and Homburg between 2015 and 2017. Dedicated questionnaires recorded CAM use, sociodemographic and personality factors (evaluated with the "Big five" model, "Hospital Anxiety and Depression"-, "Multidimensional Health Locus of Control"- score). Uni- and multivariate analyses assessed factors associated to CAM use. Results: Overall 378 patients were recruited, 92 (24.3%) reported to CAM use. On univariate analysis, female CAM users were older (p = 0.001) and more physically active (p = 0.002), male CAM users more often used homeopathy (p = 0.000), actively promoted their health (p = 0.010) or had UDC in their medication (p = 0.004). Logistic regression analysis adjusted for personality factors showed significant association of age, physical exercise (females) and satisfaction with alternative medicine (females, males) to CAM use. Conclusions: CAM use is prevalent among CLD patients in Germany and is significantly associated to satisfaction with alternative medicine (females, males), physical exercise and older age (females). Doctors should actively inquire CLD patients about CAM use, as hepatotoxicity or interaction with medication can occur. [ABSTRACT FROM AUTHOR]

Develop and test a Food-Related Control Scale (FRCS) measuring resident-perceived control in long-term care food service. A bank of 15 initial items based on a multidimensional locus of control construct was developed initially. Expert review, cognitive interviews, a pilot study, and factor analysis were used to validate the instrument and assess reliability. Individual phone-based cognitive interviews and 16 skilled nursing facilities in the US. Cognitive interviews included a convenience sample of independently living adults aged ≥ 65 (n = 13), whereas the pilot study included skilled nursing facility-residing adults (n = 166). Perception of food-related control in a long-term care setting. Cognitive interviews were analyzed to develop items. Quantitative data from skilled nursing facility residents were analyzed using SAS software for structural equation modeling and factor analysis. A 2-dimensional construct (9 items) of the FRCS demonstrated reliability with factor analysis. Concurrent validity within the locus of control construct was demonstrated with the Multidimensional Health Locus of Control Scale (standardized estimate of 0.430; P < 0.1). The FRCS may be used to determine how residents in long-term care perceive control over their food experiences. Further testing is necessary to determine the appropriateness of the FRCS for different population uses. [ABSTRACT FROM AUTHOR]

• The long-term success of organ transplantation depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. • Health behavior determinants include personality traits such as optimism, self-efficacy, and health locus of control. Strengthening personal resources is recommended to foster health practices among organ transplant recipients. It is necessary to form an internal locus of control and dispositional optimism for adherence to positive health behaviors. The long-term success of organ transplantation (Tx) depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. Health behavior (HB) determinants include personality traits such as optimism, self-efficacy, and health locus of control. Assessing the relationship between personal resources and expectations and health behaviors of organ transplant recipients. The study was conducted between 01/04/2018 and 30/10/2019 at 3 transplant centers in Poland. The study group consisted of 243 Tx recipients of kidney, heart, liver, and lung. The Health Behavior Inventory, Multidimensional Health Locus of Control Scale (MHLC), General Self-Efficacy Scale, Dispositional Optimism Scale, and Hospital Anxiety and Depression Scale were used to collect data. The study group had medium levels of dispositional optimism (mean 15) and high levels of self-efficacy (mean 30.18). The MHLC scale was dominated by a belief in the influence of others and an internal locus of control over one's health. The respondents presented a high level of HB (mean 92.09). A positive relationship was found between personal resources (self-efficacy and optimism), MHLC and HB. The presence of depression and anxiety negatively affected personal resources and internal locus of health control and HB in terms of a positive mental attitude. Type of Tx differentiated internal locus of health control and HB. Predictors of HB were dispositional optimism, self-efficacy, influence of others with health locus of control, symptoms of depression, age and time since transplantation-explaining between 6.1% and 14.5% of health behavior categories. To improve health practices among organ recipients, strengthening their personal resources is recommended. It is necessary to form an internal locus of control for adherence to positive HB. [ABSTRACT FROM AUTHOR]

Background The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied. Purpose To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort. Methods We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale—a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research. Results PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort. Conclusions Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk. [ABSTRACT FROM AUTHOR]

Health Locus of control (LOC) refers to one's beliefs regarding control over one's health. This study aimed to determine the relationship between LOC on clinical and psychosocial aspects associated with multiple sclerosis (MS). 5059 participants with MS completed a questionnaire pack including the Multidimensional Health Locus of Control Scale. Associations between LOC and sociodemographic (age, gender, educational level) and clinical variables (duration, disability, depression, anxiety, self-efficacy, QoL) were explored. LOC was found to be significantly associated with all of the clinical variables and age, but not gender or educational level. When controlling for level of disability, Chance (CLOC) was associated with higher self-efficacy, lower anxiety and higher QoL than Powerful Others (PLOC), while Internal (ILOC) had no association. The proportion with ILOC preference was lower in increased disability. In MS, believing that health is controlled mainly by chance confers the most benefit with regard to quality of life. There is prima-facie evidence that LOC preference changes with MS progression, in a pattern that is protective against psychological distress. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the status and influencing factors of professional identity among psychiatric nurses as second victims in China by using a cross-sectional design. We investigated 291 psychiatric nurses from two psychiatric hospitals. Participants were asked to complete a demographic questionnaire, Second Victim Experience and Support Scale, Multidimensional Health Locus of Control Scale, and Professional Identity Scale for Nurses. Scores of professional identity of psychiatric nurses as second victims were moderate. Regression analysis showed that the second victim experience and support and internal control were significant predictors, explaining 34.2% of the variance in professional identity. Identifying risk factors related to the professional identity of psychiatric nurses as second victims will help managers take timely preventive measures to improve the awareness of the self-health responsibility of psychiatric nurses and reduce the adverse effects of patient safety incidents to enhance their professional identity. [Journal of Psychosocial Nursing and Mental Health Services, 61(12), 47–54.] [ABSTRACT FROM AUTHOR]

The English and Spanish versions of the Multidimensional Health Locus of Control scales have not been psychometrically evaluated for use with Hispanic Americans. Hispanic American adults (N = 436) completed the English (n = 210) or Spanish (n = 226) Multidimensional Health Locus of Control scales. A multiple-group confirmatory factor analysis did not support equivalent four-factor structures for Spanish- and English-speaking Hispanic Americans. Follow-up exploratory factor analyses of the 24 items supported an 18-item, four-factor structure for English-speaking Hispanic Americans and a 22-item, three-factor structure for Spanish-speaking Hispanic Americans. These results suggest caution when using the Multidimensional Health Locus of Control scales with Hispanic Americans.

The aim of this study was to analyze the locus of health control, self-efficacy and stress coping styles of female patients treated for ovarian cancer. Learning the styles of coping with stress in patients with ovarian cancer may contribute to improve their quality of life after cancer diagnosis. A series of Pearson's r-analyses was performed in the order to evaluate the hypotheses regarding the relationship between styles of coping with stress, the locus of health control and self-efficacy. A total of 151 female patients participated in this study. Standardized psychological questionnaires were used: the General Self-Efficacy Scale (GSES) to measure coping with difficult situations and obstacles, the Multi-Dimensional Health Locus of Control Scale (MHLC) to measure health control and the Convergence Insufficiency Symptom Survey (CISS) to measure stress coping styles. All questionnaires had an adaptation in Polish. Patients using task-focused and socializing styles had higher self-efficacy, whereas focusing on negative emotions resulted in lower self-efficacy. External locus of health control was related to a task-focused approach to treatment. On the other hand, the focus on negative emotions was related to the feeling that the fate of patients was decided by chance. Self-efficacy was positively associated with internal locus of health control and with external control, which means the influence of others. The results of our study indicate the need for a multidimensional approach to the treatment of female patients with ovarian cancer. The psychological condition of female patients has an ongoing relationship with their physical health. [ABSTRACT FROM AUTHOR]

Background: Previous studies have primarily focused on the relationships among the health locus of control (HLC), healthy lifestyle and life satisfaction of college students. However, little is known about the mediating mechanism of healthy lifestyle on the other two aspects. This study aims to address this issue. Methods: A total of 2394 students from six colleges in Hubei Province validly completed self-report questionnaires, including the Satisfaction with Life Scale (SWLS), Healthy Lifestyle Questionnaire for college students and Multidimensional Health Locus of Control Scale (MHLC), which covered three dimensions: internal HLC, powerful others HLC and chance HLC. Partial least squares structural equation modelling (PLS-SEM) was employed to analyses the hypothesized relationships in the path model, and a mediation analysis was used to verify the indirect relationships. Results: Healthy lifestyle and life satisfaction showed positive relations with both internal HLC and powerful others HLC, but a significant negative association with chance HLC. In addition, healthy lifestyle mediated the relationships of internal HLC, powerful others HLC and chance HLC with life satisfaction. Conclusions: Healthy lifestyle mediates the impact of HLC on life satisfaction. Students with high IHLC tend to develop a healthier lifestyle and have higher LS. Powerful others also exert positive effects in collectivist cultural backgrounds. Thus, colleges should give full play to the positive role of psychological health and physical education courses in improving students' IHLC. Meanwhile, the positive guiding effect of powerful others should be stressed. Further, particular emphasis should also be placed on the peer influence, new media publicity functions, community intervention, and college systematic appraisal, especially during and after public health emergencies. [ABSTRACT FROM AUTHOR]

Background : Coronavirus disease 2019 (COVID-19) has impacted many people's meaning in life and health behaviors. This study aimed to verify the relationship among meaning in life (MIL), epidemic risk perception, health locus of control (HLC), and preventive health behaviors among older adults after the COVID-19 outbreak was declared a pandemic. Method: In this longitudinal study, 164 participants aged 55 years and above completed the following measures at time 1 (February 19, 2021) and one month later at time 2 (March 19, 2021): Meaning in Life in the Epidemic Questionnaire, Epidemic Risk Perception Questionnaire, Multidimensional Health Locus of Control Scale, and Health Behaviors Before and After the Epidemic Survey. Hayes' SPSS Process Macro was used to analyze the mediating effect of epidemic risk perception (model 4) and the moderating role of powerful others HLC in the mediation model (model 14). Results: The results showed that after controlling for gender, age, education level, and health behaviors at the baseline, risk perception had a significant mediating effect on the relationship between MIL and preventive health behaviors (β =.02, SE =.01, 95% CI [.00,.04]). In addition, powerful others HLC had a moderating effect on the second half of the mediating effect (β =.02, p =.02, 95% CI [.00,.03]). Specifically, compared to the older adults with low powerful others HLC, the risk perception of older adults with high powerful others HLC increased preventive health behaviors. Conclusion: Practitioners should adequately cultivate older adults' risk awareness and reinforce the importance of advice from doctors and professionals, thereby effectively enhancing the preventive health behaviors of older adults in China during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Psychological well-being is a good predictor of several health outcomes in cardiovascular disease patients (adherence, quality of life, and healthy behaviors). The perception of health control and a positive orientation seem to have a beneficial effect on health and well-being. Therefore, the aim of this study was to investigate the role of the health locus of control and positivity in the psychological well-being and quality of life of cardiovascular patients. A total of 593 cardiac outpatients completed the Multidimensional Health Locus of Control Scale, the Positivity Scale and the Hospital Anxiety and Depression Scale at baseline (January 2017) and 9 m later (follow-up; n = 323). A Spearman rank correlation coefficient and a structural equation modeling approach were determined to explore the relationships between those variables both cross-sectionally and longitudinally. A cross-sectional correlation analysis at baseline revealed that the internal health locus of control and positivity were negatively associated with anxiety (rs = −0.15 and −0.44, ps < 0.01) and depression (rs = −0.22 and −0.55, ps < 0.01) and positively associated with health-related quality of life (rs = 0.16 and 0.46, ps < 0.01). Similar outcomes were found at follow-up and in longitudinal correlations. According to the path analysis, positivity was found to be negatively associated with anxiety and depression level at baseline (β = −0.42 and −0.45, ps < 0.001). Longitudinally, positivity was negatively associated with depression (β = 0.15, p < 0.01) and together with the internal health locus of control, was positively associated with health-related quality of life (β = 0.16 and 0.10, respectively, ps < 0.05). These findings suggest that focusing on the health locus of control and especially positivity may be crucial in enhancing the psychological well-being of patients in the context of cardiac care. The potential impact of these results on future interventions is discussed. [ABSTRACT FROM AUTHOR]

Quality of life (QOL) in patients with diabetes is affected by multiple factors, and this study aimed to determine the effect of health locus of control points (HLOC) and diabetes health literacy (DHL) on QOL in Iranian patients with type 2 diabetes. This cross-sectional study was conducted between October 2021 and February 2022 among 564 people with type 2 diabetes. Patients were selected using proportional stratified sampling and simple random sampling methods. Data were collected using three questionnaires: (1) Multidimensional Health Locus of Control scale (form C), (2) World Health Organization Quality of Life Scale, and (3) Diabetes Health Literacy Scale. Data were analyzed by software's of SPSS V22 and AMOS V24. There was a positive and significant correlation between DHL and QOL. There was a positive and significant correlation between the subscales of internal HLOC, and doctors HLOC with QOL. According to the Path analysis results, all variables showed 58.93% of the direct effects and 41.07% of indirect effects of the final model. Numerate health literacy, informational health literacy, communicative health literacy, internal HLOC, other powerful people HLOC, chance HLOC, and doctors HLOC were able to predicted 49% variance of diabetes QOL (R2 = 0.49). The subscales of communicative health literacy, informational health literacy, internal HLOC, doctors HLOC, and chance HLOC had the greatest impact on QOL of people with diabetes. Based on the results of Path analysis, diabetes health literacy and HLOC play an effective role in QOL of diabetic. Therefore, there is a need to design and implement programs to improve the health literacy of patients as well as HLOC to improve QOL of patients. [ABSTRACT FROM AUTHOR]

Background: Health literacy is related to a variety of health outcomes, including disease control, health-related quality of life, and risk for death. Few studies have investigated the relation of electronic health literacy (e-health literacy) to outcomes or the mechanism by which they may be related. Methods: Secondary data were drawn from participants in a larger study on chronic disease self-management who were age 40 years and older, had at least one chronic health condition and a health literacy score of 8th grade or below on the validated short form of the Rapid Estimate of Adult Literacy in Medicine. Participants completed the e-Health Literacy Scale (eHEALS), the Multidimensional Health Locus of Control scale, a modified version of the Attitudes Toward Health Care Providers Scale (ATHCPS), the Wake Forest Physician Trust Scale (WFPTS), and the Gonzalez-Lu adherence questionnaire. Hypothesized relations were evaluated in a bootstrapped path analytic model using the Mplus statistical software. Key Results: Participants included 334 individuals (mean age: 57.5 years; 173 women and 161 men) with Black, Indigenous, and People of Color accounting for 83.3% of the participants and White individuals making up 16.7% of the participants. Model results showed that after controlling for age, education, gender, and race, the eHEALS score was significantly related to the ATHCPS and WFPTS but not to the Gonzalez-Lu adherence questionnaire (p <.05). The eHEALS score was significantly related to the Multidimensional Health Locus of Control scale. Analysis of indirect effects showed that a portion of the relation between e-health literacy and patient attitude and adherence was mediated by internal locus of control (all p <.05). Conclusions: In this study, e-health literacy was related to important patient attitude and behavior variables via locus of control. This finding has implications for the importance of improving patients' ability to use the internet to access and effectively use health information. [HLRP: Health Literacy Research and Practice. 2023;7(2):e80–e88.] Plain Language Summary: Health literacy refers to how well people can understand and use health-related information to make informed decisions about their health. This study looked at how eHealth literacy (the ability to find and use health information online) is related to health outcomes and the ways in which they are connected. The study used data from people who were older than age 40 years, had at least one chronic health condition, and had a low level of health literacy. Participants completed surveys that measured eHealth literacy, attitudes toward health care providers, trust in physicians, medication adherence, and health locus of control (the belief that one's health is under their control or the control of external factors). The results of the study showed that eHealth literacy was related to attitudes toward health care providers and trust in physicians, but not to medication adherence. The study also found that eHealth literacy was related to internal health locus of control, meaning that people who had higher eHealth literacy were more likely to believe that they have control over their health outcomes. The study showed that the relationship between eHealth literacy and patient attitude and adherence was partially mediated by internal health locus of control. Overall, the study highlights the importance of improving patients' ability to use the internet to access and use health information. It suggests that eHealth literacy may be an important factor in improving patient attitudes toward health care providers and their trust in physicians, which may ultimately lead to better health outcomes. [ABSTRACT FROM AUTHOR]

Background: The categorical approach to diagnosing mental disorders has been criticized for a number of reasons (e.g., high rates of comorbidity; larger number of diagnostic categories and combination). Diverse alternatives have been proposed using a hybrid or totally dimensional perspective. Despite the evidence supporting use of the Multidimensional Emotional Disorders Inventory (MEDI) for assessing the transdiagnostic dimensions of Emotional Disorders using a dimensional-categorical hybrid approach, no data exist on Spanish clinical samples. The present study explores the validity and reliability of the 49-item MEDI in a clinical sample and provides data for its use.Methods: A total of 280 outpatients with emotional disorders attended in different Spanish public Mental Health Units in Spain filled out all questionnaires during the assessment phase and the MEDI again one week after. The instruments used evaluate four main constructs: personality, mood, anxiety and avoidance.Results: The nine original factors were confirmed and showed adequate reliability (α: 0.66-0.91) and stability (r = 0.76-0.87). No differences in mean scores by sex were presented in any subscale (p ≥ .07). The MEDI subscales correlated significantly with the scales of each of the selected constructs (0.45 < r < 0.76).Limitations: The main limitations of this study were the limited sample size and not being able to count on MEDI scores post-transdiagnostic intervention.Conclusions: The MEDI demonstrates adequate reliability and validity. It allows to assess diverse symptoms efficiently, thus being of interest for clinical studies and practice. [ABSTRACT FROM AUTHOR]

Objective: Communication at the end-of-life (EOL) is complex and multidimensional. Although culture is acknowledged as a key influence, there remains a gap in knowledge about intracultural aspects of EOL communication in the Chinese context. This review presents a synthesis of practitioners' accounts of communication at the EOL in Hong Kong, Mainland China and Taiwan.Methods: This review was registered prospectively on PROSPERO (CRD42021297052). Five databases were systematically searched using the terms 'communication', 'End-of-Life', 'Hong Kong', 'China' and 'Taiwan'. Empirical research published between 2015 and 2021 was downloaded and appraised. Fifteen articles were included in the review.Results: Findings highlight the influence of Chinese culture and philosophy, inadequate communication skills training and psychological support for practitioners and legislative and organisational factors.Conclusion: Education and training for practitioners and public education about the EOL needs strengthening. Enhanced understanding of how culture influences EOL communication will strengthen service delivery and enhance awareness in multicultural communities.Practice Implications: EOL workers need practical and workplace-based support to engage in meaningful communication practices. The influence of culture and the readiness of patients and families to engage in communication are also important considerations. [ABSTRACT FROM AUTHOR]

Background and Objective: Health locus of control (HLC) beliefs may be valuable predictors of treatment outcomes in patients with knee osteoarthritis (OA). The study aimed to investigate the relationship between HLC with knee pain intensity and duration, knee stiffness severity and treatment satisfaction in patients with knee OA. Materials and Methods: This cross-sectional study involved 60 patients with knee OA. Multidimensional HLC, Short Assessment of Patient Satisfaction and Western Ontario and McMaster Osteoarthritis Index questionnaires were used to assess participants' self-perceived HLC factors, treatment satisfaction, pain, stiffness, and physical function, respectively. Spearman's correlation was used to find relationships among variables. Data were analysed using SPSS version 22, α was set at 5%. Result: Mean values of 24.30, 23.68 and 18.76 were reported for External HLC, Internal HLC and Chance HLC respectively. Treatment satisfaction was positively correlated with Internal HLC (r=0.33, p<0.01) Chance HLC was positively correlated with pain severity (r=0.37; p=.0.004), and physical function (r=.39; p=0.002). There was also a positive correlation between External HLC and pain duration (r=0.42; p=0.001). Discussion and Conclusion: Most patients with knee OA have high External HLC which means they ascribe their health status prominently to health care professionals, family members and friends. This could negatively influence their recovery outcome and lead to chronicity. HLC beliefs should be considered when managing patients with knee OA to positively impact adherence to instructions, treatment outcomes and overall quality of life. [ABSTRACT FROM AUTHOR]

2 BMI, body mass index; MSK, musculoskeletal; CLBP, chronic low back pain; OA, osteoarthritis; mNKOA, knee OA according to adapted National Institute for Health and Care Excellence guidelines (present if age >=45 years + frequent knee pain activity-related joint pain in the same knee); RKOA, radiographic knee OA (left and/or right knee, tibiofemoral and/or patellofemoral OA); SKOA, symptomatic knee OA (ROA + frequent knee symptoms in the same knee). Mechanical and frequent knee pain without signs of RKOA was found in 16.9% of participants; 10 had RKOA in one knee and SB m sb NKOA in the other, suggesting radiographic structural OA in one knee and early pre-radiographic OA in the other (Figure 3A). RKOA is defined as tibiofemoral (TF) OA (Kellgren & Lawrence classification grade >=2)[17] and/or patellofemoral (PF) OA (definitive osteophyte in the PF joint or definitive PF joint space narrowing plus any bone abnormality).[18],[19] Symptomatic knee OA (SKOA) is defined as RKOA plus frequent knee pain in the same knee. ELSA-Brasil MSK investigates the development, progression and adverse health consequences of the most prevalent MSK disorders worldwide, particularly chronic MSK pain (CMP), including chronic low back pain (CLBP) and osteoarthritis (OA) of knees and hands. [Extracted from the article]

Objective Among the factors forming the health behavior are the concept of locus of control and the perception of health self-efficacy. Studies investigating self-efficacy beliefs and the impact of health locus of control on immunosuppressive drugs are not adequate in number. Therefore the study sought to determine locus of control, self-efficacy perception and treatment adherence in kidney transplant patients. Methods The sample of the study comprised 276 kidney transplant patients who applied to a university hospital. We collected the data using the Personal Information Form, the Multidimensional Health Locus of Control Scale, the Health Self-efficacy Perception Scale and the Compliance to Immunosuppressive Treatment Scale. Results The study found the patients' mean Multidimensional Health Locus of Control scale external locus of control score to be 21.51 ± 3.74, mean Internal locus of control score to be 21.36 ± 3.92 and mean chance/fate score to be 15.48 ± 5.43. This result in the study demonstrates that kidney transplant individuals tend to believe in external forces in the disease management. The study determined the mean Health Self-efficacy Perception scale score of the kidney transplant patients to be 25.34 ± 3.89 and the patients had moderate level of self-efficacy perception. The study found that the patients' mean Compliance to Immunosuppressive Treatment Scale score was 11.26 ± 0.96 and their immunosuppressive treatment adherence was high but not adequate. The study found a significant negative weak correlation between the Health Self-efficacy Perception scale and the Multidimensional Health Locus of Control scale chance/fate subscale (p < 0.01). The study found no significant correlation between the Health Self-efficacy Perception scale and the Compliance to Immunosuppressive Treatment Scale (p > 0.05). Conclusion In order to increase drug adherence, we recommend that patients be supported to reinforce their self-efficacy perception. It is necessary to develop internal locus of control in kidney transplant patients in terms of treatment adherence and positive health behaviors. [ABSTRACT FROM AUTHOR]

Context: A challenge facing the provision of palliative care in sub-Saharan Africa is a means of increasing coverage of services whilst maintaining quality. Developing an evidence base that reflects patients' experiences and expectations of palliative care services, the context within which services are provided, and the approaches adopted by services in caring for patients, could facilitate and inform the planning and development of patient-centered and responsive services.Objectives: To explore the experiences and expectations of palliative care for people living with advanced cancer in Nigeria, Uganda, and Zimbabwe.Methods: A secondary qualitative analysis of in-depth interviews with 62 people with advanced cancer in Nigeria, Uganda, and Zimbabwe. Framework approach to thematic analysis of transcripts was adopted, focusing on patients' experiences and expectations when interacting with palliative care services, aligning reporting with the COnsolidated criteria for REporting Qualitative research (COREQ).Results: Four main themes were generated from the analysis: 1) Condition and community as drivers of a multidimensional burden when living with advanced cancer; 2) The expectations and endeavors of palliative care to ameliorate the impact of cancer on physical, psychological and basic needs; 3) Processes and preferences for interacting and communicating with palliative care services, and; 4) Restoration of hope in the context of limited resources.Conclusion: Wide-ranging physical, psychological, social and financial impacts on participants were outlined. These concerns were largely met with compassionate and responsive care in the context of constrained resources. Study findings can inform evolving notions of patient-centred care for serious illnesses in the participating countries. [ABSTRACT FROM AUTHOR]

Introduction: Apathy, a prevalent feature in neurological disorders including Huntington's disease (HD), is characterized by a reduction in goal-directed behavior across cognitive, auto-activation (i.e., self-activating thoughts/behavior), and emotional domains. Nonetheless, current diagnostic criteria are incapable of distinguishing multidimensional apathy profiles. Meanwhile, the short-Lille Apathy Rating Scale (LARS-s) bears potential as an operative diagnostic tool to disentangle apathy dimensions in clinical practice. The present study thereby examines the psychometric properties and factor structure of the LARS-s to tap into apathy profiles and their underlying neural correlates in HD.Methods: Forty HD individuals were scanned and evaluated for apathy using the LARS-s, assessed for reliability and validity in HD, and the short-Problem Behavior Assessment (PBA-s). To study the dimensional structure of apathy, principal component analysis (PCA) of the LARS-s was implemented. Resulting factors were associated with gray matter volume through whole-brain voxel-based morphometry.Results: The LARS-s demonstrated satisfactory psychometric properties, sharing convergent validity with PBA-s apathy and discriminant validity against depression. PCA resulted in three factors representative of apathy profiles across cognitive, auto-activation, and emotional domains. Anatomically, global apathy was significantly related with large-scale motor, cognitive, and limbic networks. Exploratory analyses of apathy profiles revealed correspondence between each factor and distinct cortical and subcortical nodes.Conclusion: The LARS-s is capable of capturing the multidimensional spectrum of apathy. At the same time, apathy profiles in HD are underpinned by functionally diverse neural networks. Such findings promote the continued study of apathy domains to pinpoint personalized therapeutic targets in neurologic disorders in addition to HD. [ABSTRACT FROM AUTHOR]

Background: Brain networks involved in language, attentional and response processes are detectable by fMRI during lexical decision (LD). Here, we investigated possible abnormalities in the functional networks involved in LD in patients with bipolar disorder (BD).Methods: fMRI and behavioural data were compared between BD (n = 25) and control (n = 21), with groups matched for age and sex. The functional brain networks involved in LD were extracted by manipulating the "word-likeness" of LD stimuli and using a multidimensional analysis method.Results: Attentional, response and language processes were captured in separate function-specific brain networks (default mode network, response network, linguistic processing network, respectively) in the BD and control groups, replicating the results of our previous study in an independent group of healthy adults. Behaviourally, the BD group showed higher performance than the control group in the LD task. Activity in the default mode network (DMN) and the linguistic processing network (LPN) did not differ between the groups, but the BD group had higher activation than the control group in the response network (RESP).Limitations: Due to the small sample, the study is underpowered, capable of only detecting large effects.Conclusions: The results suggest that BD may be associated with sustained activity in the RESP network, which might contribute to psychomotor dysfunction in BD. Future studies should investigate the possible link between altered RESP activation and psychomotor disturbances in BD, as well as the basis for altered RESP activity in BD. [ABSTRACT FROM AUTHOR]

Objectives: To explore informed choice in reproductive genetic carrier screening (RGCS).Methods: Women visiting a gynaecologist practice in Flanders (Belgium) were asked to consider participation in a study where RGCS was offered for free to them and their male partner. A modified Multidimensional Measure of Informed Choice was used to determine whether couples who opted for RGCS made an informed choice. In addition, we assessed risk perception, feelings towards RGCS, anxiety and decisional conflict.Results: Most participants (82 %, n = 63/77) made an informed choice with regard to RGCS according to our modified MMIC. Thirteen participants made an uninformed choice due to insufficient knowledge and one participant because of insufficient knowledge and value-inconsistency. Anxiety scores were elevated for three participants. Two participants presented with decisional conflict.Conclusion: Our results show high rates of informed choice among non-pregnant couples who were offered RGCS in a research study and received up to 30 min of pre-test counseling.Practice Implications: Limited resources outside a research context may impact informed choice. Pre-test counselling initiatives for RGCS should ideally be organized in such a way that information can be provided at multiple time points to avoid information overload and to allow for a reflection period. [ABSTRACT FROM AUTHOR]

Background: We examined the efficacy of a novel endoscopic ligation technique with O-ring closure (E-LOC) to prevent bleeding after gastric endoscopic submucosal dissection (ESD) under antithrombotic therapy.Methods: This single-center prospective study involved consecutive patients who were taking antithrombotic agents and underwent gastric ESD. E-LOC was performed by anchoring the nylon loop with hemoclips on both defect edges and/or the exposed muscle layer, and using O-ring band ligation around these deployed clips. The primary outcome was post-ESD bleeding rate. Secondary outcomes were complete closure rate, procedure time, sustained closure rate, and complications.Results: 48 patients were finally analyzed. The post-ESD bleeding rate was 0 %, the complete closure rate was 97.9 %, and the mean closure time was 29.9 minutes. The sustained closure rate was 95.8 % at postoperative day 2-3 and 33.3 % at postoperative day 10-11. No complications occurred.Conclusion: E-LOC may be an effective option for closing mucosal defects after gastric ESD under antithrombotic therapy. However, the preventive effect on post-ESD bleeding should be further investigated in high risk groups. [ABSTRACT FROM AUTHOR]

Objective: The protein leverage hypothesis (PLH) postulates that strong regulation of protein intake drives energy overconsumption and obesity when human diets are diluted by fat and carbohydrates. The two predictions of the PLH are that humans (i) regulate intake to maintain protein within a narrow range and that (ii) energy intake is an inverse function of percentage energy from protein because absolute protein intake is maintained within narrow limits.Methods: Multidimensional nutritional geometry was used to test the predictions of the PLH using dietary data from the Australian National Nutrition and Physical Activity Survey.Results: Both predictions of the PLH were confirmed in a population setting: the mean protein intake was 18.4%, and energy intake decreased with increasing energy from protein (L = -0.18, p < 0.0001). It was demonstrated that highly processed discretionary foods are a significant diluent of protein and associated with increased energy but not increased protein intake.Conclusions: These results support an integrated ecological and mechanistic explanation for obesity, in which low-protein highly processed foods lead to higher energy intake because of the biological response to macronutrient imbalance driven by a dominant appetite for protein. This study supports a central role for protein in the obesity epidemic, with significant implications for global health. [ABSTRACT FROM AUTHOR]

Background and Objectives: The assumption of responsibility in dealing with chronic diseases is of relevance in a resource-oriented and not only deficit-oriented medicine, especially in dealing with chronic diseases, including patients with chronic heart failure. The aim of the present study is to examine, based on the model of "locus of control", whether there are different patterns that would be relevant for a more targeted education and support of self-management in dealing with heart failure. Materials and Methods: For this purpose, a sample (n = 758) from 11 Polish cardiology centers have been assessed using the standardized self-assessment scale Multidimensional Health Locus of Control (MHLC), consisting of three dimensions: (i) internal localization of health control; (ii) external control by powerful others; (iii) external control by chance. Results: Using these three criteria, nine different clusters were extracted (mean size: 84 ± 33 patients, min 31, max 129). Three clusters included over 100 patients, whereas only two included less than 50 people. Only one cluster gathered 42 patients who will be able to cooperate with professionals in the most fruitful way. There were two clusters, including patients with beliefs related to the risk of ignoring professional recommendations. Clusters where patients declared beliefs about others' control with low internal control should also be provided with specific help. Conclusions: The division into clusters revealed significant variability of belief structures about health locus of control within the analyzed group. The presented methodological approach may help adjust education and motivation to a selected constellation of beliefs as a compromise between group-oriented vs. individual approach. [ABSTRACT FROM AUTHOR]

BACKGROUND Critical lower limb ischaemia is associated with a 20% annual risk of amputation and death. It is necessary to activate patients' personal resources which comprise mental dispositions needed to effectively cope with the disease. The objective of the study was to evaluate the correlation between the attitude toward the vascular reconstruction and self-efficacy (SE), health locus of control (HLoC) and own life quality (QOL) assessment in patients with critical lower limb ischaemia. PARTICIPANTS AND PROCEDURE The study involved 64 patients with critical lower limb ischaemia (Rutherford 4 and 5), 26 women and 38 men. Four scales were applied during primary admission: the Generalized Self-Efficacy Scale; the Satisfaction with Life Scale; the Multidimensional Health Locus of Control Scale; and the visual scale revealing attitude to vascular reconstruction. RESULTS The attitude to the vascular reconstruction was positive (M = 8.50). The lowest grades were given by those hospitalised several times during follow-up (M = 8.30); women expressed low grades (M = 7.71). An overall positive correlation was found between the positive attitude to the surgery and self-efficacy (p = .012), internal HLoC (p = .041) and external locus (p = .026). In the patients who died within six months from baseline assessment, no correlations were found. In subjects with no readmission, a correlation was found between positive attitude to surgery and the external personal HLoC (p = .023). In patients with subsequent readmissions, a correlation was found between the originally positive attitude to the surgery and poor self-efficacy (p = .009). CONCLUSIONS Patients with weak mental dispositions cannot cope with difficult situations and show a tendency to experience strong emotions, concentrating on their deficiencies, resulting in decreased motivation and feeble engagement in treatment. Poor mental disposition influences the final outcome of the vascular reconstruction. [ABSTRACT FROM AUTHOR]

Background: Frailty is an established risk factor for morbidity and mortality in older patients undergoing surgery. In people with critical illness before surgery, few data describe patient-centred outcomes. Our objective was to estimate the association of frailty with postoperative days alive at home in older critically ill patients requiring emergency general surgery.Methods: A retrospective population-based cohort study was conducted using linked administrative health data in Ontario, Canada from 2009 to 2019. All individuals aged ≥66 yr with an ICU admission before emergency general surgery were included. We compared the count of days alive at home at 30 and 365 days after surgery based on frailty status using a validated, multidimensional index. Unadjusted and multilevel, multivariable adjusted effect estimates were calculated. A sensitivity analysis based on early recovery category was performed.Results: We identified 7003 eligible patients; 2063 (29.5%) lived with frailty. At 30 days, mean days alive at home with frailty were 4.5 (standard deviation 8.2) and 7.6 (standard deviation 10.2) in those without frailty. In adjusted analysis, frailty was associated with fewer days alive at home at 30 (ratio of means [RoM] 0.68; 95% confidence interval [CI]: 0.60-0.78; P<0.001) and 365 days (RoM 0.72; 95% CI: 0.64-0.82; P<0.001). Individuals with frailty had a higher probability of poor recovery status, with effects increasing across the first postoperative month.Conclusions: In patients with critical illness requiring emergency general surgery, frailty is associated with fewer days alive at home. This information should be discussed with critically ill patients before emergent surgical intervention to better inform decision-making. [ABSTRACT FROM AUTHOR]

Objective: Israel serves as a case study for understanding the importance of undergraduate palliative care (PC) education in implementing, developing, and enabling access to palliative care services. This article presents the findings collected from the five medical schools.Method: This qualitative study supported by a survey explores and describes the state of undergraduate PC education at medical schools in Israel. The survey included questions on voluntary and mandatory courses, allocation of different course models, teaching methods, time frame, content, institutions involved, and examinations. Semi-structured interviews with teaching faculty were conducted at the same locations.Results: Eleven expert interviews and five surveys demonstrate that PC is taught as a mandatory subject at only two out of the five Israeli universities. To enhance PC in Israel, it needs to become a mandatory subject for all undergraduate medical students. To teach communication, cultural safety, and other basic competencies, new interactive teaching forms need to be developed and adapted. In this regard, nationwide cooperation is proposed. An exchange between medical schools and university clinics is seen as beneficial. The new generation of students is open to PC philosophy and multidimensional care provision but resources to support their growth as professionals and people remain limited.Significance Of Results: This study underlines the importance of teaching in PC at medical schools. Undergraduate education is a central measure of PC status and should be used as such worldwide. The improvement of the teaching situation would automatically lead to a better practical implementation for the benefit of people. Medical schools should cooperate, as the formation of expertise exchange across medical schools would automatically lead to better PC education. [ABSTRACT FROM AUTHOR]