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Background: Integrating Artificial Intelligence (AI) in educational applications is becoming increasingly prevalent, bringing opportunities and challenges to the learning environment. While AI applications have the potential to enhance structured learning, they may also significantly impact students' creativity and academic emotions. Objectives: This study aims to explore the effects of AI-integrated educational applications on college students' creativity and academic emotions from the perspectives of both students and teachers. It also assessed undergraduate students' and faculty's attitudes to AI-integrated applications. Methodology: A mixed-method research design was used. In the first phase, a qualitative research approach was employed, utilizing theoretical sampling to select informants. Data were collected through in-depth interviews with undergraduate students and university lecturers to gain comprehensive insights into their experiences and perceptions. A scale was developed, validated, and administered to 120 students and faculty in the quantitative phase. Descriptive statistics was used to analyze the data. Findings: The study revealed that AI applications often impose rigid frameworks that constrain creative thinking and innovation, leading to emotional disengagement due to AI interactions' repetitive and impersonal nature. Additionally, constant AI assessments heightened performance anxiety, and technical frustrations disrupted the learning process. Conversely, AI applications stimulated creativity by introducing new ideas and problem-solving techniques, enhanced engagement through interactive elements, provided personalized feedback, and supported emotional well-being with gamified elements and constant availability. Quantitative data also verified that teachers and students have positive attitudes toward the benefits and challenges of these applications. Conclusions: AI integration in educational applications has a dual-edged impact on college students' creativity and academic emotions. While there are notable benefits in stimulating creativity and enhancing engagement, significant challenges such as creativity constraints, emotional disengagement, and performance anxiety must be addressed. Balancing these factors requires thoughtful implementation and continuous evaluation to optimize the role of AI in education. [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated that harsh parenting negatively affects children's psychological development. This study examined the association between harsh parenting during childhood and life satisfaction of Chinese college students. We further looked at whether this association is explained in part by negative coping styles, and whether peer support lessens the potential effect of harsh parenting on negative coping styles and life satisfaction. Method: The sample included 609 Chinese students (aged 17–21 years, M = 18.39, SD = 0.82). The participants responded to questionnaires measuring past experiences with harsh parenting, life satisfaction, negative coping styles, and peer support. Results: Regression analysis showed that harsh parenting negatively contributed to students' life satisfaction via the mediator of negative coping styles, and peer support moderated this negative relationship. Specifically, the negative impact of harsh parenting on life satisfaction was only significant when there was low peer support. The effect of harsh parenting on negative coping styles was higher in individuals with high peer support than in those with low peer support. Conclusion: This study highlights the roles of intrinsic (negative coping style) and extrinsic (peer support) factors in understanding the negative effects of harsh parenting on adolescents' life satisfaction. These results provide insight into how to enhance adolescents' life satisfaction by reducing harsh parenting and negative coping styles and by promoting peer support. [ABSTRACT FROM AUTHOR]

Background: Problematic smartphone use (PSU) is adversely correlated with resilience. To completely comprehend the mechanism underlying this relationship, however, more investigation is required. Methods: For this cross-sectional study, the method of stratified random cluster sampling was applied. 834 Chinese undergraduate students (aged 17 to 24) were recruited, and self-reported questionnaires were administered to measure their levels of resilience, perceived social support, the sense of school belonging, and habitual and problematic smartphone use. Results: The findings showed that resilience both directly and indirectly predicted PSU through perceived social support and the sense of school belonging. Additionally, there were significant moderating effects of habitual smartphone use between resilience and perceived social support, the sense of school belonging, and PSU. Conclusions: Our research identified the negative influence of resilience on PSU, and specifically, highlighted the mediation effects of perceived social support and the sense of school belonging. Of significance, we also found the moderation effect of habitual smartphone use in the development of PSU. [ABSTRACT FROM AUTHOR]

Background: Both depression and anxiety are worldwide burden that is not being abated with our current knowledge and treatment of the condition. Numerous clinical trials have supported that physical activity (PA) can reduce the depression and anxiety in adolescents, but little is known about its mechanism of action. Therefore, the study objectives were to explore the potential relationship between physical activity and depression and anxiety from the perspective of body image and body mass index (BMI), and to provide an important reference for future self-esteem education and health promotion intervention. Methods: The participants in this study were 251 Chinese college students between 17 and 22 years old. Participants completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Body Image Questionnaire (BIQ), the Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS). A descriptive and correlational approach was used, using the PROCESS macro for Statistical Package for the Social Sciences (SPSS). Results: (1) Physical activity was significantly negatively correlated with both depression and anxiety (t = -0.216, p < 0.001; t = -0.184, p < 0.01). (2) Body image had a significant moderating effect on the relationship between physical activity and anxiety among college students, but there was no moderating effect between depression and physical activity. BMI has no moderating effect on the two interrelationships. Conclusion: There is only body image that moderates the relationship between anxiety and physical activity. [ABSTRACT FROM AUTHOR]

Background: Leaders' emotions and emotion regulation strategies influence subordinates' attitudes and behaviors, while previous studies have mostly taken an emotional perspective. Leaders' emotional competence also has an impact on subordinates through motivational and cognitive pathways. Based on self-determination theory, this study examined the impact of emotional leadership on subordinates' work engagement, as well as the mediating role of subordinates' intrinsic motivation and the moderating role of traditionality. Methods: We first performed a scenario experiment study in which 116 Chinese college students were asked to read experimental materials on different leadership behaviors and answer relevant questions. Subsequently, a questionnaire survey was conducted, in which 347 Chinese enterprise employees were asked to rate their own experiences with emotional leadership, work engagement and intrinsic motivation. We used SPSS 25.0 for performance reliability analysis, correlation analysis and hierarchical regression analysis to test the reliability of the scales and investigate the relationship between the variables. Bootstrap analysis was used to test the mediating and moderating effects. Results: Emotional leadership has a significant direct positive effect on subordinates' work engagement and positively influences subordinates' work engagement through the mediation of subordinates' intrinsic motivation. The effect of emotional leadership on intrinsic motivation is stronger for those with high traditionality than for those with low traditionality. Conclusion: Emotional leadership can improve subordinates' work engagement by stimulating their intrinsic motivation. Therefore, managers need to be able to effectively regulate and manage subordinates' emotions to stimulate their intrinsic motivation and to differentiate the management of subordinates with different levels of traditionality to improve subordinates' work engagement. [ABSTRACT FROM AUTHOR]

Background: The bitter taste receptor gene TAS2R38 is a member of the human TAS2R gene family. Polymorphisms in TAS2R38 affect the ability to taste the bitterness of phenylthiourea (PTC) compounds, thus affecting an individual's food preference and health status. Methods: We investigated polymorphisms in the TAS2R38 gene and the sensitivity to PTC bitterness among healthy Chinese college students in Hubei province. The association of TAS2R38 polymorphisms and PTC sensitivity with body mass index (BMI), food preference, and health status was also analyzed. A total of 320 healthy college students were enrolled (male: 133, female: 187; aged 18–23 years). The threshold value method was used to measure the perception of PTC bitterness, and a questionnaire was used to analyze dietary preferences and health status. Polymerase chain reaction (PCR) was used to analyze polymorphisms at three common TAS2R38 loci (rs713598, rs1726866, and rs10246939). Results: In our study population, 65.00% of individuals had medium sensitivity to the bitterness of PTC; in contrast, 20.94% were highly sensitive to PTC bitterness, and 14.06% were not sensitive. For the TAS2R38 gene, the PAV/PAV and PAV/AAI diplotypes were the most common (42.19% and 40.63%, respectively), followed by the homozygous AVI/AVI (8.75%) and PAV/AVI (5.00%) diplotypes. Conclusion: There was a significant correlation between the sensitivity to PTC bitterness and sex, but there was no correlation between the common diplotypes of TAS2R38 and gender. Polymorphisms in the TAS2R38 gene were associated with the preference for tea, but not with one's native place, BMI, health status, or other dietary preferences. There was no significant correlation between the perception of PTC bitterness and one's native place, BMI, dietary preference, or health status. We hope to find out the relationship between PTC sensitivity and TAS2R38 gene polymorphisms and dietary preference and health status of Chinese population through this study, providing relevant guidance and suggestions for dietary guidance and prevention of some chronic diseases in Chinese population. [ABSTRACT FROM AUTHOR]

Background: Owing to the coronavirus disease 2019, medical learning burnout has attracted increasing attention in educational research. It has a serious negative impact on medical students and their service quality. This could impair the professional development of medical students; weaken their personal and professional quality; and lead to problems such as increased medical errors and reduced patient care quality and satisfaction. This study aimed to examine the effects of perceived stress, social support, and the Big Five personality traits on learning burnout among medical students. Methods: In November 2021, a cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 616 third- year students. Learning burnout, perceived stress, social support, and the Big Five personality traits (neuroticism, extroversion, openness, agreeableness, and conscientiousness) were anonymously measured. A total of 583 students were included in the final sample. Hierarchical linear regression was performed to explore the effects of perceived stress, social support, and Big Five personality traits on medical students' learning burnout. Results: Perceived stress was positively associated with learning burnout (emotional exhaustion: ß = 0.577, p < 0.001; cynicism: ß = 0.543, p < 0.001; low professional efficacy: ß = 0.455, p < 0.001) whereas social support was negatively related with it (low professional efficacy: ß = -0.319, p < 0.001). Neuroticism had a positive effect on emotional burnout (ß = 0.152, p = 0.009). Extraversion (ß = -0.116, p = 0.006) and conscientiousness (ß = -0.363, p < 0.001) had a negative effect on low professional efficacy. Agreeableness negatively affected emotional exhaustion (ß = -0.181, p < 0.001) and cynicism (ß = -0.245, p < 0.001) and positively affected low professional efficacy (ß = 0.098, p = 0.008). The associated factors together accounted for an additional variance of learning burnout (emotional exhaustion: 39.0%; cynicism: 36.8%; low professional efficacy: 48.7%). Conclusions: Social support is a positive resource for fighting medical students' burnout. Perceived stress was the strongest indicator of learning burnout. In addition to reducing perceived stress, developing extraversion, agreeableness, and conscientiousness should be included in burnout prevention and treatment strategies, particularly for medical students. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a severe health problem closely related to adverse childhood experiences (ACEs). However, the underlying mechanisms by which ACEs may affect NSSI are largely unknown. Self-efficacy (NSSI-SE) and recent negative life events (RNLEs) may play important roles in this relationship. This study aimed to clarify the relationship between ACEs and NSSI among college students by examining the role of self-efficacy (NSSI-SE) and RNLEs in this process. Method: Relevant self-report questionnaires were used to evaluate ACEs, RNLEs, NSSI-SE, and NSSI. A questionnaire of 1036 Chinese undergraduates (Mage = 19.65, 28.9% males, 71.1% females) was collected in a cross-sectional manner. The associations between ACEs, RNLEs, NSSI-SE and NSSI were assessed using Pearson correlation analyses. Then, hierarchical multiple linear regressions were used to analyze the effects of ACEs and RNLEs on NSSI, as well as the protective effect of NSSI-SE on the above relations. Results: NSSI was associated with both ACEs and RNLEs. ACEs and RNLEs could directly increase the risks of participating in NSSI, and the effects of ACEs and RNLEs on NSSI were independent without an interactive effect. NSSI-SE buffered the relationship between ACEs and NSSI, as well as between RNLEs and NSSI. Compared to individuals with a low level of NSSI-SE, ACEs and RNLEs were not significantly associated with NSSI in persons with a high level of NSSI-SE. Conclusion: NSSI-SE may buffer the effect of ACEs and RNLEs on NSSI, indicating that future interventions can be enhanced by targeting NSSI-SE among college students with ACEs or RNLEs to prevent their engagement in NSSI. [ABSTRACT FROM AUTHOR]

Background: This study aimed to categorize different subgroups of problematic smartphone use in Chinese college students. Differences in gender and psychosocial characteristics of the categorized groups were also examined. Methods: A total of 1123 participants completed the Mobile Phone Addiction Index Scale, the Center for Epidemiologic Studies Depression Scale, the Perceived Social Support Scale, and the Perceived Stress Scale. Using latent profile analysis, we identified different subgroups of problematic smartphone use in college students. Multivariate logistic regression analysis was implemented to examine the relationship between latent classes and demographic and psychosocial covariates. Results: The four following latent classes were identified: a low-risk group, a moderate-risk with no evasiveness group, a moderate-risk with evasiveness group, and high-risk group that accounted for 11%, 24.1%, 35.5%, and 29.4% of the total sample, respectively. Further analysis revealed that female participants were more likely to be in the moderate-risk with evasiveness and high-risk groups, and individuals with depressed mood were more likely to be in the moderate-risk and high-risk groups. Conclusions: Classifying college students according to the features of problematic smartphone use is potentially useful for understanding risk factors and developing targeted prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Background: Although patient-centred medical services are widely recognized and accepted, how to define and evaluate them remains a controversial topic. Objectives: This study attempts to evaluate the underlying structure of the Patient-Practitioner Orientation Scale (PPOS) with a homogenous population and clarify the connotation of patient-centredness. Methods: In this cross-sectional study, 279 7th year Chinese medical students in were selected to examine the internal structure of the PPOS by means of internal consistency, exploratory, and confirmatory factor analyses. Results: Both the two-factor model and the four-factor model showed acceptable internal consistency and structural validity. The four-factor model that endorsed the implicit attitude towards the doctor–patient relationship outperformed the two-factor model in terms of adaptability. Conclusions: The PPOS has good psychometric attributes, as evaluated by Chinese medical students. This article attempts to explore patient-centredness from the perspective of implicit attitudes that affect the doctor–patient relationship and resummarizes the four factors. These four dimensions may suggest a deeper attitude towards the doctor–patient relationship, while "sharing information" or "caring about" the "patient" is the behaviour and preference expressed on the basis of these four attitudes, which is the result rather than the cause. Practice implications: Understanding the underlying attitudes towards the doctor–patient relationship can help to construct a patient-centred medical service concept and improve the doctor–patient relationship in medical education courses and the system design of medical activities. [ABSTRACT FROM AUTHOR]

Background: Smartphone addiction bodes adverse consequences, affecting different populations, including medical students. Parental bonding in childhood had been associated with addiction and recovery in later life. Therefore, this study aimed to examine the associations between parental bonding and smartphone addiction among Chinese medical students. Method: Binary logistic regressions were used to investigate the associations between parental bonding with mothers and fathers, respectively, and smartphone addiction. Interaction terms of care and protection were included in the models. Results: A total of 517 medical students were included in the study. The prevalence of smartphone addiction was 48.16% (n = 249). The estimated effects of maternal and paternal parenting on smartphone addiction differed. Maternal protection was positively associated with smartphone addiction (OR, 1.046;95% CI, 1.005-1.087), and maternal care enhanced the estimated effect of protection on smartphone addiction. Paternal care was negatively associated with smartphone addiction (OR, 0.954;95% CI, 0.919-0.989). Conclusions: Chinese medical students with overprotective mothers or with indifferent fathers tended to exhibit traits of smartphone addiction. Further studies on factors influencing the associations between parental bonding and smartphone addiction may pave the way for potential family-oriented interventions for smartphone addiction. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive facial cosmetic surgery (MIFCS) is becoming more and more popular and acceptable in Chinese young people, and it influences people in many aspects. However, there is little research on the associations between MIFCS and psychopathology in Chinese college students. The purpose of this study was to identify the prevalence of MIFCS and its associated factors among Chinese college students. Methods: A cross-sectional design was applied in this study. A total of 8089 students completed an online questionnaire on demographic data, depressive symptoms (Self-Rating Depression Scale), anxiety symptoms (Self-Rating Anxiety Scale) and MIFCS. Logistic regression was used to identify independent factors associated with MIFCS. Results: The prevalence of MIFCS in Chinese college students was 2.7% (221/8098). Students with MIFCS were more likely to be from urban areas, from a single child household, experience depression or anxiety and have a history of smoking (all p < 0.05). They were also less likely to be right-handed or have a good relationship with father or mother (all p < 0.05). Binary logistic regression showed that older age (OR,1.162; 95%CI [1.061,1.273]), female sex (OR,1.837; 95%CI [1.352, 2.497]), community (urban) (OR,0.601; 95%CI [0.441,0.818]), right-handedness (OR,0.668; 95%CI [0.454,0.985]), depressive symptoms (OR, 4.708; 95%CI [1.690,13.112]), family income (30,000–70,000 yuan per year) (OR,0.572; 95%CI [0.403,0.812]) and smoking (OR,1.571; 95%CI [1.09,2.423]) were independently associated with MIFCS. Conclusions: Minimally invasive facial cosmetic surgery (MIFCS) is very common in Chinese college students, indicating the importance of paying attention to MIFCS. This study provides valuable evidence for college counselors and doctors in the cosmetic department to provide better and healthier services to students who undergo MIFCS, especially those with depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: The association between childhood trauma (CT) and psychotic-like experiences (PLEs) is well-established. Many previous studies have recognized wisdom as a protective factor for mental health, but its role in the relation between CT and PLEs remains unknown. We aimed to investigate the mediating effect of wisdom in the above association among Chinese college students. Methods: We conducted a nationwide survey covering 9 colleges across China and recruited a total of 5873 students using online questionnaires between September 14 and October 18, 2021. Convenience sampling was adopted. We employed the San Diego Wisdom Scale (SD-WISE), the Childhood Trauma Questionnaire (CTQ-28), and the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-15) to measure the wisdom, CT and PLEs, respectively. Descriptive, correlation, and mediation analysis were utilized. Results: The positive correlation between CT and PLEs was well-replicated among college students (Pearson's r = 0.30, p < 0.001). Wisdom was negatively associated with CT (Pearson's r = − 0.46, p < 0.001) and frequency of PLEs (Pearson's r = − 0.25, p < 0.001). Total wisdom scores partially mediated the relationship between cumulative childhood trauma, neglect, abuse and PLEs, separately. The mediated model respectively explained 21.9%, 42.54% and 18.27% of the effect of CT on PLEs. Our model further suggested that childhood trauma could be related to PLEs through decreasing the following wisdom components: decisiveness, emotional regulation and prosocial behavior. Conclusion: For the first time, our results suggested that impaired wisdom played a role in the translation from childhood adversity to subclinical psychotic symptoms, implicating wisdom as a possible target for early intervention for psychosis among young individuals. Longitudinal work is warranted to verify the clinical implications. [ABSTRACT FROM AUTHOR]

The literature has shown that mobile phone addiction is an important risk factor for depression. However, the internal mechanisms of mobile phone addiction leading to depression are still not clear. This study examined the mediating role of sleep quality and moderating role of peer relationships in the association between mobile phone addiction and depression. A sample of 450 Chinese medical students were recruited to complete measures of mobile phone addiction, depression, sleep quality and peer relationships. In this study, SPSS 25.0 and macro PROCESS were used to conduct statistical analysis on the collected data. The results showed that sleep quality partially mediated the association between mobile phone addiction and depression. Moreover, the effect of sleep quality on depression was moderated by peer relationships. The present study can advance our understanding of how and when mobile phone addiction leads to depression. Limitations and implications of this study are discussed. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to use a moderated mediation model to understand and examine the relationship between negative emotions and creativity among college students during the COVID-19 pandemic, using psychological resilience as a mediator and posttraumatic growth as a moderator. Methods: A sample of 881 college students in mainland China completed a self-report questionnaire that included four scales: the Depression-Anxiety-Stress Scale, Psychological Resilience Scale, Runco Ideational Behavior Scale and Posttraumatic Growth Inventory. Results: Findings indicated that:(1) negative emotions were a strong predictor of creativity; (2) psychological resilience partially mediated the association between negative emotions and creativity; and (3) posttraumatic growth moderated the positive effect of psychological resilience, such that the indirect effect between negative emotions and creativity via psychological resilience was stronger for someone with a low level of resilience. Conclusion: The findings further clarify the mechanisms that affect the relationship between negative emotions and creativity among college students. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have established that foreign language anxiety (FLA) has a significant impact on learners' language acquisition and performance. FLA is a unique form of anxiety that occurs in response to a certain circumstance. Even though a growing amount of research has extended to the examination of skill-based anxiety in specific, such as listening, speaking, reading, and writing, little used corresponding skilled-based FLA scales to assess learners' skill-based FLA at one group of learners. To fill a void in this line of research, the study aimed to explore learners' primary FLA by comparing their four language skill-specific FLAs with four different skill-based FLA scales. Additionally, we wished to investigate the variables that influence learners' FLA. Methods: All participants in the study were first-year medical students. Individual instructors delivered and collected a total of 1023 questionnaires using an open questionnaire platform during normal English lessons in the mid-semester. SPSS 24.0 (Statistical Package for Social Science 24 version) was used to analyze all statistics. Internal validity tests were undertaken on each scale to ascertain the component structure of certain modified scales. The study employed the independent sample t-test and a statistical description to investigate students' major FLA and its variables. Results: With a mean value of 106.863, the predominant FLA arouses from English listening anxiety. English reading anxiety was the lowest, with a mean score of 62.726. Male and female students both demonstrated the greatest degree of FLA in English listening and the least anxiety in English reading. However, their mean difference was not statistically significant (t = 1.220). By comparing the mean scores for four skill-based FLAs across language proficiency groups, it became clear that the scores for the medium were much higher than the average, with average scores of ESA: 91.988, ELA: 106.864, EWA: 74.157, ERA: 62.726, respectively, and the higher-level group scored lower than the average. Students' prior English learning achievements are negatively connected with their FLA, with r values of −.207 (ELA), −.143 (EWA), and −.204 (ERA). The self-evaluation of students' English listening, writing, and reading abilities was considerably adversely connected with FLA, but the self-evaluation of their English-speaking abilities was favorably correlated with FLA. Conclusion: A comparison of students' FLA revealed that the primary skill-based FLA is related to English listening anxiety. Regardless of gender or language proficiency level, FLA was mainly driven by foreign language listening anxiety in all individuals. Prior language achievement and students' self-evaluation are associated with their FLA. [ABSTRACT FROM AUTHOR]

Background: Due to insufficient basic medical knowledge and inappropriate learning strategies, students of 8-year medical programme encountered many obstacles in the initial stage of basic medicine learning. This study was to determine whether a prerequisite course can improve basic medicine learning performance and adjust learning strategies to adapt to basic medicine learning. Methods: A prerequisite course of histology was constructed by a two-round modified Delphi study. Seventy-four students of 8-year medical programme were subjected to two groups: the prerequisite course group (PC group) and non-prerequisite course group (NPC group). The PC group take part in the prerequisite course by student-centred blended learning approach but NPC group not. The PC and NPC group underwent requisite histology teaching activities after prerequisite course. Examination of the prerequisite course and requisite histology course were carried out. Effect of the prerequisite course was evaluated by an empirical method using a questionnaire-based approach. Results: The results of examinations showed students' scores of the PC group were significantly higher than those of students of NPC group in both prerequisite course and requisite histology examinations (P < 0.05). The results of questionnaires showed that students were satisfied with the prerequisite course, which was beneficial for uptake in medical knowledge, cultivation of clinical thinking and scientific research ability and adaptation in learning strategies (P < 0.01). Furthermore, our prerequisite course is conducive to subsequent courses learning, especially for pathology (P < 0.01). Conclusion: Our prerequisite course could effectively supplement knowledge of basic medicine, improve clinical thinking and scientific research ability and adapt their learning strategies. These findings suggest that the prerequisite course is useful and should be introduced in medical curriculum reform at the early stages of basic medical training. [ABSTRACT FROM AUTHOR]

Background: Constructivism theory has suggested that constructing students' own meaning is essential to successful learning. The erroneous example can easily trigger learners' confusion and metacognition, which may "force" students to process the learning material and construct meaning deeply. However, some learners exhibit a low level of elaboration activity and spend little time on each example. Providing instructional scaffolding and elaboration training may be an efficient method for addressing this issue. The current study conducted a randomized controlled trial to examine the effectiveness of erroneous example elaboration training on learning outcomes and the mediating effects of metacognitive load for Chinese students in medical statistics during the COVID-19 pandemic. Methods: Ninety-one third-year undergraduate medical students were randomly assigned to the training group (n = 47) and the control group (n = 44). Prerequisite course performance and learning motivation were collected as covariates. The mid-term exam and final exam were viewed as posttest and delayed-test to make sure the robustness of the training effect. The metacognitive load was measured as a mediating variable to explain the relationship between the training and academic performance. Results: The training significantly improved both posttest and delayed-test performance compared with no training (Fposttest = 26.65, p < 0.001, Partial η2 = 0.23; Fdelayed test = 38.03, p < 0.001, Partial η2 = 0.30). The variation trend in metacognitive load in the two groups was significantly different (F = 2.24, p < 0.05, partial η2 = 0.20), but metacognitive load could not explain the positive association between the treatment and academic performance (β = − 0.06, se = 0.24, 95% CI − 0.57 to 0.43). Conclusions: Erroneous example learning and metacognitive demonstrations are effective for academic performance in the domain of medical statistics, but their underlying mechanism merits further study. [ABSTRACT FROM AUTHOR]

Background: Medical students in China who face the dual pressure of study and employment tend to experience subclinical depressive symptoms. Parental care plays an important direct and indirect role in the psychological development of medical students, and the extent and mechanism of this role urgently need to be studied and discussed. Methods: After simple random sampling and screening of valid questionnaires, data from a total of 924 people were used. The participants completed the parental bonding instrument, self-rating depression scale, Chinese version of the Jefferson empathy scale-medical student edition and self-rating anxiety scale to evaluate parental care, empathy, depressive symptoms and anxiety. The data were statistically processed using a descriptive analysis, correlation analysis and test of moderated mediation. Results: Maternal care had a significant negative predictive effect on depressive symptoms among medical students. Strong maternal care can reduce the occurrence of depressive symptoms in medical students. Empathy played a positive mediating role such that both types of empathy could alleviate the effect of weak maternal care on the depressive symptoms of medical students. However, neither cognitive empathy nor affective empathy played a mediating role in the relationship between paternal care and depressive symptoms. Nevertheless, the relationship between maternal care and empathy was moderated by the medical students' gender. Conclusions: The effect of this relationship on female medical students deserves special attention. The results of this study provide a reference and basis for the adjustment of medical education. This study could also help in the design of effective psychological intervention measures to reduce the degree of depressive symptoms and enhance personal empathy. [ABSTRACT FROM AUTHOR]

Background: The internet has become an important resource for the public to obtain health information. Therefore, the ability to obtain and use such resources has become important for health literacy. This study aimed to establish a prediction model of Chinese students' electronic health literacy (EHL) to guide government policymaking and parental interventions, identify the predictors of EHL in Chinese students using random forests, and establish a corresponding prediction model to help policymakers and parents determine whether primary and secondary school students have high EHL.Methods: This is a cross-sectional study. From June to August 2021, a cluster sample survey was conducted with 1,300 students from seven primary and secondary schools in Shaanxi Province, China. We evaluated 1,235 primary and secondary school students using the e-health literacy scale. The data were divided into training and testing datasets in a 70:30 ratio for further analysis using random forest. The predictive accuracy of the score was measured using the area under the receiver operating characteristic curve. We also used decision curve analysis to determine the usefulness of the prediction model by quantifying the net benefits at different threshold probabilities in the validation dataset.  RESULTS: We found that 33.6% of students had high EHL. The univariate analysis showed that age (P < 0.001), grade (P < 0.001), employment status (P < 0.001), household location (P < 0.001), parental phubbing behavior (P < 0.001), and general self-efficacy (P < 0.001) were significantly associated with EHL. A random forest classification model was developed with the training dataset (872 students), and seven variables were confirmed as important: age, grade, employment status, father education level, game time, parental phubbing behavior, and general self-efficacy. The validation of the model showed good discrimination, with an area under the curve of 0.975 in the training dataset and 0.738 in the testing dataset. The model was translated into an online risk calculator, which is freely available ( https://xietao.shinyapps.io/DynNomapp/ ).Conclusions: In this study, an intuitive tool to predict the EHL of Chinese primary and secondary school students was developed and validated. [ABSTRACT FROM AUTHOR]

Background: Childhood trauma (CT) is considered as a highly risk factor for depression. Although the pathway of CT to depression, especially the mediating or moderating effects of cognitive emotion regulation strategies (CERS) or neuroticism, have investigated by several studies, the results were inconsistent and there is a paucity of full models among these interactive factors. This study aims to examine the relationships among CT, adaptive / maladaptive CERS, neuroticism, and current depression symptoms in university students. Methods: We recruited 3009 freshman of 2019, aged averagely 18.00 (SD = 0.772) years, from universities in Hunan province in 2019. A moderated mediation model was built to examine the relationships among CT, CERS, neuroticism, and current depression using the SPSS PROCESS 3.5 macro. We conducted bootstrapping of regression estimates with 5000 samples and 95% confidence interval. Results: Results revealed that the significant mediating effects of adaptive CERS (β = 0.012; 95% CI: 0.006 to 0.018) and maladaptive CERS (β = 0.028; 95% CI: 0.016 to 0.040) between CT and depression were observed, accounting for 5.69% and 13.52% of the total effect respectively. Then, moderated mediation analyses results showed that neuroticism simultaneously moderated the direct effect of CT on current depression (β = 0.035; 95% CI: 0.001 to 0.009), and the indirect effects of CT on current depression through adaptive CERS (adaptive CERS – current depression: β = − 0.034; 95% CI: − 0.007 to − 0.001) and maladaptive CERS (maladaptive CERS – current depression: β = 0.157; 95% CI: 0.017 to 0.025). However, the moderating effects of neuroticism in the indirect paths from CT to adaptive CERS (β = 0.037; 95% CI: 0.000 to 0.014) and maladaptive CERS (β = − 0.001; 95% CI: − 0.006 to 0.005) were not significant. Conclusions: This study provides powerful evidences through a large university students sample for the mediating role of adaptive / maladaptive CERS and the moderating role of neuroticism between CT and current depression. This manifests that cognitive emotion regulation may be a vital factor for people who suffered from CT and current depression. Furthermore, the influence of neuroticism in this process cannot be ignored. [ABSTRACT FROM AUTHOR]

Background: Gender bias in career choices has always been a matter of great concern, including in the field of medicine. This study reports on the current situation in this regard in China, including the reasons for Chinese medical students' willingness to engage in surgical careers; investigates their accounts of gender bias; and analyzes the effect of gender bias on their surgical career choices. Methods: This study invited medical students from Harbin Medical University to fill out a non-mandatory questionnaire on whether they had witnessed gender bias, their surgical career intentions, and factors influencing their career intentions. A one-way analysis of variance was used to compare the differences between continuous variables. Pearson's chi-squared test was used to compare the differences between the categorical variables, the Kendall correlation coefficient (tau) was used to assess the correlation between the reasons rankings reported by gender, and a multiple regression analysis was conducted by logit model. Results: A total of 643 students responded to the questionnaire. Of them, 63.76% expressed a willingness for a surgical career, with "interest" being a key driving factor (73.41%). Almost all respondents (96.27%) answered that there were more male leaders in the surgical departments they had rotated through or had contacted. Only a few respondents reported gender barriers influencing recruitment (32.19%). However, witnessing gender bias (recruitment of male required) was correlated to choice of surgical career (P < 0.05). Females were less willing to pursue a career in surgery if they had witnessed gender barriers in surgical recruitment. Male dominance also correlated to the choice of a surgical career (P < 0.1). Of the respondents, 53.19% believed that surgery was not suitable for females; among female respondents, this number was 56.12%, higher than for male respondents. When females think that the surgical profession is not suitable for them, it reduces the possibility of their pursuing a career in surgery. Conclusion: Most medical students were interested in surgical care. Witnessing gender bias decreases females' willingness to pursue a career in surgery. It is necessary to stimulate medical students' interest in surgery when formulating strategies to promote surgical career choices, as well as to reduce gender bias in surgery; in this way, females' surgical careers should be ensured. [ABSTRACT FROM AUTHOR]

Objectives: Smokers or never smokers exposed to environmental tobacco use are usually associated with various diseases and cancers. In order to better help college students prevent the tobacco use and thus lower the incidence of avoidable diseases, this study explored the predictive power of different variables including demographic and psychological variables in relation to smoking behaviors. Methods: Maslach Burnout Inventory-Student Survey and Kessler Psychological Distress Scale (K10) were used in this study. Results: There were 1449 college students participating in the study with 1340 pieces of valid data left, the effective ratio was 92.48%. The valid data included 37.1% male and 62.9% female aged 18.83 on average with 1.55 standard deviation. The multivariate logistic regression indicated that college students who were male (versus female, OR = 9.55), majoring in medicine and sports (versus nursing, ORmedicine = 2.19, ORsports = 2.81), born in the non-singleton family (versus singleton family, OR = 0.63) with higher family income (versus lower family income, OR = 0.45), surrounded with smoking friends (versus without smoking friends, OR = 0.18), were more vulnerable to smoke. In addition, combined with the theory of planned behavior, the dimensions of learning burnout had full mediation effects between psychological distress and smoking behavior. Conclusions: Psychological distress can only indirectly affect smoking behavior via learning efficacy, cynicism and emotional exhaustion. Adjustments from different dimensions of learning burnout such as avoiding cynicism about learning, enhancing learning efficacy and emotion exhaustion will help college students better prevent the tobacco use. [ABSTRACT FROM AUTHOR]

Background: This study examined the role of anxiety and coronavirus disease 2019 (COVID-19) burnout in the relationship between coronavirus stress and overeating among Chinese college students during the COVID-19 pandemic. Methods: Chinese college students (N = 2926; Mage = 19.90, SD = 1.47, range = 18–25 years old; 54.34% female) completed self-reported online questionnaires regarding coronavirus stress, anxiety, COVID-19 burnout, and overeating. Results: Anxiety showed partially indirect effect on the association between coronavirus stress and overeating. COVID-19 burnout exacerbated the indirect pathway between coronavirus stress and overeating via anxiety. Discussion and conclusion: This is the first study, to our knowledge, that examines the underlying mechanisms of the coronavirus stress and overeating behavior association among Chinese college students. The results support several existing theories on stress and problematic eating behaviors and provide practical implications for prevention and intervention programs of overeating during the COVID-19 pandemic. Plain English summary: One's response is not arbitrary when confronted with the coronavirus disease 2019 (COVID-19). Previous research has found that individuals with coronavirus stress still be more prone to overeat. We also know from other research that anxiety is the most salient aspect of overeating. However, no research has investigated whether the coronavirus stress of college students is significantly associated with overeating and examine the potential indirect pathway and moderating mechanisms in this association. With the aid of 2926 participants, we found that, coronavirus stress was linked to college students' overeating. We also found that this relationship was partially explained by anxiety. In addition, the association between anxiety and overeating was stronger for those with higher COVID-19 burnout. This study is an important step in unpacking how coronavirus stress relates to overeating of Chinese college students. However, they are limited by the cross-sectional nature of the study, meaning we cannot imply causality. We recommend that further research replicate our findings in people with diagnosed feeding and eating disorders using a longitudinal design. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess Chinese medical students' smartphone addiction and its effects on subhealth and insomnia. Methods: A cross-sectional survey was conducted from October 14, 2020 to November 14, 2020 by administering an online questionnaire to Wannan Medical College students. Results: Of 2741 students who completed the survey, 1,447 (52.8%) had smartphone addiction. Medical specialty (p = 0.004), alcohol consumption (p = 0.001), smartphone use in bed (p = 0.000), depression (p = 0.000) and anxiety (p = 0.000) were strongly associated with smartphone addiction. The impacts of smartphone addiction on subhealth (p = 0.000) and insomnia (p = 0.000) were significant. Conclusion: This survey shows that the smartphone addiction detection rate among medical students was 52.8%. Students who did not like their medical specialty, consumed alcohol, used their smartphones in bed, and suffered from depression and anxiety had a higher smartphone addiction detection rate. The subhealth and insomnia of medical students are adversely associated with smartphone addiction. [ABSTRACT FROM AUTHOR]

Background: Individual-centred career questionnaires are important for understanding the motivations of medical students. This study aimed to collect validity evidence of a questionnaire to measure the career choice of medical undergraduates. Methods: A cross-sectional survey was sent to third-year undergraduate students at a Chinese university-affiliated hospital. The questionnaire was formed using items that were selected after a systematic literature review. Item reduction was conducted using Mokken scale analysis, followed by reliability and validity testing, which described the validity evidence of the content, response process and internal structure. Results: The preliminary 20-item questionnaire was returned by 213 undergraduate students (response rate: 86.59%). To construct a monotone homogeneity model, 6 items were removed after testing for unidimensionality, local independence, and latent monotonicity according to the sequence. The final questionnaire included 14 items in two subscales: a 10-item 'career advantage' subscale and a 4-item 'career disadvantage' subscale. The questionnaire was judged to be acceptably reliable (Molenaar-Sijtsma method: 0.87 and 0.75, Cronbach's alpha: 0.87 and 0.74) and to have good construct validity (χ2/df: 1.748, normed fit index: > 0.9, comparative fit index: > 0.9, root mean square error of approximation: 0.05–0.08). Male and female undergraduates had different responses regarding their salary, subspecialty, career prospects, and ability to serve their relatives. Male undergraduates might be more willing to accept on-call positions and have subspecialties with greater likelihoods of patient–physician conflict. Conclusion: We used Mokken scale analysis to develop and collect evidence of the validity of a 14-item questionnaire regarding career preferences among Chinese medical undergraduate students. This short and simple questionnaire may provide a suitable tool for exploring insights regarding the motivations of Chinese medical students. [ABSTRACT FROM AUTHOR]

Background: Negative body image is a common psychological phenomenon among Chinese college students meriting investigation. Peers and the media are important factors that negatively influence body image. This study explored the mechanisms of media and peers promoting negative body image among Chinese college students. Method: Data from 407 college students (173 men and 234 women) were collected using the Revised Social and Cultural Attitude Questionnaire of Appearance, Appearance Comparison Scale, Peer Impact Scale, and Negative Body Image Scale. Results: Correlational analysis results demonstrated that media attention was not significantly correlated with negative body image. All other variables were significantly positively correlated. Path analysis results indicated that the direct effect of media attention on negative body image was not significant, while the direct effect of peer impact was significant. In addition, appearance comparison and internalization of the thin ideal acted as a chained indirect effect between negative body image, media attention, and peer impact. Conclusions: The research revealed that focusing on perfect bodies displayed in the media did not produce a negative body image. However, focusing on the media and peer conversations regarding the body caused the participants to compare appearances and internalize ideal body shape standards, leading to negative self-evaluations. Plain English Summary: Adolescents' peers and media have far-reaching influence. This study explored their impact on the body image of Chinese college students. A questionnaire survey was distributed to 461 Chinese college students. The results showed that peers directly affected body image, while media attention did not. Media attention and peer impact further increased students' negative body image evaluations through the indirect effects of appearance comparison and internalization of the thin ideal. [ABSTRACT FROM AUTHOR]

Background: The Debriefing Experience Scale (DES) is a tool that is used to explore nursing students' subjective experiences during a debriefing and to help determine best debriefing practices. A Chinese version of the scale has not been found; its development can enhance learning in simulation activites in Chinese healthcare education programs. Methods: A simplified Chinese version of the DES was developed and tested using 34 Chinese undergraduate (second year) nursing students. They participated in six simulation scenarios and debriefings. Eight experts were consulted to determine the content validity of the scale. Critical ratio method, Cronbach's alpha, intraclass correlation coefficient, correlation coefficient and factor analysis were used in testing the psychometric properties of the scale. Results: Analysis of 200 scales showed that the simplified Chinese version of the DES had good potential in discriminatiing Chinese nursing students' experiences of debriefing. Conclusions: The simplified Chinese DES was effective in evaluating the experience of debriefing. A larger sample size and multicenter research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Bedside teaching is a primary educational tool to improve the clinical practice of medical students. As a new medical pedagogical approach, team-based learning (TBL) is gradually being integrated into Chinese medical education programmes to promote clinical reasoning, knowledge application, teamwork and collaboration. The aim of this controlled study is to investigate the effects of TBL on pediatric bedside teaching in medical students. Methods: Thirty medical students in pediatric clinical practice were randomly assigned to an intervention and a control group. Students in the intervention group exposed bedside teaching activity with TBL while students in the control group received traditional bedside teaching. Teaching for the two groups was conducted biweekly, and the same clinical cases were selected for both groups with the same instructors. After six months of clinical practice, the differences of learning outcomes between the two groups were compared through assessments by computer-based case simulations (CCS) and mini-Clinical Evaluation Exercise (mini-CEX). Student feedback following completion of bedside teaching was collected by questionnaire. Results: The CCS scores in the intervention group were significantly higher than that in the control group (p < 0.05). The mini-CEX results showed that clinical judgment and counseling skills of the intervention group were higher than those in the control group (p < 0.01). Medical interviewing skills and overall clinical competence in the intervention group were better than those in the control group (p < 0.05). In the questionnaire survey, students in the intervention group believed that bedside teaching activity with TBL could promote active learning ability, improve counseling skills and strengthen teamwork. Conclusions: Application of TBL in bedside teaching not only enhanced clinical practice skills among medical students but also improved their clinical reasoning and counseling skills. [ABSTRACT FROM AUTHOR]

The purpose of the present study is to examine the relationship between mindfulness and mental health of graduate students and the mediating effects of sense of purpose in life on mindfulness and mental health. The participants include 419 graduate students from 6 universities in China, and there are 190 males and 229 females. The Hayes Process is adopted to analyze the effects of the sense of purpose in life on mindfulness and mental health of graduate students. The results reveal that mindfulness can effect the mental health of graduate students positively and significantly. The sense of purpose in life is found to mediate the relationship between mindfulness and mental health. In further moderated mediation analyses, the effect of mindfulness on mental health can be adjusted by family economic condition. The type of degree can adjust the effect of mindfulness on sense of purpose, and academic Interest can adjust the mediating effect of sense of purpose. Finally, this study discusses several empirical and methodological implications of the findings. [ABSTRACT FROM AUTHOR]

Background: Understanding dental students' future career choice and motivation could provide beneficial references for both educators and students, but there were few studies on students in a Chinese dental school. The study aimed to investigate Chinese final year dental students' the short-term and long-term plans, motivations, and identify the influence of gender on the future plans. Methods: A total of 265 final year dental school students of the School of Stomatology, China Medical University from 2016 through 2020 were invited to complete an anonymous, 27-item questionnaire. Moreover, almost all of questions were in multiple-choice formats. Data were categorized and analysed using chi-square comparative analyses. Results: 88.3% of respondents decided to pursue a graduate degree after graduating from dental school. Moreover, the single most important reason influencing their plans was "eligible for better jobs" (42.8%). More females than males studied dentistry (222 vs 111), and gender had an influence on the choice of specialty. Conclusions: This study listed the selection tendency and influencing factors of students in a Chinese dental school for the reference of educators and students. And the results could raise some useful influence and feedback effect on current health and education policy, and on the career development of practicing dentists or dental students. [ABSTRACT FROM AUTHOR]

Background: This study examined the mediating effect of sense of control and the moderating effect of coronavirus stress on the relationship between life history strategy and overeating among Chinese college students during the COVID-19 period. Methods: 3310 Chinese students (Mage = 19.74, SD = 1.50; 47% males) completed self-reported questionnaires regarding life history strategy, sense of control, overeating, and coronavirus stress. The data were analyzed using Pearson's r correlations and moderated mediation analysis. Results: The results revealed that control sense mediated the link between life history strategy and college students' overeating. College students' coronavirus stress moderated the associations between life history strategy and college students' sense of control and between control sense and overeating. The association between life history strategy and sense of control was stronger for those with lower coronavirus stress, and the association between sense of control and overeating was stronger for those with lower coronavirus stress. Conclusions: This study identified that the critical factors were associated with overeating. On the one hand, the research deepens the application and interpretation of life history theory in the field of eating; on the other hand, it provides evidence for the prevention of overeating, and provides theoretical basis for psychological assistance among Chinese college students. Plain English summary: One's response is not arbitrary when confronted with COVID-19 pandemic. Previous research has found that individuals with fast life history strategies still be more prone to overeat. We also know from other research that sense of control is the most salient aspect of overeating. However, no research has investigated whether the life history strategy of college students is significantly associated with overeating and examine the potential mediating and moderating mechanisms in this association. With the aid of 3310 participants, we found that, life history strategy was linked to college students' overeating. We also found that this relationship was partially explained by sense of control. In addition, the association between life history strategy and sense of control was stronger for those with lower coronavirus stress, and the association between sense of control and overeating was stronger for those with lower coronavirus stress. This study is an important step in unpacking how life history strategy relates to overeating in Chinese college students. However, they are limited by the cross-sectional nature of the study, meaning we cannot imply causality. We recommend that further research replicate our findings in people with diagnosed eating disorders using a longitudinal design. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between health literacy (HL) and health-related quality of life (HRQoL) among primary and high school students in Nanjing, China.Methods: A cross-sectional study was conducted among randomly selected primary (graders 4-6), junior (graders 7-9) and senior (graders 10-12) high school students in 2018 in Nanjing Municipality of China. HRQoL, the outcome variable, was assessed with the validated Chinese version of Child Health Utility 9D (CHU9D) and used as continuous variable, while HL, our independent variable, was measured with the validated Chinese Students' Health literacy Assessment Scale and treated as categorical variable ("adequate" or "inadequate") in the analysis. Mixed-effects linear regression models were introduced to calculate mean difference and 95% confidence interval (CI) for examining the association between HL and HRQoL.Results: Totally, 4388 of 4498 students completed the survey. Among these responders, the mean score of CHU9D was 0.78 ± 0.17, and the proportion of participants with adequate HL was 85.8% (95% CI = 84.7%, 86.8%). After adjustment for potential confounders and class-level clustering effects, participants who had adequate HL were observed having, on average, an elevated HRQoL score of 0.08 (95% CI = 0.06, 0.11) units compared to their counterparts with inadequate HL. Such a positive HL-HRQoL association was also identified among each stratum of participants' age, gender and residence.Conclusions: HL was positively associated with HRQoL score among primary and high school students in China. It has public health implications that HRQoL may be improved through school-based health literacy intervention among children and adolescents in China. [ABSTRACT FROM AUTHOR]

Background: Cross-sectional and longitudinal studies have found that problematic mobile phone use, bedtime procrastination, sleep quality, and depressive symptoms are strongly associated. However, studies are inconsistent regarding whether problematic mobile phone use predicts depressive symptoms or vice versa, and sleep factors have been infrequently focused on in this regard. In addition, few studies have examined the longitudinal associations and directions of effects between these factors. Therefore, this study aims to explore the longitudinal relationship among problematic mobile phone use, bedtime procrastination, sleep quality, and depressive symptoms in college students. Methods: Overall, 1181 college students completed questionnaires on problematic mobile phone use, bedtime procrastination, sleep quality, and depressive symptoms at two time points 12 months apart. A cross-lagged model was used to examine the longitudinal relationship between these factors. Results: Cross-lagged analyses showed significant bidirectional relationships of problematic mobile phone use with bedtime procrastination and depressive symptoms. Additionally, there were also significant bidirectional relationships of sleep quality with bedtime procrastination and depressive symptoms. Problematic mobile phone use predicted subsequent sleep quality one-way, and bedtime procrastination predicted subsequent depressive symptoms one-way. Conclusions: This study further expands our understanding of the longitudinal and bidirectional relationships among problematic mobile phone use, bedtime procrastination, sleep quality and depressive symptoms and helps school mental health educators design targeted interventions to reduce problematic mobile phone use, sleep problems, and depressive symptoms among college students. [ABSTRACT FROM AUTHOR]

Background: The outbreak of COVID-19 has led to increased workload and infection risks among medical staff. This situation may influence current medical and health-related students' decision on the choices of their future careers. Hence, this study investigated the impact of COVID-19 on their future career intentions. Methods: This is a cross-sectional observational study that included medical and health-related students from three universities between October 2020 and January 2021. The study questionnaire was divided into two main sections: Section 1, which comprised students' basic information. And section 2 focused mainly on the impact of COVID-19 pandemic on students' professional intentions. The chi-squared χ2 test was used to compare the responses before and after the pandemic outbreak among Chinese and non-Chinese students. Results: In overall, 1253 students completed the questionnaires. The responses showed that the number of students who preferred clinical medicine, public health, pharmacy and oral medicine increased significantly after the pandemic outbreak. In contrast, the number of students who chose nursing and medical technology decreased significantly. The change mainly occurred in Chinese students, predominantly females. Half of students (50.35%) were more willing to engage in medical and health work after completing their current program. Also, 36.39% of students felt that knowledge was too limited in the pandemic's face and would like to continue studying after graduation to gain more knowledge. Due to the pandemic, 34.18% of students would like a future workplace near their hometown, and 19.63% preferred to work in urban areas. Conclusion: The COVID-19 outbreak impacted current medical and health-related students' career planning on their future workplaces and employment time choices. Additionally, the pandemic influenced the intention of Chinese students in choosing their future careers. This study provided the basis for the policymaking, specialty setting of colleges and supplied the medical health department's talent reserve information. [ABSTRACT FROM AUTHOR]

Background: A motivation dimension of the core psychiatric symptom anhedonia additional has been suggested. The Temporal Experience of Pleasure Scale (TEPS) has been reported to assess anticipatory and consummatory pleasure separately in multiple factor-structure models. This study explored the factor structure of a Chinese version of the 18-item TEPS and further explored the measurement invariance of the TEPS across sex and clinical status (non-clinical, psychiatric). Methods: Best-fit factor structure of the TEPS was examined in a non-clinical cohort of 7410 undergraduates, randomized into sample 1 (N = 3755) for exploratory factor analysis (EFA) and sample 2 (N = 3663) for confirmatory factor analysis (CFA). Additionally, serial CFA was conducted to evaluate measurement invariance across sex and between clinical (N = 313) and non-clinical (N = 341) samples. Results: EFA supported a new four-factor structure with a motivation component, based on the original two-factor model (consummatory pleasure with/without motivation drive, anticipatory pleasure with/without motivation drive). CFA confirmed the four-factor model as the best-fit structure and revealed a second-order hierarchy in non-clinical and clinical samples. Full scalar invariance was observed across clinical and non-clinical samples and across sex in the clinical sample; only partial scalar invariance was observed across sex in the non-clinical sample. Conclusions: A four-factor structured TEPS can assess motivation-driving dimensions of anticipatory and consummatory pleasure, consistent with the recently advanced multidimensional structure of anhedonia. CFA and measurement invariance results support application of the TEPS for assessing motivation aspects of anhedonia. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to understand the influencing factors of Chinese college students' satisfaction with online teaching and psychological pressure on learning during the novel coronavirus epidemic. Methods: We assessed the effect of online teaching of 7084 medical students from wannan medical college in March 5 to April 2, 2020 using cluster sampling. The respondents were asked to complete a 7-item self-compiled online teaching satisfaction questionnaire. Chi-square test and multivariate logistic regression analysis are used. Results: Sex is female (OR = 1.257, 95%CI: 1.132 ~ 1.396), grades are second and third grades (second grades: OR = 1.228, 95%CI: 1.080 ~ 1.397; third grades: OR = 1.197, 95%CI: 1.048 ~ 1.367), normal/unfamiliar learning platform operation (OR = 3.692, 95%CI: 3.321 ~ 4.103) were risk factors for satisfactory teaching effect. In addition, students whose school year system is four-year (OR = 0.870, 95%CI: 0.781 ~ 0.969) and grade 4 and above (OR = 0.594, 95%CI: 0.485 ~ 0.727) were more satisfied with the teaching effect of teachers. And, during the period of the COVID-19 epidemic, the risk factors for college students to have psychological stress were: female (OR = 1.258, 95%CI: 1.096 ~ 1.442), from rural areas (OR = 1.511, 95%CI: 1.312 ~ 1.740), and the academic year system is four-year system (OR = 1.191, 95%CI: 1.028 ~ 1.380), using mobile phones and other learning tools (OR = 1.388, 95%CI: 1.205 ~ 1.600), general/unfamiliar with learning platform operations (OR = 2.273), 95%CI: 1.888 ~ 2.735). While the protective factors for college students' psychological stress included: grade three and four and above (OR = 0.463, 95%CI: 0.387 ~ 0.554; OR = 0.232, 95%CI: 0.187 ~ 0.286), and they think that the teaching effect is satisfactory (OR = 0.314, 95%CI: 0.261 ~ 0.379). Conclusion: This survey shows that compared with male college students, female college students were more dissatisfied with the teaching effect of teachers and havd greater psychological pressure on learning. Psychological counseling should be strengthened for students in rural areas and those who were not familiar with the operating platform to relieve their psychological pressure on learning. [ABSTRACT FROM AUTHOR]

Background: Critical thinking (CT) is an essential competency for medical students. This study's aim was to evaluate Chinese medical students' disposition for CT and to explore the impact of current trends in medical education on students' CT development. Methods: We used multistage stratified cluster sampling to recruit a total of 1241 medical students among five different years of training and from three medical institutions in China. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) and self-reported information were used to collect cross-sectional data. Based on the data from the CTDI-CV, 112 medical students in clinical course training from a single institution continued one-year follow-up. Their one-year CTDI-CV score changes were collected regarding various medical education variables. Results: The mean CTDI-CV score of the 1241 medical students was 287.04 with 729 (58.7%) students receiving a score of 280 or higher. There were statistically significant differences in schools attended(F = 3.84, P < 0.05), year of school attended(F = 10.32, P < 0.001), GPA(F = 6.32, P < 0.01), weekly time spent learning after class(F = 14.14, P < 0.001), attitude toward medicine(F = 28.93, P < 0.001), desire to be a doctor after graduation(t = − 3.35, P < 0.001), familiarity with CT(F = 20.40, P < 0.001), and perception of importance of CT(F = 22.25, P < 0.001). The participants scored the highest on the CTDI-CV subscales of "inquisitiveness" and the lowest on "truth seeking." The 112 students in the longitudinal study had significantly lower total CT scores after one academic year follow-up. Conclusions: Chinese medical students generally exhibited positive CT dispositions. The cross-sectional survey and one-year longitudinal study indicated that students' CT disposition diminished as they progressed through traditional medical training. Our study contributes to understanding the status of Chinese medical education of and influential factors on medical students' CT disposition. [ABSTRACT FROM AUTHOR]

Background: Hypersexuality is associated with many psychiatric disorders and creates enormous burden for the affected individual, family and society. There are numerous inventories measuring behavioral, emotional or stressful features of hypersexuality, we still need a structure-validated questionnaire to measure hypersexuality in a comprehensive way. Methods: Based on previous inventories and related clinical descriptions of hypersexuality, we designed a matrix of 72 items related to hypersexual experience, and we invited 282 heterosexual university students who experienced hypersexuality at least once life-long to answer the matrix. Results: Through exploratory factor analyses and exploratory structural equation modeling, we constructed a Hypersexuality Scale, with a satisfactory model structure of five factors (or scales, 4 items for each scale) of hypersexuality, and named them as the Negative Impact, Emotional Coping, Uncontrolled Behavior, Post-sex Regret, and Increased Interest. Most inter-correlations of these factors were significant but in low or medium levels in all participants. Male students scored significantly higher on Negative Impact and Increased Interest than females did. Conclusions: The five scales described in this study might help to understand hypersexuality, and the Hypersexuality Scale might be applied to the clinical conditions related to hypersexuality. [ABSTRACT FROM AUTHOR]

Background: Among Chinese medical students, there is a high prevalence of mental health-related issues and low empathy. Effective strategies to improve this situation are lacking. This study aims to investigate the efficacy of the intervention courses designed to enhance the mental health and empathy of senior Chinese medical students. Methods: A total of 146 3rd - and 4th -year medical students were randomized to an intervention group (n = 74) and a control group (n = 72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and content of the intervention courses. The designed courses were delivered in the intervention group once a month three times, while the control group had no specific intervention. Five self-assessment questionnaires, including the General Self-Efficacy (GSE) scale, Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS), were completed by the students before and one month after the courses to evaluate their levels of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy, respectively. Qualitative data were collected via e-mail two years after the intervention. Results: Compared to the control group, the intervention group showed significantly higher scores for empathy (111.0 [IQR 102.0, 118.0] vs. 106.0 [IQR 93.0, 111.5]; P =.01) and QoL (32.0 [IQR 28.0, 35.0] vs. 29.5 [IQR 26.0, 34.0]; P =.04). The rate of depression was significantly lower in the intervention group than in the control group (13.5 % vs. 29.2 %; chi-square test, P =.02). However, no significant differences in self-efficacy (25.6 ± 4.8 vs. 24.3 ± 6.3; P =.16) or burnout (27.0 % vs. 34.7 %; Chi-square test, P =.31) were observed between the two groups. Conclusions: The intervention courses had a positive impact on mental well-being and empathy in senior Chinese medical students, which might help provide novel information for their incorporation into the medical school curriculum. Trial registration: ClinicalTrials.gov Identifier: NCT02645643; Date of registration: 05/01/2016. [ABSTRACT FROM AUTHOR]

Background: Blue-enriched white light at night has the potential to delay the circadian rhythm in daily life. This study was conducted to determine whether the use of high correlated color temperature (CCT) light at home at night is associated with delay of sleep timing in university students. Methods: The survey was conducted in 2014–2015 in 447 university students in Japan and 327 students in China. Habitual sleep timing and type of CCT light at home were investigated by using a self-administered questionnaire. The Japanese students were significantly later than the Chinese students in bedtime, wake time, and midpoint of sleep. They were asked whether the lighting in the room where they spend most of their time at night was closer to warm color (low CCT) or daylight color (high CCT). The amount of light exposure level during daily life was measured for at least 1 week by the use of a light sensor in 60 students in each country. Results: The percentages of participants who used high CCT lighting at night were 61.6% for Japanese students and 80.8% for Chinese students. Bedtime and sleep onset time on school days and free days were significantly later in the high CCT group than in the low CCT group in Japan. The midpoint of sleep in the high CCT group was significantly later than that in the low CCT group on free days but not on school days. On the other hand, none of the sleep measurements on school days and free days were significantly different between the high CCT and low CCT groups in China. Illuminance level of light exposure during the night was significantly higher in Japanese than in Chinese, but that in the morning was significantly higher in China than in Japan. Conclusions: The use of high CCT light at night is associated with delay of sleep timing in Japanese university students but not in Chinese university students. The effects of light at night on sleep timing and circadian rhythm may be complicated by other lifestyle factors depending on the country. [ABSTRACT FROM AUTHOR]

Background: Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. Methods: Fifty Year-6 medical students attending the 'Serious Illness Communication Module' were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. Results: Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients' emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients' attention to treatment options; (4) acknowledging concerns about dying patients' physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients' emotional and physical needs. They also often informed and acknowledged the patients' family members. Conclusions: When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients' participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted. [ABSTRACT FROM AUTHOR]

Background: To investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students. Methods: An epidemiological survey of the prevalence of the CHR syndrome in Chinese college students that was selected by stratified random sampling from Shanghai, Nanjing and Nanchang cities was done following a 3-stage procedure. Participants were initially screened with the Prodromal Questionnaire-brief version (PQ-B), and whose distress score of PQ-B exceeded 24 would be invited to a telephone assessment using the subscale for positive symptoms of the Scale of Prodromal Symptoms (SOPS)/Structured Interview for Prodromal Syndromes (SIPS). Lastly, participants who scored 3 or higher in any item of the subscale would be administered with the SIPS interview conducted by trained researchers to confirm the diagnosis of CHR syndrome. Results: Twenty-three thousand sixty-three college students completed the survey during September 2017 to October 2018. Seventy-two students were diagnosed as CHR subjects, and the detection rate in the total sample was 0.3%. The peak age range for the first diagnosis of CHR was 17 to 20 years. Thirteen and forty-six were set as the cutoff points of PQ-B total score and distress score to balance the greatest sensitivity and specificity. Binary logistic regression revealed that 8 items in PQ-B showed significant distinction for detecting CHR subjects. Conclusions: The 3-stage screening method can be utilized in the detection of CHR subjects for psychosis in the general population, during which delusional ideas, perceptual abnormalities and suspiciousness deserve great attention. [ABSTRACT FROM AUTHOR]

Background: The current study aims to track the changes in the levels of smart phone addiction (SPA) and depressive symptoms between pre and during COVID-19 and potential risk factors of among Chinese college students in a four-wave longitudinal study. Methods: The participants were recruited from a Chinese university (n = 195; 58.5% females). The first three-wave surveys were conducted before COVID-19 (during December of Year 1, June of Year 1, and December of Year 2 of their college study; Time 1, Time 2, Time 3), while the fourth survey (Time 4; during June of Year 2 of their college study) was conducted in June 2020 during COVID-19. COVID-19-related factors, including quarantine, lockdown, boredom, emotional loneliness, and social loneliness, were investigated. Results: The results showed a significant increase in the levels of depressive symptoms and prevalence of probable depression during COVID-19 (69.2%) compared to those 18 months, 12 months and 6 months before COVID-19 (41.5, 45.6, 48.2%) but non-significant changes in SPA. Boredom and emotional loneliness were positively associated with both SPA and depressive symptoms during COVID-19. Social loneliness was also positively associated with depressive symptoms during COVID-19. Quarantine and lockdown were not significantly associated with SPA or depressive symptoms. Discussion and conclusions: The results highlight that the study population may be a high risk group of probable depression. Future studies should continue to track these mental and behavioral status with the progression of the epidemic. The identified emotional factors could be used to reduce depressive symptoms during COVID-19 and prevent the potential risk of SPA. [ABSTRACT FROM AUTHOR]

Background: In response to the rising concern with promoting the wellbeing of university students and relative lack of domain-specific wellbeing measurement instruments in China, the current study aimed to validate a Chinese version of the College Student Subjective Wellbeing Questionnaire (CSSWQ), a 16-item self-report English-language rating scale assessing four aspects of wellbeing (academic satisfaction, academic efficacy, school connectedness, and college gratitude). Methods: The Chinese translation of the CSSWQ, the Students' Life Satisfaction Scale, the Positive and Negative Affect Schedule, the 10-Item Big Five Personality Inventory, and demographic questions were completed by 252 Chinese students at a university in Suzhou, China. Results: Exploratory factor analysis found four factors each with the same four items as in the original English scale. Each subscale showed good internal consistency. Test–retest for a one-month interval showed generally moderate reliability. As predicted, Pearson correlational analysis found positive correlations between the Chinese CSSWQ and life satisfaction, positive affect, extraversion, and GPA, and negative correlations with neuroticism and negative affect. Monthly income had small negative correlations with academic satisfaction and academic efficacy, smoking had a small positive correlation with school connectedness, and exercise had a small positive correlation with academic efficacy. Conclusion: Data for the Chinese CSSWQ in the current study showed validity and reliability, supporting the use of this instrument as a measurement of college student wellbeing in China. [ABSTRACT FROM AUTHOR]

Background: The Personality Inventory for DSM-5 Brief Form (PID-5-BF) is a 25-item measuring tool evaluating maladaptive personality traits for the diagnosis of personality disorders(PDs). As a promising scale, its impressive psychometric properties have been verified in some countries, however, there have been no studies about the utility of the PID-5-BF in Chinese settings. The current study aimed to explore the maladaptive personality factor model which was culturally adapted to China and to examine psychometric properties of the PID-5-BF among Chinese undergraduate students and clinical patients. Methods: Seven thousand one hundred fifty-five undergraduate students and 451 clinical patients completed the Chinese version of the PID-5-BF. Two hundered twenty-eight students were chosen randomly for test-retest reliability at a 4-week interval. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to discover the most suitable factor structure in China, measurement invariance(MI), internal consistency, and external validity were also calculated. Results: The theoretical five-factor model was acceptable, but the exploratory six-factor model was more applicable in both samples (Undergraduate sample: CFI = 0.905, TLI = 0.888, RMSEA = 0.044, SRMR = 0.039; Clinical sample: CFI = 0.904, TLI = 0.886, RMSEA = 0.047, SRMR = 0.060). In the Chinese six-factor model, the Negative Affect domain was divided into two factors and the new factor was named "Interpersonal Relationships", which was in line with the Big-Six Personality model in Chinese. Measurement invariance across non-clinical and clinical sample was established (configural, weak, strong MI, and partial strict MI). Aside from acceptable internal consistency (Undergraduate sample: alpha = 0.84, MIC = 0.21; Clinical sample: alpha = 0.86, MIC = 0.19) and test-retest reliability(0.73), the correlation between the 25-item PID-5-BF and the 220-item PID-5 was significant(p < 0.01). The six PDs measured by Personality diagnostic questionnaire-4+ (PDQ-4+) were associated with and predicted by expected domains of PID-5-BF. Conclusions: Both the theoretical five-factor model and the exploratory six-factor model of the PID-5-BF were acceptable to the Chinese population. The five-factor model could allow for comparison and integration with other work on the original theoretical model. However, the Chinese six-factor structure may be more culturally informed in East Asian settings. In sum, the PID-5-BF is a convenient and useful screening tool for personality disorders. [ABSTRACT FROM AUTHOR]

Background: The 7-item Gaming Addiction Scale (GAS) has been used as a screening tool for addictive game use worldwide, and this study aimed to examine its psychometric properties and measurement invariance among college students in China. Methods: Full-time students from multiple colleges in China were recruited. A total of 1040 completed questionnaires were used in the final analysis. Reliability of the GAS was assessed by internal consistency and split-half reliability. Validity of the GAS was assessed by structural validity, convergent validity, discriminant validity, and concurrent validity. A series of Multigroup Confirmatory Factor Analysis (MG-CFA) were conducted to test and establish measurement invariance across gender, class standing, family income and parental educational level. Results: Exploratory factor analysis revealed a unidimensional structure of the GAS. The GAS exhibited excellent internal consistency (Cronbach's α = 0.951, theta coefficient = 0.953, omega coefficient = 0.959) and structural validity (χ2 /df = 0.877 (p < 0.05), CFI = 0.999, TIL = 0.996, RMSEA =0.000). Concurrent validity of the GAS was confirmed by its correlation with problematic internet use, sleep quality, nine dimensions of psychiatric symptoms, and substance use. The GAS also demonstrated measurement invariance across father's educational level (Δχ2 (df) = 19.128 (12), ΔCFI = − 0.009, ΔRMSEA = 0.010 for weak factorial model; Δχ2 (df) = 50.109 (42), ΔCFI = − 0.010, ΔRMSEA = 0.007 for strict factorial model.) and mother's educational level (Δχ2 (df) = 6.679 (12), ΔCFI = 0.007, ΔRMSEA = − 0.010 for weak factorial model; Δχ2 (df) =49.131 (42), ΔCFI = − 0.009, ΔRMSEA = − 0.004 for strict factorial model), as well as partial measurement invariance across gender (except for item 2), class standing (except for item 7) and family income (except for item 5). Conclusions: The Chinese version of the 7-item GAS can be an adequate assessment tool to assess internet gaming disorder among the college student population in China. [ABSTRACT FROM AUTHOR]

Background: Development of an entry-level physiotherapy curriculum in China currently follows the World Confederation for Physical Therapy (WCPT) guidelines, however there is no standard, validated, assessment tool for physiotherapy practice in use in China. This article reports the process of translation of the "Assessment of Physiotherapy Practice" (APP), a validated assessment instrument adopted by all universities in Australia and New Zealand, into Chinese (APP-Chinese) and its implementation by Chinese physiotherapy clinical educators (CEs) and students during clinical placements. Methods: The process of forward and backward translation of the APP was undertaken by a team of academics from universities in Shanghai, Hong Kong, United States and Australia. An APP-Chinese version was produced and used for assessment of the clinical performance of 4th year students at a university in Shanghai. Feedback on the implementation of the APP-Chinese was solicited from students and CEs using the same two questionnaires employed to assess implementation of the original APP. Results: All CEs agreed that the rules used to score the APP-Chinese were helpful in assessing student performance. Over 90% of the CEs considered the APP-Chinese was pragmatic for use in the clinical environment in China. All students agreed with the rating of their performance on the APP-Chinese marked by their educators, and that the performance indicators were useful in guiding their expected performance behaviour. Conclusion: The APP-Chinese is the first standardised assessment tool for evaluation of clinical performance of physiotherapy students in China and was shown to be well accepted by both students and CEs in the clinical education unit and university involved in this study. [ABSTRACT FROM AUTHOR]

Background: Existing studies reporting on the levels of physical fitness among college students used relatively few fitness tests as a reflection of physical fitness, which could not comprehensively evaluate the levels of physical fitness. Thus, the current study aimed to investigate the cross-sectional relationship between body mass index (BMI) and a physical fitness index (PFI) based on six indicators of fitness in Chinese college students.Method: Anthropometric measurements and six measures of physical fitness (Vital capacity, 50-m sprint, sit and reach, standing long jump, 800/1000-m run, pull-up/bent-leg sit-up) were measured. BMI was calculated to classify individuals into underweight, normal weight, overweight, and obesity groups. Z-scores based on sex-specific mean and standard deviation were calculated, and the sum of z-scores for the six fitness tests was used as a PFI. Three models (a linear regression model, polynomial regression model with a second-order BMI term and a restricted cubic spline regression model) were fitted to discuss the potential relation between BMI and PFI. We compared the models using Akaike Information Criterion (AIC) and R square.Results: Totally, 8548 freshmen from the years 2014 to 2016 in a medical college completed the physical fitness tests. There was a decreasing trend of physical fitness index from the years 2014 to 2016 (P for trend < 0.01). More male than female students were overweight or obese (23.5% vs. 11.9%), but more female than male students were normal weight (74.7% vs. 64.8%). A restricted cubic spline regression model was superior to linear and polynomial regression model with lower AIC and higher R square.Conclusions: The relationships between BMI and PFI in college students were non-linear. Underweight, overweight and obese students had poorer performance in physical fitness index than normal weight students. Future prospective, longitudinal cohort studies to identify the causal relations and potential mechanism in a good manner are required. [ABSTRACT FROM AUTHOR]