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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Purpose: To investigate the prevalence and associated factors of pseudoexfoliation syndrome (PEX) in an Iranian elderly population. Methods: This study, a population-based cross-sectional study conducted on individuals ≥60 years in Tehran, the capital of Iran in 2019 using a multi-stage stratified random cluster sampling. All study participants underwent complete ocular examination (including measurement of uncorrected and best-corrected visual acuity, refraction, slit-lamp biomicroscopy). The PEX was diagnosed based on the presence of white fluffy dandruff-like pseudoexfoliative material on the pupillary margin, on the anterior lens capsule, and/or the trabecular meshwork. Results: Of the 3791 invitees, 3310 participated in the TGES (response rate: 87.3%). After applying exclusion criteria, the data of 3274 individuals were analyzed for this report. The overall prevalence of PEX was 3.63% (95% CI:2.67–4.58) in this study. 81.1% of PEX cases were bilateral. The prevalence of PEX increased significantly with advancing age in a linear trend from 2.38% (95%: 1.27–3.48) in the age group 60–64 years to 6.48% (95%: 2.02–10.95) in the age group ≥80 years (OR = 1.05, p = 0.008). According to the multiple logistic regression model, advancing age (OR: 1.06, p = 0.002) and the presence of cataract (OR: 5.02, p < 0.001) were significantly associated with increased odds of PEX. Conclusion: The results showed a lower prevalence of PEX in the Iranian elderly compared to previous studies on the elderly population. Advancing age and cataracts were the only associated factors of PEX in the present study. [ABSTRACT FROM AUTHOR]

Since the detection of antigenically atypical very virulent Infectious bursal disease viruses (vvIBDV) in Egypt in 1999, the country has been experiencing recurrent outbreaks with high mortality rates and typical gross lesions associated with typical vvIBDV. However, a significant change occurred in 2023, marked by a notable increase in reported subclinical IBDV cases. To evaluate the field situation, samples from 21 farms in 2023 and 18 farms from 2021 and 2022, all of which had experienced IBD outbreaks based on clinical diagnosis, were collected, and subjected to VP2-HVR sequencing. Phylogenetic analysis revealed that all samples collected in 2021 and 2022 clustered with classical virulent strains and vvIBDV. In 2023, one sample clustered with the Egyptian vvIBDV, another with classical virulent IBDV, and the rest with the novel variant IBDV (nVarIBDV) circulating in China. The alignment of deduced amino acid sequences for VP2 showed that all Egyptian classic virulent strains were identical to the Winterfield or Lukert strains, while vvIBDV strains exhibited two out of the three typical residues found in Egyptian vvIBDV, namely Y220F and G254S, but not A321T. Meanwhile, all Egyptian variant strains exhibited typical residues found in nVarIBDV. However, all Egyptian variants showed a mutation at position 321 (321V), which represents the most exposed part of the capsid and is known to have a massive impact on IBDV antigenicity, except for one sample that had 318G instead. This report highlights the emergence of a new variant IBDV in Egypt, clustered with the Chinese new variants, spreading subclinically in broiler farms across a wide geographic area. RESEARCH HIGHLIGHTS New variant IBDV which emerged in Egypt clustered with Chinese nVarIBDV. nVarIBDV spread subclinically across a wide geographic area. Mutation at 321 represents capsid's most exposed part, a defining feature. Antigenically modified vvIBDV still circulating in Egypt with typical lesions. [ABSTRACT FROM AUTHOR]

The purpose of this interventional experimental study was to determine the effect of health education program on physical activity and blood pressure in middle-aged women with pre-hypertension in Kohdasht. Eighty middle-aged women with pre-hypertension were selected and divided into two groups randomly. After the one-month online training program for intervention group, by conducting an interview, the data was completed using questionnaire and it was analyzed using spss 27 software (significance level of 0.05). Before the intervention, there was no significant difference between the two groups. After 3 months of follow-up, a significant increase in attitude, perceived behavioral control and behavioral intention related to physical activity was observed in the intervention group compared to the control group (P <.05). Also, the average blood pressure in the intervention group was higher than the control group. Considering the effect of the online health education program based on the theory of planned behavior in improving the stages of changing physical activity and reducing blood pressure, the use of these developed models with an emphasis on modifying the subjective norm related to physical activity in the field of prevention is recommended for high blood pressure. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists require research and evaluation skills to deliver evidence-based care, making research education integral to their training. We aimed to develop a student and staff-informed strategy to further embed research into the occupational therapy programmes and enhance the research culture at a United Kingdom Higher Education Institution. Method: We used group concept mapping to gather ideas from students and staff on how to embed research and improve research culture within the occupational therapy programmes at a United Kingdom Higher Education Institution. Participants generated, sorted and rated ideas for importance and success. We analysed the data to create a concept map and identified rating values for the themed clusters and their ideas. Results: The concept map contained four themed clusters of ideas: Wider research community, Integration of research into the core programme, Advanced research support and capacity building and Research awareness. Successes and improvement targets were identified within each cluster. Conclusion: Group concept mapping provided a structured and comprehensive method to develop a strategy for embedding research and fostering a research culture in occupational therapy programmes at a higher education institution. The four-themed concept map and identified priority targets serve as a foundation for implementing the strategy and improving research integration in occupational therapy education. [ABSTRACT FROM AUTHOR]

The significance of the spiritual climate in enhancing job performance is acknowledged, yet there exists a notable lack of empirical understanding regarding mechanisms, particularly in the social work profession. This study aims to address this gap by examining the serial mediation effect of organisational commitment and work engagement in delineating the relationship between spiritual climate and job performance. A sample of 1,023 social workers from H City, China, was procured using a multistage cluster random sampling approach. The results of the serial mediation analyses show a direct positive effect of spiritual climate on job performance (b = 0.130, p  < 0.001) and significant indirect effects through organisational commitment (b = 0.640, p  < 0.001) and work engagement (b = 0.516, p  < 0.001), underscoring the crucial roles these variables play in mediating spiritual climate's influence on job performance. Findings reveal a sequential mediating pathway from organisational commitment to work engagement, operating between spiritual climate and job performance. This research clarifies the complex mechanisms linking spiritual climate and job performance, augmenting the limited empirical knowledge within the social work profession. Additionally, it offers practical implications for meeting social workers' spiritual needs at work. [ABSTRACT FROM AUTHOR]

This study aims to examine the experiences of secondary traumatic stress of Bachelor of Social Work (BSW) students' field education process in Turkey. In the scope of the research, nineteen BSW students, eleven of whom were female and eight of whom were male, who performed field education were interviewed. A semi-structured interview form consisting of twenty-three questions was used to collect the data. The obtained data were analysed using the descriptive analysis approach of qualitative research. The findings express the different experiences of BSW students in challenging cases encountered during the field education process and effects of challenging cases after field education and coping. Based on the research findings, it was concluded that BSW students are at risk of experiencing secondary traumatic stress throughout the entire field education process, and some recommendations were developed in this regard. [ABSTRACT FROM AUTHOR]

Background. This study aimed to investigate the validity and reliability of the Persian translation of the Susceptibility to Driver Distraction Questionnaire (SDDQ) among the inner-city drivers in Tabriz. Methods. In this cross-sectional study, 411 telephone taxi drivers from Tabriz city (northwest of Iran) and selected using a two-stage cluster random sampling were included. To produce an accurate Persian translation of the SDDQ, first, some bilingual specialists were asked to translate the questionnaire into Persian from English and, then, another bilingual expert was asked to back-translate the produced Persian translation into English using a standard "forward-backward" translation procedure. The accurate content agreement of the translation with the above-mentioned versions was finally approved by the research team. Data management and analysis were performed using SPSS 26.0 and LISREL 8.80. Results. The internal consistency of the whole scale and subscales of the SDDQ was determined between 0.72 and 0.90 using Cronbach's α coefficient. The agreement between the original version and re-translation version was determined 0.66 to 1 using modified Kappa coefficient (k*). The results of the equal structural equation indicated that the construct validity of the six-factor model had a greater structural fit. Pearson's correlation coefficient between subscales and the whole-scale was found to be between 0.41 and 0.92. Furthermore, the correlation between SDDQ and Mindfulness Attention Awareness Scale (MAAS) was 0.39, while the correlation between SDDQ and Conner’s Adult ADHD Rating Scales (severity of ADHD symptoms) was 0.25 (P<0.01). Conclusion. In sum, the Persian version of susceptibility to driver distraction questionnaire may have been used as a valid and reliable scale for investigating the Persian-speaking drivers in Iran. Practical Implications. SDDQ may have been used in universities and police research centers. Furthermore, it may have been applied for screening the high-risk drivers. [ABSTRACT FROM AUTHOR]

Vocational education is studying courses that allow students to learn specific, practical skills for the establishment. However, both the curriculum courses and the lifestyles of students may be affected by multiple factors that influence their mental health. Understanding various factors predicting the mental health status of these students is necessary to develop programs for preventing mental health problems. This cross-sectional study aimed to identify biopsychosocial factors predicting depression, anxiety, and stress among vocational education students in the East of Thailand. Multistage cluster sampling was applied to recruit 1,474 voluntary participants. Data was collected using six questionnaires, including Sociodemographic Data, the Brief-Alcohol, Smoking, and Substance Involvement Screening Test, The Substance Use Risk Profile Scale, The Revised Olweus Bully/Victim Questionnaire, Difficulties in Emotion Regulation Scale-short form, Depression Anxiety and Stress Scale. Multivariable logistic regression was employed for data analyses. The findings revealed that students reported depression (11.6%), anxiety (20.8%), and stress (3.9%), all classified at a mild level. The strongest predicting factor of depression was the hopelessness personality profile. At the same time, anxiety was predicted by victim and bullying behavior patterns, and stress was predicted by substance use behaviors. In addition, the difficulty of emotional regulation was associated with all their mental health problems. The results suggested that personnel in educational institutions and community nurses should promote students' abilities to regulate emotions and personality development and prevent bullying behaviors. Through the use of nursing process to screen for these significant factors and monitor at-risk students based on our findings should help to reduce the incidence rate and severity of mental health problems. [ABSTRACT FROM AUTHOR]

Objective: Our study aimed to evaluate the effectiveness of an intervention based on Motivational Interviewing (MI) performed by healthcare professionals in Primary Care (PC) patients with risky alcohol use through a multicenter, two-arm parallel, cluster-randomized, open-label controlled clinical trial. Methods: PC professionals were randomized into two groups: an Experimental Group (EG) and a Control Group (CG). The study was carried out in PC centers of the Andalusian Health Service, located in Cordoba, Spain. An MI-based approach was implemented with patients recruited in the EG, while health advice was provided to those included in the CG. The follow-up period was 12 months, with five visits scheduled. The consumption of standard drinking units per week was quantified, and risky alcohol use was estimated using the Alcohol Use Disorders Identification Test (AUDIT). An intention-to-treat statistical analysis was performed. Relative risk (RR), absolute risk reduction (ARR) and the number of subjects needed to treat (NNT) were used to estimate the intervention effect size. Results: A total of 268 patients were included, 148 in the EG and 120 in the CG. Considering the quantification of risky alcohol use, the ARR at 12 months after baseline visit was 16.46% (95% CI: 5.37–27.99), with an NNT of 6 (95% CI: 4–19). According to the AUDIT, the ARR at 12 months was 13.15% (95% CI: 2.73–24.24%), and the NNT was 8 (95% CI: 4–37). Conclusions: We concluded that MI is more effective than the usual health advice in decreasing risky alcohol use in patients treated in PC. [ABSTRACT FROM AUTHOR]

Background/Objectives: The previous literature has identified increased work-related stress among healthcare workers (HCWs) during the COVID-19 pandemic. This study analyzes work-related perceived stress experienced by therapists during the COVID-19 pandemic in Germany to identify potential for supporting this crucial group of HCWs in future health crises. Methods: Survey data on stress, measured through the Perceived Stress Scale 4, among HCWs (therapists n = 612, nurses n = 501, and doctors n = 461) were analyzed using descriptive statistics, and data from four semi-structured interviews and seven focus group discussions with therapists were analyzed using thematic content analysis. Data were collected from March to September 2022. Results: Therapists reported similar stress levels to other HCWs, with the reporting of perceived stress differing between work contexts. Eight stressors were identified through the thematic analysis: (1) concerns about maintaining the quality of care, (2) uncertainty about the future, (3) workload, (4) interactions with colleagues and patients, (5) PPE, (6) the risk of infection, (7) insufficient information flow, and (8) the lack of public and political recognition. Conclusions: This study emphasizes the distinct challenges that therapists experienced during the COVID-19 pandemic. By identifying the factors that contributed to the stress experienced, the study can inform targeted support strategies which can enhance therapists' work, ultimately contributing to sustaining essential healthcare services during public health crises. [ABSTRACT FROM AUTHOR]

Given the critical role of media in political socialization, the relationship between media use and political trust has attracted considerable attention from Western scholars. To examine the media mobilization effect in contemporary China, this paper aims to investigate how the use of New Propaganda Media (NPM) by youth relates to their patriotism and political trust based on a cross-sectional study conducted by cluster random sampling among Chinese youth in 31 provinces (N = 3011). Results indicated that (1) NPM use, in generally, positively predicts patriotism and political trust; (2) the intensity of patriotism mediates the connection between NPM use and political trust; and (3) usage of official media, social media and learning media has a positive impact on political trust, while the effect of entertainment media use is not significant. Our findings contributed to a better understanding of the effect of NPM on political trust and provide theoretical and practical significance in media mobilization and youth's political socialization of future research. [ABSTRACT FROM AUTHOR]

In unsupervised domain adaptation (UDA), knowledge is transferred from label-rich source domains to relevant but unlabeled target domains. Current most popular state-of-the-art works suggest that performing domain alignment from the class perspective can alleviate domain shift. However, most of them based on domain adversarial which is hard to train and converge. In this paper, we propose a novel contrastive learning to improve diversity and discriminability for domain adaptation, dubbed as IDD_ICL, which improve the discriminativeness of the model while increasing the sample diversity. To be precise, we first design a novel implicits contrastive learning loss at sample-level by implicit augment sample of the source domain. While augmenting the diversity of the source domain, we can cluster the samples of the same category in the source domain together, and disperse the samples of different categories, thereby improving the discriminative ability of the model. Furthermore, we show that our algorithm is effective by implicitly learning an infinite number of similar samples. Our results demonstrate that our method doesn't require complex technologies or specialized equipment, making it readily adoptable and applicable in practical scenarios. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to determine the prevalence of addictive behaviors among in-school and out-of-school adolescents of age 13–19 years in Chandigarh, India. Methods: Problem Behavior Theory (PBT) was used to identify the risk and protective factors for addictive problem behaviors among adolescents. Results: A total of 1634 adolescents were included from in-school (n = 1134) and out-of-school (n = 500) categories. The prevalence of addictive behaviors was 19.1% (current smoking 6%, alcohol drinking 6.1%, and drug use 7%) among adolescents aged 13 to 19. Significant predictors of smoking were being male (aOR = 4.43; 95%CI: 1.92,10.20; p <.001) and having a working father (aOR = 3.19; 95%CI: 1.10, 9.20; p <.05). Total protective score [smoking: aOR = 0.99; 95% CI:0.97, 0.99: p <.05; alcohol use: aOR:0.98;95% CI:0.97,0.99; p <.01; drug use: OR:0.99, 95%CI: 0.98,0.99; p <.05] and total risk score [smoking: aOR = 1.14; 95%CI:1.11, 1.17: p <.001; alcohol use: aOR:1.10;95% CI:1.07,1.12; p <.001; drug use: aOR:1.05, 95%CI: 1.04,1.06 p <.001] were significantly associated with all three addictive behaviors. Conclusions: The current study's findings can inform the development of intervention programs focusing on both adolescents and communities (social environment surrounding adolescents) to enhance the protection of adolescents at risk for addictive behaviors. [ABSTRACT FROM AUTHOR]