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Abstract Aim Understanding vaccine hesitancy, as a critical concern for public health, cannot occur without the use of validated measures applicable and relevant to the samples they are assessing. The current study aimed to validate the Vaccine Hesitancy Scale (VHS) and to investigate the predictors of children’s vaccine hesitancy among parents from Australia, China, Iran, and Turkey. To ensure the high quality of the present observational study the STROBE checklist was utilized. Design A cross-sectional study. Method In total, 6,073 parent participants completed the web-based survey between 8 August 2021 and 1 October 2021. The content and construct validity of the Vaccine Hesitancy Scale was assessed. Cronbach’s alpha and McDonald’s omega were used to assess the scale’s internal consistency, composite reliability (C.R.) and maximal reliability (MaxR) were used to assess the construct reliability. Multiple linear regression was used to predict parental vaccine hesitancy from gender, social media activity, and perceived financial well-being. Results The results found that the VHS had a two-factor structure (i.e., lack of confidence and risk) and a total of 9 items. The measure showed metric invariance across four very different countries/cultures, showed evidence of good reliability, and showed evidence of validity. As expected, analyses indicated that parental vaccine hesitancy was higher in people who identify as female, more affluent, and more active on social media. Conclusions The present research marks one of the first studies to evaluate vaccine hesitancy in multiple countries that demonstrated VHS validity and reliability. Findings from this study have implications for future research examining vaccine hesitancy and vaccine-preventable diseases and community health nurses.

Abstract Aim This study explored the influence of student computer competency on e‐learning outcomes among Iranian nursing students and examined its mediating role in the relationship between virtual learning infrastructure, student collaboration, access to electronic facilities, and e‐learning outcomes. Design A cross sectional study. Method A self‐administered online survey was used from August to October 2022, with a sample size of 417 nursing students selected through convenience sampling. Descriptive statistics, correlation analyses, and PROCESS macro v4.1 (Model 4) were used for data analysis. Results The results revealed that virtual learning infrastructure, access to electronic facilities, and student collaboration, significantly predict student computer competency and e‐learning outcomes. Virtual learning infrastructure and access to electronic facilities were found to be the strongest predictors of student computer competency, while student collaboration had a smaller but still significant effect. Student computer competency was found to mediate the relationship between virtual learning infrastructure, access to electronic facilities, student collaboration, and e‐learning outcomes.

IntroductionThe psychometric properties of the body esteem scale have not been assessed in Iran. Therefore, the aim of this study was to translate and determine the validity and reliability of the Persian version of the body esteem scale among Iranian adolescents.MethodsThe sample of this methodological study consisted of 504 adolescents [mean age: 16.55 (SD = 1.54) years] living in Tehran City, Iran. After translation of the scale, its content validity (quantitative and qualitative) and structural (exploratory and confirmatory factor analysis), convergent, and discriminant validity were evaluated. Exploratory graph analysis was performed to determine the number of factors. Cronbach’s alpha, composite reliability, and maximal reliability were calculated.ResultsIn the content validity evaluation step, all items had acceptable scores and were retained. The results of exploratory factor analysis with Promax rotation and exploratory graph analysis extracted three factors accounting for 49.49% of the variance, comprising 18 items. Furthermore, after necessary modifications during CFA, the final model was approved. Convergent and discriminant validity were confirmed. Cronbach’s alpha, CR, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability.ConclusionAccording to the results, the Persian version of the body esteem scale has a valid structure and acceptable reliability. Health professionals, in many ways, can use this scale.

The need for accurate measurement of constructs and understanding of diverse phenomena has prompted researchers to investigate the validity and reliability of developed measures in a continuous effort to improve our understanding of their psychometric properties. However, at times, these endeavors are flawed by serious methodological inadequacies. In this article, we discussed one example of a psychometric study that appears to be deeply flawed, providing some recommendations for remediating the issue.

Purpose – Since the onset of the COVID-19 pandemic in China, student engagement in online learning has been a critical issue for all educational institutions. The university student engagement inventory (USEI) is the most used scale for assessing the construct of student engagement. The present study aimed to evaluate the psychometric properties of the USEI among 1504 Chinese university students who completed a survey through an online platform between December 2020 and January 2021. Design/methodology/approach – In this cross-sectional study, content validity, construct validity and reliability of the scale were assessed. Findings – The results supported the three-factor model with acceptable goodness of fit (χ2 (71) = 369.717, p = 0.13, χ2/df = 5.207, comparative fit index (CFI) = 0.967, normed fit index (NFI) = 0.960, Tucker–Lewis index (TLI) = 0.958, standardized root mean square residual (SRMR) = 0.030, root mean square error of approximation (RMSEA) (90% CI) = 0.053 [0.049, 0.057]), good internal consistency and construct reliability (Cronbach's alpha and omega coefficient >0.70) and strong convergent validity. Also, the measurement invariance was confirmed across gender. Originality/value – This study showed that the 3-factor structure of USEI with Chinese university students had good construct validity, internal consistency and reliability. It could help measure student engagement in online learning in China.

Abstract Background The resilience construct is considered a personal trait composed of multiple aspects. Connor–Davidson Resilience Scale is a standard tool composed of five factors and 25 items. This study aimed to determine the psychometric properties of this scale. Methods In this cross-sectional study, after the scale translation, the factorial structural validity was assessed via the confirmatory factor analysis with 70 180 samples. Internal consistency, composite reliability, convergent validity were assessed by calculating Cronbach’s alpha, composite reliability, maximum reliability, and Average Variance Extracted. The discriminant validity was assessed using Heterotrait-monotrait ratio of correlations matrix and also, measure invariance was evaluated. Results The original five-factor model had good model fit indices but due to low factor loading of item 2 and 20, the model was modified. The Cronbach’s alpha and composite reliability for four factors were above 0.7 (except for factor 5). The convergent validity for all five factors were achieved. Between factors 1 with 2 and 4, 2 with 3 and 4 discriminant validity was not established (correlations > 0.9) and the results suggested that there might be a second-order latent construct behind these factors. Therefore, a second-order assessment was performed. The results of the second-order latent construct assessment showed a good goodness-of fit and strong measurement invariance for both men and women. Conclusion The 23-item version of Connor-Davidson Resilience Scale is a reliable and valid scale to measure resilience as a complex construct in the Iran context.

Abstract Aim There has been growing concern about the nurses' turnover intention as well as life satisfaction during COVID‐19 pandemic in Iran. The past research has provided evidence on the effect of organizational support on nurses' job satisfaction and turnover intention. However, little is known about the underlying mechanism behind these associations. Design A cross‐sectional survey was undertaken. Methods An online survey was conducted in Iran from May to June 2020 through Google Docs Forms. In total, 305 nurses were participated and completed the online survey. Data were analysed using structural equation modelling through (AMOS). This study was checked with the STROBE checklist. Result The results showed that nurses' perception of organizational support was positively related to their job satisfaction which in turn decreases the turnover intention. Likewise, the job satisfaction partially mediated the relationship between organizational support and nurses' life satisfaction.

The practice of inclusive education in schools has led to changes in policy and pedagogy, hence teacher acceptance and attitude are important components of its success. The aim of this study is to identify the differences in attitudes of primary and secondary pre-service teachers on inclusion and the potential relationship between demographic variables such as definitions of inclusion, previous experience working in a school, completion of a module on inclusive schools, and other variables. The study included 548 Australian university students studying primary (n = 348) or secondary (n = 193) professional teaching. All participants completed the Teacher Attitudes to Inclusion Scale (TAISA). Principle components analysis was performed to transform the TAISA questionnaire into smaller set of components and two-way between-groups analysis of variance was used to analyse data. Results showed that primary pre-service teachers have more positive attitudes towards inclusion than secondary pre-service teachers. Primary pre-service teachers were also more responsive to training on inclusive education. Implications for practice and future research are discussed.

Background and purposeRecent new mutations and increases in transmission of COVID-19 among adolescents and children highlight the importance of identifying which factors influence parental decisions regarding vaccinating their children. The current study aims to explore whether child vulnerability and parents' attitudes toward vaccines mediate the association between perceived financial well-being and vaccine hesitancy among parents.MethodA predictive, cross-sectional, multi-country online questionnaire was administered with a convenience sample of 6,073 parents (Australia, 2,734; Iran, 2,447; China, 523; Turkey, 369). Participants completed the Parent Attitude About Child Vaccines (PACV), the Child Vulnerability Scale (CVS), a Financial Well-being (FWB) measure, and Parental Vaccine Hesitancy (PVH) questionnaire.ResultsThe current study revealed that perceived financial well-being had significant and negative associations with parents' attitudes toward COVID-19 vaccines and child vulnerability among the Australian sample. Contrary to the Australian findings, results from Chinese participants indicated that financial well-being had significant and positive predictive effects on parent attitudes toward vaccines, child vulnerability, and parental vaccine hesitancy. The results of the Iranian sample revealed that parents' attitudes toward vaccines and child vulnerability significantly and negatively predicted parental vaccine hesitancy.ConclusionThe current study revealed that a parents' perceived financial well-being had a significant and negative relationship with parental attitudes about vaccines and child vulnerability; however, it did not significantly predict parental vaccine hesitancy among Turkish parents as it did for parents in Australia, Iran, and China. Findings of the study have policy implications for how certain countries may tailor their vaccine-related health messages to parents with low financial wellbeing and parents with vulnerable children.

The COVID-19 pandemic caused unprecedented changes to educational institutions, forcing their closure and a subsequent shift to online education to cater to student learning requirements. However, successful online learning depends on several factors and may also vary between countries. As such, this cross-sectional study sought to investigate how engagement of university students, a major driver of online learning, was influenced by course content, online interaction, student acceptance, and satisfaction with online learning, as well as self-efficacy across nine countries (China, India, Iran, Italy, Malaysia, Portugal, Serbia, Turkey, and the United Arab Emirates) during the COVID-19 pandemic. Using a questionnaire-based approach, data collected from 6,489 university students showed that student engagement was strongly linked to perception of the quality of the course content and online interactions (p < .001). The current study also indicated that online interactions are a major determinant of academic efficacy but only if mediated by engagement within the online learning context. A negative correlation between student engagement and satisfaction with online learning was found, demonstrating the importance of students being engaged behaviorally, emotionally, and cognitively to feel satisfied with learning. Academic efficacy and student satisfaction were explained by course content, online interaction, and online learning acceptance, being mediated by student engagement. Student satisfaction and, to a lesser degree academic efficacy, were also associated with online learning acceptance. Overall, the structural equation model was a good fit for the data collected from all nine countries (CFI = .947, TLI = .943; RMSEA = .068; SRMR = .048), despite differences in the percentage variations explained by each factor (no invariance), likely due to differences in levels of technology use, learning management systems, and the preparedness of teachers to migrate to full online instruction. Despite limitations, the results of this study highlight the most important factors affecting online learning, providing insight into potential approaches for improving student experiences in online learning environments.

With the development of internet technology, e-learning has become an essential part of the modern education system. However, the e-learning market faces enormous competition. Consumers' continuance purchase intention has become a vital factor in the success of e-learning courses. Thus, factors that influence consumers' continuance purchase intention should be examined in the e-learning market. However, little research has focused on identifying the continuance purchase intention of an e-learning course. Based on the information system continuity model ISC), this paper develops a research model to investigate the factors influencing satisfaction and continuance purchase intention in e-learning. A cross-sectional, questionnaire-based research design was used in this study. We collected data from consumers who had enrolled in paid online Python courses. In total, 508 paid online Python course users completed the online survey. SmartPLS software was used for data analysis. The results demonstrated that perceived course quality, service quality, convenience, and usefulness significantly affect consumers' satisfaction with the experience course. Moreover, the findings show that satisfaction, self-efficacy, and e-word of mouth (e-WOM) determine the consumers' continuance purchase intention of the reminder course. This study also found that satisfaction mediates the effects of experience courses on consumers' continuance purchase intention of the online Python course. The implications for theory and practice and future research directions are discussed.

ObjectiveDespite the abundance of studies linking fear and anxiety to COVID-19, there are limited studies that examine how these elements impact psychological behavioral responses, especially in Iran. The aim of this study was to investigate the relationship between anxiety and fear of COVID-19 with psychological behavior response, whether this relationship is mediated by role of perceived stress among Iranian population during the COVID-19 pandemic.MethodsA predictive cross-sectional study was used to investigate the relationships between COVID-19 anxiety syndrome, fear of COVID-19 with psychological behavioral responses due to the pandemic, and the mediating role of the COVID-19 perceived stress in these relationships.ResultsThe current study revealed that during the COVID-19 pandemic, fear and anxiety of COVID-19 can influence the psychological behavioral responses of individuals; however, this can be explained through perceived stress.ConclusionAs such, the current study points out that the individuals who perceived high stress due to COVID-19 were more likely to comply with guidelines, which has given new insight into this field. The current study findings are applicable for health policymakers in order to help them in understanding human behavior for developing health promotion programs and also for fostering resilience among the general population.

Background: The consideration of future consequences (CFC) determines the extent to which individuals consider the potential future outcomes of their current behavior. The significance of assessing the CFC scale’s validation in different contexts has been acknowledged by the previous studies. While the majority of the studies have been conducted in western countries, no study has been conducted in Malaysia. The aim of the current study was to validate a Malaysian version of the CFC scale among Malaysian young adults.Methods: The methodological cross-sectional approach was adopted in this study. The study recruited 529 young adults (age range from 25 to 40) who fulfilled the inclusion criteria of the paper survey. Construct validity was assessed using content validity, convergent validity, and discriminant validity. Cronbach’s alpha, McDonald’s omega, and average inter-item correlation (AIC) were used to assess the scale’s internal consistency. Also, composite reliability (CR) and maximal reliability (MaxR) were used to assess the construct reliability. Measurement invariance was tested across gender.Results: The findings of the exploratory factor analysis indicated that the Malaysian version of the CFC scale has a two-factor structure (i.e., CFC-Future and CFC-Immediate) with 10-item explaining 61.682% of the total variance. The confirmatory factor analysis (CFA) supported the two-factor structure of the CFC scale with good construct validity. The internal consistency and CR were acceptable. [The Cronbach’s alpha, McDonald’s omega, and CR for CFC-I were 0.901 (CI 95%: 0.881–918), 0.901, and 0.887, respectively. Also, these parameters for CFC-F were 0.867 (CI 95%: 0.838–891), 0.868, and 0.867, respectively].Conclusion: We found acceptable psychometric evidence for the 10-item two-factors CFC scale used in the context of young adults in Malaysia. The validated instrument can be used in future studies to assess young adults’ CFC tendency and CFC-related behavior in Malaysia.

Background: Studies have revealed an increase in discrimination, neglect, and abuse among the older adult population during this period. This study assessed the validity and reliability of the Persian version of the ageism survey instrument tested on a sample of the Iranian older adult population during coronavirus disease (COVID-19) pandemic. An important move in counteracting ageism is to classify the ageism scale comprehensively by employing adequate psychometrics.Methods: The Persian version of the ageism scale was developed using a two-step procedure. The first step involved translating and revising the original scale to develop a Persian version of the ageism scale. The second step involved assessing the psychometric features of the newly adapted scale using construct validity through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and thereafter assessing the reliability through the average inter-item correlation (AIC), Cronbach's alpha. The sample consisted of 400 older adults (age 65 and older), who were recruited through online data collection, with samples for EFA and CFA randomly selected from the total samples.Results: The Persian version of the ageism survey has three factors: age-related deprivation with five items, dignity with three items, and employment with three items; all of which explained 57.02% of the total variance. The outcome of the EFA was verified by the CFA, with internal consistency reliability being excellent (Cronbach's alpha was 0.725, 0.698, and 0.708 for the three factors).Conclusion: This study specifically offers a restructured three factors Persian version of the ageism survey for Iranian older adults with acceptable construct validity and reliability.

This study investigates the relationship between spiritual well-being, social support, and financial distress with depressive symptoms due to the COVID-19 pandemic. A path analysis was used to analyze data collected from 1,156 Iranian participants via an online survey. The results showed that spiritual well-being and social support were negatively related to depressive symptoms and financial distress. The impact of COVID-19 events showed negative associations with depressive symptoms. In addition, the link between spiritual well-being and financial distress with depressive symptoms was partially mediated by the impact of events.

The aim of this study was to investigate the relationship between interaction and online learning satisfaction, whether this relationship is mediated by academic self-efficacy and student engagement among Chinese university students during the COVID-19 pandemic. A serial mediation model was developed to examine the proposed relationship. This study employed a cross-sectional, questionnaire-based research design. A sample of 1,504 Chinese university students (Mage=19.89years, SDage=1.93) from five provinces in China completed an online survey questionnaire from December 2020 to January 2021 to respond to questions on demographic characteristics and items to measure the variables in the research model. The partial least squares structural equation modeling was used to assess the measurement model and proposed serial mediation model. Data were analyzed using SmartPLS software version 3.3.2. The results of the measurement model showed good reliability and validity for all constructs. The results of the structural model and hypothesis testing showed that all hypotheses were supported in this study. Particularly, there was a significant positive relationship between interaction and online learning satisfaction (Q1), interaction and academic self-efficacy (Q2), academic self-efficacy and student engagement (Q3), and the student engagement and online learning satisfaction (Q4). In addition, the results showed that academic self-efficacy and student engagement serial mediated the relationship between interaction and online learning satisfaction (Q5). The serial mediation model explained 34.6% of the variance of online learning satisfaction. The findings shed light on the underlying mechanisms that explain students’ online learning satisfaction during the COVID-19 pandemic. Universities and policymakers need to make better decisions that ultimately could lead to students’ academic outcomes and achievement.

The motivational basis of self-regulated learning lays a solid theoretical framework for education researchers to look closely at the learners' intrinsic motivational factors in enhancing their academic outcomes. Particularly, learners' motivation forces, embedded in the self-regulatory learning (SRL) process, have not been well researched in an online learning environment, yet the correlations to learners' academic success. Hence, the current study employed 713 online university students and focussed on the motivational path rooted in the SRL model to elucidate the extent to which learners' motivational forces contribute to academic achievements. The results indicated that learning goal orientation was positively correlated to academic outcomes, while this correlation was not found to be mediated by academic self-efficacy, engagement, and learning satisfaction in an online learning environment. Further, the correlation between learning goal orientation and learning satisfaction was found to be mediated by academic self-efficacy and learning engagement. Directions for future research on the motivational bases of self-regulated learning are discussed.

Objective: This study aims to evaluate sources of validity and reliability of the University Student Engagement Inventory among Indian Students. Method: The data of this study was collected from 518 Indian university students in the design of a cross-sectional study from May to June 2022. Then the validity and reliability of the inventory were assessed. Results: The results showed that all three factor models indicated good evidence of construct validity (TLI = 0.960, CFI = 0.967), NFI = 0.960, and SRMR = 0.043), and reliability. The internal consistency of all three factors was > 0.7. Conclusions: According to the findings of the present study, it was found that the concept of university student engagement in Indian students is a concept with three sub-concepts and 15 items. For more learning, academic progress, and development, as well as obtaining better educational results, student participation is important. Significance Statement: Considering the importance of students' engagement in improving their performance and learning, it is necessary to evaluate it. Since, in other countries, the psychoanalysis of the USEI tool has also been discussed; in this study, the researchers investigated the validity and reliability of student engagement tools in India.

Riboflavin kinase (RFK) is essential in riboflavin metabolism, converting riboflavin to flavin mononucleotide (FMN), which is further processed to flavin adenine dinucleotide (FAD). While RFK enhances macrophage phagocytosis of Listeria monocytogenes, its role in macrophage polarization is not well understood. Our study reveals that RFK deficiency impairs M(IFN-γ) and promotes M(IL-4) polarization, both in vitro and in vivo. Mechanistically, RFK interacts with inducible nitric oxide (NO) synthase (iNOS), which requires FMN and FAD as cofactors for activation, leading to increased NO production that alters energy metabolism by inhibiting the tricarboxylic acid cycle and mitochondrial electron transport chain. Exogenous FAD reverses the metabolic and polarization changes caused by RFK deficiency. Furthermore, bone marrow adoptive transfer from high-riboflavin-fed mice into wild-type tumor-bearing mice reprograms tumor-associated macrophage polarization and inhibits tumor growth. These results suggest that targeting RFK-iNOS or modulating riboflavin metabolism could be potential therapies for macrophage-related immune diseases.

Purpose The objective of this study was to assess the accuracy of FreeStyle Libre Pro (FSL-Pro) flash continuous glucose monitoring (CGM) in patients with type 2 diabetes mellitus (T2DM) and acute myocardial infarction (AMI). Methods A single-arm, single-center prospective study was conducted in the cardiac care unit from January 2021 to September 2023. Patients underwent finger-prick blood glucose (FPBG) testing before breakfast (6:00 am) and after meals (at 9:00, 13:00, 19:00 pm), along with CGM during their hospitalization. Statistical analyses included mean differences (MDs), mean absolute relative difference (MARDs) of blood glucose levels, and hypoglycemia occurrences. A Bland–Altman plot analysis and Pearson correlation were performed. Results Ninety-seven T2DM and AMI patients underwent CGM for up to 72 h (1142 monitoring point). Mean daily BG, Fasting plasma glucose (FPG) and mean postprandial plasma glucose (PPG) were significantly lower by CGM than by FPBG with an estimated MD of −0.89 mmol/L in BG, −0.88 mmol/L in FPG, and −0.90 mmol/L in PPG, respectively. The maximum effect was mainly in the first day and then the difference was gradually declined (falling range, Day1, −1.24; Day 2, −0.70; Day 3, −0.68, mmol/L, respectively). The incidence rates of hypoglycemia and potential hypoglycemia was 1.57% and 8.5% higher, respectively, in CGM than in FBPG. A Bland–Altman Plot revealed some variability and bias between the two methods of measurement of glucose monitoring ( p

ObjectivesTo explore the utility of gray-scale ultrasound (GSUS) and mammography (MG) for radiomic analysis in distinguishing between breast adenosis and invasive ductal carcinoma (IDC).MethodsData from 147 female patients with pathologically confirmed breast lesions (breast adenosis: 61 patients; IDC: 86 patients) between January 2018 and December 2022 were retrospectively collected. A training cohort of 113 patients (breast adenosis: 50 patients; IDC: 63 patients) diagnosed from January 2018 to December 2021 and a time-independent test cohort of 34 patients (breast adenosis: 11 patients; IDC: 23 patients) diagnosed from January 2022 to December 2022 were included. Radiomic features of lesions were extracted from MG and GSUS images. The least absolute shrinkage and selection operator (LASSO) regression was applied to select the most discriminant features, followed by logistic regression (LR) to construct clinical and radiomic models, as well as a combined model merging radiomic and clinical features. Model performance was assessed using receiver operating characteristic (ROC) analysis.ResultsIn the training cohort, the area under the curve (AUC) for radiomic models based on MG features, GSUS features, and their combination were 0.974, 0.936, and 0.991, respectively. In the test cohort, the AUCs were 0.885, 0.876, and 0.949, respectively. The combined model, incorporating clinical and all radiomic features, and the MG plus GSUS radiomics model were found to exhibit significantly higher AUCs than the clinical model in both the training cohort and test cohort (p0.05).ConclusionThe effectiveness of radiomic features derived from GSUS and MG in distinguishing between breast adenosis and IDC is demonstrated. Superior discriminatory efficacy is shown by the combined model, integrating both modalities.

Abstract Background Atrial fibrillation (AF) is a common arrhythmia that requires anticoagulation therapy to prevent stroke. However, there is still a significant under-/over-treatment in stroke prevention for patients with AF. The adherence and the risk of bleeding associated with oral anticoagulation therapy (OACs) are major concerns. Shared decision-making (SDM) is an approach that involves patients and healthcare providers in making decisions about treatment options. This study aims to assess the effectiveness of a novel SDM tool for anticoagulation management in AF. Methods The study will be a prospective, cluster randomized controlled trial involving 440 patients with AF in 8 community health service centers (clusters) in Shanghai, China. The SDM group will receive anticoagulation management through the novel SDM tool, while the control group will receive standard care. The follow-up period will be at least 2 years. The primary outcome will be any bleeding event, while secondary outcomes include the accordance of stroke prophylaxis for AF according to the current guidelines, time in therapeutic range (TTR), the occurrences of major bleeding and thrombosis events, and patient knowledge, adherence, and satisfaction. Discussion This study will provide evidence of the effectiveness of shared decision-making in improving the appropriateness of OAC use in Chinese AF patients. The findings may inform the development of guidelines and policies for the management of AF and anticoagulation therapy in China and other countries. Trial registration ChiCTR ChiCTR2200062123. Registered on 23 July 2022.