Completed Questionnaires Research Articles

Breathlessness, but not breathing instability varies with posttraumatic stress symptoms in University students.

Obstructive sleep apnoea (OSA) is a chronic sleep-related breathing disorder that is highly prevalent in individuals with posttraumatic stress disorder (PTSD). The reason for this high prevalence remains unclear. We hypothesised that breathing instability, , one of the key contributors to OSA, may be altered in PTSD and predispose OSA. Healthy participants (214 females, 98 males) aged 17 to 42 (M = 19.92; SD = 2.85) completed online questionnaires measuring PTSD symptomatology, sleep disturbances, and self-reported breathlessness. A subset of these participants (16 females, 14 males) aged 18 to 42 (M = 23.50; SD = 7.18) completed an in-lab breathing instability assessment, whereby they performed a series of 20-second and maximal duration breath-holds. PTSD severity positively predicted subjective perceptions of breathlessness (p<.001) but not objective measures of breathing instability, namely ventilation following 20-second breath-holds (p=.93) and maximal breath-hold duration (p=.41). These results suggest that breathing instability may not be the driving factor behind the high prevalence of OSA in PTSD. Instead, other factors such as a low arousal threshold, elevated ventilatory responses to arousal, or coexisting insomnia may explain the high rates of OSA in PTSD. One explanation for the discrepancy between subjective breathlessness and breathing stability measures relating to PTSD severity may be that hypervigilance and increased anxiety impacted self-perceptions of breathlessness while not altering breathing instability per se.

Contactless Service: Artificial Intelligence Applications of Airports

Airports are an essential part of the airline value chains. Artificial intelligence (AI) technologies are widely used at airports; they utilize two technologies: face detection and recognition. The study examines how passengers' performance expectancy and emotions affect satisfaction and willingness to adopt the AI service of passengers via familiarity. Based on the AI device, it uses acceptance and socio-technical systems perspectives; participants who adopted the AI service in airports in Beijing, Taipei, and Singapore who have the potential to use AI service usage experience more than three times; 387 completed questionnaires. A satisfaction model was analyzed using the partial least squares approach; this study used purposed sampling to collect data based on the passenger volume analysis by those airports, and 387 completed questionnaires were analyzed. With the rise of AI innovation services in airports, passengers can quickly complete boarding procedures through AI innovative services. The research findings point out that passengers' performance expectancy and emotions positively affect familiarity with AI services for passengers. AI innovations provide a service change driver for and have the potential to replace human tasks and intelligence and analytics applications at airports. AI services are a powerful tool for airports to serve their passengers efficiently, and airports will collaborate with airlines to serve passengers with AI.

Knowledge, attitudes, and practices on the use of local anaesthesia in the Emergency Department

Background: Local anaesthesia (LA) is frequently used in the Emergency Department (ED). Local anaesthetic systemic toxicity (LAST) is a potentially fatal complication associated with its use. It is assumed that all doctors administering LA are trained in all aspects of its use including the management of LAST.Methods: A prospective, multicentre cross-sectional study was conducted at three academic EDs in Gauteng. Doctors working in the ED completed an online questionnaire designed to assess knowledge, attitudes and practices regarding the use of LA as well as the recognition and management of LAST.Results: A total of 94 completed questionnaires were analysed. Of these, 44% of participants had graduated from medical school less than 5 years ago, and 72% had less than 5 years of experience working in the ED. The overall mean knowledge score percentage for the safe use of LA was 48.2%. The overall mean knowledge score percentage for recognition and management of LAST was 56.7%. A total of 78% of participants knew that intravenous intralipid emulsion (ILE) therapy is needed in managing LAST; however, only 25% of participants knew where to access ILE and only 33% knew how to use it.Conclusion: The overall level of knowledge on LA and the management of LAST among doctors working in the ED is low. There is also an apparent lack of awareness of the potential for toxicity despite frequent use of LA. Although the occurrence of LAST is rare, our findings highlight an obligation for continuous education on local anaesthesia and the management of LAST.Contribution: The result of this research indicates a gap in training regarding the potential for toxicity of local anaesthesia, recognition of systemic toxicity, and the management thereof. These findings suggest the possibility of misdiagnosis and under reporting of LAST.

Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study.

Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact. This study aims to evaluate the feasibility of a social gaming app in reducing loneliness among older adults by evaluating recruitment strategies, data collection procedures, and gameplay activity. This mixed methods study recruited participants via newsletters, articles, and a social media campaign. We used semistructured interviews and descriptive analysis of questionnaire answers and game data to assess feasibility. Key measures included recruitment reach and efficiency, participant demographics, in-app activity, and app usability and engagement feedback. The social media campaign reached 192,641 potential participants, resulting in 1363 game downloads. A total of 155 participants (aged 65 years and older: n=34, 21.9% and aged less than 65 years: n=121, 78.1%) provided informed consent, yielding a conversion rate of 0.08%. The recruitment campaign focusing on distanced playful interaction had a significantly (P<.001) higher click-through rate (1.98%) than a campaign focusing on research participation (click-through rate=0.51%; P<.001). The overall conversion rate from advertisement exposure to research participation was 0.08%. Participants had a mean age of 48 (SD 16) years. The 65 years and older group averaged 70 (SD 5) years, while the less 65 years group averaged 42 (SD 12) years. Additionally, 45.2% (57/126) reported at least moderate levels of loneliness at baseline. Of the initial 554 players, 91 (16.4%) remained active after the first week, and 32 (5.8%) remained active for more than 90 days. Active participants tended to interact with those within their own age group, as indicated by a Pearson correlation of r=0.31 between the ages of the message sender and receiver. Interviews with 12 (48%) participants (aged 65-79 years; female: n=12, 83%) revealed barriers such as excessive chatbot questions and a mismatch between the target group and app design focus. Questionnaire completion rates dropped from 46% at baseline to 10% at follow-up. These findings underscore the challenges of recruitment and retention for older adults in a fully digital social gaming intervention. Effective recruitment strategies and targeted app design are crucial for engagement. Based on these insights, future interventions should focus on simplified interfaces, clear guidance for gameplay, and addressing the specific needs and preferences of older adults, thereby enhancing the effectiveness of digital mental health interventions.

Like parents, like children… this is not always the case! Alongitudinal study on the family transmission of intergroupcontact.

During adolescence, opportunities for interethnic interactions can shape future attitudes toward diversity. However, it is unclear how family can influence adolescents' quality of contact in different life contexts. This study aims to fill this gap. A sample of 702 Italian adolescents (Mage = 15.61, SDage = 1.11, 48.58% girls) and their parents (615 mothers, Mage = 48.45, SDage = 4.34; 487 fathers, Mage = 51.22, SDage = 4.92) completed questionnaires at two time points. Cross-lagged models indicated that adolescents' intergroup contact at T1 was associated with mothers' contact over time, mainly in structured (i.e., school and work) contexts. No significant associations were found regarding fathers' intergroup contact and unstructured contexts. These results shed new light on the process of family transmission during adolescence, particularly regarding intergroup dynamics.

How We Communicate Forgiveness to Our Partners Matters: Forgiveness-Granting Strategies, Forgiveness Tendency, Commitment, and Relationship Satisfaction in Dating and Married Couples

Abstract Individuals in dating and marital relationships experience various transgressions that require forgiveness (e.g., hurtful communication, mistrust, lies, or infidelity). This study examines forgiveness-granting strategies in the context of forgiveness tendency, relationship length, commitment, satisfaction, and relational consequences to better understand relationship dynamics. 649 individuals (532 dating, 117 married), aged 18–65 (M = 26.00, SD = 8.82) participated. The sample included 517 women (79.7 %) and 132 men (20.3 %). Participants described a forgiven transgression and completed questionnaires, including the Multidimensional Forgiveness-Granting Scale (MFGS), Transgression-Related Interpersonal Motivations Inventory (TRIM-18), Relationship Assessment Scale (RAS), and the commitment subscale from the Investment Model Scale. One open-ended question (types of forgiven transgressions) was analyzed consensually. Quantitative data were analyzed using correlational analysis, regression analysis, and t-tests. The most common transgression was infidelity. A linear regression analysis showed that the strongest positive predictor of relationship satisfaction was the tendency to forgive one’s partner. Nonverbal displays positively predicted relationship strengthening, while the discussion strategy predicted relationship deterioration negatively. These findings emphasize the importance of how forgiveness is communicated and may inform interventions to enhance romantic relationships.

Digital health literacy among undergraduate nursing students in China: associations with health lifestyles and psychological resilience

BackgroundDigital health literacy (DHL) is pivotal for individuals to access trustworthy health information and make informed decisions, closely intertwined with health behaviors and psychological resilience—these factors collectively shape an individual’s approach to health management. Despite extensive research on digital health literacy in broader populations, the specific dynamics of digital health literacy in relation to health behaviors and psychological resilience among undergraduate nursing students in China remain understudied, highlighting a gap that this research endeavors to address. This study aims to assess the levels of digital health literacy among undergraduate nursing students in China, and to explore its association with health lifestyles and psychological resilience, which are considered influential factors.MethodsEmploying a descriptive cross-sectional research design, eligible Chinese nursing undergraduates were surveyed from June to October 2023. This study recruited a total of 418 undergraduate nursing students. After excluding 11 students on leave, 407 students participated in questionnaire completion and submission. The College Students’ Digital Health Literacy Scale, Healthy Lifestyle Assessment Scale and The Psychological Resilience Scale were used in this study.ResultsThe mean scores for digital health literacy, health lifestyles, and psychological resilience were 74.78 ± 8.44, 127.14 ± 11.22, and 79.21 ± 11.02, respectively. Pearson correlation analysis results indicated that the correlations between digital health literacy and both health lifestyles (r = 0.707, P < 0.01) and psychological resilience (r = 0.638, P < 0.01) were statistically significant and positive. The multiple linear regression analysis revealed that volunteer activity experience, academic performance, physical fitness, psychological traits, health lifestyle, and psychological resilience significantly predicted digital health literacy (F = 58.091, P < 0.001, R² = 0.678, adjusted R² = 0.666). Specifically, excellent academic performance (β = 0.210, P < 0.001) and good physical fitness (β = 0.188, P = 0.002) were the strongest predictors of higher digital health literacy.ConclusionsThere is a correlation between the digital health literacy of nursing undergraduates and their health lifestyles and psychological resilience. Future research should consider interventions in digital health literacy for undergraduate nursing students in China from the perspectives of health lifestyles and psychological resilience.

Attachment anxiety mediates the relationship of need to belong and Fear of Missing Out (FoMO)

Fear of Missing Out (FoMO), the concern one is presently absent from a rewarding experience, is an emerging topic in the empirical literature. Though it has been demonstrated that numerous factors including anxiety and depression predict the extent an individual experiences FoMO, more research is needed to understand the inner mechanisms that work between these variables to result in FoMO. One such factor which may mediate the relations of anxiety and depression on FoMO is the need to belong (NTB). The goal of the current research aims to evaluate if NTB mediates the relationship of anxiety and depression with FoMO. In addition, we aimed to detect if attachment anxiety mediates the relationship of anxiety and FoMO. Lastly, the current study evaluated if attachment anxiety mediates the relationship between NTB and FoMO. An effective sample of 397 adults from the United States were recruited to complete multiple questionnaires. Structural Equation Modeling (SEM) was used to test a theoretical model depicting anxiety and depression as predictors of NTB, NTB predicting both attachment anxiety and FoMO, attachment anxiety predicting FoMO, and anxiety predicting attachment anxiety. Our results indicated that NTB was a strong predictor of FoMO, and this effect was mediated by attachment anxiety. Moreover, NTB mediated the influence of depression on FoMO, while attachment anxiety mediated the impact of anxiety on FoMO. The current research outlines that NTB is a key individual difference for why everyone does not uniformly experience FoMO. Limitations and suggestions for future research are outlined.

Leveraging Green Finance to Improve SME Sustainability in Nigeria

This research investigates the impact of various dimensions of green finance on the environmental performance of SMEs, focusing on selected manufacturing SMEs in Lagos, Nigeria. Two hundred and fifty surveys were distributed to the designated participants, resulting in the successful collection of 235 completed questionnaires. The data analysis utilized both the Pearson Product Moment Correlation Coefficient (PPMCC) and Path Analysis-Structural Equation Modeling (PA-SEM). The findings indicate a positive association between green investment and green training with SME environmental performance, although the correlation is not statistically significant. This suggests that while green investment and training show potential for enhancing SMEs' environmental performance, further exploration is needed. Conversely, the study confirms a positive and significant relationship between green loans, green technology, and SME environmental performance, highlighting the effectiveness of green loans and technology in promoting environmental responsibility among SMEs. In light of these results, it is recommended that governmental bodies, financial institutions, and other stakeholders provide financial incentives and support to SMEs for the adoption of green technology and green loans. Additionally, a collaborative effort is encouraged to actively promote green training initiatives for SME employees. This collective approach aims to cultivate a sustainable and environmentally conscious business environment, aligning with the overarching objectives of environmental sustainability.

Sex influences whether hippocampal volumes mediate the relationship between depression and cognition in older adults without dementia: A UK Biobank study.

Depression is a modifiable risk factor for dementia; however, it remains unclear whether there are sex differences in how depression affects dementia risk. To better understand sex-specific differences in how depression confers risk of dementia, the link between depression, hippocampal volumes, and cognition was evaluated in a sample of older adults without dementia from the UK Biobank cohort. A total of 18,220 participants (women n = 9,474; men n = 8,746) were selected based on completion of the Patient Health Questionnaire (PHQ-9), structural MRI, and cognitive assessments. Causal mediation analyses were used to evaluate if the relationship between depression and cognition is mediated by the hippocampus differently by sex. Women reported greater depression severity than men. Hippocampal volumes were found to mediate the relationship between depression severity and fluid intelligence only in women. Upon categorization of the depression symptoms as either cognitive/affective or somatic, the mediation effect of the hippocampus was seen for both cognitive/affective and somatic symptom severity in women for fluid intelligence. These results offer insight into the sex-specific pathways underlying the relationship between depression, hippocampal volumes, and cognition in older adults without dementia with a focus on the type of depression symptoms. This knowledge could aid in the development of sex-focused dementia prevention strategies and treatments.

Parental attachment and mental health in Chinese early adolescents: The mediation role of narcissism

The generalization of multiple attachment models in Chinese youth is still unknown, and the specific effect of combined parental attachment on the mental health of early Chinese adolescents and the mechanism behind it remains unclear. Therefore, the aim of this study was to empirically investigate the effect of parental attachment on early Chinese adolescents’ mental health, to examine which multiple attachment model could best explain this impact, and to explore the mediating effect of narcissism between them. A sample of 834 early adolescents was recruited to complete standard questionnaires. Regression analyses, MANOVA, and mediation analysis were performed. We found (1) the effects of parental attachment on the mental health of early Chinese adolescents were generally consistent with the integrative model of multiple attachment; (2) a linear relationship was observed between combined parental attachment and anxiety/depression, while a curvilinear relationship was observed between combined parental attachment and life satisfaction; (3) combined parental attachment could affect mental health through vulnerable narcissism instead of grandiose narcissism. The current study offered one of the first evidence for the association between parental attachments and early adolescents’ mental health within a multiple attachment framework in China and provided valuable insight into the role of narcissism between them, as well as contributing to the literature by suggesting that the integrative model could be better refined by considering the characteristics of the indicators.

Influence of Defense Mechanisms on Sport Burnout: A Multiple Mediation Analysis Effects of Resilience, Stress and Recovery.

The aims of this study were: (a) to explore the relationships between adaptive defense mechanisms (ADMs), maladaptive defense mechanisms (MADMs), stress, recovery, resilience, and sport burnout; and (b) to examine resilience, stress, and recovery as mediators of the relationship between defense mechanisms and burnout. One hundred and seventy-five athletes (M = 20.30 years, SD = 3.75) completed self-report questionnaires assessing defense mechanisms, resilience, stress, and recovery. Correlation analysis revealed that MADMs were positively associated with burnout, while ADMs had no significant link with burnout. Concerning mediation analysis, results showed a mediating effect of resilience in the relationship between ADMs and burnout. The findings also demonstrated a mediating effect of resilience and recovery in the relationship between MADMs and burnout. Our study highlighted that certain defenses categorized as adaptive might not be suitable in specific situations, thus underscoring the influence of mediating variables. The findings of mediation analysis demonstrated that resilience appears to serve as a particularly protective factor against burnout. On the contrary, MADMs would have a deleterious influence in the management of stress, which could lead to burnout. Coaches may consider fostering athletes' resilience in conjunction with ADMs and implementing targeted psychological exercises to reduce the use of MADMs.

Attachment, emotion regulation, and their roles in refugee post-traumatic stress and post-migration living difficulties

ABSTRACT Background: Upon arrival in the host country, refugees and asylum seekers (RAS) experience a range of post-migration living difficulties (PMLD), which are often linked to psychological symptoms such as post-traumatic stress (PTS). Initial research suggests that attachment insecurity partly explains the association between PMLD and psychological symptoms in RAS. However, the mechanisms through which attachment insecurity may act as a mediator are not well understood, though emotion dysregulation is one of the potential candidates. Objectives: This study investigated (1) whether attachment insecurity (i.e. anxiety and avoidance) mediate the association between PMLD and PTS, and (2) whether this mediation model can be extended to emotion dysregulation. Methods: 134 treatment-seeking RAS living in Switzerland completed questionnaires assessing PMLD, attachment insecurity, emotion dysregulation, and PTS. Two models were tested: (1) a parallel mediation analysis with attachment anxiety and avoidance as mediators, and (2) a serial mediation analysis with attachment anxiety as the first and emotion dysregulation as the second mediator. Results: First, PMLD was indirectly associated with PTS through attachment anxiety but not avoidance. Second, the association between PMLD and PTS was further explained by a pathway through attachment anxiety and emotion dysregulation. Conclusions: Although this study is limited by its cross-sectional design, we identified attachment anxiety and emotion dysregulation as potential mechanisms explaining how PMLD affects symptoms of PTS in RAS. Systematically assessing attachment style and addressing emotion regulation may therefore help improve treatment of refugee and asylum-seeking patients.

Evaluation of retear rates following transtibial anterior cruciate ligament reconstruction: Functional outcomes and GNRB assessment with a mean 6.3-year follow-up

The method of reconstruction of the anterior cruciate ligament (ACL) using the tibia-dependent femoral tunnel technique is highly criticized. It would not allow anatomical placement of the graft and would therefore lead to a high rate of retear. This retrospective study aimed to evaluate the rate of retear in ACL reconstructions using the transtibial tunnel (TT) technique and assess functional outcomes. The study included 148 patients (153 knees) who underwent ACL reconstruction with a minimum two-year follow-up period. Patients underwent clinical examinations, completed functional questionnaires (KOOS, Lysholm, ACL-RSI), and underwent laximetry measurements with GNRB at 134 N and 200 N. Two patients had retears detected on MRI and underwent revision surgery prior to the study, leaving 151 knees for evaluation. The retear rate was 6.6 %, with an overall rate of 7.8 % when including revision cases. Laxity measurements obtained with GNRB showed a strong correlation with functional scores, indicating worse scores with greater laxity differences (p < 0.0001). The retear rate observed in this study was at the higher end of those reported in the literature. The study indications for TT ACL reconstructions must be defined more specifically to reduce failure rates.Level of evidence: III (retrospective cohort study).

Mobile health monitoring of children with CHDs.

Mobile health has been shown to improve quality, access, and efficiency of health care in select populations. We sought to evaluate the benefits of mobile health monitoring using the KidsHeart app in an infant CHD population. We reviewed data submitted to KidsHeart from parents of infants discharged following intervention for high-risk CHD lesions including subjects status post stage 1 single ventricle palliation, ductal stent or surgical shunt, pulmonary artery band, or right ventricular outflow tract stent. We report on the benefits of a novel mobile health red flag scoring system, mobile health growth/feed tracking, and longitudinal neurodevelopmental outcomes tracking. A total of 69 CHD subjects (63% male, 41% non-white, median age 28 days [interquartile range 20, 75 days]) were included with median mobile health follow-up of 137 days (56, 190). During the analytic window, subjects submitted 5700 mobile health red flag notifications including 245 violations (mean [standard deviation] 3 ± 3.96 per participant) with 80% (55/69) of subjects submitting at least one violation. Violations precipitated 116 interventions including hospital admission in 34 (29%) with trans-catheter evaluation in 15 (13%) of those. Growth data (n = 2543 daily weights) were submitted by 63/69 (91%) subjects and precipitated 31 feed changes in 23 participants. Sixty-eight percent of subjects with age >2 months submitted at least one complete neurodevelopment questionnaire. In our initial experience, mobile health monitoring using the KidsHeart app enhanced interstage monitoring permitting earlier intervention, allowed for remote tracking of growth feeding, and provided a means for tracking longitudinal neurodevelopmental outcomes.

Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study.

This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach. In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6weeks postpartum for 3 to 6months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6weeks, 6months and 12months postpartum and were divided, by their own choice, into users and non-users of the pessary. Initially 857 women were enrolled. After 6weeks 137 pessary users and 133 non-users, after 12months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6weeks postpartum. At 12months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6weeks to 12months postpartum, among pessary users compared to non-users. Pessary users had a significantly greater improvement in pelvic floor function from 6weeks to 12months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group. The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.

Development and validation of an image-based questionnaire ARTROVIS to identify risk factors for the articular syndrome and related conditions

Background: The importance of timely diagnosis of rheumatic diseases is beyond any doubt. However, in the real practice the time from manifestation of the first symptoms to the assessment by a rheumatologist and treatment administration often exceeds the window of opportunity for disease control. At the moment, there has been no Russian-language questionnaire that would allow a primary care physician to suspect a rheumatic disease manifesting with an articular syndrome. Aim: To develop, validate and test a questionnaire to identify risk factors for joint disorders and related conditions. Methods: From November 2022 to April 2024, we performed the study on the image-based questionnaire on identification of the risk factors for joint syndromes and associated conditions (ARTROVIS), which we have developed for early detection of both joint syndromes, as well as comorbid conditions associated with elevated serum uric acid levels (hyperuricemia). The initial test version of the questionnaire was tested in a focus group of respondents (n = 20) who came for regular medical examination. Based on the results of this face validity assessment, we corrected the wording of 10 questionnaire items. At the second study step, we assessed the primary validity and reliability of the questionnaire in a group of 41 rheumatology patients. The third study step involved 828 respondents (408 men and 420 women, median age 19 [18,0; 20,0] years; 21% with joint syndromes), who came for routine medical examination. The reliability of the questionnaire, its face and discriminant validity, as well as sensitivity and specificity (the ROC analysis) were assessed from 827 questionnaires included in the final processing (one was excluded due to questionnaire completion defects). Results: The self-report questionnaire for patients (ARTROVIS) has 24 items aimed at collecting social and demographic data, identifying risk factors for non-communicable diseases, assessing genetic aspects, identifying complaints from various organ systems, providing information on medical treatments taken by the patient (non-steroid anti-inflammatory agents, diuretics, antihypertensives, glucocorticosteroids, chemotherapy and radiation therapy), as well as an additional question for women on current pregnancy pathology. The questionnaire contains visual aids (colored photos) that facilitate the detection of clinical signs of autoimmune (psoriatic arthritis, Reynolds’s syndrome) and inflammatory rheumatic disease (gout), as well as the differential diagnosis of the joint syndrome. The assessment of face validity of the questionnaire showed the total number of missed answers of 3.42%; 62.85% of the respondents gave their full answers to all items. Good discriminant validity was demonstrated. The ROC analysis showed high correlation between the questionnaire score and the presence of a joint syndrome: the area under the curve was 0.884. The Cronbach’s alfa was 0.798, which is sufficient for a medical questionnaire. Conclusion: We have performed the approbation and standardization of the questionnaire to identify risk factors for the joint syndrome and related comorbidities by assessing its validity and reliability. The ARTROVIS as a self-report questionnaire can be used in primary care as a tool enabling general practitioners and internists to decide on further patient routing to corresponding specialists.

Parental Phubbing Behavior and Adolescents' Online Gaming Time: The Mediating Role of Electronic Health Literacy.

The purpose of this study is to explore the relationship between parents' phubbing behavior and children's online gaming time. More importantly, we investigated the mediating role of electronic health literacy in this association. A total of 1200 questionnaires were sent out and 1130 effective questionnaires were returned, an effective recovery of 94.17%. As some students did not answer part of the EHL survey, eventually only 867 students were included in this study based on the selected independent variables and the degree of questionnaire completion. Both tools used for measuring parental phubbing and electronic health literacy passed confirmatory factor analyses. To analyze the mediating effect of electronic health literacy on parental phubbing behavior and online gaming time, 5000 datapoints were sampled using the Bootstrapping method. The results indicated that parents' phubbing was positively related to their children's online gaming time, which was mediated by electronic health literacy, parental phubbing is positively and significantly correlated with electronic health literacy, and electronic health literacy is negatively and significantly correlated with online gaming time among adolescents. Electronic health literacy partially mediates the relationship between parental phubbing behavior and adolescent online gaming time, and Chinese students' electronic health literacy is a two-dimensional structure consisting of health information acquisition and application. This study is the first empirical study to explore the relationship between parental phubbing behavior and the amount of time adolescents spend playing games online.

Serum per- and polyfluoroalkyl substance (PFAS) levels and health-related biomarkers in a pilot study of skiers in New England

BackgroundPer- and polyfluoroalkyl substances (PFAS), synthetic chemicals with adverse health effects, are used extensively in consumer products. Ski waxes, applied to the base of skis, contain up to 100% PFAS by mass, but exposure and health effects are poorly characterized. ObjectivesOur objectives were to quantify serum PFAS concentrations among skiers and explore associations with reported ski wax use and biomarkers of cardiometabolic, thyroid, and immune health. MethodsWe recruited 30 active adult skiers to provide non-fasting blood samples and complete questionnaires. We quantified 18 PFAS using mass spectrometry, and measured serum lipids, thyroid hormones, and immunoglobulins. We explored associations of individual and aggregate measures of serum PFAS with wax use indicators and health biomarkers using multivariable regression models, adjusted for age and gender identity. ResultsNine PFAS (PFBS, PFHpS, PFHxS, Sm-PFOS, n-PFOS, PFDA, PFNA, PFUnDA, n-PFOA) were detected in 100% of participants, and MeFOSAA in 93%. Compared to NHANES, median serum concentrations (ng/ml) were similar, but higher in coaches (e.g., PFOAall: 1.1, PFOAcoaches: 2.7, PFOANHANES: 1.2; PFNAall: 0.5, PFNAcoaches: 1.7, PFNANHANES: 0.4). Factors reflecting wax exposure were positively associated with PFAS: e.g., >10 years as a snow sport athlete, compared to ≤10 years, was associated with 3.2 (95% CI: 0.7, 5.6) ng/ml higher aggregate PFAS, as defined by National Academies of Science, Engineering, and Medicine (NASEM). An IQR (6.3 ng/ml) increase in NASEM PFAS was associated with 32.1 (95% CI: 7.0, 57.2), 35.5 (13.5, 57.5), and 12.8 (0.6, 25.1) mg/dl higher total cholesterol, LDL-C, and sdLDL-C, respectively. DiscussionOur study provides early evidence that recreational skiers, particularly coaches, are exposed to PFAS through ski wax. Several PFAS were associated with higher serum lipids among these physically active adults. Interventions to remove PFAS from fluorinated wax could decrease direct exposure to skiers and reduce PFAS release into the environment.

Development of a new patient-reported outcome measure for patients with multiple sclerosis: the Multiple Sclerosis Autonomy Scale (MSAS)

BackgroundIn multiple sclerosis (MS), the measure of the loss of autonomy appears to be particularly relevant to provide adapted and personalized responses to improve the quality of care in routine clinical practice. In this context, this research aimed to develop a new patient-reported outcome measure (PROM) evaluating MS patients’ autonomy, in order to provide an easy-to-use tool in the context of the relations between healthcare professionals and patients with MS, and to be used in future clinical trials for treatment assessment. MethodsThis research was conducted in two consecutive stages. First, a preliminary questionnaire was generated using an innovative sociological approach for MS (after literature review, patient interviews, experts’ opinion, and patient focus groups). This questionnaire was then completed by patients with MS, before the reduction of the scale while maintaining relevant information, using a principal component analysis. The internal consistency reliability was assessed using the Cronbach's alpha coefficient. The external validity was evaluated using an analysis of variance to estimate the relation between the reduced questionnaire dimension scores and disease severity classes assessed by the SymptoMScreen questionnaire. ResultsThe first qualitative step of the research led to provide a definition of disease-related autonomy as perceived by patients (to be able to carry out the roles the patient thinks the most important whether or not he/she receives assistance) as well as an associated taxonomy. On this basis, a preliminary questionnaire of 131 items grouped into 13 social dimensions was generated (seven dimensions with 63 questions concerning all the patients, and six dimensions with 68 questions concerning specific patients). This questionnaire was completed on a web platform by 653 analyzable patients with MS. Their main characteristics were as follows: female patients: 83.6 %, mean age at MS diagnosis: 34.8 ± 10.5 years, age ≥40 years at data collection: 68.1 %, MS duration ≥5 years: 68.4 %, severe MS (SymptoMScreen score ≥30): 36.8 %. On the basis on completed 131-item questionnaires, it was reduced in a 36-item short form of 10 social dimensions (five dimensions with 19 questions concerning all the patients, and five dimensions with 17 questions concerning specific patients). The internal consistency of the final questionnaire was good for all the dimensions, as the Cronbach's alpha coefficient ranged from 0.77 to 0.85 depending on dimensions. The construct validity of the questionnaire was also confirmed. ConclusionOur research allowed to build the first PROM designed to evaluate the autonomy of patients suffering from MS: the Multiple Sclerosis Autonomy Scale (MSAS). A confirmatory study, conducted in patients with MS using this validated questionnaire, is currently conducted.