Cross-sectional Study Research Articles

Sex differences in the association between the muscle quality index and the incidence of depression: A cross-sectional study

BACKGROUND Depression presents significant challenges to mental health care. Although physical activity is highly beneficial to mental and physical health, relatively few studies have conducted on the relationship between them. AIM To investigate the association between muscle quality index (MQI) and incidence of depression. METHODS The data used in this cross-sectional study were obtained from the 2011-2014 National Health and Nutritional Examination Survey, which included information on MQI, depression, and confounding factors. Multivariable logistic regression models were employed, while taking into account the complex multi-stage sampling design. A restricted cubic spline model was utilized to investigate the non-linear relationship between the MQI and depression. Additionally, subgroup analyses were performed to identify influential factors. RESULTS The prevalence of depression in this population was 8.44%. With the adjusted model, the MQI was associated with depression in females (odds ratio = 0.68, 95% confidence interval: 0.49-0.95) but not in males (odds ratio = 1.08, 95% confidence interval: 0.77-1.52). Restricted cubic spline adjustment of all covariates showed a significant negative non-linear relationship between depression and the MQI in females. The observed trend indicated an 80% decrease in the risk of depression for each unit increase in MQI, until a value of 2.2. Subsequently, when the MQI exceeded 2.2, the prevalence of depression increased by 20% for every unit increase in the MQI. Subgroup analyses further confirmed that the MQI was negatively associated with depression. CONCLUSION The MQI was inversely correlated with depression in females but not males, suggesting that females with a higher MQI might decrease the risk of depression.

Psychosocial profiles influencing healthy dietary behaviors among adolescents in Shandong Province, China: a cross-sectional study

ObjectivesWe aimed to assess the influence of psychosocial profiles on dietary behaviors among school-aged adolescents in China.MethodsA cross-sectional study was conducted involving 7,862 adolescents from 100 schools in Shandong, China. Psychosocial profiles and dietary behaviors were assessed using the Junior High School Students’ Psychosocial Profiles Questionnaire (JPPQ) and the Chinese Diet Quality Questionnaire (DQQ), respectively. Linear regression models were used to investigate the association between adolescents’ psychosocial profiles and dietary behaviors.ResultsThe mean age of the participants was 13.18 ± 1.15 years; 48.5% of them were boys. The majority of participants (97.90%) were Han Chinese, and approximately half of the participants (50.90%) resided in rural areas. After adjusting for sociodemographic characteristics and family computer and Internet ownership and usage, healthy dietary behavior was positively correlated with higher psychosocial profile scores (p < 0.05). The stratified analysis results revealed that the group with the highest psychosocial profile score was associated with an increased overall global dietary reference (GDR) score in “households without a family computer and Internet” (β: 5.357, 95% Cl: 4.931–5.784, p < 0.05).ConclusionGood psychosocial profiles exhibit a positive influence on healthy dietary behaviors. Therefore, policymakers should focus on Internet usage to maximize the positive effects on global youth health behaviors.

Weekend Variation in Ultra-Processed Food Intake of Patients after Metabolic and Bariatric Surgery: A Cross-Sectional Study

This study analyzed changes in ultra-processed food consumption patterns during weekends in patients in the post-metabolic and bariatric surgery periods. It is a cross-sectional study, which recruited and collected data via social media from adults who underwent metabolic and bariatric surgery. The Brazil Food and Nutritional Surveillance System markers of dietary consumption and the NOVA Ultra-Processed Food Screening tools were applied to evaluate dietary patterns and ultra-processed food consumption from the previous day. A total of 1525 participants were included, with a mean age of 38 ± 8 years and a mean body mass index of 29.9 ± 5.8 kg/m2. From these, 766 (50.3%) individuals answered the questionnaire referring to a weekend day. After adjusting for confounders, ultra-processed food consumption was higher on weekends compared to weekdays (NOVA Score 3.07 vs. 2.42; p < 0.01). The consumption of fruits and vegetables was lower on weekends, whereas the consumption of hamburgers/sausages, sugar-sweetened beverages, boxed/canned juice, and frozen pizza increased on weekends. Instant noodles and sandwich cookies did not show differences between weekdays and weekend days. This pattern suggests the need to monitor eating habits on weekends in individuals after metabolic and bariatric surgery.

The Impact of Electronic Device Use on Dry Eye Disease Symptoms based on Age and Gender: A Cross-sectional Study in Health Science University Students

Background Individuals with dry eye disease (DED) may experience ocular symptoms, affecting their quality of life. DED is multifactorial and is related to age, gender, and other factors. While a study may contain examination results of DED symptoms in elderly populations, where electronic device use has contributed to DED, disease occurrence in younger populations, such as university students, remains unclear. Purpose We evaluated DED frequency and risk factors for health science university students using electronic devices during online courses. Methods This study is a cross-sectional study using a previously validated DED questionnaire [Computer Vision Syndrome questionnaire (CVSQ)], which contains three parts: student demographics, electronic device information, and DED symptoms. We conducted an observational cross-sectional study of 359 health science students (aged 18 and above) at King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, between October 2022 and January 2023. We collected data on electronic device variables and DED symptoms in this cohort. Results We recruited 359 male (29.2%) and female (70.8%) health science students. Participant ages ranged from 18–20 (62.4%) to 21–27 (37.6%) years old. Participants were asked 24 questions, which gathered information on electronic device type, screen time in online classes, occupational characteristics (smoking status), and associated eye symptoms, such as pain, redness, itchiness, dryness, and heavy eyelids. Based on most responses, the Tablet was the most used and preferred device (85%), with continuous use of the device during university courses/ activities (85.8%). The correlation of the survey parameters was only significantly related to gender and study years with DED symptoms. The highest eye symptom intensity levels (always to severe) indicated burning (6.7%) and dryness (8.6%) sensations. Lastly, a significant association was identified between DED symptoms and screen time, gender, and smoking status. Conclusion DED symptoms were commonly reported in university students who used electronic devices. Our study provides valuable insights into electronic device usage duration impacted the ocular health of females and younger students, aiding in preventing dry eye disease risks and maintaining good eye health.

The mediating role of perceived stress in the association between family resilience and psychological distress among gynecological cancer patients: a cross-sectional study

BackgroundGynecological cancer patients face various stressors and suffer from severe psychological distress. The activation of family resilience supports patients to overcome daily stressors, yet the relationship between family resilience and psychological distress is poorly understood. The purpose of this study is to investigate the degree of psychological distress in patients diagnosed with gynecological cancer, and whether perceived stress mediate the relationship between family resilience and psychological distress.MethodsA cross-sectional study was undertaken on 358 gynecological cancer patients in China from September 2021 to November 2022. The participants completed surveys that included the Chinese Version of the Family Resilience Assessment Scale, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, the Distress Management Screening Measure, and socio-demographic questions. Using Pearson’s correlation analysis to investigate the association between variables, and the bias corrected bootstrapping method was utilized to establish perceived stress as a mediator.ResultsChinese patients with gynecological cancer experienced a moderate psychological distress. In addition, psychological distress exhibited a negative correlation with family resilience and a positive correlation with perceived stress in gynecological cancer patients (both P < 0.01). Perceived stress partially mediated the correlation between family resilience and psychological distress (β=-0.182; 95% CI: -0.224 to -0.140; P < 0.001). The total indirect effect value was − 0.182, and the total effect value was − 3.060.ConclusionsThe findings indicate that higher family resilience and lower perceived stress can reduce psychological distress in gynecological cancer patients, and family resilience also tends to reduce perceived stress in cancer patients. Clinical staff and psychologist should consciously cultivate patients’ family resilience to reduce psychological distress. Meanwhile, identifying potential mediators between family resilience and psychological distress are able to promote the development and assessment of interventions in the future.

Postoperative Pain Management in Patients Undergoing Hernia Repair Surgery. A cross-sectional study

Background: Hernia repair surgery is the most frequently performed surgical operation across the world and pain management after the surgery is important to avoid chronic pain and improve the quality of life. Objectives: to assess the effectiveness of acetaminophen monotherapy against combination analgesic regimens (acetaminophen plus pethidine or parecoxib) in managing postoperative pain in individuals having hernia repair surgery. Methods: This was a cross-sectional study on patients who were 18-65 years old and had elective hernia repair surgery. Participants were assigned to three groups: Group A was given IV acetaminophen along with IM pethidine, Group B was given IV acetaminophen with IV parecoxib and Group C was given IV acetaminophen alone. Pain was evaluated by Numeric Rating Scale (NRS) at various time intervals within 24 hours following surgery. Data were analysed employing repeated measures analysis of variance (ANOVA) and multiple regression analysis. Results: The research had a total of 259 patients. In comparison to Group C, patients in Groups A and B consistently reported far lower pain scores. Group C had the greatest mean pain score (7.91) at 45 minutes post-surgery, whereas Groups A and B demonstrated lower ratings (5.99 and 6.87). Pethidine and parecoxib when paired with acetaminophen were equally effective, as evidenced by the lack of a significant difference between Groups A and B. If acetaminophen monotherapy was used, combination treatment produced better pain relief. Conclusion: Following hernia repair surgery, combination analgesic regimens comprising acetaminophen and either pethidine or parecoxib are more successful at reducing postoperative pain than acetaminophen monotherapy. As a normal procedure, multimodal analgesia should be taken into account to reduce the incidence of chronic pain and enhance patient recovery.

Family Peace and Affecting Factors in Family Caregivers of Patients With Cancer: A Cross-Sectional Study.

Objective: During the care process, family members who provide care for a patient with cancer are confronted with changes in their family dynamics. The purpose of this study was to evaluate the family peace of caregivers of patient with cancer and the associated factors. Methods: A cross-sectional study was conducted in a single center. The sample of the study included caregivers who were family members of patients with cancer. Data were collected with Caregiver and Patient Information Forms, General Self-Efficacy Scale, Family Peace Scale, Self-Care Behaviors Scale, and MD Anderson Symptom Inventory. Results: It was found that the mean age of the caregivers was 50.20 ± 0.71 years, 64.1% were female, 78.7% were married. The mean score of the caregivers on the total family peace scale was above the average value with 46 ± 0.75 out of 75 points. The caregivers' level of family peace increases as their scores on the scale increase. The family peace of caregivers who were widowed or divorced, were self-employed, had less income than their expenses, had a chronic disease, reported that their health was affected, had low self-efficacy was worse than that of others. The family peace of caregivers of patients who had gynecological cancer and had a good income was better (P < 0.05). The self-efficacy level of the caregivers and the symptoms of the patient with cancer were significant predictors of family peace (P < 0.001). Conclusions: Family peace of caregivers was affected by the type of cancer, symptom burden, self-care behaviors of the patient, and caregivers' income status, chronic disease, marital status, and self-efficacy. Physicians and nurses, who are in close contact with caregivers of cancer patients, should be aware of the issue, professionals should assess the family environment of the caregivers of patient with cancer and counseling should be provided if deemed necessary.

Prevalence, satisfaction and preference of tooth shades and their correlation with age, gender and skin shade: A cross sectional study

Shade selection is one of the most important factors that determines the satisfaction of the patient with the dental prosthesis and thus the overall success of the treatment. Conventional methods of shade selection require the presence of existing teeth or past dental/photographic records. In the absence of these, shade selection becomes challenging and must be done subjectively and arbitrarily based on the patient’s age and sex. This study aims to assess the prevalence, satisfaction, and preference of tooth shades, investigating their correlation with age, sex, and skin shade in a diverse sample of 120 participants. Methods A total of 120 participants, evenly distributed among 60 males and 60 females, were surveyed. Participants were categorized into age groups (n=15) and asked about their satisfaction with existing tooth shades and their preferences. Results The most common existing tooth shade was Value 2 (52.5%). Statistical analysis using Chi-square tests revealed that Value 2 was the most desired shade among males and females alike, particularly in the age group of 41 to 50 years (p &lt; 0.001). Shade 2L1.5 was the most prevalent (n=26), with Value 2 (59.16%) being the most sought-after shade, followed by Shade 2L1.5 (n=21), Shade 2M1 (n=18), Shade 1M1 (n=15), and Shade 2R1.5 (n=14). Existing tooth shades of Value 0 were the least common. The highest satisfaction with existing shades was observed in males aged 41 to 50 (n=15), followed by males aged 51 to 60 (n=14) and females aged 31 to 40 (n=12) and 41 to 50 (n=12). Significant differences in satisfaction were noted among males (p &lt; 0.001). Conclusions This study reveals a consistent and strong preference among both males and females for tooth shades classified as Value 2, following the VITA Tooth-Guide 3D Master shade guide. This universal preference suggests the relevance and acceptance of this shade category across diverse patient groups.

Dental students’ healthy lifestyle behaviors, physical activity levels and social media use: cross sectional study

BackgroundHealthy lifestyle behavior includes appropriate behaviors such as eating habits, physical activity and weight control in order to stay healthy and prevent diseases. The aim of this cross-sectional study is to evaluate healthy lifestyle behaviors, physical activity levels and social media use of dental students.MethodsAn online questionnaire including demographic characteristics, International Physical Activity Questionnaire Short Version (IPAQ-S) and Health Promoting Lifestyle Profile (HPLP) was filed by 420 dental students. The data were evaluated statistically.ResultsThe mean age was 21.6 ± 1.96 years and the majority of the students (71.7%) were living with their families. Obesity and overweight in males and underweight in females were statistically higher. There was no difference between the genders in terms of social media use. The most preferred applications were Instagram (92.7%), YouTube (85%) and Twitter (59.7%). In terms of IPAQ durations and HPLP scores, there was no gender difference. According to the IPAQ classification, while the majority of students (64.3%) were physically low active, 23.1% were physically inactive. As the total HPLP score increased, the total IPAQ score increased.ConclusionIt is concluded that as the university students make up the majority of the young adults, encouraging their health-promoting behaviors is crucial for improving public health.

ANALYSIS OF COLIFORM BACTERIA IN DUG WELL WATER

In Indonesia, in rural and urban areas, you can find a lot of dug wells, because in general people use a lot of dug wells, because dug wells are relatively easy and cheap to make. However, dug wells have a very high risk of pollution in the form of physical, chemical and biological pollution. Water and health are two things that are interconnected. If the quality of the water consumed by the public is contaminated by coliform bacteria and E coli bacteria, it can cause diseases including diarrhea. This research aims to determine the relationship between the distance of the septic tank and the physical condition of the dug well on the number of coliform bacteria in the dug well water using the Cross Sectional method. Samples were taken using a simple random sampling technique with a total sample of 89 dug wells. The data obtained were analyzed using the Chi-Square test. Univariate analysis. The presence of coliform bacteria was 31.5%, 65.8% absent, septic tank distance did not meet the requirements, 43.8% met the requirements, 56.2%, the physical condition of the dug well met the requirements. 36.0% requirements, 60.0% eligible. Bivariate analysis of septic tank distance obtained a value of 0.000, the physical condition of the dug well had a p value of 0.000. The conclusion was that there was a significant relationship between the distance of the septic tank and the physical condition of the dug well and the presence of coliform bacteria.

Association between subcortical nuclei volume changes and cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: a cross-sectional study

BackgroundNeurocognitive disorders frequently occur in patients with cyanotic congenital heart disease (CCHD) because of the hemodynamic abnormalities induced by preoperative cardiac structural changes. We aimed to evaluate subcortical nuclei volume changes and cognition in postoperative tetralogy of Fallot (TOF) children, and analyze their relationship with preoperative cardiac structural changes.MethodsThis case-control study involved thirty-six children with repaired TOF and twenty-nine healthy controls (HCs). We utilized three-dimensional (3D) T1-weighted high-resolution structural images alongside the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV) to evaluate the cognitive differences between the TOF and HC group.ResultsWe observed notable differences in subcortical nuclei volume between the TOF and HC group, specifically in the left amygdala nucleus (LAM, TOF: 1292.60 ± 155.57; HC: 1436.27 ± 140.62, p < 0.001), left thalamus proper nucleus (LTHA, TOF: 6771.54 ± 666.03; HC: 7435.36 ± 532.84, p < 0.001), and right thalamus proper nucleus (RTHA, TOF: 6514.61 ± 715.23; HC: 7162.94 ± 554.60, p < 0.001). Furthermore, a diminished integrity of LAM ( β:-19.828, 95% CI: -36.462, -3.193), which showed an inverse relationship with the size of the preoperative ventricular septal defect (VSD), correlated with lower working memory indices in children with TOF.ConclusionsOur findings indicate that subcortical nuclei structural injuries possibly potentially stemming from cardiac anatomical abnormalities, are associated with impaired working memory in preschool-aged children with TOF. The LAM in particular may serve as a potential biomarker for neurocognitive deficits in TOF, offering predictive value for future neurodevelopmental outcomes, and shedding light on the neurophysiological mechanisms of these cognitive impairments.

Does the optimal level of illumination improve both visual functions and visual comfort in schoolchildren with low vision?

Lighting modification is commonly performed by optometrists and occupational therapists to enhance visibility and visual comfort among schoolchildren with low vision. The purpose of this study is to determine the optimal illumination level for visual function and visual comfort of schoolchildren with low vision and the relationship between them. A cross-sectional study was conducted to assess five levels of illumination ranging from 125 lux to 2000 lux to determine the optimal illumination for visual functions and visual comfort in schoolchildren with low vision from a special education school for blind in Malaysia. Purposive sampling was done to recruit forty-two schoolchildren with low vision for this study. Visual functions assessed were visual acuity, measured using the Early Treatment Diabetic Retinopathy Study LogMAR chart at distance and near, contrast sensitivity (CS) measured using the Pelli-Robson chart at distance and the Mars CS chart at near. Reading speed was determined using the Universiti Kebangsaan Malaysia Malay Language Related Word Reading Text test chart. Subjects were asked to rate their visual comfort using a validated questionnaire at the end of each measurement of visual functions and reading speed for the different illumination levels. Visual acuity and contrast sensitivity at distance and near, visual comfort and reading speed improved significantly with increase in illumination levels (p&lt;0.05). However, the interaction between illumination level and level of low vision was not significant (p&gt;0.05). Visual comfort was significantly associated with visual function (p&lt;0.05), while direct association between visual comfort and illumination level was not significant (p&gt;0.05). Optimal illumination for improvement of visual function, reading speed and visual comfort range from 276.67 lux to 701.59 lux. Majority of the schoolchildren with low vision had improved visual function, reading speed and visual comfort with increased illumination. Illumination of at least 600 lux is recommended for maximum visual functioning and visual comfort of schoolchildren with low vision.

Long COVID is not the same for everyone: a hierarchical cluster analysis of Long COVID symptoms 9 and 12 months after SARS-CoV-2 test

BackgroundIdentifying symptom clusters in Long COVID is necessary for developing effective therapies for this diverse condition and improving the quality of life of those affected by this heterogeneous condition. In this study, we aimed to identify and compare symptom clusters at 9 and 12 months after a SARS-CoV-2 positive test and describe each cluster regarding factors at infection.MethodsThis is a cross-sectional study with individuals randomly selected from the Portuguese National System of Epidemiological Surveillance (SINAVE) database. Individuals who had a positive RT-PCR SARS-CoV-2 test in August 2022 were contacted to participate in a telephonic interview approximately 9 and 12 months after the test. A hierarchical clustering analysis was performed, using Euclidean distance and Ward’s linkage. Clustering was performed in the 35 symptoms reported 9 and 12 months after the SARS-CoV-2 positive test and characterised considering age, sex, pre-existing health conditions and symptoms at time of SARS-CoV-2 infection.Results552 individuals were included at 9 months and 458 at 12 months. The median age was 52 years (IQR: 40–64 years) and 59% were female. Hypertension and high cholesterol were the most frequently reported pre-existing health conditions. Memory loss, fatigue or weakness and joint pain were the most frequent symptoms reported 9 and 12 months after the positive test. Four clusters were identified at both times: no or minor symptoms; multi-symptoms; joint pain; and neurocognitive-related symptoms. Clusters remained similar in both times, but, within the neurocognitive cluster, memory loss and concentration issues increased in frequency at 12 months. Multi-symptoms cluster had older people, more females and more pre-existing health conditions at 9 months. However, at 12 months, older people and those with more pre-existing health conditions were in joint pain cluster.ConclusionsOur results suggest that Long COVID is not the same for everyone. In our study, clusters remained similar at 9 and 12 months, except for a slight variation in the frequency of symptoms that composed each cluster. Understanding Long COVID clusters might help identify treatments for this condition. However, further validation of the observed clusters and analysis of its risk factors is needed.

Prevalence of schistosomiasis among school children at Esuekyir community in the Central Region of Ghana

Schistosomiasis, an endemic neglected tropical disease in areas with poor sanitation, causes physical and mental defects in both children and adults. Various strategies, especially drug administration for morbidity control, have been implemented to combat the disease in Ghana and globally. Despite these efforts, schistosomiasis remains prevalent in Ghana, negatively impacting children's academic performance, growth, and overall quality of life. This study aimed to determine the prevalence of schistosomiasis in school children at Esuekyir, a peri-urban community in Ghana. A cross-sectional study using simple random sampling technique to select participants and collect stool and urine samples from 246 school children in Esuekyir was adopted. Microscopy of urine and stool samples was performed involving urine sedimentation and stool formol-ether sedimentation techniques to analyse for parasite eggs. Questionnaires were developed to help detect risk factors that expose these children to the disease. The prevalence of urogenital schistosomiasis in children at Esuekyir was 15.45% while that of intestinal schistosomiasis was 6.957.0%. There was one case of co-infection of urogenital and intestinal schistosomiasis from a 13 year old primary student. Children in primary school had higher risks of infection due to their activities around the water body. There was a significant association between class groups and urogenital schistosomiasis (p-value = 0.042). The presence of schistosomiasis in school children highlights the importance of targeted interventions and public health initiatives in addressing this specific disease condition especially in primary school children. Findings from the research revealed a higher prevalence of urogenital schistosomiasis in the study population as compared to intestinal schistosomiasis.

Cardiorespiratory Fitness Is Not Associated with Cardiovascular Disease Risk in Firefighters: A Cross-Sectional Study in South African Firefighters

Cardiorespiratory Fitness Is Not Associated with Cardiovascular Disease Risk in Firefighters: A Cross-Sectional Study in South African Firefighters

Clinical and radiographic assessment of gummy smile patients with altered passive eruption: a cross-sectional study in a Thai population

Clinical and radiographic assessment of gummy smile patients with altered passive eruption: a cross-sectional study in a Thai population

Prevalence of self-medication practices with antibiotics and associated factors among students in five colleges in Eritrea: a cross-sectional study

BackgroundDespite their significant contribution to reducing mortality and morbidity from infectious diseases, antibiotics face challenges due to their inappropriate use, one of which is self-medication. This study assessed the prevalence of|| self-medication with antibiotics among Eritrean college students and its associated factors.MethodsAn analytical cross-sectional study evaluated the prevalence of self-medication with antibiotics among students from five colleges from September 2019 to February 2020. Participants were selected through simple random sampling, and each participant completed a structured questionnaire covering socio-demographic characteristics, knowledge and attitudes toward antibiotics, and self-medication practices. Logistic regression analysis was employed to identify factors associated with self-medication with antibiotics.ResultsThe study distributed 380 questionnaires, with 375 returned, yielding a response rate of 98.68%. Findings revealed that 80.3% of participants were familiar with antibiotics. Additionally, 18.8% agreed with non-prescription antibiotic use for simple ailments. Of the 252 respondents who answered, 67.1% reported self-medication with antibiotics. Within the preceding six months, the prevalence of such self-medication was 34.3%. Factors associated with self-medication included college affiliation, with participants from the College of Science (COS) exhibiting lower odds (AOR = 0.38, 95% CI: 0.16–0.91, p = 0.03) compared to the College of Business and Social Sciences (CBSS) students. Those living in dormitories had 2.4 times higher odds (AOR = 2.42, 95% CI: 1.7–5.02, p = 0.017) to self-medicate compared to those living with family. Moreover, individuals unaware of antibiotic resistance had higher odds (AOR = 2.41, 95% CI: 1.24–4.7, p = 0.009) of self-medication. Attitude score was also significantly associated with self-medication (AOR = 0.88, 95% CI: 0.8–0.98, p = 0.027).ConclusionsThese results highlight the necessity for tailored educational programs to advocate for appropriate antibiotic utilization and mitigate the prevalent misuse of antibiotics among college students. Initiatives focused on increasing knowledge about the dangers linked with self-medication and advocating for conscientious antibiotic usage are essential in combating the escalating challenge of antibiotic resistance and safeguarding public health.

The interplay between autonomy support and structure in the prediction of challenge-seeking, novelty avoidance, and procrastination

Although teachers’ autonomy support and structure are considered essential elements of the classroom environment to promote effective learning strategies, prior research has sometimes provided conflicting results. This inconsistency may stem from how autonomy support and structure relate to some outcomes but not others. Alternatively, this variability might be attributed to nonlinear relations, which have been scarcely tested thus far. In this cross-sectional study, we revisited this issue by examining both the linear and curvilinear relations of autonomy support and structure to challenge-seeking, novelty avoidance, and procrastination. Participants were 3,271 adolescents (M age = 15.91, SD = 0.34 years; 59.8% females) from 116 classrooms. Multilevel polynomial regression analyses revealed that, compared to structure, autonomy support was a more reliable predictor of challenge-seeking, both at the student and the classroom levels. In contrast, structure predicted novelty avoidance and procrastination more reliably at both levels than autonomy support. Response surface analyses indicated that the most desired pattern existed at the line of congruence. Our findings suggest that both autonomy support and structure are needed to enhance students’ learning strategies. However, the degree of necessity may vary for specific outcomes, with one potentially being more crucial than the other.

Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study

Background Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. Objective This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. Methods An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: “Have you ever considered committing suicide in the past 12 months?” Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. Results Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant. Conclusions IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study.

Self-perceived oral health and happiness

In recent years, studies investigating psychological states such as happiness in individuals’ health have increased. Aim: This study investigated a possible association between self-perceived oral health and happiness in university students. Methods: This cross-sectional study was performed in a cohort of university students who entered in the 2016 academic year at the Federal University of Pelotas, located in southern Brazil. Data were collected using a self-administered questionnaire, including demographic and socioeconomic characteristics, psychosocial traits, and oral health-related questions. Happiness was measured through a question accompanied by the Faces Scale of Andrews and Whitey. Poisson regression models with robust variance were used to assess the association between the exposure variables (oral health measures) and the outcome (happiness). Results: The prevalence of happiness was 48.6%. A significant association between happiness and oral health, including satisfaction with dental appearance (PR 1.86; 95% CI 1.73-2.01), oral health-related to quality of life (PR 1.19; 95% CI 1.09-1.31), and halitosis (PR 1.10; 95% CI 1.01-1.20), was found. Conclusion: Individuals who reported dissatisfaction with dental appearance, an impact on oral health-related to quality of life, and halitosis perceived themselves as unhappy.