Main Study Variables Research Articles

Psychological distress, social media use, and academic performance of medical students: the mediating role of coping style

BackgroundGiven that social media use (SMU) is an increasingly widespread activity among university students, more information is needed to evaluate its relationship with students’ mental health, particularly medical students.ObjectiveThe present study assessed the relationships between SMU and coping style with psychological distress and academic performance of medical students.MethodsAn offline cross-sectional survey conducted with 398 undergraduate medical students. The survey collected data on demographics, psychological distress (DASS-21), coping strategies (Brief COPE Scale), academic performance (grade point average) and estimated average time spent on social media per day. Structural equation modeling was used to clarify relationships between the main study variables. The study also examined the mediating effect of maladaptive coping between SMU and psychological distress.ResultsStudents with higher levels of psychological distress were more likely to be engaged in frequent social media use. Spending more than two hours a day on social media use had a positive association with maladaptive coping (p < 0.001), particularly with substance use and behavioral disengagement both of which could negatively affect academic performance. Maladaptive coping mediated the relationship between students’ SMU and psychological distress.ConclusionThe findings suggest that medical students commonly use social media as a maladaptive coping tool to deal with psychological distress. Empowering students to adopt and foster appropriate coping strategies could help them to enhance resilience against life stresses and ameliorate potential long-term mental health consequences associated with maladaptive behaviors.

Cultural and gender differences in predicting flourishing through gratitude and life purpose: A moderated mediation analyses

Background: This study investigated the relationship between gratitude, purpose in life and flourishing, as well as the mediating role of purpose in life in the relationship between gratitude and flourishing in two different cultures, Indian and Polish. We also examined the moderating role of gender in the relationship between gratitude and purpose in life. Methods: A sample of 328 Indian and 303 Polish participants aged 18–56 years completed the Gratitude, Resentment, and Appreciation Scale, the Purpose in Life Questionnaire, and the Flourishing Scale. Pearson’s correlations were used to assess the associations between the main study variables, and PROCESS software was used to calculate moderated mediation. Results: Findings showed that gratitude and purpose in life were positively related to flourishing. Life purpose mediated the relationship between gratitude and flourishing. In the Indian sample, gender was a statistically significant moderator between gratitude (and its three facets) and purpose in life. In the Polish sample, gender moderated the relationship between overall gratitude and only one dimension (a sense of abundance) and purpose in life. Conclusions: The results suggest that enhancing gratitude and a sense of purpose in life can significantly improve individuals’ flourishing, considering gender and cultural differences.

Impact of an Intervention Aimed at Improving Sleep Quality in Hospitalized Children.

Hospitalized children need adequate sleep to favor early recovery. To study the sleep pattern of children admitted to a pediatric inpatient unit, a cross-sectional study was carried out at a reference hospital in northern Spain. The main study variables were medical specialty of admission, sleep-inducing treatment, hours of sleep at home and during admission, number of nocturnal awakenings, and reasons for awakening. Differences in the hours of sleep and nighttime awakenings between the initial period and at six months were calculated using the Student's t-test. We included 100 baseline patients and 100 post-intervention patients. Up to 4% of the baseline sample and 3% of the six-month sample had been prescribed a sleep-promoting drug. Regarding awakenings, 79% of the children in the baseline sample suffered awakenings, with a mean of 1.98 awakenings (range 1-13). At six months, the percentage of children who experienced awakenings decreased by 17%, with a mean of 1.34 (range 1-5). In the baseline sample, 48% were caused by nursing care, decreasing to 34% after the intervention. An educational intervention with the implementation of targeted evidence-based practices is a useful measure for improving the sleep pattern by decreasing the number of awakenings.

Relationships among health promotion behaviors, patient engagement, and the nurse practitioner-patient partnership.

Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion. This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting. A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index). Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors (R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors. Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients. Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.

Association of urinary excretion rates of uric acid with biomarkers of kidney injury in patients with advanced chronic kidney disease.

The potential influence of hyperuricemia on the genesis and progression of chronic kidney disease (CKD) remains controversial. In general, the correlation between blood levels of uric acid (UA) and the rate of progression of CKD is considered to be modest, if any, and the results of relevant trials oriented to disclose the effect of urate-lowering therapies on this outcome have been disappointing. Urinary excretion rates of UA could reflect more accurately the potential consequences of urate-related kidney injury. Using a cross-sectional design, we investigated the correlation between different estimators of the rates of urinary excretion of UA (total 24-hour excretion, mean urinary concentration, renal clearance and fractional excretion)(main study variables), on one side, and urinary levels of selected biomarkers of kidney injury and CKD progression (DKK3, KIM1, NGAL, interleukin 1b and MCP)(main outcome variables), in 120 patients with advanced CKD (mean glomerular filtration rate 21.5 mL/minute). We took into consideration essential demographic, clinical and analytic variables with a potential confounding effect on the explored correlations (control variables). Spearman's rho correlation and nonlinear generalized additive regression models (GAM) with p-splines smoothers were used for statistical analysis. Multivariate analysis disclosed independent correlations between urinary UA concentrations, clearances and fractional excretion rates (but not plasma UA or total 24-hour excretion rates of UA), on one side, and the scrutinized markers. These correlations were more consistent for DKK3 and NGAL than for the other biomarkers. Glomerular filtration rate, proteinuria and treatment with statins or RAA axis antagonists were other independent correlates of the main outcome variables. Our results support the hypothesis that urinary excretion rates of UA may represent a more accurate marker of UA-related kidney injury than plasma levels of this metabolite, in patients with advanced stages of CKD. Further, longitudinal studies will be necessary, to disclose the clinical significance of these findings.

Blood glucose fluctuation and in-hospital mortality among patients with acute myocardial infarction: eICU collaborative research database.

To assess the relationship between glycemic variability, glucose fluctuation trajectory and the risk of in-hospital mortality in patients with acute myocardial infarction (AMI). This retrospective cohort study included AMI patients from eICU Collaborative Research Database. In-hospital mortality of AMI patients was primary endpoint. Blood glucose levels at admission, glycemic variability, and glucose fluctuation trajectory were three main study variables. Blood glucose levels at admission were stratified into: normal, intermediate, and high. Glycemic variability was evaluated using the coefficient of variation (CV), divided into four groups based on quartiles: quartile 1: CV≤10; quartile 2: 10<CV≤20; quartile 3: 20<CV≤30; quartile 4: CV>30. Univariate and multivariate Cox regression models to assess the relationship between blood glucose levels at admission, glycemic variability, glucose fluctuation trajectory, and in-hospital mortality in patients with AMI. 2590 participants were eventually included in this study. There was a positive relationship between high blood glucose level at admission and in-hospital mortality [hazard ratio (HR) = 1.42, 95%confidence interval (CI): 1.06-1.89]. The fourth quartile (CV>30) of CV was associated with increased in-hospital mortality (HR = 2.06, 95% CI: 1.25-3.40). The findings indicated that only AMI individuals in the fourth quartile of glycemic variability, exhibited an elevated in-hospital mortality among those with normal blood glucose levels at admission (HR = 2.33, 95% CI: 1.11-4.87). Additionally, elevated blood glucose level was a risk factor for in-hospital mortality in AMI patients. Glycemic variability was correlated with in-hospital mortality, particularly among AMI patients who had normal blood glucose levels at admission. Our study findings also suggest early intervention should be implemented to normalize high blood glucose levels at admission of AMI.

The association between family socioeconomic status and suicide ideation among adolescent: A conditional process model

Traditionally, most researchers believe that low family socioeconomic status (SES) is closely related to high suicide ideation, but this view remains controversial in empirical studies. Meanwhile, less is known about the mechanisms underlying this association. Moreover, previous studies on the relationship between family SES and suicide ideation have mostly focused on adults rather than adolescents and relatively lacked support from Chinese samples. Therefore, this study is based on the integrated motivational–volitional model of suicide behaviour and the context-process-outcomes model, aiming to determine whether and how family SES is associated with adolescents’ suicide ideation and to evaluate the chain-mediating effect of effortful control and irritability, as well as the moderating effect of future orientation on this association. Data were extracted from 1058 girls and 855 boys, aged 11 to 19 years (14.86 ± 1.61 years), who completed a self-reported online survey. Descriptive statistics, t-test, chi-square test, bivariate correlations, and regression analysis were performed using IBM SPSS version 25. The conditional process model (CPM) was examined using SPSS PROCESS Macro 4.0. The results showed that there were differences in some demographic factors and the main study variables between adolescents with and without suicide ideation. In addition, the results suggested that family SES was not directly related to suicide ideation in adolescents, but it could indirectly effect suicide ideation through the chain-mediating effect of effortful control and irritability. Furthermore, future orientation moderated the relationship between irritability and suicide ideation. These findings provide evidence for current debates and conflicting conclusions, reveal the effect mechanism of family SES on suicide ideation, and add to empirical support for the prevention and intervention of adolescent suicide ideation.

Sex-based differences in the comprehensive geriatric assessment in elderly hospitalized patients with non-valvular atrial fibrillation

Atrial fibrillation (AF) represents the most common supraventricular arrhythmia, with a prevalence of 1–3 % in the world population. Growing evidences show that AF plays an important role as a risk factor for the development of cognitive impairment (CoI) and dementia, depression and functional limitation. The purpose of the study is to evaluate, in a large cohort of elderly hospitalized patients with nonvalvular AF (NVAF) on direct oral anticoagulants (DOACs) therapy, the prevalence of CoI, depression, and functional limitation, and to assess the different variables that may be detrimental or protective on the risk of CoI or functional limitation. 1004 elderly patients were enrolled, 384 men and 620 women, with a mean age of 84±7.1 years. The two groups were comparable for the main study variables, except for age, prevalence of hypertension and CKD, which were higher in women, while ischemic heart disease was higher in men. In addition, the two groups differed in the CHA2DS2VASc score 5.3 ± 1.3 vs 4.2 ± 1.4 pts (p < 0.0001) and HAS-BLED score 2.5 ± 0.7 vs 2.3 ± 0.8 pts (p = 0.009) that were significantly higher in women. Our study revealed that in a cohort of elderly patients hospitalized with AF taking DOACs, CoI and disability are widely represented, and female sex increases the risk of being affected by CoI by about 3-fold, while improvement of functional limitations reduce this risk by about 15 %. In addition, CoI and depressive symptoms increase the risk of functional impairment about 2-fold and 28 % respectively, while antihypertensive and anti-diabetic therapy reduce this risk.

The association between use of social media and the development of body dysmorphic disorder and attitudes toward cosmetic surgeries: a national survey.

Body dysmorphic disorder (BDD) causes distress due to one's negative appraisal of their body image. The development of BDD has been linked to the passive use of social media and photo-editing apps. People with BDD typically pursue cosmetic surgeries to remedy their perceived flaws. The dramatic increase in the use of photo-editing apps and their well-established effects on mental health is a public health concern. To study the association between use of social media and the development of BDD and acceptance toward cosmetic surgeries (ACSS) among Saudis. An online, cross-sectional, validated survey conducted among Saudis 18 and older. Descriptive analyses were utilized for demographics and prevalence rates of main study variables. ANOVA was used to compare mean scores in BDD and ACSS among different demographic groups. Tukeys post-hoc test was done to identify the categories that were different when the ANOVA test showed a statistically significance. A p-value of <0.05 was considered statistically significant. A total of 1,483 Saudi adults completed the questionnaire. Key results showed that BDD was found in 24.4 % of the sample. The percentage of participants with BDD who spent 4-7 h per day on Instagram and Snapchat (29%) was significantly higher than those who spent only less than an hour per day on these platforms (19%) (p < 0.001). Individuals with BDD had a significantly higher risk of accepting cosmetic surgery compared to those without BDD (p < 0.001). A growing body of evidence suggests that social media may impact mental health in different ways. This study reveals that heavy use of these platforms is associated with negative appraisals about one's physical appearance, and it fosters one's tendency toward cosmetic surgery, especially among females.

Use of Vitex agnus-castus in patients with menstrual cycle disorders: a single-center retrospective longitudinal cohort study

PurposeTo evaluate clinical characteristics, quality of life (QoL) and effectiveness in patients with menstrual cycle disorders (MCDs) including abnormal uterine bleeding, dysmenorrhea and mastodynia/mastalgia related to premenstrual syndrome taking the Vitex agnus-castus (VAC) products Cyclodynon® or Mastodynon® in a real-world setting.MethodsA single-center retrospective longitudinal cohort study (3 ± 1 months), using data obtained from healthcare data archive and telephone interviews. The main study variables were changes in bleeding, menstrual pain, breast tenderness and patients’ QoL.ResultsData from 1700 women with a mean age of 30.2 years (± 6.3) were analyzed. The most common MCDs were dysmenorrhea (43.8%) and mastodynia/mastalgia (21.1%). Three-month treatment with VAC extract substantially decreased the percentage of patients with irregular cycle (from 9.1% to 0.1%) and breast tenderness (from 39.9% to 0.8%). Improvement in bleeding intensity, frequency and menstrual pain was experienced by 83.4%, 79.2%, and 85.2% of the patients, respectively. When analyzed by disease category, these parameters improved in almost all dysmenorrhea patients, while they improved to a lesser extent in mastodynia/mastalgia patients. QoL improved in all aspects, but was reported by a higher proportion of dysmenorrhea patients compared to mastodynia/mastalgia patients. Treatment was overall well tolerated with a favorable safety profile.ConclusionThese real-world data demonstrate the effectiveness of the VAC-containing products Cyclodynon® and Mastodynon® in the three-month treatment of MCDs, with a pronounced improvement in key disease symptoms and QoL. Intriguingly, while QoL was generally greatly improved, the response to VAC therapy varied depending on the type of underlying MCD.

Effects of affectively-loaded childhood-related photos from the IAPS on the induction of involuntary autobiographical memories in young and older adults.

Aging produces changes in emotional reactivity and the retrieval of autobiographical memories. The main aim of this study was to assess age-related differences, comparing emotion induction and autobiographical memory recall using photos from the International Affective Picture System (IAPS) that are thematically related to childhood. A cross-sectional observational study was conducted, with the participation of 327 individuals (168 young adults and 159 older adults) with no cognitive impairment and aged between 18 and 88 years. We showed the participants a set of five pictures from the IAPS, the affective content of which was related to childhood. Two of these were considered to be positive images, two negative and one neutral, according to the valence of these pictures in the literature. The main study variables were the reactions associated with emotional valence or pleasure, arousal and dominance, after viewing the photos, and the autobiographical memories retrieved by the participants. The younger adults retrieved a larger number of memories than their older counterparts. As regards the responses to the five affective pictures (IAPS) on valence, arousal and dominance (IAPS), statistically significant differences were only found for pictures 2,345 (BlackEye), with a more positive valence in the group of older adults and higher arousal in the young ones, and 2,312 (Mother), with a more positive valence in the group of older persons. A greater number of memories were retrieved for the photos that generated higher levels of pleasure, greater relaxation and greater emotional control. Of the variables that may be associated with the elicitation of involuntary autobiographical memories, the most significant are age and a positive stimulus.

Illness Anxiety Disorder and Distress among Female Medical and Nursing Students.

This study aims to compare the prevalence of illness anxiety disorder (IAD) and distress between medical and nursing students and examine their associations with students' characteristics. Cross-sectional data were collected using the Short Health Anxiety Inventory (SHAI, for measuring IAD) and the Medical Students' Disease (MSD) Perception and Distress Scales. Two hundred and sixteen Medical students and 250 Nursing students were recruited from a public female university in Saudi Arabia. Their mean age was 21.27 years. The findings showed that the overall prevalence of IAD (SHAI scores ≥18) among the total sample was 38.8%, with a significantly lower prevalence in medical students compared to the prevalence in nursing students (57.2% vs 17.6%, respectively, X2=45.26, p<.001). Nursing students had significantly higher SHAI scores and lower MSD Perception scores than medical college students, but there were no significant differences among them in the MSD Distress scale. Significant differences in the main study variables scores were reported among nursing students but not among medical students, with the fourth-year level nursing students having higher SHAI and lower MSD Perception and perception scores than other nursing students. The highlights that medical and nursing students are susceptible to developing anxiety-related disorders and distress that may have negative impacts on their academic achievements and future careers. Both nursing and medical faculty should help in identifying strategies to support the students' mental health and well-being.

Measuring the knowledge and perception of Jordanian health science students towards self-prescribed medications: a descriptive analysis study

Abstract Objectives To assess the level of perception and awareness of health science students towards using over-the-counter (OTC) medicines and reveal any malpractice. Methods A descriptive cross-sectional correlational study employing an internet-based self-administered questionnaire collected data from 342 participants. The study model comprised four compartments: introductory, socio-demographic, utilizing OTC medications, and estimating the perception level. Descriptive statistics were used to describe participants’ demographics and main study variables. Non-parametric descriptive analysis and chi-squared tests were used to determine significance across the three medical schools. The response rate among students in their first academic year (33.9%) was the highest. Findings Most participants rely on OTC to treat minor conditions like pain and the common cold. Nutraceuticals have been used heavily. The participants showed a positive attitude towards self-treatment; the average perception score was 3.45 (SD = 0.60; 95%CI: 3.38–3.51). Besides, participants on regularly prescribed medications still determined the interaction between their treatments and non-prescribed medications. No significant association between attitude average score and participant age (r = −0.06; P = .273). Likewise, no differences were found in perceived attitude towards OTC based on gender (P = .41), academic level (P = .223), and college (P = .84). Conclusion This study provides an overview of the level of medical student’s perception towards self-treatment; despite the promising levels of knowledge and perception, it is necessitated to introduce interprofessional medical education to get an integrated knowledge and qualified graduates to provide the best health services.

Association between GLIM-defined malnutrition and hospitalizations in kidney transplant candidates: A post hoc analysis of a cohort study.

Malnutrition is frequent in patients with chronic kidney disease (CKD) and has a negative impact on morbidity, mortality, and quality of life. The objective of this study was to assess the value of the Global Leadership Initiative for Malnutrition (GLIM) criteria to predict hospitalizations and mortality in candidates to kidney transplant during their first year on the waiting list. This was a post hoc analysis of 368 patients with advanced CKD. The main study variables were malnutrition, according to the GLIM criteria; number of hospital admissions during the first year on the waiting list; and mortality at the end of follow-up. Kaplan-Meier survival curves and binary logistic regression were performed, adjusting for age, frailty status, handgrip strength, and Charlson Index as potential confounders. The prevalence of malnutrition was 32.6%. Malnutrition was associated with increased risk of hospitalizations during the first year on the waiting list (odds ratio [OR] = 3.33 [95% CI = 1.34-8.26]), which persisted after adjustment for age and frailty status (adjusted OR = 3.61 [95% CI = 1.38-10.7]), age and handgrip strength (adjusted OR = 3.39 [95% CI = 1.3-8.85]), and age and Charlson Index (adjusted OR = 3.25 [95% CI = 1.29-8.13]). Malnutrition according to the GLIM criteria was highly prevalent in patients with CKD and was associated with a threefold increased risk of hospitalizations during the first year on the waiting list; these associations remained significant after adjusting for age, frailty status, handgrip strength, and comorbidities.

Influence mechanism of the louver on the thermal performance of the mechanical draft wet cooling tower

To explore the performance influence of louvers on mechanical draft wet cooling towers (MCTs), the specific structure of the louver is described in this paper. The inclination angle of louvers, crosswind velocity, and crosswind direction are taken as the main study variables. Numerical analysis is employed to elaborate the impact mechanism of louvers on tower performance under crosswinds, by estimating the airflow distribution, air-water ratio distribution, ventilation capacity, and outlet water temperature. Results show that the thermal and ventilation performance of MCTs can be regulated in a large range by controlling the inclination angle of louvers. Compared with the MCT without the louver, the variation range of ventilation rate is −16.45 % to 6.25 %, and that of outlet water temperature is −0.73 °C to 0.81 °C. The MCT has the best thermal performance when the inclination angle of louvers is 90°, with an average decrease of outlet water temperature by 0.40 °C under the crosswind angle of 0°, 0.36 °C under that of 45°, and 0.25 °C under that of 90°. With the increase of the inclined angle of the louver, the influence range of the longitudinal vortex on the upper edge of the air inlet of the MCT gradually declines or even disappears. The current findings can promote efficient regulation of the thermal performance of the MCT by adjusting the inclination angle of the louver.

Effects of stigma, anxiety and depression, and uncertainty in illness on quality of life in patients with prostate cancer: a cross-sectional analysis

PurposeAlthough much work has been carried out on stigma, anxiety and depression, and quality of life(QoL) in cancer patients, far less work has been done to examine their associations. This study explores the effects of stigma, anxiety and depression, and uncertainty in illness on QoL in prostate cancer patients.MethodsA cross-sectional study surveyed levels of stigma, anxiety and depression, QoL, and uncertainty in illness in 263 people diagnosed with prostate cancer from the First Affiliated Hospital, Zhejiang University School of Medicine. The main study variables were analyzed by structural equation modeling.ResultsAnxiety and depression were significantly negatively related to QoL, with a standardized regression coefficient (β=−0.312, S.E. =0.478, p < 0.05), which means that participants reporting higher levels of anxiety reported decreased levels of QoL. Stigma was positively related to anxiety and depression (β = 0.135, S.E. =0.203, p < 0.001) and uncertainty in illness (β = 0.126, S.E. =2.194, p < 0.05). Stigma has direct effects on QoL (β=−0.209, S.E. =1.655, p < 0.001), but in the presence of a third variable (anxiety and depression overall), direct effects are reduced, as indirect effects emerge through the variable anxiety and depression overall, with an indirect effect size of − 0.054.ConclusionsStigma impacts mental health, such as anxiety and depression, uncertainty in illness, and QoL. Health care professionals may help patients alleviate feelings of anxiety, depression, and uncertainty in illness to improve QoL outcomes.

Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip.

To investigate factors associated with postoperative avascular necrosis of the femoral head (ANFH) in developmental dysplasia of the hip (DDH) patients, and if or how the associations varied among different subpopulations of age, sex and surgical method. Patients with DDH were enrolled between October 31, 2016 and July 15, 2020 in this retrospective cohort study. The average follow-up time was 21.42 ± 10.02 months. The outcome was postoperative ANFH. The main study variables were the DDH classification, Tonnis grade, International Hip Dysplasia Institute (IHDI) classification, and preoperative traction. Multivariate logistic regression was employed to assess the associations between main study variables and postoperative ANFH. Subgroup analysis was carried out based on age at reduction, sex and surgical method. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated. A total of 427 children with DDH were included, with 92 (21.55%) in the ANFH group, and 335 (78.45%) in the non-ANFH group. DDH classification was positively correlated with the risk of postoperative ANFH (OR = 4.14, 95% CI, 1.08-15.77, P = 0.038). Children with preoperative traction had a significantly decreased risk of postoperative ANFH in contrast to those without preoperative traction (OR = 0.37, 95% CI, 0.22-0.61, P < 0.001). Children aged 1-3 years who received preoperative traction has a significantly reduced risk of postoperative ANFH than those who did not receive preoperative traction (OR = 0.28, 95% CI, 0.15-0.51, P < 0.001). For children aged >3 years, positive association was found between DDH classification and the risk of postoperative ANFH (OR = 3.75, 95% CI, 1.51-9.31, P = 0.004). Girls with a more severe DDH type had a significantly higher risk of postoperative ANFH (OR = 3.80, 95% CI, 1.80-8.02, P < 0.001). Receiving preoperative traction was associated with a significantly decreased risk of postoperative ANFH in girls (OR = 0.37, 95% CI, 0.22-0.61, P < 0.001). For children undergoing open reduction, DDH classification was positively associated with the risk of postoperative ANFH (OR = 3.01, 95% CI, 1.65-5.50, P < 0.001), and those with preoperative traction had a lower risk of postoperative ANFH compared with those without preoperative traction (OR = 0.35, 95% CI, 0.20-0.61, P < 0.001). DDH classification and preoperative traction were associated with the risk of postoperative ANFH, and these associations varied across DDH patients with different ages, sexes and surgical methods.

Do the innovation and digital transformation strategies induce sme performances In new normal era? Structrual &amp; confirmatory analysis models

One of major challenge in a sustainable growth, which organizations face is a slow adoption of the digital transformation. This research work presents the reasons that lead to the slow digitization process in medical device SMEs in southern Germany. In addition, by developing the conceptual model, this work highlights the effect of these improper implementations on SME's business performances and financial situation. The researchers applied correlational research design methodology, with simple random sampling techniques along with empirical and statistical study with primary data collection. The main study variables are SME’s financial situation, SMEs organizational performance, and medical digitization rules. The study demonstrated the negative impact of delayed digital mechanisms in terms of businesses and financial performances.The extra transparency restrictions that add burdens for SMEs, and the lack of training for the employees, which in overall add more difficulties for adopting innovation and digital transformation are other factors negatively affecting the studied process.

A Cross-Sectional Study: Determining Factors of Functional Independence and Quality of Life of Patients One Month after Having Suffered a Stroke.

(1) Background: loss of quality of life (QoL) and functional independence are two of the most common consequences of suffering a stroke. The main objective of this research is to study which factors are the greatest determinants of functional capacity and QoL a month after suffering a stroke so that they can be considered in early interventions. (2) Methods: a cross-sectional study was conducted which sample consisted of 81 people who had previously suffered a stroke. The study population was recruited at the time of discharge from the Neurology Service and Stroke Unit of the hospitals of Burgos and Córdoba, Spain, through a consecutive sampling. Data were collected one month after participants experienced a stroke, and the main study variables were quality of life, measured with the Stroke-Specific Quality of Life Measure (NEWSQOL), and functional independence, measured with the Functional Independence Measure-Functional Assessment Measure (FIM-FAM). (3) Results: the factors associated with a worse QoL and functional capacity one month after having suffered a stroke were living in a different dwelling than the usual flat or house (p < 0.05), a worse cognitive capacity (p < 0.001) and a worse functional capacity of the affected upper limb (p < 0.001). A higher age was related to a worse functional capacity one month after suffering a stroke (p = 0.048). (4) Conclusions: the type of dwelling, age, cognitive ability and functional capacity of the affected upper limb are determining aspects in functional independence and QoL during the first weeks after a stroke.

Boards of directors and firm internationalization: A bibliometric review

This paper conducts a bibliometric review of the research on the relationship between boards of directors and the internationalization of companies. Boards of directors play an important role in the success of the internationalization process of companies, as they contribute to strategic decision-making and support access to the resources and capabilities needed to enter the international market. The bibliometric analysis documents are the most influential articles, authors, journals and countries in this field of knowledge, highlighting the diversity of topics addressed. In addition, the co-occurrence analysis reveals the theoretical and conceptual core of the research, knowing the main theories and study variables analyzed. This review lays the groundwork for future research on boards of directors and the internationalization of companies, highlighting the need for more research at a global level, especially in Latin America. It also suggests future lines of research on emerging issues such as board capital and board-to-board networking