Standard Scale Research Articles

Co-designing a pedagogical model for immersive virtual environments in healthcare education

ABSTRACT Technology is flooding the healthcare sector, making it essential to advance pedagogy in conjunction with technology. The aim of this study was to inquiry about participants` learning experience with IVR application and to co-design a pedagogical model for using IVR in healthcare education. The study employed a design-based approach utilizing several data gathering and analysis methods. After each learning experience, data were gathered through an online questionnaire utilizing the standardized simulation design scale. After the experiment, participants co-designed a pedagogical framework based on their learning experience. Data were analyzed using qualitative methods and descriptive statistics (M, MD). Altogether, the study involved 47 informants. Based on the data analysis, the participants were generally satisfied with IVR and believed it offered enhanced possibilities for training, although there were doubts about whether it actually helped them learn. Participants valued the support provided by the facilitators, whereas statements concerning the fidelity of the scenarios scored lowest. The pedagogical framework was developed based on the data. The study’s results can be utilized when designing immersive learning experiences for healthcare students and professionals.

Assessment of functional outcome and quality of life after-treatment of oral squamous cell carcinoma

Objective To assess the functional outcome and impact on the quality of life after treatment for squamous cell carcinoma using Qol questionnaire. To assess the level of anxiety and depression among patients treated for SCC. To emphasize the implementation of the QoL questionnaire as a regular assessment tool to identify post-treated patients' special needs and improve care protocol. Methodology A cross-sectional survey was done with post-operative patients of oral squamous cell carcinoma, where a structured, closeended questionnaire was used comprised of 30 items that are intended to inquire about patient's post-operative status of quality of life based on standardized scales as EORTC Quality of life (QLQ-C30), Quality of life Questionnaire Head & Neck (QLQ-H&N35) and HADS Questionnaire of hospital Anxiety and depression scale. However, the sample was subdivided into three groups according to the treatment received Patients treated with surgery & reconstruction, Patients treated with Radiotherapy, and Patients treated with Surgery + Reconstruction and Radiotherapy respectively. The data was collected from three tertiary care hospitals and the total sample size was 120. Results and conclusion Treatment that included both surgery and radiotherapy resulted in the highest level of symptom burden and psychological morbidity including depression and anxiety. These changes were most devastating to younger patients as they mostly lamented over loss of bodily function, reduced ability to work and changes in body appearance became key determinants of social and psychological well-being. The study also highlights the need to establish a more long-term follow-up beyond treatment and perform a QoL questionnaire to discover per-patient needs.

Advancing health equity: evaluating AI translations of kidney donor information for Spanish speakers

BackgroundHealth equity and access to essential medical information remain significant challenges, especially for the Spanish-speaking Hispanic population, which faces barriers in accessing living kidney donation opportunities. ChatGPT, an AI language model with sophisticated natural language processing capabilities, has been identified as a promising tool for translating critical health information into Spanish. This study aims to assess ChatGPT’s translation efficacy to ensure the information provided is accurate and culturally relevant.MethodsThis study utilized ChatGPT versions 3.5 and 4.0 to translate 27 frequently asked questions (FAQs) from English to Spanish, sourced from Donate Life America’s website. The translated content was reviewed by native Spanish-speaking nephrologists using a standard rubric scale (1–5). The assessment focused on linguistic accuracy and cultural sensitivity, emphasizing retention of the original message, appropriate vocabulary and grammar, and cultural relevance.ResultsThe mean linguistic accuracy scores were 4.89 ± 0.32 for GPT-3.5 and 5.00 ± 0.00 for GPT-4.0 (p = 0.08). The percentage of excellent-quality translations (score = 5) in linguistic accuracy was 89% for GPT-3.5 and 100% for GPT-4.0 (p = 0.24). The mean cultural sensitivity scores were 4.89 ± 0.32 for both GPT-3.5 and GPT-4.0 (p = 1.00). Similarly, excellent-quality translations in cultural sensitivity were achieved in 89% of cases for both versions (p = 1.00).ConclusionChatGPT 4.0 demonstrates strong potential to enhance health equity by improving Spanish-speaking Hispanic patients’ access to LKD information through accurate and culturally sensitive translations. These findings highlight the role of AI in mitigating healthcare disparities and underscore the need for integrating AI-driven tools into healthcare systems. Future efforts should focus on developing accessible platforms and establishing guidelines to maximize AI’s impact on equitable healthcare delivery and patient education.

RADAR-AD: assessment of multiple remote monitoring technologies for early detection of Alzheimer’s disease

BackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disorder affecting millions worldwide, leading to cognitive and functional decline. Early detection and intervention are crucial for enhancing the quality of life of patients and their families. Remote Monitoring Technologies (RMTs) offer a promising solution for early detection by tracking changes in behavioral and cognitive functions, such as memory, language, and problem-solving skills. Timely detection of these symptoms can facilitate early intervention, potentially slowing disease progression and enabling appropriate treatment and care.MethodsThe RADAR-AD study was designed to evaluate the accuracy and validity of multiple RMTs in detecting functional decline across various stages of AD in a real-world setting, compared to standard clinical rating scales. Our approach involved a univariate analysis using Analysis of Covariance (ANCOVA) to analyze individual features of six RMTs while adjusting for variables such as age, sex, years of education, clinical site, BMI and season. Additionally, we employed four machine learning classifiers – Logistic Regression, Decision Tree, Random Forest, and XGBoost – using a nested cross-validation approach to assess the discriminatory capabilities of the RMTs.ResultsThe ANCOVA results indicated significant differences between healthy and AD subjects regarding reduced physical activity, less REM sleep, altered gait patterns, and decreased cognitive functioning. The machine-learning-based analysis demonstrated that RMT-based models could identify subjects in the prodromal stage with an Area Under the ROC Curve of 73.0 %. In addition, our findings show that the Amsterdam iADL questionnaire has high discriminatory abilities.ConclusionsRMTs show promise in AD detection already in the prodromal stage. Using them could allow for earlier detection and intervention, thereby improving patients’ quality of life. Furthermore, the Amsterdam iADL questionnaire holds high potential when employed remotely.

The relationship between perceived stress and job burnout of police officers during the COVID-19 pandemic: the mediating role of social support, sleep quality and resilience

BackgroundWith the rapid spread of Corona Virus Disease 2019 (COVID-19) in China, police officers were undergoing higher job stress, which made them physically and mentally exhausted, eventually leading to job burnout. The research aims to explore the mediating role of social support, psychological resilience, and sleep quality in the relationship between perceived stress and burnout.MethodsData collection was based on multistage cluster random sampling of police in Wuhan, China, from June 2021 to October 2022. A self-administered questionnaire was adopted. Perceived stress, social support, resilience, sleep quality and job burnout were measured using international standard scales. Spearman correlation analysis was utilized to explore the correlation between various psychological conditions and job burnout. Cronbach’s α coefficient methods and confirmatory factor analysis (CFA) were applied to check the scales’ reliability and discriminant validity. The structural equation model (SEM) was performed to adjust the model fitting.Results2125 eligible participants were included. The job burnout score was 1.90, and 8.52% showed severe burnout. The Cronbach’s α coefficients of the above scales were all ≥ 0.8. The goodness of fit test for the first-order and second-order models reached all fit indices standards in CFA. Police’s burnout and its dimensions were correlated with sleep quality, perceived stress, and social support, except between burnout, emotional exhaustion, depersonalization, and resilience. Parallel multiple mediations showed that social support, sleep quality, and resilience mediated the relationships between perceived stress and job burnout. The mediating effect of the three factors accounted for 6.72%, 55.39%, and − 7.14% of the total effect, respectively.ConclusionsPerceived stress affects burnout through mediating variables such as social support, sleep quality, and resilience. The mediating effect of sleep quality is the most potent.

Isolated congenital diaphragmatic hernia and three-year neurodevelopmental outcomes.

To retrospectively investigate the developmental outcomes at 3 years of age in patients with congenital diaphragmatic hernia (CDH) using a multicenter collaborative research approach. We evaluated patients with CDH and no other malformations born between 2010 and 2016 in seven facilities in the Japanese CDH Research Group. The developmental quotient (DQ) at 3 years of age was evaluated using the Kyoto Scale of Psychological Development 2001, the most standardized scale in Japan. Factors associated with a DQ score < 85 were also analyzed. Of 196 patients, developmental assessments at 3 years of age were performed in 132 patients (67%). Among these, 99 patients (75%) had a DQ score ≥ 85, 25 (19%) had a DQ score between 70 and 84, and 8 (6%) had a DQ score < 70. Multivariate analysis showed that the observed/expected lung area-to-head circumference ratio was an independent predictor of a DQ score < 85, with an adjusted odds ratio of 0.62 (95% confidence interval: 0.40-0.96; p = 0.03). Generally, isolated CDH is associated with good developmental outcomes for survivors, even after intensive care. However, there is a risk of neurodevelopmental impairment if pulmonary hypoplasia is present. This research highlights the observed/expected lung area-to-head circumference ratio (o/e LHR) as a crucial indicator to predict neurodevelopmental outcomes in 3-year-old children diagnosed with isolated congenital diaphragmatic hernia (CDH). Our results provide robust evidence from a large multicenter cohort, emphasizing the importance of o/e LHR in early risk stratification and prolonged neurodevelopmental follow-up. These findings highlight the need for comprehensive management and tailored follow-up care in CDH patients, potentially improving clinical protocols and enhancing the quality of life and outcomes for affected children.

A solution to the pervasive problem of response bias in self-reports

Self-reports are used ubiquitously to probe people's thoughts, feelings, and behaviors and inform medical decisions, enterprise operations, and government policy and legislation. Despite their pervasive use, self-report measures such as Likert scales have a profound problem: Standard analytic approaches do not control for the confounding effects of idiosyncratic response biases. Here, we present a model-based solution to this problem. Our model disentangles response bias from latent constructs of interest to obtain less biased scores of the latent states of respondents. Inspired by Thurstonian approaches in the psychophysics literature, the model requires nothing further than standard Likert scale design assumptions. The model uses a data-driven approach to control for response biases, without the need to prespecify bias types or response strategies. We demonstrate the model's ability to uncover more precise estimates of latent state associations, outperforming bias-affected standard scoring techniques, and garner insights into previously undetected codependencies between certain latent states and particular forms of response bias. The model is thus a tool which outperforms standard scoring methods and generates insights into, and controls for, the potentially confounding effects of response bias on self-report Likert scale data.

Development and psychometric testing of the school-life conflict scale (SLCS) among nursing students.

Nursing students often face a heavy academic burden compared to students in other programs, possibly affecting their personal lives. However, a standardized scale assessing how academic demands interfere with the personal well-being in student nurses is lacking. This study was conducted to develop and test the psychometric properties of the School-Life Conflict Scale (SLCS). Exploratory sequential research design. Three government nursing schools in the Philippines. A total of 1014 student nurses participated in the study. Both the inductive and deductive methods were employed to generate the scale items. The factor structure of the scale was established through exploratory factor analysis (EFA) and confirmed through confirmatory factor analysis (CFA). Five faculty experts examined the content validity of the scale. A 14-item scale with three-factor structure was identified through factor analyses. These factors were labeled 'Academic Demands and Well-being', 'Social Interactions and Relationships', and 'Engagement in Extracurricular Activities'. The overall Cronbach's alpha coefficients of the scale was 0.900, while the Cronbach's alpha coefficients for the 3 factors ranged from 0.808 to 0.859. The SLCS shows excellent psychometric properties and can be used to assess the extent to which academic responsibilities intersect and interfere with personal life in student nurses. This scale may be utilized by nurse faculty to identify students at risk of conflict and to implement approaches to support their health and well-being.

Clinical Outcomes of a New Foot-Worn Non-Invasive Biomechanical Intervention Compared to Traditional Physical Therapy in Patients With Chronic Low Back Pain. A Randomized Clinical Trial.

Randomized Controlled Trial. Chronic low back pain (CLBP) is a major public health concern that will continue to grow with the expected aging of the population. The purpose of this study was to examine the clinical effect of a personalized, home-based biomechanical intervention compared to traditional physical therapy in patients with CLBP. This was a randomized controlled trial. One-hundred and sixty-two patients were randomized in a 2:1 ratio to a home-based biomechanical intervention (HBBI, AposHealth) or traditional physical therapy (TPT), respectively. Patients were assessed at baseline and after 12weeks and 52weeks. The primary outcome measure was pain at 52weeks, using a standard Numeric Rating Scale (NRS). Secondary outcomes included pain and function metrics, quality of life and objective spatio-temporal gait test. A Linear Mixed Model assessed changes over time across all study visits. A significant reduction in NRS was found after 52weeks with a superiority effect of the HBBI arm compared to TPT (F = 13.82, P < 0.001). Patients in the HBBI arm demonstrated a marginal mean reduction of 3.5 points, from 6.2 to 2.7 (a 56% reduction), while patients in the TPT arm reported a mean decrease of 1.8 points from 6.9 to 5.1 (a 26% reduction). A new foot-worn, home-based, biomechanical intervention for patients with chronic non-specific back pain was found to be clinically effective. Given the lack of non-surgical, non-pharmacological interventions for this populations, this treatment might serve as an adjunct to the current standard of care.

Academic pressure and perceived stress: The mediating role of life satisfaction

The level of perceived stress of college students has been increasing steadily in recent years. This study investigated the effect of academic pressure on perceived stress and examined whether life satisfaction mediated this relationship. We conducted a cross-sectional survey of 290 Chinese college students using standardized scales for measuring life satisfaction, academic pressure, and perceived stress. Pearson correlation and mediation analysis results showed that academic pressure had both direct and indirect effects on perceived stress, with life satisfaction playing a mediating role. The multiple mechanisms by which academic pressure affects perceived stress point to its harmful effects and the need to reduce its impact. Our findings suggest that health interventions aimed at improving life satisfaction may be beneficial to mitigate the severity of perceived stress both directly and indirectly among college students.

How Delphi studies in the health sciences find consensus: a scoping review

BackgroundDelphi studies are primarily used in the health sciences to find consensus. They inform clinical practice and influence structures, processes, and framework conditions of healthcare. The practical research—how Delphi studies are conducted—has seldom been discussed methodologically or documented systematically. The aim of this scoping review is to fill this research gap and to identify shortcomings in the methodological presentation in the literature. On the basis of the analysis, we derive recommendations for the quality-assured implementation of Delphi studies.MethodsForming the basis of this scoping review are publications on consensus Delphi studies in the health sciences between January 1, 2018, and April 21, 2021, in the databases Scopus, MEDLINE via PubMed, CINAHL, and Epistemonikos. Included were publications in German and English containing the words “Delphi” in the title and “health” and “consensus” in the title or abstract. The practical research was analyzed for the qualitative content of the publications according to three deductive main categories, to which an influence on the result of Delphi studies can be imputed (expert panel, questionnaire design, process and feedback design).ResultsA total of 287 consensus Delphi studies were included in the review, whereby 43% reported having carried out a modified Delphi. In most cases, heterogeneous expert groups from research, clinical practice, health economics, and health policy were surveyed. In about a quarter of the Delphi studies, affected parties, such as patients, were part of the expert panel. In the Delphi questionnaires it was most common for standardized Likert scales to be combined with open-ended questions. Which method was used to analyze the open-ended responses was not reported in 62% of the Delphi studies. Consensus is largely (81%) defined as percentage agreement.ConclusionsThe results show considerable differences in how Delphi studies are carried out, making assessments and comparisons between them difficult. Sometimes an approach points to unintended effects, or biases in the individual judgments of the respondents and, thus, in the overall results of Delphi studies. For this reason, we extrapolate suggestions for how certain comparability and quality assurance can be achieved for Delphi studies.

PITSZI: Probing Intra-cluster medium Turbulence with Sunyaev-Zel'dovich Imaging. Application to the triple merging cluster MACS J0717.5+3745

Turbulent gas motions are expected to dominate the non-thermal energy budget of the intracluster medium (ICM). The measurement of pressure fluctuations from high angular resolution Sunyaev-Zel'dovich imaging opens a new avenue to study ICM turbulence, complementary to X-ray density fluctuation measures. We developed a methodological framework designed to optimally extract information on the ICM pressure fluctuation power spectrum statistics, and publicly released the associated software named PITSZI (Probing ICM Turbulence from Sunyaev-Zel'dovich Imaging). We applied this tool to the New IRAM KIDs Array (NIKA) data of the merging cluster MACS J0717.5+3745 to measure its pressure fluctuation power spectrum at high significance, and to investigate the implications for its non-thermal content. Depending on the choice of the radial pressure model and the details of the applied methodology, we measured an energy injection scale L_ inj ∼ 800 kpc. The power spectrum normalization corresponds to a characteristic amplitude reaching A_ δ P / P (k_ peak ) ∼ 0.4. These results were obtained assuming that the ICM of MACS J0717.5+3745 can be described as pressure fluctuations on top of a single (smooth) halo, and were dominated by systematics due to the choice of the radial pressure model. Using simulations, we determined that fitting a radial model to the data can suppress the observed fluctuations by up to $ ∼ 50$%, while a poorly representative radial model can induce spurious fluctuations, which we also quantified. Assuming standard scaling relations between the pressure fluctuations and turbulence, we find that MACS J0717.5+3745 presents a turbulent velocity dispersion σ_v ∼ 1200 km/s, a kinetic to kinetic plus thermal pressure fraction P_ kin / P_ kin+th ∼ 20%, and we estimate the hydrostatic mass bias to b_ HSE ∼ 0.3-0.4. Our results are in excellent agreement with alternative measurements obtained from X-ray surface brightness fluctuations, and in agreement with the fluctuations being adiabatic in nature.

A Comprehensive Machine Learning Approach for COVID-19 Target Discovery in the Small-Molecule Metabolome.

Background/Objectives: Respiratory viruses, including Influenza, RSV, and COVID-19, cause various respiratory infections. Distinguishing these viruses relies on diagnostic methods such as PCR testing. Challenges stem from overlapping symptoms and the emergence of new strains. Advanced diagnostics are crucial for accurate detection and effective management. This study leveraged nasopharyngeal metabolome data to predict respiratory virus scenarios including control vs. RSV, control vs. Influenza A, control vs. COVID-19, control vs. all respiratory viruses, and COVID-19 vs. Influenza A/RSV. Method: We proposed a stacking-based ensemble technique, integrating the top three best-performing ML models from the initial results to enhance prediction accuracy by leveraging the strengths of multiple base learners. Key techniques such as feature ranking, standard scaling, and SMOTE were used to address class imbalances, thus enhancing model robustness. SHAP analysis identified crucial metabolites influencing positive predictions, thereby providing valuable insights into diagnostic markers. Results: Our approach not only outperformed existing methods but also revealed top dominant features for predicting COVID-19, including Lysophosphatidylcholine acyl C18:2, Kynurenine, Phenylalanine, Valine, Tyrosine, and Aspartic Acid (Asp). Conclusions: This study demonstrates the effectiveness of leveraging nasopharyngeal metabolome data and stacking-based ensemble techniques for predicting respiratory virus scenarios. The proposed approach enhances prediction accuracy, provides insights into key diagnostic markers, and offers a robust framework for managing respiratory infections.

Investigation of stakeholder perceptions of the wheelchair service delivery process

Introduction: The wheelchair service delivery process (SDP) is a large complex system and therefore has many potential points of failure; determining priorities for improvement is challenging. The complexities introduce several barriers to accessing and maintaining wheelchairs for individuals with mobility impairments. Given the breadth and depth of the barriers, it is important to know in which areas to focus future policy reform efforts. Purpose:The purpose is to explore the perceptions of stakeholders regarding the performance of the wheelchair SDP in the United States and guide future policy reforms. Methods: A cross-sectional, observational, online questionnaire was deployed. Questions were positive statements regarding the wheelchair SDP and participants rated their agreement with the statements on a standard six-point Likert scale. A snowball sampling strategy was used and consisted of emailing 42 organisations representing 5 stakeholder groups: (1) consumers/caregivers; (2) clinicians; (3) manufacturers; (4) payers; and (5) suppliers. Results: 1,052 responses were collected: 41% clinicians, 30% suppliers, 24% consumers/caregivers, 3% manufacturers, 2% payers. Stakeholders view the wheelchair SDP as not performing well. Less than 18% of all responses indicate a positive perception. Funding and procurement was viewed in the least positive light, with 5% positive responses. Follow-up, maintenance, and repair was the second least positive component with 9% positive responses. Fitting, training, and delivery was viewed most positively with over 42% positive responses. Conclusion: The wheelchair SDP is not viewed as performing well by its stakeholders. Funding, procurement, maintenance, and repairs are viewed particularly negatively, representing opportunities for focused system reform efforts.

Human-centered design of a health recommender system for orthopaedic shoulder treatment

BackgroundRich data on diverse patients and their treatments and outcomes within Electronic Health Record (EHR) systems can be used to generate real world evidence. A health recommender system (HRS) framework can be applied to a decision support system application to generate data summaries for similar patients during the clinical encounter to assist physicians and patients in making evidence-based shared treatment decisions.ObjectiveA human-centered design (HCD) process was used to develop a HRS for treatment decision support in orthopaedic medicine, the Informatics Consult for Individualized Treatment (I-C-IT). We also evaluate the usability and utility of the system from the physician’s perspective, focusing on elements of utility and shared decision-making in orthopaedic medicine.MethodsThe HCD process for I-C-IT included 6 steps across three phases of analysis, design, and evaluation. A team of health informatics and comparative effectiveness researchers directly engaged with orthopaedic surgeon subject matter experts in a collaborative I-C-IT prototype design process. Ten orthopaedic surgeons participated in a mixed methods evaluation of the I-C-IT prototype that was produced.ResultsThe HCD process resulted in a prototype system, I-C-IT, with 14 data visualization elements and a set of design principles crucial for HRS for decision support. The overall standard system usability scale (SUS) score for the I-C-IT Webapp prototype was 88.75 indicating high usability. In addition, utility questions addressing shared decision-making found that 90% of orthopaedic surgeon respondents either strongly agreed or agreed that I-C-IT would help them make data informed decisions with their patients.ConclusionThe HCD process produced an HRS prototype that is capable of supporting orthopaedic surgeons and patients in their information needs during clinical encounters. Future research should focus on refining I-C-IT by incorporating patient feedback in future iterative cycles of system design and evaluation.

The Effect of Clinical Observations on Nursing Students' Compliance with Standard Precautions: A Cross-sectional Study.

Healthcare-associated infections pose a significant global challenge, highlighting the need for enhanced knowledge and practices among healthcare professionals. This study investigates the impact of clinical observations on nursing students' compliance with standard precautions. Employing a cross-sectional descriptive design, the study surveyed 405 nursing students using a 'Personal Information Form', the 'Nurses' Observations on Infection Control and Prevention Questionnaire', the 'Standard Precautions Scale', and the 'Factors Affecting Compliance with Standard Precautions Scale'. The mean scores for the Nurses' Observations on Infection Control and Prevention Questionnaire, the Standard Precautions Scale, and the Factors Affecting Compliance with Standard Precautions Scale were 33.39±12.98, 10.93±4.79, and 53.38±10.35, respectively. A significant negative correlation was found between students' observations on infection control and their compliance with standard precautions (r=-.254, p<0.01), with their observations explaining only 6% of the variance in compliance. The findings suggest that the influence of nursing students' observations during clinical practice on their compliance to standard precautions is minimal. This study highlights the necessity of developing more effective strategies to improve nursing students' compliance to standard precautions, extending beyond observational learning alone.

Willingness to pay for exercise oncology services: a mixed methods study.

To evaluate cancer patients' willingness to pay for exercise services and oncology health professionals' perception of patients' willingness to pay. A mixed-methods design was used. Online questionnaires and semi-structured interviews were administered to people with any type of cancer and oncology health professionals delivering clinical care. Questionnaires assessed patients' willingness to pay for one consultation with a cancer-trained exercise specialist (i.e. exercise physiologist/physiotherapist) and regular group exercise sessions supervised by cancer-trained exercise specialists. Interviews probed factors associated with the out-of-pocket cost of adopting exercise guidelines. Data were analysed using standard descriptive statistics and an interpretive descriptive approach to qualitative analysis. Participants included 450 cancer patients and 300 oncology health professionals. A randomly selected sub-set of 30 patients and 31 health professionals completed interviews. The majority of patients surveyed would pay for an exercise consultation (94%) and regular group exercise sessions (58.4% extremely likely; 24.7% moderately likely; standard 7-point Likert scale response options). A greater proportion of patients who were employed (97.2% p = 0.030), below average general health (97.0% p = 0.031), were female (96.1% p = 0.013), and insufficiently active (95.3% p = 0.048) were willing to pay for exercise services. Oncology health professionals perceived fewer patients would be willing to pay for exercise services (p < 0.001; consultation = 7.0% extremely likely, 32.7% moderately likely; regular supervised sessions = 5.3% extremely likely; 32.0% moderately likely). When briefly informed of the benefits and costs of exercise, the majority of patients in this study would pay for cancer-specific exercise services. There is an opportunity to align perceptions of willingness to pay among patients and health professionals involved in their care to help facilitate the uptake of exercise guidelines.

Reliability test and revision of stress coping scale for early childhood teachers.

The purpose of this research was to determine the reliability and validity of the Early Childhood Teachers' Stress Coping Strategies Scale measured among early childhood teachers in Guangdong Province, China. The researcher used the Early Childhood Teachers' Stress Coping Strategies Scale and a simplified version of the COPE questionnaire (Coping Inventory). The Early Childhood Teachers' Stress Coping Strategies Scale consists of three dimensions: "Rational Thinking," "Emotional Regulation," and "Support Seeking," and the simplified COPE questionnaire was consists of 2 dimensions: "Help Seeking" and "Cognitive Coping." The scale was administered to 653 in-service ECE teachers and retested with a sample of 320 ECE teachers 1 month later. The internal consistency coefficient (ICC) of the questionnaire as a whole was 0.91, the internal consistency reliabilities of the 3 subscales ranged from 0.86-0.91, and the ICC values of the intragroup correlation coefficients of the latent variables ranged from 0.864-0.881, with a p < 0.05, which showed good reliabilities. Validity: exploratory factor analysis extracted a total of three factors with characteristic roots greater than 1. The three factors were denominated as, Rational Thinking, Emotion Regulation, and Support Seeking, and the three factors explained a total of 53.82% of the variance. The validation factor analysis showed that the model fit indices were GFI > 0.85, CFI > 0.9, NFI > 0.85, TLI > 0.9, IFI > 0.9, RMSEA<0.10, and RMR = <0.05, which indicated that the coping strategy scale with a good structural stability. Among the three-factor model, the discriminant and convergent validity of the three factors were reasonable. The correlation coefficients of rational thinking, emotion regulation, and support seeking with the two dimensions of help-seeking and cognitive coping in the COPE questionnaire were significantly positive and greater than 0.4, indicated that the correlation between this scale and the standardized scales was high. Overall, the Early Childhood Teachers' Stress Coping Strategies Scale could be used for the measurement of early childhood teachers' stress coping strategies.

Self-care tendencies and their pain-relieving effects in patients with endodontic pain: a descriptive survey

OBJECTIVE: This paper aims to search for sociodemographic/ dental models predicting the self-care orientations in endodontic patients and to explore the effectiveness of the applied methods in relieving pain. MATERIALS AND METHOD: Patients with a history of endodontic pain presenting at the endodontic clinic of Gazi University were subjected to a survey. Their sociodemographic and clinical data were obtained. They were asked to select from a structured list whether they had used any self- or formal care methods. Pain relief was measured using a 5-point standard Likert scale. Statistical analyses were done using multivariate logistic regression, Wilcoxon and Kruskal-Wallis tests, and Benjamini-Hochberg correction. RESULTS: Among 356 patients, 90% applied self-care alone or in combination with formal care. Maximum pain level, age, and pattern of dental clinic attendance were the variables that predicted orientations to various subcategories of self-care behaviors, with the first two variables remaining statistically or marginally significant in all tested conditions (P &amp;lt; .05 or &amp;lt; .10). Among the home remedies, drinking or local application of alcohol and intraoral cold treatment by the patient provided significantly greater pain relief than the others (P = .001). Medication under the guidance of a professional was more effective than self-medication (P &amp;lt; .001; except for NSAIDs, which were similarly effective in both cases). CONCLUSION: Before applying to the dental school hospital, most of the patients used various self-care methods for relieving toothache. Maximum pain and age were the common covariates of various self-care orientations. Overall, formal care relieved pain better than self-care. Home remedies generally displayed little effectiveness.

Voice Quality as Digital Biomarker in Bipolar Disorder: A Systematic Review.

Voice analysis has emerged as a potential biomarker for mood state detection and monitoring in bipolar disorder (BD). The systematic review aimed to summarize the evidence for voice analysis applications in BD, examining (1) the predictive validity of voice quality outcomes for mood state detection, and (2) the correlation between voice parameters and clinical symptom scales. A PubMed, Scopus, and Cochrane Library search was carried out by two investigators for publications investigating voice quality in BD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Studies were assessed using the modified methodological index for non-randomized studies (MINORS). Of the 400 identified publications, 16 studies met the inclusion accounting for 575 BD patients. Machine learning approaches were implemented in 87.5% of studies, with classification accuracies ranging from 70.9% to 96.9%. Manic state detection showed the strongest predictive validity [area under the curve (AUC) up to 0.89], while depression detection demonstrated moderate performance (AUC:0.66-0.78). Individual-specific models outperformed population-level approaches (correlation coefficients: 0.78 versus 0.44). Voice quality showed significant correlations with standardized clinical scales, particularly Young Mania Rating Scale and Hamilton Depression Rating Scale (normalized root mean square errors: 1.985 and 3.945, respectively). Prosodic features were examined in 81.25% of studies, with pitch consistently elevated during manic episodes. MINORS varied from 10 to 14, with notable limitations in sample size calculations and blinding procedures. Voice quality is a promising biomarker in BD, particularly for manic state detection and individualized monitoring. While controlled settings showed strong performance, naturalistic applications yielded more modest results. Future research should focus on standardizing protocols across different environments and conducting large-scale longitudinal studies with robust methodological controls.