Effects of physical activity on subjective well-being: the mediating role of social support and self-efficacy.

Objective: Subjective well-being is an essential component of college students' mental health, and the purpose of this study was to investigate the relationship between physical activity and subjective well-being among college students and to examine the mediating role of social support and self-efficacy between the physical activity and subjective well-being. Methods: This study utilized a cross-sectional design with a stratified whole group sample of 989 college students (Mage = 19.65 years, SD = 1.1) from three universities in Guangdong Province, China, and used the Physical Activity Scale, Subjective Well-Being Scale, Social Support Scale, and Self-Efficacy Scale for data collection. In this study, SPSS 26.0 was used for descriptive statistical analysis and correlation analysis of the collected data. Harman's one-way method was used to test for common method bias. Results: (1) Physical activity, subjective well-being, social support and self-efficacy were significantly correlated with each other. Among them, physical activity was significantly and positively correlated with subjective well-being (r = 0.36), physical activity directly predicted subjective well-being (ß = 0.125, t = 3.992, p < 0.01). (2) Physical activity positively predicted social support (ß = 0.386, t = 12.505, p < 0.01) and self-efficacy (ß = 0.358, t = 11.793, p < 0.01), social support significantly positively predicted subjective well-being (ß = 0.332, t = 11.370, p < 0.01) and self-efficacy (ß = 0.254, t = 8.744, p < 0.01), self-efficacy significantly and positively predicted subjective well-being (ß = 0.255, t = 8.251, p < 0.01). (3) Not only did social support and self-efficacy play an independent mediating role between physical activity and subjective well-being, but social support and self-efficacy played a chain mediating role between physical activity and subjective well-being. Conclusion: This study enriched the theoretical guidance for physical activity in promoting college students' subjective well-being. In the practical teaching of promoting college students' subjective well-being, in addition to paying attention to stimulating physical activity, special attention should be paid to the promotion of social support and self-efficacy.

Depression and Smartphone Addiction Among College Students: The Mediating Effect of Emotional Exhaustion.

Objective: Multiple studies claim that depression was a triggering factor for smartphone addiction among college students. But we still know very little about the underlying mechanisms of smartphone addiction. The aim was to shed light on the underlying mechanisms of smartphone addiction from the perspective of depression and emotional exhaustion, to provide alternative paths for university administrators to address smartphone addiction among college students. Methods: A total of 2764 Chinese college students participated in the survey. They independently filled out self-assessment questionnaires including the Cell Phone Addiction Scale, Beck Depression Inventory II, and Emotional Exhaustion Scale. Subsequently, mediation analysis was conducted using the PROCESS macro developed by Hayes (v 4.0; Model 4). Results: Statistical analysis showed that depression was positively correlated with emotional exhaustion and smartphone addiction, emotional exhaustion was positively correlated with smartphone addiction, all of which were statistically significant. In addition, the effect of depression on smartphone addiction among college students was partially mediated by emotional exhaustion. Conclusion: The impact of depression and emotional exhaustion on smartphone addiction had been preliminarily explored, which had certain value for further understanding of smartphone addiction among college students. This study could provide references for universities to develop intervention measures for smartphone addiction.

Factors related to Electrical Burn Injuries in Occupational and Non-occupational settings from 2010 to 2021 in Colombia: Cross-sectional Design.

Burns affect 11 million people worldwide annually. Electrical burns are renowned for inflicting extensive harm and long-term consequences that can lead to severe illnesses and fatalities. People in both occupational and non-occupational settings may be exposed to electrical burns, leading to functional or anatomical consequences. We identified sociodemographic features related to electrical burns in both settings. A cross sectional design, using an open dataset of electrical shock injuries occurred in Colombia during 2010-2021 period, was carried out. Sociodemographic features of people injured in occupational and non-occupational settings were described in counts (%), incidence per 100.000 people (I0;95% CI). To identify related factors (age-sex adjusted) with injuries in occupational and non-occupational settings, we applied a Binary Logistic Regression. Over the 12-year period, there were 1.274 electrical burns (I0: 2.47;2.34-2.61), 287 in the occupational setting (I0: 1.35;1.20-1.51) and 987 in the non-occupational setting (I0: 3.25;3.05-3.46). Age median was 31 years, most cases distributed in middle adulthood (52.8%), males (88.1%), high school/technician (42.8%), urban location (73.7%), weekdays (95.3%), and daytime hours (85.5%). Factors related to electrical burns in the occupational setting were males, middle adulthood, high school/technician, Thursday, and daytime hours. Otherwise, factors related to electrical burns in the non-occupational setting were early childhood, primary school, urban location, and weekends. Both settings pose a risk of injuries to individuals. We have identified sociodemographic factors related to these injuries in both occupational and non-occupational settings, which could aid in preventing damages and long-term complications, especially among vulnerable subgroups such as determined above.

Actual Scope of Nursing Practice in Saudi Ministry of Health Hospitals.

BACKGROUND: Articulating a clear scope of practice for all nursing categories is essential for improving patient safety, quality of care, and nurse retention. However, this is not the case in many countries, including Saudi Arabia. This study aimed to analyze the actual scope of practice for nursing staff in Saudi Ministry of Health hospitals. METHODS: The study used a cross-sectional exploratory design. The sampling method used in the study was the quota sampling technique. The scale utilized in this study was the Actual Scope of Practice (ASCOP) scale. Data were collected in March 2021 through an electronic form questionnaire completed by 286 nurses in two hospitals in Al-Hasa province in Saudi Arabia. RESULTS: The overall mean score for ASCOP was 4.64 out of 6. When participants were grouped according to select characteristics (various nursing staff categories, educational levels, years of experience, nationality, gender, and type of work setting), the results revealed no statistically significant differences in overall ASCOP mean scores, except for gender and nationality. CONCLUSIONS: The overall mean scores of nursing activities performed in practice do not significantly differ across nurses with different professional categories (health assistant, nursing technician, nursing specialist, and senior nursing specialist), indicating no clear scope of practice for each nursing category, in turn leading to role overlap among them in practice. The current study's findings can guide decision-makers to develop a clear scope of practice for nurses. The findings should also urge the decision-makers to reevaluate the usefulness of having multiple professional categories of nurses who are allowed to carry out almost the same job duties.

Adolescent Mental Health and Resilience Before and During the COVID-19 Pandemic.

PURPOSE: We aimed to assess levels of depression, anxiety, and resilience factors before and during the COVID-19 pandemic in a school sample of adolescents. We also aimed to examine the compensatory and protective effects of individual, family, and school resilience factors on adolescent mental health. METHODS: We used fall 2019 and fall 2020 survey responses from a cluster randomized controlled trial implemented in 20 schools in a Midwestern county. The sample consisted of 3,085 responses from students in grades 5 and 6. Multilevel mixed-effects models with cluster robust standard errors were used to investigate the associations between exposure to the COVID-19 pandemic, mental health (anxiety, depression), and resilience factors (future orientation, family engagement, and having a caring school adult). RESULTS: Anxiety, but not depression, was higher in fall 2020 compared to fall 2019. Family engagement increased during the pandemic, while future orientation of the student body was lower during that time and the prevalence of having a caring adult at school was unchanged. A positive future orientation was associated with lower levels of anxiety and depression, while having a caring school adult was associated with lower depression. Adolescents with less positive future orientations, low family engagement, and no caring school adults experienced the greatest increases in anxiety. DISCUSSION: Positive future orientations, family engagement, and supportive nonparental adult relationships had compensatory and protective effects on adolescent mental health during the COVID-19 pandemic. Adding these measures to the inventory of modifiable resilience factors during natural disasters may promote healthy adaptation among adolescents.

A sampling strategy for longitudinal and cross-sectional analyses using a large national claims database.

Importance: The United States (US) Medicare claims files are valuable sources of national healthcare utilization data with over 45 million beneficiaries each year. Due to their massive sizes and costs involved in obtaining the data, a method of randomly drawing a representative sample for retrospective cohort studies with multi-year follow-up is not well-documented. Objective: To present a method to construct longitudinal patient samples from Medicare claims files that are representative of Medicare populations each year. Design: Retrospective cohort and cross-sectional designs. Participants: US Medicare beneficiaries with diabetes over a 10-year period. Methods: Medicare Master Beneficiary Summary Files were used to identify eligible patients for each year in over a 10-year period. We targeted a sample of ~900,000 patients per year. The first year's sample is stratified by county and race/ethnicity (white vs. minority), and targeted at least 250 patients in each stratum with the remaining sample allocated proportional to county population size with oversampling of minorities. Patients who were alive, did not move between counties, and stayed enrolled in Medicare fee-for-service (FFS) were retained in the sample for subsequent years. Non-retained patients (those who died or were dropped from Medicare) were replaced with a sample of patients in their first year of Medicare FFS eligibility or patients who moved into a sampled county during the previous year. Results: The resulting sample contains an average of 899,266 ± 408 patients each year over the 10-year study period and closely matches population demographics and chronic conditions. For all years in the sample, the weighted average sample age and the population average age differ by <0.01 years; the proportion white is within 0.01%; and the proportion female is within 0.08%. Rates of 21 comorbidities estimated from the samples for all 10 years were within 0.12% of the population rates. Longitudinal cohorts based on samples also closely resembled the cohorts based on populations remaining after 5- and 10-year follow-up. Conclusions and relevance: This sampling strategy can be easily adapted to other projects that require random samples of Medicare beneficiaries or other national claims files for longitudinal follow-up with possible oversampling of sub-populations.

The association between appreciative management and work engagement among health- and social care professionals: A cross-sectional study.

BACKGROUND: The importance of work engagement has been emphasised due to the increasing demand for health- and social care and the shortage of skilled labour. Improving organisational and managerial factors is important when enhancing professionals' work engagement. The association between management and work engagement has only been established in previous studies at a general level, but the association between appreciative management and work engagement has not received equivalent research interest. AIM: This study aimed to describe the association between appreciative management and work engagement among health- and social care professionals. METHODS: The study used a cross-sectional survey design. The data were collected in five health and social services centres in one city in Finland from September to October 2022 using the Appreciative Management Scale 2.0 and the Utrecht Work Engagement Scale-9. A total of 182 health- and social care professionals participated. The data were analysed using correlations, linear regression analyses, independent samples t-tests and two-way analyses of variance (ANOVAs). RESULTS: A moderate association was found between appreciative management and work engagement and its dimensions of vigor, dedication and absorption. Systematic management had the strongest association and equality had the weakest association with work engagement. Among the dimensions of work engagement, appreciative management had the strongest association with vigour and the weakest association with absorption. Appreciative management and work type predicted 18% of the variance in work engagement. Full-time employees reported higher levels of work engagement and all its dimensions than did part-time employees. CONCLUSION: The results indicate that appreciative management and full-time work predict work engagement among health- and social care professionals. Due to this positive association, it is important to promote managers' appreciative management skills by educating them to understand how appreciative management enables and supports professionals' vigour, dedication and absorption in health- and social care.

A Cross-Sectional Study of Cognitive Function, Illness Perceptions, and Immunosuppression Medication Adherence After Heart Transplantation.

BACKGROUND: There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions. OBJECTIVE: The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients. METHODS: A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson's correlations, and logistic regression were used to describe relationships. RESULTS: Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment. CONCLUSION: Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.

APOL1 Risk Variants Associate With the Prevalence of Stroke in African American Current and Past Smokers.

BACKGROUND: African American smokers have 2.5 times higher risk for stroke compared with nonsmokers (higher than other races). About 50% of the African American population carry 1 or 2 genetic variants (G1 and G2; rare in other races) of the apolipoprotein L1 gene (APOL1). Studies showed these variants may be associated with stroke. However, the role of the APOL1 risk variants in tobacco-related stroke is unknown. METHODS AND RESULTS: In a cross-sectional study, we examined whether APOL1 risk variants modified the relationship between tobacco smoking and stroke prevalence in 513 African American adults recruited at University of California, San Francisco. Using DNA, plasma, and questionnaires we determined APOL1 variants, smoking status, and stroke prevalence. Using logistic regression models, we examined the association between smoking (ever versus never smokers) and stroke overall, and among carriers of APOL1 risk variants (1 or 2 risk alleles), and noncarriers, separately. Among participants, 41% were ever (current and past) smokers, 54% were carriers of the APOL1 risk variants, and 41 had a history of stroke. The association between smoking and stroke differed by APOL1 genotype (Pinteraction term=0.014). Among carriers, ever versus never smokers had odds ratio (OR) 2.46 (95% CI, 1.08-5.59) for stroke (P=0.034); OR 2.00 (95% CI, 0.81-4.96) among carriers of 1 risk allele, and OR 4.72 (95% CI, 0.62-36.02) for 2 risk alleles. Among noncarriers, smoking was not associated with a stroke. CONCLUSIONS: Current and past smokers who carry APOL1 G1 and/or G2 risk variants may be more susceptible to stroke among the African American population.

Adding up fine motor skills: Developmental relations between manual dexterity and numerical abilities.

The strength and development of the relationship between mathematical and motor skills is explored across three age groups of normally developing children. The presence of this relationship is postulated in classical accounts of human development. In contemporary research, the existence of a relationship between motor development and the development of abstract concepts may inform theories of embodied cognition. Existing work supports a link between fine motor skills and various numerical and mathematical tasks in young children; however, few attempts have been made to investigate this relationship across different ages. We use a cross-sectional design to investigate the link between fine motor and mathematical skills in samples of 81-96 Kindergarten, 2nd-grade, and 4th-grade children. Bayesian correlations were performed to explore the relationship between fine motor skills and mathematical skills at different time points. The results show that correlational patterns vary across the three ages: in Kindergarten, manual dexterity of the dominant hand is related to math skills, in 2nd grade, the manual dexterity of the nondominant hand is related to math skills; and finally in 4th grade no such correlations are observable. These findings contribute to understanding the developmental trajectory of the relationship between motor skills and mathematical abilities and the internalization of numerical embodiment. Further investigation is needed to determine if fine motor skills can serve as an early indicator of mathematical skill development risk. Future work could also explore whether incorporating spatial and motor elements into mathematical tasks through whole-body or finger movement training supports the development of mathematical skills.

Patterns of Sun Protection Behaviours among Australian Adolescents and Adults over a Six-Year Period.

The major cause for skin cancer is the excessive and unprotected exposure to ultraviolet radiation (UVR), which can be prevented by engaging in sun protection behaviours. As longitudinal studies on both adolescents' and adults' performances of sun protection behaviours are limited, the current study aimed to investigate changes in sun protection in these population segments in Western Australia, a region with high annual UVR. During six summer seasons (2015/16 to 2020/21), cross-sectional surveys were conducted among 1806 adolescents (14 to 17 years old) and 1808 adults (18-45 years old), investigating the frequency of five sun protection behaviours (wearing clothing, applying sunscreen, wearing a hat, wearing sunglasses, and seeking shade) and sun avoidance (staying indoors). Over the six-year period, staying indoors increased in both groups. Among adolescents, a decrease in wearing clothing and sunglasses and an increase in seeking shade was demonstrated, and hat and sunscreen use remained relatively stable. Among adults, an increase in sunscreen use was shown, whereas all other sun-related behaviours remained consistent over the six-year period. The results from this study can provide directions for health communications focusing on improving sun protection behaviours among both adolescent and adult populations.

People with intellectual disabilities' sexuality from three different perspectives: Parents, professionals, and themselves.

BACKGROUND: A positive conception of sexuality among people with intellectual disabilities is crucial and relies on several social and interpersonal contexts. The goal of this study is to analyse the interaction and impact of three different contextual groups: individuals with intellectual disabilities, their parents, and professionals working with them. METHODS: Survey data were collected from 330 people with intellectual disabilities attending occupational centres in eastern Spain, 330 parents, and 100 professionals. RESULTS: Correlation and variance analyses of dyad-level data show significant differences among the three groups in all variables. Professionals perceived people with intellectual disabilities to have higher knowledge of socio-sexual norms than people with intellectual disabilities actually appear to be, but they are also more concerned about aspects related to this area of people with intellectual disabilities. Compared to people with intellectual disabilities and professionals, parents perceived people with intellectual disabilities to have lower sexual knowledge. CONCLUSIONS: Our study demonstrates inconsistent perceived knowledge of people with intellectual disabilities' socio-sexual norms and sexual knowledge among the three groups, leading to disparate levels of concern regarding people with intellectual disabilities sexuality. Thus, the need to collect information from different perspectives for more accurate reporting and the critical need for sex education programs that involve the target population, but also parents and professionals who frequently interact with people with intellectual disabilities are highlighted.

[Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis]. / Prävalenz von neuropsychiatrischen Symptomen bei Menschen mit Demenz in der stationären Langzeitpflege.

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis Abstract: Background: In a progress of dementia, most people develop neuropsychiatric symptoms. However, there is little knowledge about the prevalence of these symptoms and their specific characteristics in long-term care. Aims: A differentiated investigation of the prevalence and characteristics of neuropsychiatric symptoms in people with dementia in a long-term care setting. Methods: The prevalence of neuropsychiatric symptoms of people with dementia in a long-term care setting was examined using a secondary analysis of cross-sectional data from the research projects LebenQD I and II and FallDem. The data were collected using the neuropsychiatric inventory - nursing home version. The analysis included data from 699 people with dementia from a total of 21 long-term care facilities in North Rhine-Westphalia. Results: The symptoms agitation/aggression (36%), depression/dysphoria (33%), apathy/indifference (33%), irritability/lability (30%) and aberrant motor behaviour show the highest prevalence. The symptoms hallucinations (9%) and euphoria/elation (6%) have the lowest prevalence. Conclusions: The high prevalence of specific neuropsychiatric symptoms and their characteristics in people with dementia illustrates the need for care-related or psychosocial interventions to counteract the reasons for the occurrence of the symptoms.

Exploring the relationship between insomnia and depression: a cross-sectional prospective study.

This is a cross-sectional prospective study aimed to examine the association between insomnia and depression among individuals attending an outpatient psychiatric clinic. Methods: A total of 416 participants were recruited from the psychiatric and mental health outpatient clinic using a cross-sectional design. The participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) to measure sleep disturbances and depressive symptoms, respectively. Ethical approval was obtained from the Institutional Review Board at Ninevah University. Descriptive statistics, bivariate correlations, and multivariate regression analysis were used to analyze the data. The data collected in the study was analyzed using SPSS v0.26. Results: A total of 416 participants were recruited from the psychiatric and mental health outpatient clinic in Iraq through convenience sampling. The sample included 227 (54.6%) females and 189 (45.4%) males, with a mean age of 35.4 years (SD=9.8, range=18-65). Participants had a mean PSQI score of 11.6 (SD=3.7, range=2-21) and a mean BDI score of 21.8 (SD=11.1, range=0-54). Bivariate correlations showed a significant positive relationship between sleep disturbances (as measured by the PSQI) and depressive symptoms (as measured by the BDI) (r=0.67, P<0.001). Conclusions: The study provides valuable insights into the relationship between insomnia and depression in a sample of individuals from Iraq. These findings could contribute to the development of interventions to improve mental health outcomes among this population.

APOL1 Risk Variants Associate with the Prevalence of Stroke in African American Current and Past Smokers.

Introduction: Among African Americans, tobacco smokers have 2.5 times higher risk for stroke compared to non-smokers; the tobacco-related stroke risk being higher than in other races/ethnicities. About one half of African Americans carry at least one of two genetic variants (G1 and G2; rare in other races) of apolipoprotein L1 (apoL1), a component of high-density lipoproteins. Several studies showed APOL1 G1/G2 risk variants associate with stroke. However, the role of APOL1 variants in tobacco-related stroke is unknown. Methods: In a cross-sectional study, we examined whether APOL1 risk variants modify the relationship between smoking and stroke in 513 African American adults (median age 58 years, 52% female) recruited through the University of California, San Francisco Lipid Clinic. Using DNA, plasma, and questionnaires we determined APOL1 variants, smoking status, and history of stroke. Using unstratified and stratified multivariable logistic regression models we examined the association between smoking history (ever smokers vs. never smokers) and odds of stroke overall, and among carriers of risk variants and non-carriers, separately. Results: Among participants, 41% were ever (current and past) smokers, 54% were carriers of the APOL1 risk variant, and 41 have had stroke. In all stroke cases, where full medical records were available, stroke types were determined to be an ischemic, and not hemorrhagic, stroke. The association of smoking history and stroke differed by APOL1 genotype status in the unstratified model (Pinteraction term=0.016). Among carriers of risk variants, ever smokers had odds ratio (OR) =2.88 for stroke compared to never smokers (P=0. 0.038). The OR for stroke comparing ever vs. never smokers showed a dose-response trend among carriers of one risk allele of 2.35 and two risk alleles of 4.96. Among non-carriers, smoking history was not associated with a stroke. Conclusion: In conclusion, current and past smokers who carry APOL1 G1 and/or G2 risk variants may be more susceptible to stroke, in particular ischemic stroke, among African Americans.

Feasibility, Reliability, and Safety of Remote Five Times Sit to Stand Test in Patients with Gastrointestinal Cancer.

Background: To determine the feasibility, reliability, and safety of the remote five times sit to stand test (5STS) test in patients with gastrointestinal cancer. Methods: Consecutive adult patients undergoing surgical treatment for lower gastrointestinal cancer at a major referral hospital in Sydney between July and November 2022 were included. Participants completed the 5STS test both face-to-face and remotely, with the order randomised. Outcomes included measures of feasibility, reliability, and safety. Results: Of fifty-five patients identified, seventeen (30.9%) were not interested, one (1.8%) had no internet coverage, and thirty-seven (67.3%) consented and completed both 5STS tests. The mean (SD) time taken to complete the face-to-face and remote 5STS tests was 9.1 (2.4) and 9.5 (2.3) seconds, respectively. Remote collection by telehealth was feasible, with only two participants (5.4%) having connectivity issues at the start of the remote assessment, but not interfering with the tests. The remote 5STS test showed excellent reliability (ICC = 0.957), with limits of agreement within acceptable ranges and no significant systematic errors observed. No adverse events were observed within either test environment. Conclusions: Remote 5STS for the assessment of functional lower extremity strength in gastrointestinal cancer patients is feasible, reliable, and safe, and can be used in clinical and research settings.

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study.

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

Euthanasia Attitudes Questionnaire in Medical Personnel (AHE-PM) / Cuestionario de actitudes hacia la eutanasia en personal médico (AHE-PM)

Abstract The right to die is an international dilemma. Some countries and states already have laws regulating one of the most common applications of this right, the active voluntary euthanasia. The evidence from these countries highlights the importance of a bioethical framework to limit some of its applications. In this regard, the evaluation of attitudes towards euthanasia in medical personnel will allow to understand the attitudes of these professionals and how they can deal with such requests, whether this assisted death is decided by the patients or their surroundings. Consequently, the aim of this study was to develop a brief scale to evaluate attitudes, as well as to determine their significance according to the gender and seniority of the professionals in this situation. A double design strategy was followed. On the one hand, a psychometric design with an exploratory and confirmatory factor analysis and, on the other, a descriptive analytical design for the comparison of groups. A six-item scale (AE-PM) and two factors were extracted. The first focuses on attitudes towards euthanasia to alleviate suffering for medical reasons and the second one to alleviate the patient's emotional suffering. The scale (AHE-PM) is useful for the rapid exploration of attitudes towards euthanasia in physicians, a professional group with limited free time, who may also encounter relatively frequent requests for active voluntary euthanasia. The two factors obtained allow attitudes to be assessed from a bioethical perspective, providing information on the application under apparent medical justification and in situations based on the patient's subjective emotional suffering.

Resumen La eutanasia voluntaria activa se define como la petición de un paciente que quiere morir y la acción que es llevada a cabo por otra persona para provocar dicha muerte. El derecho a morir es un dilema sobre el que se debate a nivel internacional. Algunos países y estados ya cuentan con leyes que regulan una de las aplicaciones más comunes de este derecho. Los datos aportados por estos países ponen de manifiesto la importancia de un marco bioético que permita limitar algunas de sus aplicaciones. En este sentido, la evaluación de las actitudes hacia la eutanasia en personal médico permitirá conocer las actitudes de estos profesionales y cómo estos pueden enfrentarse a dichas solicitudes, o no, sea de muerte asistida por parte de los pacientes o su entorno. Además, se ha reportado en la bibliografía diferentes actitudes según la experiencia o el sexo de los trabajadores, por lo que es de relevancia su exploración diferencial. Por ello, el objetivo del presente trabajo un instrumento de evaluación de actitudes hacia la eutanasia diseñado y validado por y para profesionales médicos en ejercicio. En esta línea, los objetivos de este estudio son obtener una escala corta con propiedades psicométricas adecuadas, que proporcione información relevante sobre las actitudes hacia la eutanasia, así como la posible evaluación de algunas prácticas médicas relacionadas con ésta que pueden ser bioéticamente dudosas. La muestra estaba compuesta por 419 profesionales de la medicina procedentes de tres provincias del sur de España. Se siguió una doble estrategia en el diseño. Por un lado, un diseño psicométrico con un análisis factorial exploratorio y confirmatorio. Se dividió la muestra en dos submuestras aleatorias para realizar de forma paralela ambos análisis. Se utilizaron los estadísticos KMO, Bartlett, RMSEA, RMRS, CFI, NNFI, GFI y AGFI para explorar el ajuste de modelos. Po otro lado, se utilizó un diseño asociativo descriptivo para la comparación de grupos mediante la t de Student, ANOVA, Tukey y la prueba d de Cohen. Se extrae una escala de seis ítems (AE-PM) y dos factores. El primero de ellos está centrado en las actitudes hacia la eutanasia para aliviar el sufrimiento por cuestiones médicas y el segundo para aliviar el sufrimiento emocional del paciente. Respecto al estudio de las diferencias, no se observaron diferencias significativas según el sexo del profesional ni la antigüedad en la profesión. La escala (AHE-PM) es útil para la exploración rápida de las actitudes hacia la eutanasia en médicos, un grupo profesional con limitado tiempo libre que, además, puede encontrarse con relativa frecuencia ante solicitudes de eutanasia voluntaria activa. Los dos factores obtenidos permiten evaluar, por un lado, las actitudes desde una perspectiva bioética. Es de especial relevancia en estas situaciones el conocimiento de las actitudes del personal médico hacia la eutanasia, exponiéndolo a un dilema bioético y personal. La autoconciencia de estos profesionales sobre sus propias actitudes hacia la eutanasia y su adaptación a los códigos éticos vigentes podría minimizar el impacto generado por estas situaciones y, por tanto, mejorar la relación terapéutica y la calidad asistencial. Por otro lado, el instrumento aporta información sobre la posible recomendación de estas prácticas bajo aparente justificación médica y/o en situaciones basadas en el sufrimiento emocional subjetivo del paciente. Estudios previos indican que los profesionales se ven afectados emocionalmente cuando se enfrentan a los conceptos de muerte y eutanasia en pacientes terminales. En este sentido, la escala también podría servir de evaluación de actitudes y el trabajo en planes de prevención de salud laboral en los centros sanitarios.

The Impact and Perception of England's Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study.

BACKGROUND: It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously. OBJECTIVE: This study aimed to understand who accesses England's heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services. METHODS: There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis. RESULTS: Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24%), those from White ethnic background (3,972,293/4,898,532, 81.09%), and those living in the least deprived 20% of areas (707,747/4,898,532, 14.45%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior. CONCLUSIONS: England's web-based HAT has engaged large number of people in their heart health. Improvements to England's HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the test on behavioral outcomes are warranted.

Public Health Residents' Anonymous Survey in Italy (PHRASI): Study Protocol for a Cross-Sectional Study for a Multidimensional Assessment of Mental Health and Its Determinants.

The COVID-19 pandemic has evolved into a severe psychosocial crisis affecting patients, their relatives, friends, and healthcare professionals. In Italy, public health residents (PHRs) remain essential to the national response to the pandemic. To assess their mental sphere, the "Public Mental Health" working group of the medical residents' Assembly of the Italian Society of Hygiene and Preventive Medicine has designed the Public Health Residents' Anonymous Survey in Italy (PHRASI). This is a nation-wide cross-sectional study based on an 88-item self-administered voluntary survey that evaluates how sociodemographic variables are associated with mental issues, including wellness, eating disorders, sleeplessness, alcohol misuse, depression, and anxiety. Data will be gathered by disseminating a Google Forms link across the Assembly network of medical residents. All PHRs enrolled in a four-year program in one of the Italian postgraduate schools of public health will be qualified as participants. PHRASI aims to draw a comprehensive and detailed picture of the mental health state of Italian PHRs. PHRs are a significant group of healthcare professionals that may serve as a future benchmark for developing and enacting regulations intended to support the mental health of healthcare professionals.