This study translated, adapted, and validated a modified version of the Patient Satisfaction with Pharmacist Services Questionnaire 2.0 in Traditional Chinese (C-mPSPSQ 2.0) for heart failure (HF), aiming to streamline the tool for clinical applicability in Taiwan while maintaining psychometric rigor.

A five-phase process was implemented, comprising forward-backward translation, pretesting, a pilot study, psychometric analysis, and content validation of the final model. Patients from the HF clinic and cardiology wards at National Taiwan University Hospital were invited to participate. Confirmatory factor analysis was employed to assess construct validity across two prespecified models (Model 1: a 16-item version following the original; Model 2: an 8-item adaptation), as well as Model 3, which was iteratively developed using both quantitative criteria and qualitative feedback. The multitrait-multimethod matrix was used to examine construct validity in Model 3, with content validation conducted using a mixed-methods approach. Reliability was evaluated using McDonald's omega, Cronbach's alpha, and corrected item-to-total correlations. Test-retest reliability was assessed at 2-week and 3-month intervals, coupled with random measurement error evaluation.

The study included 245 patients. Model 3, a modified 6-item version, demonstrated acceptable model fit and good internal consistency (McDonald's omega = 0.922). Results of test-retest reliability, standard error of measurement, and minimal detectable change collectively supported instrument consistency for C-mPSPSQ 2.0.

The C-mPSPSQ 2.0 is an easy-to-use, reliable, and valid 6-item scale. Its concise design minimizes respondent burden while preserving psychometric robustness, making it effective for evaluating pharmacist-provided services in Taiwan's clinical settings, especially among older adults with HF.

Digital health interventions targeting substance use disorders are being increasingly implemented. Data science methodology has the potential to enhance involvement and efficacy of these interventions, though application may raise ethical considerations. This study aimed to explore possible ethical aspects and preferences among users of an online digital intervention for substance use and gambling disorder regarding the application of supervised machine learning (ML) methodology.

We recruited participants from a widely used, evidence-based online substance use and gambling intervention from the Netherlands (Jellinek Digital Self-help). Initially, we conducted two online focus groups (n = 5 each) to explore topics related to ethical considerations and user preferences regarding the application of ML for adapting unguided digital interventions. Subsequently, the findings from these focus groups informed the development of an online, quantitative, self-reported questionnaire study regarding this topic (n = 157). Data collection and analyses were guided by the principles of biomedical ethics by Beauchamp and Childress.

Our qualitative and quantitative results revealed that digital intervention users found the application of machine learning analyses to be ethically acceptable, although they had difficulties conceptualizing ML applications. Participants believed that it could benefit the intervention and subsequently their well-being. Both qualitative and quantitative results emphasized the importance of preserving user autonomy in applying supervised ML to adjust digital interventions. In addition, based on both data sources we found that digital intervention users trusted Jellinek's integrity to apply ML. Ethical concerns identified in the qualitative data (e.g., data security, human control), were not confirmed in our quantitative findings.

This mixed-methods study revealed that users of digital intervention demonstrated limited concern for ethical aspects regarding applying ML to adapt digital interventions. Ethical aspects were primarily pertained to their needs for autonomy and privacy.

Teledentistry can improve access to care, but children's acceptance of different imaging techniques is underexplored.

The aim of this study was to assess children's acceptance of intraoral cameras and smartphones for caries detection.

A randomized controlled trial was conducted in rural Egyptian nurseries, with children aged ≤ 6 years randomized into intraoral camera or smartphone groups. Behavior during imaging was assessed using four indicators: fear, mouth-opening difficulty, opposition, and cooperation, with a total score calculated from their sum. Imaging time was recorded, and mood was assessed using the Positive and Negative Affect Scale. Linear regression assessed associations between behavior and time with technique and mood, adjusting for confounders.

The study included 508 children, mean (SD) = age 4.54 [1.04] years. Children in the intraoral group showed higher fear and difficulty keeping their mouths open, with lower overall behavior scores (mean [SD] = 16.64 [2.95] vs. 17.18 [3.06], B = -1.05, p < 0.001). The intraoral camera required less time (mean [SD] = 3.62 [1.49] vs. 5.33 [2.82] minutes, B = -1.56, p < 0.001). Positive mood improved behavior (B = 0.25, p < 0.001), while negative mood increased time (B = 0.30, p < 0.001) and worsened behavior (B = -0.64, p < 0.001).

Smartphones improved behavior, while intraoral cameras were more time-efficient. Device choice should balance efficiency with child comfort.

ClinicalTrials.gov identifier: NCT06019884.

Menstruation is a natural biological process that occurs in women. The menstrual cycle significantly affects women's physical and psychological well-being. Data obtained from surveys indicates that the burden of menstrual distress resulting from dysmenorrhea should not be underestimated. In a survey conducted with 385 Indonesian women, 79.2% reported experiencing a significant burden on their daily activities due to dysmenorrhea. In light of its considerable impact, it is essential to evaluate the level of distress associated with the menstrual cycle within clinical practice. The Menstrual Distress Questionnaire (MEDI-Q) is an instrument that has been validated for the comprehensive assessment of menstrual-related distress.

With no validated instruments currently available in Indonesia for measuring menstrual distress, validating the Indonesian version of the MEDI-Q within the Indonesian-speaking population is essential for its wider adoption and utility.

The questionnaire underwent forward and backward translation. The Indonesian version of MEDI-Q is distributed to women aged 19-49. Participants were recruited using a consecutive sampling method and completed the questionnaire twice, with a two-week interval between each completion. Test-retest reliability is evaluated using the Intraclass Correlation Coefficient (ICC), while internal consistency is determined using Cronbach's alpha.

The study included 53 participants, with a mean age of 26.17 ± 4.78. The mean MEDI-Q total scores for the initial and subsequent tests are 8.79 ± 9.11 and 10.64 ± 11.68, respectively. The ICC of the participant's responses is 0.892, while Cronbach's alpha coefficient is 0.972.

The Indonesian version of MEDI-Q exhibits good test-retest reliability and internal consistency. The results demonstrate that the Indonesian version of the MEDI-Q can be utilized in clinical and research settings.

Iron deficiency is a widespread global health concern affecting women, in particular, but also individuals adhering to vegan or vegetarian diets, as well as athletes. Inadequate iron intake can lead to various diseases, necessitating an iron-rich diet or dietary supplements. In addition to existing iron-enriched functional foods and supplements, the potential emergence of iron-biofortified vegetables, high in vitamin C, could enhance iron absorption in the future. As these vegetables are not established in the German food market, identifying the target group before market launch is crucial. To address this, a quantitative online survey of 1000 German consumers was conducted, focusing on purchase and consumption motives such as sustainability, naturalness, fitness, fresh food, convenience, preventive medical care, and pleasure. The analysis revealed four health-oriented consumer clusters. The "holistically committed" cluster pursued a comprehensive health approach, including active self-care, medical precautions, and environmental considerations. The "fitness pragmatists" cluster, primarily composed of young consumers, prioritized external health aspects with a focus on physical appearance. The "simply provisioners" cluster viewed preventive health care as integral to medical attention, emphasizing the need for quick and easy health solutions. Despite initially appearing unrelated to health concerns, the "hedonist" cluster, valuing pleasure-driven food choices, regularly cooked and appreciated variety and naturalness, indirectly supporting a health-oriented lifestyle. The cluster analysis showed high purchase potential for biofortified foods among sustainability- and naturalness-focused innovators, as well as pleasure-oriented consumers. Their broad acceptance highlights the demand for healthy, minimally processed foods. However, biofortified foods compete with dietary supplements and functional foods, resulting in an individualized product mix among target groups.

Selective attention mechanisms change in response to variations in sensory experiences and environmental demands. In other words, they are influenced not only by favorable contextual experiences but also by unfavorable ones. Therefore, exposure to environmental unpredictability and chaos could influence selective attention. However, there is a lack of studies directly investigating this relationship. This study examined how household chaos and daily unpredictability relate to selective attention at behavioral and neural levels in young adults (n = 39). Participants were categorized as experiencing high or low unpredictability and chaos based on their scores on respective scales. Using EEG recordings, we measured the amplitude of the N2pc and Pd components, along with accuracy and reaction times, during the performance in two visual search tasks that varied in the level of interference from distracting stimuli (presence vs. absence of a color singleton distractor). The results revealed differences in neural activity related to unpredictability but not chaos. Specifically, in the high-interference visual search task, both groups exhibited an N2pc component associated with the singleton distractor, reflecting attentional capture by distracting information. However, the high-unpredictability group showed a larger N2pc amplitude associated with the target and a larger Pd amplitude associated with the distractor. These findings suggest greater engagement of reactive attentional resources to suppress distractors and select the target, and support hypotheses suggesting that adverse contexts involving unpredictability or chaos relate to changes in how individuals process distracting or irrelevant information.

to confirm the validity of the Comprehensive Score for Financial Toxicity (COST) Scale in Chinese patients with wet age-related macular degeneration.

A tertiary hospital in Wuxi's ophthalmology outpatient clinic treated 217 patients with wet age-related macular degeneration (wAMD) were chosen using the convenience sample approach for a questionnaire survey between October 2023 and February 2024. The Chinese version of the COST and general patient information were included in the survey. Critical ratio analysis and correlation analysis were used to examine the items on the scale. The structural validity of the scale was evaluated using factor analysis, the reliability of the scale was evaluated using Cronbach's α coefficient and retest reliability, and the content validity of the scale was evaluated using the Content Validity Index (CVI).

The item analysis results demonstrated that high and low subgroups could be identified using The COST scale's Chinese translation (P < 0.01).; A linear positive correlation was observed between the scores of each item and the scale's overall scores (r values of 0.243 ~ 0.878, P < 0.01), and the scores of factor 1, factor 2, and factor 3 showed a linear positive correlation with the total scores of the scale (accordingly, r values were 0.974, 0.505, and 0.300; P < 0.01). and the scores of each item were linearly and positively correlated with the scores of the common factors to which they belonged (r values of 0.642 to 1.000, P < 0.01). Content validity showed that the I-CVI of each item was 0.857 ~ 1.00, and the S-CVI was 0.974. Three metrics in all, with a cumulative variance contribution rate of 67.739%, were obtained through exploratory factor analysis. Each item's loading on the corresponding dimensions varied from 0.638 to 0.954. The Cronbach's α coefficient for the entire scale was 0.876(95% CI: 0.85-0.899). The reliability of the retest was 0.970 (95% CI: 0.936-0.990).

The Chinese version of the COST scale shows potential applicability pending further validation.

Individuals with anorexia nervosa (AN) often face significant challenges in maintaining motivation for recovery. Understanding the perceived pros and cons associated with the disorder is crucial for promoting recovery. This study aimed to translate, adapt, and validate the Pros and Cons of Anorexia Nervosa Scale (P-CAN) for use with Chinese adults with AN, thereby facilitating a clearer understanding of the motivations and barriers encountered by these patients.

This study employed a cross-sectional survey design to collect data from 207 Chinese adults with AN (Mage25.58 and SD 6.011). Content validity was assessed by a panel of professionals. Reliability testing included internal consistency, test-retest reliability, item-total correlation, and correlation analysis between subscales. Principal Component Analysis (PCA) assessed the factor structure, focusing on two components (Pro and Con-AN) and ten subscales-Safe/Structured, Appearance, Fertility/Sexuality, Special, Fitness, Communicate Emotions/Distress for Pro-AN and Trapped, Guilt, Hatred, Stifled for Con-AN as per the original scale. Criterion validity was evaluated using the eating pathology tested by Eating Disorder Examination Questionnaire (EDE-Q) and Body Mass Index (BMI).

The content validity of the overall scale was 0.86. The Pro-AN and Con-AN subscales exhibited strong internal consistency (α = 0.84 and 0.82) and test-retest reliability (r = 0.912 and 0.704, p < 0.001). Item-Total Correlations exceeded 0.3 for all items except item 2, and there was no significant correlation between the Pro-AN and Con-AN subscales. The PCA results indicated that the Chinese P-CAN retained two components, which are consistent with the original scale. Differences emerged in more granular dimensions that may not be appropriate within the Chinese context. Significant correlations were found between the Pro-AN (r = 0.279, p < 0.001) and Con-AN (r = 0.240, p < 0.001) subscales and eating pathology and Con-AN was significantly correlated with BMI (r = -0.214, p < 0.01).

The P-CAN has shown promising psychometric properties among Chinese patients with AN. In terms of dimensionality, the Chinese context aligns closely with the original scale's binary division into Pro-AN and Con-AN. However, the further differentiation into ten dimensions, may not be culturally appropriate for the Chinese context.

This study aimed to investigate the impact of a 10-week park visit program on subjective well-being, emotional stress, health-related quality of life, depressive symptoms, and sleep quality of older adults living in subsidized senior housing (SSH) and to explore residents' perceptions of the program. Thirty-four residents from four SSH participated in the study. The program involved transporting residents from each SSH to the same urban neighborhood park once a week for 10 consecutive weeks. During each park visit, research assistants monitored each resident from a distance while the resident walked for 20-30 min. Data from self-reported questionnaires and hair samples were collected at pre- and post-program evaluations. Quantitative analysis showed that subjective well-being scores increased significantly after the program. In addition, significant improvements of hair cortisol levels were observed after outlying change scores in hair cortisol levels were removed. Feedback from exit interviews revealed four themes: improved mental well-being with reduced stress, increased physical activity, improved self-efficacy, and increased reflection on health and lifestyle. These findings provide preliminary evidence that a 10-week program of once-weekly park visits lasting about 30 min can improve the emotional health of SSH residents.

This study assesses international travelers' risk perceptions and travel decisions related to three recent emerging diseases. Travelers can facilitate the spread of emerging infectious diseases and their decision-making on where to travel is influenced by outbreaks. These feedback loops can potentially impact the tourism economy. Often, travelers' judgment and actions towards a risk are based on their perceptions.

We conducted two surveys, using constructs from the Health Belief Model, with 747 individuals who had recently traveled to selected Latin American countries, and who had heard about Zika virus, chikungunya, and/or COVID-19. Using segmentation analysis, the respondents were grouped based on their risk perception level (i.e., low, medium and high), and we tested the differences between groups for different constructs of the model.

We found a significant difference between the risk perception groups for most of the sociodemographic factors, as well as for the purpose of the trip, regarding travel preferences. Personal experience with a disease and perceived efficacy towards diverse protective measures also differed between groups. Higher risk perception was related to reporting more changes in past travel plans, and higher likelihood of future travel avoidance if facing different risk scenarios in a tourism destination.

Including the concepts of risk perception, sociodemographic factors, previous experience, and efficacy can help better explain the individual behavior of international travelers. These findings can inform tailored and more effective mitigation and management strategies to promote safe travel and prevent disease spread in the event of a future outbreak.

To develop and validate the Mental Health Literacy Assessment Scale for assessing mental health literacy among community health workers.

A total of 24 items were initially generated and refined through cognitive interviews and expert evaluation. The final scale consisted of 20 items. Face validity was ensured through cognitive interviews conducted in two phases with community health workers and volunteers. Content validity was assured based on the ratings of six experts. Cross-sectional survey was performed among 233 community health workers. Exploratory factor analysis using Varimax rotation was performed to identify latent variables with factor loadings > 0.4. Confirmatory factor analysis was employed to validate the model, using root mean square error of approximation < 0.05, standardized root mean square residual < 0.08, comparative fit index ⩾ 0.90, and Tucker-Lewis index ⩾ 0.90. Reliability was assessed through Cronbach's alpha where alpha coefficient > 0.70 indicated internal consistency.

Exploratory factor analysis identified four factors explaining 50.75% of variance explained by positive mental health behaviors (21.44%), misconceptions about mental health (14.24%), symptoms of mental distress (8.70%), and mental health stigma (6.37%). The confirmatory factor analysis demonstrated excellent model fit, with indices such as the normed Chi-square (1.31), comparative fit index (0.95), Tucker-Lewis index (0.94), and root mean square error of approximation (0.03). The scale displayed strong convergent and discriminant validity, with an average variance extracted > 0.43 and composite reliability > 0.70 for all factors. Internal consistency was confirmed, with a Cronbach's alpha value of 0.78 for the overall scale.

The Mental Health Literacy Assessment Scale has demonstrated robust psychometric properties and comprehensive coverage of mental health literacy components, making it a valuable tool for both research and practical applications among Community health workers in Nepal. While these findings support its utility in this context, further validation is needed to establish its applicability across other low- and middle-income countries to assess its effectiveness in diverse cultural and geographic settings.

This study is an external evaluation of the Patient Reported Outcome Measure (PROM) EFAS-DK developed by the European Foot and Ankle Society (EFAS). The evaluation included a test of the psychometric properties.

From October 2019 to September 2022, 101 patients undergoing elective foot or ankle surgery completed questionnaires (EFAS-DK, SEFAS-DK, EQ-5D-5L) prior to surgery and 6 months post-surgery. A subgroup of patients completed a retest. A foot-healthy group control group was added. Testing covered construct validity with hypothesis testing, floor and ceiling effects, internal consistency (Cronbach's Alpha), test-retest reliability (ICC 2.1), effect size (ES), Standardized Response Mean (SRM), Smallest Detectable Change (SDC) and Minimal Important Change (MIC).

Moderate construct validity with 59% confirmed hypothesis. High content validity, no floor ceiling effects. Cronbach's alpha 0.88, ICC 0.93. ES and SRM were both 1.06. SDC 4 and MIC 6. Control group score changes was insignificant.

EFAS-DK is a valid, reliable, and responsive foot and ankle PROM score. EFAS-DK can detect a clinically subjective relevant change score of 6 (25% of the total scale), which makes it useful for implementation in the clinic when evaluating patients undergoing foot and ankle surgery. Comparison with a control group showed results that significantly differ from the patients.

IIa prospective observational analytic cohort study.

Elder abuse is a significant global issue, with health and social care professionals playing a crucial role in its detection and management. This cross-sectional study quantitatively surveyed 291 community care professionals in Singapore, recruited through convenience sampling. Participants completed a self-administered questionnaire assessing their capabilities (knowledge, attitudes, and confidence) and the barriers and enablers influencing their ability to address elder abuse. Findings revealed significant gaps: 27.7% felt knowledgeable about elder abuse, 25.4% reported positive attitudes, and 57.7% expressed confidence in managing such cases. Over half of respondents reported no prior training and a lack of workplace guidelines. Key barriers included victims' or families' denial or reluctance to seek help. Univariate analyses identified significant associations (p < .05) between professionals' capabilities and factors such as occupation, education, training, guidelines, citizenship, ethnicity, and work experience. Multivariable logistic regression highlighted occupation, education, prior training, and the presence of guidelines as significant predictors (p < .05) of enhanced capabilities. Respondents emphasized the need for comprehensive training, clear protocols, shared community responsibility, targeted interventions for service users, and increased systemic support. These findings underscore the need for targeted interventions for service users, interventions to strengthen professionals' ability to address elder abuse effectively.

BackgroundWork conditions are critical for construction workers' personal health and project safety performance. However, few studies have explored the effect of construction work conditions on safety outcomes from a systematic perspective.ObjectiveThis study examined the relationship between construction work conditions (CWCs, including high temperature, rainy day, nighttime, and low temperature) and safety outcomes (including physical symptom, psychological symptom, and unsafe event), while construction safety resilience (CSR) performing as a mediator.MethodsThe techniques of structural equation modeling were used with 762 survey data collected from the Chinese construction industry to empirically test the structural equation model.ResultsThe results show that CWCs directly affected CSR, and indirectly impacted safety outcomes through CSR. Meanwhile, CSR directly reduced physical and psychological symptoms of construction workers, and indirectly cut down unsafe events through physical and psychological symptoms, respectively. Further, CSR completely mediated the relationship between CWCs and safety outcomes.ConclusionsThere exist complex relationships among construction work conditions, safety resilience and safety outcomes. The results also remind the safety managers to improve construction work conditions from the perspective of safety resilience, and initiate a resilient safety management system integrating physical, psychological, and environmental factors, thus enhancing safety outcomes of construction projects.

This study assessed the accuracy of three International Classification of Diseases (ICD) codes methods derived from Global Burden of Disease (GBD) sepsis study (modified GBD method) in identifying sepsis, compared to the Angus method. Sources of errors in these methods were also reported.

Prospective multicentre, observational, study. Emergency Department patients aged ≥ 16 years with high sepsis risk from nine hospitals in NSW, Australia were screened for clinical sepsis using Sepsis 3 criteria and coded as having sepsis or not using the modified GBD and Angus methods. The three modified GBD methods were: Explicit-sepsis-specific ICD code recorded; Implicit-sepsis-specific code or infection as primary ICD code plus organ dysfunction code; Implicit plus-as for Implicit but infection as primary or secondary ICD code. Agreement between clinical sepsis and ICD coding methods was assessed using Cronbach alpha (α). For false positive cases (ICD-coded sepsis but not clinically diagnosed), the ICD codes leading to those errors were documented. For false negatives (clinically diagnosed sepsis but ICD-coded), uncoded sources of infection and organ dysfunction were documented.

Of 6869 screened patients, 450 (median age 72.4 years, 48.9% females) met inclusion criteria. Clinical sepsis was diagnosed in 215/450 (47.8%). The explicit, implicit, implicit plus and Angus methods identified sepsis in 108/450 (24.0%), 175/450 (38.9%), 222/450 (49.3%) and 170/450 (37.8%), respectively. Sensitivity was 41.4%, 58.1%, 67.4% and 55.8%, and specificity 91.9%, 78.7%, 67.2% and 79.1%, respectively. Agreement between clinical sepsis and all ICD coding methods was low (α = 0.52-0.56). False positives were 19, 50, and 77, while false negatives were 126, 90, and 70 for the explicit, implicit, and implicit plus methods, respectively. For false positive cases, unspecified urinary tract infection, hypotension and acute kidney failure were commonly assigned infection and organ dysfunction codes. About half (44.3%-55.6%) of the false negative cases didn't have a pathogen documented.

The modified GBD method demonstrated low accuracy in identifying sepsis; with the implicit plus method being the most accurate. Errors in identifying sepsis using ICD codes arise mostly from coding for unspecified urinary infections and associated organ dysfunction.

The study was registered at the ANZCTR (ACTRN12621000333819) on 24 March 2021.

Patients with coronary heart disease (CHD) will have a series of sexual problems, and their sexual life quality can be affected. However, a standardised evaluation tool for patients with CHD was lacking. Therefore, this study aimed to develop a sexual life quality questionnaire for patients with CHD and to evaluate its psychometric properties.

Based on previous phenomenological studies, literature analysis and group discussion, questionnaire items were formed. After two rounds of expert consultation and pre-survey, the questionnaire items were modified. Items were screened by item analysis. Exploratory factor analysis and confirmatory factor analysis were used to explore and confirm the structure of the questionnaire. Content validity and criterion validity were evaluated using the expert consultation and correlation analysis, respectively. The questionnaire reliability was evaluated using internal consistency, split half reliability, and test-retest reliability.

The sexual life quality questionnaire of patients with CHD was developed, which included two versions: male version and female version. The male version of the questionnaire contains 3 dimensions and 20 items, while the female version contains 3 dimensions and 17 items. After reliability and validity test, the two versions of the questionnaire have good reliability and validity.

In this study, the sexual life quality questionnaire of patients with CHD was developed and its psychometric properties were confirmed, which can be used to evaluate the sexual life quality of patients with CHD.

The development of a sexual life quality evaluation tool for patients with coronary heart disease to provide objective and quantitative tools for clinical staff to evaluate patients' sexual life status.

Patients were invited to participate in a questionnaire survey for this study.

Due to the non-availability of formal training during residency for clinicians in transfusion medicine, there is a prevalent knowledge gap for transfusion practices, which leads to increased patient risks and elevated healthcare costs. There is no indigenous questionnaire available, which could be used for knowledge assessment. This study aims to develop and validate an Indigenous questionnaire to assess clinicians' knowledge of transfusion medicine and bedside transfusion practices.

The questionnaire was designed using a nominal group technique involving subject experts, considering the type of information required, themes, appropriate wording, layout, and presentation. The questionnaire consisted of 25 knowledge-based questions and 4 general questions. Piloting of the questionnaire was done to check for feasibility, validation, and reliability. Content validity was assessed by six experts using the Content Validity Index (CVI). Reliability was assessed using test-retest and split-half methods, with a sample of 56 participants. Cronbach's alpha and Kappa statistics were used to measure internal consistency and agreement, respectively.

The questionnaire displayed acceptable feasibility with a mean difficulty score of 6.93 on a scale of 1-10, with test-retest responses showing near-perfect agreement (kappa value 0.8-0.99). All experts gave more than 70% agreement on the relevance of content, with a mean CVI of 85%. Test-retest reliability showed near-perfect agreement (Kappa 0.8-0.99, p = 0.008) and good internal consistency (Cronbach's α = 0.806). The split-half method yielded a Cronbach's α of 0.89 and an intraclass correlation coefficient of 0.88 (95% CI 0.57, 0.97, p = 0.001) Construct validity was confirmed through factor analysis.

The developed indigenous questionnaire is a reliable and valid tool for assessing the knowledge of clinicians towards transfusion medicine and bedside transfusion practices. The detailed, methodical strategy used to prepare and validate the questionnaire ensures its applicability and relevance in various clinical settings and can be easily adopted by others intending to prepare similar questionnaires. The questionnaire is available with the author and, on demand, may be provided for knowledge assessment.

The study aimed to determine how pain documentation audits and repeated feedback (REFPAD intervention) affect registered nurses' pain documentation and knowledge, and to discover how background variables relate to such documentation and knowledge.

A cluster randomized trial.

Thirty work units in a university hospital were randomized into intervention (n = 15) and control (n = 15) groups. The intervention group received monthly pain documentation audits and feedback, while the control group received no feedback. A pain knowledge test was conducted in three phases. Data were collected from February to November 2022. A linear mixed model was used to detect the effects of the REFPAD intervention.

The REFPAD intervention positively affected pain documentation quality, but its statistical significance was lost because of substantial within-unit variation. At baseline, pain documentation quality scores were in intervention 35% and control 38%. After 8 months of feedback, the quality scores were 44% and 43%. The number of pain assessments per patient per day was the only factor that affected pain documentation quality. The REFPAD intervention had no effect on pain knowledge.

The REFPAD intervention may improve pain documentation quality. A more comprehensive analysis of implementation barriers and facilitators is needed to reduce variations between and within work units.

More focus should be paid to feedback implementation and continuous monitoring of the quality of pain care is recommended.

ClinicalTrials.gov Identifier: NCT05373641. Registration date: February 22, 2022.

The study aimed to validate a revised Italian version of the Anterior Knee Pain Scale (AKPS) by addressing shortcomings in previous adaptations and following the COSMIN guidelines to ensure robust psychometric evaluation.

One hundred thirty patients with anterior knee pain symptoms were recruited, with 65 undergoing a retest after 7 days to assess the scale's reliability. Structural validity was assessed through confirmatory factor analysis (CFA) to evaluate the scale's dimensionality. Internal consistency was measured using Cronbach's alpha, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Measurement error was evaluated using the standard error of measurement (SEM) and the smallest detectable change (SDC). Construct validity was examined by correlating the AKPS with other established scales, including the Knee Injury and Osteoarthritis Outcome Score, Internal Knee Documentation Committee, Victorian Institute of Sport Assessment - Patella, Short-Form 36 Health Survey, and the Visual Analogue Scale.

The CFA supported a three-factor model encompassing pain intensity and interference, functional limitations in daily activities, and knee structural and functional issues. The scale demonstrated good internal consistency (Cronbach's α=0.79) and excellent test-retest reliability (ICC=0.91), with low measurement error (SEM<5%). Construct validity was confirmed through moderate-to-strong correlations with related scales, particularly in domains related to pain intensity, symptoms, and daily functioning.

The newly validated scale, demonstrating strong psychometric properties, meets international standards for clinical assessment tools, making it a reliable and effective instrument for assessing anterior knee pain in the Italian context.

This study assesses the reliability and validity of two short forms of the German Revised Children's Anxiety and Depression Scale (RCADS 11- and 25-item versions) and provides normative data.

Data were collected from a representative sample of N = 1562 German schoolchildren and N = 757 pediatric chronic pain patients (ages 8-17).

Cronbach's α demonstrated acceptable to good internal consistency for the total score as well as the depression and anxiety scales. Confirmatory factor analysis (CFA) demonstrated acceptable to good model fit for both a 2-factor structure (RCADS-11) and a higher-order structure (RCADS-25). Multi-group CFAs demonstrated similar model structures across the school and pediatric chronic pain samples. Convergent validity was supported by moderate to high negative correlations with health-related quality of life and a high positive correlation with functional impairment. Girls-and to some extent, adolescents - scored significantly higher on anxiety and depression scales. The short versions demonstrated excellent agreement with the original 47-item RCADS (0.78 ≤ Cohen's κ ≤ 1.0). German normative data are provided.

The short versions of the German RCADS are reliable and valid instruments for assessing anxiety and depressive symptoms in children and adolescents.

Alterations in associative threat learning have been thought to underlie the aetiology and maintenance of anxiety disorders. Recent insights into the facilitatory role of parasympathetic arousal for threat coping have raised the question whether individual differences in sympathetic versus parasympathetic dominance during threat learning may shed light on the complex relationship with anxiety vulnerability versus resilience. We applied an established differential-cue delay threat conditioning paradigm in 78 neurotypical individuals and assessed parasympathetic responses (threat-induced bradycardia), as well as sympathetic responses (threat-induced tachycardia and increased skin conductance responses-SCR). We found evidence that patterns of threat-induced bradycardia as well as tachycardia are present during associative learning. Threat bradycardia was linked to weaker initial conditioned SCRs (mainly driven by responses to the CS+), a finding that may be relevant for current common practice in the field of threat learning: namely participants with weak differential skin conductance responses - who according to frequently applied 'SCR non-learner' criteria are often considered non-learners and sometimes even excluded from analyses - were in fact showing successful learning in terms of parasympathetic arousal. Additionally, the presence of threat bradycardia as well as the magnitude of overall conditioned heart rate responses were linked to relatively lower trait anxiety. These findings not only have practical research implications but also clinical implications when assessing markers for anxiety vulnerability versus resilience.

The use of artificial intelligence (AI) and machine learning (ML) is increasingly widespread in radiation oncology. However, patient engagement to date has been poor. Respect for persons in the healthcare setting and the principle of informed consent requires recognition of patient perspectives. The aim of this study was to provide a baseline understanding of patient views about the use of AI/ML in the specific context of radiotherapy to contribute towards future governance of the technology.

We developed a new questionnaire regarding AI/ML use in radiotherapy. Radiation oncology patients were surveyed from June to October 2024 at two public hospitals in Australia. Questions were on a five-point Likert scale and grouped into six topics. A free text item allowed participants to comment further.

We analysed 474 completed questionnaires (474/811, 58 % completion rate). Most participants supported using AI/ML to help physicians with radiation oncology specific tasks (Median Score (MS) 4.3) and held positive views on the general benefits of AI/ML (MS 4.0). Patients also strongly expressed a preference to be aware and informed (MS 2.2). Significant uncertainty remained about whether AI/ML use would enable retention of the human touch and equity in care (MS 3.1).

This is the largest questionnaire study to date of radiation oncology patients' perceptions of AI/ML, establishing a clear baseline. These results can inform future governance around AI/ML in radiotherapy. Actionable steps include informing patients of AI/ML use in their care and engaging physicians during development and regulation of the technology.

Adjustment disorder (AjD) is a prevalent mental disorder with evolving definitions in the International Classification of Diseases, 11th Revision (ICD-11). The Adjustment Disorder-New Module-20 (ADNM-20) assesses six AjD symptom clusters based on the ICD-11 criteria and has demonstrated strong psychometric validity. This study aimed to develop and validate a Japanese version of the ADNM-20 in the general population.

A forward-backward translation approach was used to develop the Japanese version of the ADNM-20. Psychometric properties were assessed through a web-based survey of 1314 participants, examining factorial validity, construct validity, and internal consistency.

Confirmatory factor analysis supported the theoretical six-factor model (comparative fit index = 0.923, root-mean-square error of approximation = 0.079), with strong correlations between the ADNM-20 subscales and external measures (e.g., depression PHQ-9, r = 0.71; anxiety GAD-7, r = 0.72). The total ADNM-20 showed excellent internal consistency (Cronbach's α = 0.953).

The Japanese ADNM-20 is a valid and reliable scale for assessing AjD symptoms in the Japanese general population. Further studies involving clinical populations are warranted to confirm its applicability in clinical settings.

Polycystic ovary syndrome (PCOS) is a common reproductive-endocrinological-metabolic condition in women, causing bodies to diverge from cis-heteronormative feminine expectations. Greater body image concerns have been identified among women with PCOS, but further research is needed to identify drivers and mitigating factors. The ability to inhabit the body positively may be one such mitigating factor, and the developmental theory of embodiment is a novel framework allowing exploration of an integrated range of protective (and risk) sociocultural factors that may contribute to embodied well-being. This cross-sectional survey study therefore examined relationships among embodied well-being, severity of PCOS symptoms, body mass index (BMI), mental freedom (exposure to a social environment that facilitates an internalised critical stance towards oppressive social discourses, including femininity discourses on appearance and comportment), and perceived body acceptance by others in a sample of 140 women with PCOS, 18 years and over, living in Australia. Results of hierarchical multiple regression demonstrated that BMI and PCOS severity were negatively related to embodied well-being, but that when mental freedom and perceived body acceptance by others were added to the model, only PCOS severity, mental freedom, and body acceptance by others were significantly related to embodied well-being. Neither mental freedom nor body acceptance by others moderated the relationship between PCOS severity and BMI and embodied well-being. Results support BMI and PCOS severity as drivers of, and mental freedom and body acceptance by others as protective factors for, embodied well-being in women with PCOS, and have implications for interventions to support embodied well-being.

BackgroundHarmful alcohol consumption has significant negative implications for the workplace. The workplace offers a strategic opportunity for alcohol prevention due to the substantial time employees spend at work.ObjectiveUtilizing a social-ecological framework, this study aims to investigate whether universal alcohol prevention strategies in the workplace are associated with employees' alcohol-related perceptions or behaviorsMethodsA cross-sectional survey study was conducted in December 2019 using a web-based questionnaire distributed through the Laboratory of Opinion Research Citizen Panel. Participants included 2771 employed adults aged 16-80 in Sweden. Multiple- and logistic regressions were used to investigate significant explanatory factors.ResultsHaving alcohol procedures, as well as having received information from a supervisor regarding how to act on concerns, were associated with a higher probability of being comfortable informing a supervisor of concerns. A restrictive alcohol culture was associated with lower threshold for perceived risk-free alcohol consumption. Having an alcohol policy only was not associated with any of the examined alcohol-related perceptions or behaviors when controlling for other factors.ConclusionsAlcohol preventive measures can significantly influence employee perceptions of responsibility to act on concerns, and the feeling of being comfortable doing so. The findings support the integration of alcohol preventive measures at multiple levels within the workplace, as well as having a restrictive alcohol culture.

Urban green spaces (UGS) may improve mental health in high-income countries. However, evidence from low-income African countries is scarce. Here, we assessed the associations of UGS with depressive and anxiety symptoms among adult residents of Kampala District (Uganda), the potential effect modification by sociodemographic factors, and the mediation roles of social interaction, outdoor physical activity, and residential distance to major roads as a proxy of traffic-related air pollution.

We conducted a cross-sectional survey among 641 adults. We objectively measured UGS using the Normalized Difference Vegetation Index (NDVI) within buffers of 100 m and 1,000 m around the residences. We assessed the utilization of UGS as a self-reported frequency (never, occasionally, and frequently) by which individuals visited UGS in the past 6 months. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-item scale were used to examine the severity of depressive and anxiety symptoms respectively. We used modified Poisson regression models to obtain prevalence ratios (PR) with their 95 % confidence intervals (CI), stratified our models, and conducted mediation analyses.

We observed an inverse association between UGS and both outcomes. For example, an inter-quartile range increase in UGS within a 100 m buffer was associated with a 6 % and 8 % decrease in depressive and anxiety symptoms, respectively (PR=0.94; 95 % CI=0.89-0.99, and PR=0.92; 95 % CI=0.85-0.95, respectively). Consistently, frequent visits to UGS relative to no visits were associated with a 33 % and 35 % lower prevalence of depressive and anxiety symptoms (PR=0.67; 95 %CI=0.53-0.84, and PR=0.65; 95 %CI=0.47-0.91, respectively). Depending on the UGS metric, we observed varying potential effect modification findings by sex, age, and educational level. Finally, residential distance to major roads emerged as a mediator in the association between residential surrounding greenness and depressive symptoms.

Our study suggests that UGS may also improve the mental health among residents of rapidly urbanizing African low-income cities.

The second victim phenomenon, involving emotional and psychological distress after adverse events, is underexplored among pharmacy professionals. The validated Second Victim Experience and Support Tool measures these experiences and support options, with the improved version also assessing resilience.

This study aimed to validate the Second Victim Experience and Support Tool-Revised, measure the second victim phenomenon, and present results among pharmacy professionals in Serbia.

This cross-sectional study included 350 pharmacy professionals (MPharm and technicians). The questionnaire, with 9 factors and 35 statements, was translated and adapted following guidelines, and the content was validated by five experts. A pre-test with 30 participants ensured clarity, followed by Confirmatory Factor Analysis for construct validity and Cronbach's Alpha for reliability.

Content validity was confirmed with item scores from 0.8 to 1 and a mean scale score of 0.83. Factor analysis identified 9 factors and 30 items (Chi-square = 545.6, degrees of freedom = 366, p < 0.001). The model fit was supported by a Root Mean Square Error of Approximation of 0.037, a Comparative Fit Index of 0.958, a Tucker-Lewis Index of 0.950, and a Standardised Root Mean Square Residual of 0.040. Reliability analysis showed a Cronbach's alpha of 0.88, with factor values from 0.60 to 0.90. Among participants, 49.5% feared future events, 47.4% felt exhausted, 22.6% considered quitting, 72.6% valued peer support, and 28.9% improved work quality.

The Serbian resilience measuring tool is valid and reliable, effectively evaluating second victim experiences and support, with half of pharmacy professionals affected.

This study aimed to develop the Japanese version of the Pregnancy and Weight Gain Attitude Scale (J-PWGAS) as a measurement of body image regarding body weight and shape during pregnancy. This cross-sectional study was conducted at a perinatal medical center in Osaka, Japan, between March and November 2020. We recruited pregnant women in their second or third trimester, who were 20 years old or older and without pregnancy complications. This study evaluated the criterion validity, construct validity, internal consistency, and test-retest reliability. Of the participants, 218 and 102 women participated in the validation and test-retest reliability studies, respectively. An exploratory factor analysis revealed a 17-item, five-factor structure. The J-PWGAS indicated acceptable criterion validity, internal consistency, and test-retest reliability. The J-PWGAS can measure attitudes toward gestational weight gain in Japanese pregnant women and would be useful in examining the association of body image with weight gain and psychological status during pregnancy.

The experience of online flow, characterized by immersion and time distortion, may enhance gaming enjoyment but also contribute to disordered gaming patterns. The present paper examined online flow components and their associations with disordered gaming symptoms among 565 role-playing-gamers. Network analysis identified the centrality of time distortion and loss of control within flow states and highlighted their connections to disordered gaming indicators, such as impaired control and gaming prioritization. Enjoyment and positive challenge were core features within flow, suggesting they support adaptive engagement. However, pathways linking prolonged immersion with gaming disorder symptoms indicate that intense flow experiences may increase problematic gaming risks. These findings reveal a nuanced interaction between online flow and disordered gaming, where adaptive enjoyment and challenge can coexist with maladaptive control loss. Overall, the findings highlight how elements of flow can differentially affect gaming outcomes, contributing both to healthy engagement and potential disorder.

The Short Index of Job Satisfaction (SIJS) has demonstrated favorable psychometric properties and has been utilized across diverse cultural contexts. However, no studies adapting the SIJS to China were found. The Chinese version of the SIJS can contribute to a cross-cultural understanding of job satisfaction and provide valuable insight into cross-cultural differences. Purpose. To assess the psychometric properties of the SIJS among Chinese nurse, both classical test theory (CTT) and item response theory (IRT) were used.

The translation procedure followed the guidelines of the World Health Organization. A convenience sampling approach was used to obtain 636 valid questionnaires. The data collected were evenly partitioned into two equal segments, with one portion allocated for CTT analysis and the other for IRT analysis.

According to classical test theory, the content validity (S-CVI = 0.98), construct validity (AVE = 0.50), and internal consistency reliability (Cronbach's alpha coefficient = 0.76, McDonald's Omega = 0.80) of the SIJS were good. Rasch analysis indicated acceptable item fit (MnSq indices ranging from 0.767 to 1.406 for the INFIT and OUTFIT corresponding to all response categories), item discrimination (p values ranging from 0.060 to 0.831), and item reliability (person separation reliability = 0.708).

The findings of this study demonstrate the favorable reliability and validity of the Chinese version of the SIJS when applied to nurses, as evidenced by both CTT and IRT analyses. By assessing job satisfaction levels using the SIJS, nursing managers can identify employees who may be at risk of burnout or dissatisfaction, allowing them to take appropriate actions to mitigate these issues and promote a positive work environment.

Physical activity has positive benefits in promoting the physical and mental health of adolescents. This study focuses on the importance of adolescent mental health issues, exploring the relationship between physical activity and insomnia in adolescents, as well as the mediating roles and pathways of cognitive flexibility and depression.

A cross-sectional study was conducted using self-reports to collect data on physical activity, insomnia, cognitive flexibility, and depression. A total of 501 valid questionnaires were collected from two middle schools in the western region of Hunan Province.

Physical activity directly and significantly predicted insomnia negatively (β =-0.153, SE = 0.047, p < 0.01). However, the predictive effect of physical activity on insomnia was no longer significant in the indirect effect analysis (β =-0.053, SE = 0.041, p > 0.05). Serial mediation analyses identified significant indirect effects through cognitive flexibility and depression in sequence (β =-0.029, 95% CI [-0.053,-0.011]), accounting for 18.95% of the total effect.

The study strengthens evidence for the associations between adolescent physical activity, insomnia, cognitive flexibility and depression, demonstrating that the beneficial effects of physical activity on insomnia are sequentially mediated through cognitive flexibility and depression. Given the dual benefits of physical activity for both sleep quality and mental health, we recommend implementing targeted physical activity interventions for adolescents, with particular emphasis on activities designed to enhance cognitive flexibility.

Adverse childhood experiences (ACEs) have been linked to chronic health conditions, at-risk behaviors, and reduced quality and length of life. Public health interventions targeting childhood trauma require an investigation of overall prevalence of ACEs and associations with outcomes and behaviors.

We created an ACE score using aggregated North Dakota (ND) Behavioral Risk Factor Surveillance System (BRFSS) data from 2019 to 2022. Adjusted odds ratios for selected chronic conditions, health risk behaviors, and health burdens were obtained using a logistic regression model.

ND adults with 4+ ACEs had more than a 2x increased risk for chronic kidney disease, cardiovascular problems, asthma, arthritis, currently smoking, and frequent poor physical health and more than a 4x increased risk for COPD, using marijuana, frequent poor mental health, and having a depressive disorder. A 2-fold increased risk for frequent poor physical, frequent poor mental health, and having a depressive disorder was seen for ND adults with 1-3 ACEs.

ACEs, especially for ND adults with an ACE score of 4+, are associated with poorer mental and physical health outcomes. Using marijuana had the strongest association with health risk behaviors and having a depressive disorder had the strongest association of the health conditions in the study. Our results emphasize the importance of evidence-based ACE prevention strategies and trauma-informed approaches that public health officials and policy makers in ND and across the nation can use to help build resilience, prevent ACEs, and improve well-being across the population.

Recently, the most critical psychological challenges have compelled healthcare professionals to confront their mental health issues. Consequently, many employees experiencing elevated levels of psychological stress have reported disengagement and dissatisfaction across various aspects of their work. Given the strong association between individual well-being and job satisfaction, how healthcare employees regulate their emotions and psychological health to attain job satisfaction remains largely unexplored. To address this issue, the present study investigates the effects of mindfulness, emotional intelligence, and employee well-being on healthcare workers' emotional and mental health while considering the mediating role of employee satisfaction and the moderating role of digital leadership. Data were collected through a structured questionnaire distributed to 633 healthcare employees in China. We employed SPSS and Smart PLS for reliability, discriminant validity, and structural equation modeling analyses. The findings reveal that mindfulness (MFN), emotional intelligence (EI), and employee well-being (EWB) significantly and positively influence both emotional health (EH) and mental health (MH). Furthermore, employee satisfaction (ES) mediated the relationship between mindfulness, emotional intelligence, and employee well-being to emotional and mental health. The moderating role of digital leadership (DL) was also examined, demonstrating its influence on emotional and mental health. These findings hold important implications for healthcare professionals, managers, policymakers, practitioners, and other stakeholders seeking to enhance employee well-being and job satisfaction in healthcare settings.

This study translated the Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire into Arabic and evaluated the psychometric properties and conceptual validity of the Arabic version. This process involved forward translation, back-translation, research team review, and pretesting of the Arabic SCRAM. A sample of 649 adults completed the Arabic SCRAM along with validation measures of sleep disturbances (Jenkins Sleep Scale: JSS) and depression severity (Patient Health Questionnaire: PHQ-9). Psychometric analyses included descriptive statistics, reliability analysis, test re-test, confirmatory factor analysis, and tests of convergent validity. The sample (77% female, mean age 26.31 years, range 18-47 years) demonstrated normal score distributions and adequate reliability on the Arabic SCRAM subscales. A three-factor structure was confirmed, aligning with the original English version. The Good Sleep and Depressed Mood subscales showed good convergence with the JSS and PHQ-9 scores, respectively. The Morningness subscale was not tested in the present research for convergent validity against other measures. The results provide preliminary support for a three-factor structure of the Arabic version of the SCRAM, with improved reliability indices (McDonald's ω ≈ 0.70) after removing three culturally non-optimal items; further validation is recommended before confirming these modifications.

There are many shoulder assessment outcome measures in the literature that have been studied for validity and reliability. However, there is no study examining the Turkish-adapted patient outcome measures (PROMs) on the shoulder according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. In addition, there is a small number of studies that carry out this examination on the shoulder internationally. Determining the most appropriate questionnaires for clinical use will also be an important guide in patient evaluation by filling the gap in both literature and clinical aspects.

Our aim in this study is to identify the valid and reliable Turkish scales used to evaluate shoulder pain and disability, to reveal how compatible these scales are with the aspects of study quality and psychometric quality according to COSMIN criteria list.

A systematic search was performed in the following electronic databases: MED-LINE, Web of Science (WOS), EMBASE, SCOPUS, and ULAKBIM were searched from inception to September 2024.

A total of 2890 articles were found in the databases. Four articles were included additionally without a search. Then, after eliminating the duplicates, 2231 articles were included based on the title and abstract search. 63 articles were included in full-text review. After the full-text review, according to our criteria, 29 articles were included in the systematic review. According to the assessment by the COSMIN checklist, 28 articles received the final classification of "inadequate". Only 1 article (UCLA-Tr) received the final classification of "adequate".

There is a wide range of Turkish PROMs available for the shoulder, with only one fully meeting COSMIN methodology criteria. However, this does not imply that other PROMs lack clinical utility. Future studies should focus on refining PROMs by incorporating MCID and PASS scores and prioritizing their responsiveness to enhance their clinical relevance. Additionally, variations in PROM performance across different patient populations highlight the need for context-specific evaluations to ensure their applicability in diverse clinical settings.

PROSPERO registration number: CRD42022298425.

Objective: This study aimed to evaluate the validity and reliability of the Turkish version of the Amyotrophic Lateral Sclerosis Specific Quality of Life Instrument Short Form (ALSSQOL-SF), a quality-of-life scale originally developed by Simons et al., for Turkish Amyotrophic Lateral Sclerosis (ALS) patients. Methods: Using a rigorous six-step translation process, the scale was adapted without altering any items to maintain linguistic and cultural equivalence. The study included 100 patients diagnosed with ALS, aged 18 years and older, and native Turkish speakers. Results: Psychometric evaluations revealed strong content validity (CVI: 100%) and high internal consistency (Cronbach's alpha: 0.86 for the overall scale, 0.74-0.95 for subscales). Item-total correlation coefficients, except for three items, exceeded 0.20, and removing these items did not improve the scale's reliability, preserving the scale's integrity. Construct validity was supported by significant correlations with the Short Form 12 Health Survey Questionnaire (SF-12) and ALS Functional Rating Scale Revised (ALSFRS-R), confirming the scale's ability to assess physical and mental health in ALS patients. Exploratory factor analysis showed a 6-factor structure consistent with the original structure. Conclusion: Turkish version of ALSSQOL-SF (ALSSQOL-SF-Tr) is a reliable and valid instrument for assessing the quality of life in Turkish ALS patients. Its application in clinical and research settings can help evaluate patient needs and improve disease management.

Research is a critical component of medical education, fostering critical thinking and evidence-based practice. However, in China, particularly in the context of general practice, undergraduate medical students often face significant barriers to engaging in research. This study aims to assess the perception, attitude, and practice toward research among undergraduate medical students in a tertiary hospital in Guangdong, China, and to identify the barriers they face.

A cross-sectional study was conducted among 90 undergraduate medical students from a tertiary hospital in Guangdong, China, from May to June 2024. A self-administered questionnaire was used to collect data on students' perception, attitudes, practices, and perceived barriers toward research.

The majority of students (46.6%) expressed a strong desire to pursue postgraduate studies, while only 25.5% showed a strong interest in participating in research. Key barriers included lack of time (65.5%), insufficient research guidance (56.6%), and limited access to resources (47.8%). Students' self-assessment of their research abilities was generally low, with only 9.5% feeling confident in their ability to handle data. Positive correlations were found between access to research guidance and interest in scientific literature (r = 0.62, P < 0.001).

This study identifies key areas for improving research training among undergraduate medical students, particularly in general practice programs. It suggests that standardized curricula, enhanced mentorship, and hospital-university research platforms may help address existing gaps. Given the study's limited sample and setting, further research is needed to confirm these findings in broader contexts.

Not applicable.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy. Implementation of Value-Based Healthcare (VBHC) to GDM care is worthwhile as traditional GDM care is fragmented and fails to meet the needs of women with GDM. Value of care can be improved through optimization and redesign of the care pathway and implementation of an outcome-based payment model. This study was conducted to perform a value-based evaluation of GDM care pathway redesign by using cost- and outcome data.

This study was designed as a single center, prospective, observational cohort study. In January 2022, GDM care was redesigned by substituting GDM care activities from an Internal Medicine Department (IMD) to an Integrated Maternity Care Organization (IMCO) in the Netherlands. Women diagnosed with GDM in 2021 were assigned to a pre-intervention cohort (N = 264) and those diagnosed in 2022 to a post-intervention cohort (N = 407). The impact of the intervention on value of care for women with GDM was evaluated by comparing clinical outcomes, patient-reported experience measures (GDM Responsiveness questionnaire), and costs (Time-Driven Activity-Based Costing) between the cohorts.

Referrals to the IMD for GDM decreased by 84.8% (pre-intervention: 100%, post-intervention: 15.2%, p <.001), patient-reported experiences significantly improved (Mean responsiveness pre-intervention: 3.46, post-intervention: 3.63, p: 0.00). Initiation of insulin treatment decreased by 46.8% (pre-intervention: 25.0%, post-intervention: 13.3%, p <.001). Maternal- and neonatal clinical outcomes were not different after redesign. Weighted average costs per GDM treatment were 9.7% lower post-intervention (pre-intervention: €168,37, post-intervention: €151,97).

The redesign of GDM care positively impacted value through decreased referrals and improved patient-reported experiences while clinical outcomes remained constant. By de-fragmenting GDM care, cost savings were realized. This study contributes to the improvement of care delivery, particularly in pregnancy and childbirth, by promoting the adoption of comprehensive, value-based evaluations of redesign initiatives and supports the further uptake of VBHC in maternity care.

The adoption of artificial intelligence (AI) is gaining increased interest in medical imaging. However, most medical imaging students in Ghana do not receive training on AI as part of their education. This study aimed to evaluate the effect of a tailored classroom-based medical imaging AI educational intervention in Ghana.

A pre-test/post-test study was conducted. Medical imaging students were recruited. A one-week structured lecture format was employed, integrating pre-tests at the beginning of each class, followed by theoretical presentations, discussions and post-tests. The pre-test and post-test questions were identical to assess retention and attention. The pre-test survey consisted of socio-demographic details, basic medical imaging AI concepts, applications of AI, developing AI systems and AI ethics. Descriptive, paired t-tests and multiple linear regression analyses were performed.

A total of 144 medical imaging students participated in this study, with a mean age of 21 ± 2.41 years. All the participants indicated that they have not received any previous training on medical imaging AI systems. There were significant improvements in participants' knowledge and understanding on basic concepts in medical imaging AI, applications of AI in medical imaging, developing medical imaging AI systems and AI ethics after the intervention (p < 0.001). Year of study was identified as a predictive factor to increased understanding post-test (p = 0.015).

The results of this study showed strong evidence that classroom-based intervention is an effective approach to improving students' knowledge and understanding on medical imaging AI systems.

This short medical imaging AI course can be integrated into the medical imaging curriculum in Ghana to provide students with theoretical knowledge in AI.

Background: The Iowa Infant Feeding Attitude Scale (IIFAS) is widely used to assess breastfeeding attitudes, which are linked to positive breastfeeding practices. However, its psychometric validation in Southeast Asian healthcare students remains limited. Objectives: To investigate the reliability and validity of the IIFAS among Vietnamese healthcare students. Methods: A cross-sectional study was conducted at three medical universities in Vietnam. A total of 542 healthcare students, including medical, nursing, and midwifery students, participated. The students completed the Iowa Infant Feeding Attitude Scale, Breastfeeding Knowledge Scale, and Generalized Anxiety Disorder Scale. The reliability was assessed through the internal consistency and test-retest reliability. The construct validity was tested using exploratory and confirmatory factor analysis. The divergent validity, convergent validity, and known-group comparison were also assessed. Results: The IIFAS showed an excellent internal consistency (Cronbach's α = 0.94) and test-retest reliability (intraclass correlation = 0.91). A two-factor structure of the Vietnamese IIFAS was identified using exploratory and confirmatory factor analysis with satisfactory fit indices (χ2/df = 1.318, comparative fit index = 0.985, Tucker-Lewis Index = 0.983, and Root Mean Square Error of Approximation = 0.034). Breastfeeding attitudes positively correlated with breastfeeding knowledge (r = 0.74, p < 0.001) and negatively correlated with anxiety symptoms (r = -0.13, p = 0.04). Students who were older, in a higher academic year, and majoring in medicine had significantly higher breastfeeding attitude scores (ps < 0.05). Conclusions: The Vietnamese version of the IIFAS demonstrates excellent reliability and validity, making it a robust tool for assessing breastfeeding attitudes and informing tailored educational programs among healthcare students.