bluuebunny/crossref_metadata_2025 huggingface dataset:
Action Research on Applying Compound Stimulus Approach to Improve Empathetic Communication: The Case of Physical Therapy Students
Authors: Chu Yu-Hsiu , Lee Shin-Yi , Li Yao-Chuen , Chen Shu-Ya , Ma Wei-Fen
Published: February 2023

(1) Background: Empathetic communicative skills are the first step in establishing a good therapeutic relationship. The purpose of this study is to understand the effectiveness of improving the empathetic communicative skills applied to obtain accurate and precise information from patients via compound stimulus-drama in education. (2) Methods: A cross-sectional, one-group, pre- and post-test design was used for this study. In the two-day workshop, four clinical physiotherapists acted as tutors for the “Compound Stimulus-Drama in Education” module and assessed students’ performances. The Standard Patient Rating Scale (SPRS), Objective Structured Clinical Examination Scale (OSCES), Professional and Communication Self-Assessment Scale (PCSS), Patients’ Information (PI), and the Jefferson Scale of Empathy (JSE) were used to assess the students’ empathy scores and communication skills, before and after the course. (3) Results: Fifty-seven students participated in this study. The results showed that there were significant improvements in the SPRS, OSCES, PCSS, PI, and JSE (p < 0.05). Both the quantitative data and the participants’ reflection feedback suggest that this novel module was more helpful than traditional clinical practice courses for improving clinical empathy communication skills. (4) Conclusions: This study provided an innovative teaching model and assessment tools for learning clinic empathetic communicative skills in future education training.
Variability in the Agronomic Behavior of 12 White Grapevine Varieties Grown under Severe Water Stress Conditions in the La Mancha Wine Region
Authors: Serrano A. Sergio , Martínez-Gascueña Jesús , Alonso Gonzalo L. , Cebrián-Tarancón Cristina , Carmona M. Dolores , Mena Morales Adela , Chacón-Vozmediano Juan L.
Published: February 2023

Viticulture around the world is currently affected by climate change, which is causing an increasing scarcity of water resources necessary for the maintenance of vineyards. Despite the drought hardiness of grapevine (Vitis vinifera L.), this threat seriously compromises its cultivation in the near future, particularly in wine-growing areas with a semi-arid climate. Identifying varieties capable of producing suitable yields and good-quality grapes under drought conditions is integral to ensuring the sustainability of the wine sector. This study focuses on vines from both minority and widely grown varieties, which were supplied only with the water intended to ensure their survival. The carbon and oxygen isotope ratios, yield, and quality parameters were evaluated on the vines and musts during the period of 2018–2020. The results revealed that not all varieties responded equally well to drought. Albillo Real, Coloraillo, Macabeo, and Verdejo adapted well to drought conditions, simultaneously maintaining high yields and must quality. By contrast, Pedro Ximénez can be considered poorly adapted. This variety was the one that produced the lowest yield and had low acidity levels in the must.
Comparison of Tree-Based Ensemble Algorithms for Merging Satellite and Earth-Observed Precipitation Data at the Daily Time Scale
Authors: Papacharalampous Georgia , Tyralis Hristos , Doulamis Anastasios , Doulamis Nikolaos
Published: February 2023

Merging satellite products and ground-based measurements is often required for obtaining precipitation datasets that simultaneously cover large regions with high density and are more accurate than pure satellite precipitation products. Machine and statistical learning regression algorithms are regularly utilized in this endeavor. At the same time, tree-based ensemble algorithms are adopted in various fields for solving regression problems with high accuracy and low computational costs. Still, information on which tree-based ensemble algorithm to select for correcting satellite precipitation products for the contiguous United States (US) at the daily time scale is missing from the literature. In this study, we worked towards filling this methodological gap by conducting an extensive comparison between three algorithms of the category of interest, specifically between random forests, gradient boosting machines (gbm) and extreme gradient boosting (XGBoost). We used daily data from the PERSIANN (Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks) and the IMERG (Integrated Multi-satellitE Retrievals for GPM) gridded datasets. We also used earth-observed precipitation data from the Global Historical Climatology Network daily (GHCNd) database. The experiments referred to the entire contiguous US and additionally included the application of the linear regression algorithm for benchmarking purposes. The results suggest that XGBoost is the best-performing tree-based ensemble algorithm among those compared. Indeed, the mean relative improvements that it provided with respect to linear regression (for the case that the latter algorithm was run with the same predictors as XGBoost) are equal to 52.66%, 56.26% and 64.55% (for three different predictor sets), while the respective values are 37.57%, 53.99% and 54.39% for random forests, and 34.72%, 47.99% and 62.61% for gbm. Lastly, the results suggest that IMERG is more useful than PERSIANN in the context investigated.
Anaerobic Storage Completely Removes Suspected Fungal Pathogens but Increases Antibiotic Resistance Gene Levels in Swine Wastewater High in Sulfonamides
Authors: Zhao Xinyue , Zhang Mengjie , Sun Zhilin , Zheng Huabao , Zhou Qifa
Published: February 2023

Wastewater storage before reuse is regulated in some countries. Investigations of pathogens and antibiotic resistance genes (ARGs) during wastewater storage are necessary for lowering the risks for wastewater reuse but are still mostly lacking. This study aimed to investigate pathogens, including harmful plant pathogens, and ARGs during 180 d of swine wastewater (SWW) storage in an anaerobic storage experiment. The contents of total organic carbon and total nitrogen in SWW were found to consistently decrease with the extension of storage time. Bacterial abundance and fungal abundance significantly decreased with storage time, which may be mainly attributed to nutrient loss during storage and the long period of exposure to a high level (4653.2 μg/L) of sulfonamides in the SWW, which have an inhibitory effect. It was found that suspected bacterial pathogens (e.g., Escherichia–Shigella spp., Vibrio spp., Arcobacter spp., Clostridium_sensu_stricto_1 spp., and Pseudomonas spp.) and sulfonamide-resistant genes Sul1, Sul2, Sul3, and SulA tended to persist and even become enriched during SWW storage. Interestingly, some suspected plant fungal species (e.g., Fusarium spp., Ustilago spp. and Blumeria spp.) were detected in SWW. Fungi in the SWW, including threatening fungal pathogens, were completely removed after 60 d of anaerobic storage, indicating that storage could lower the risk of using SWW in crop production. The results clearly indicate that storage time is crucial for SWW properties, and long periods of anaerobic storage could lead to substantial nutrient loss and enrichment of bacterial pathogens and ARGs in SWW.
Understanding Use Intention of mHealth Applications Based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) Model in China
Authors: Zhu Yancong , Zhao Zhenhong , Guo Jingxian , Wang Yanna , Zhang Chengwen , Zheng Jiayu , Zou Zheng , Liu Wei
Published: February 2023

The COVID-19 pandemic has significantly impacted the healthcare industry, especially public health resources and resource allocation. With the change in people’s lifestyles and increased demand for medical and health care in the post-pandemic era, the Internet and home healthcare have rapidly developed. As an essential part of Internet healthcare, mobile health (mHealth) applications help to fundamentally address the lack of medical resources and meet people’s healthcare needs. In this mixed-method study, we conducted in-depth interviews with 20 users in China (mean age = 26.13, SD = 2.80, all born in China) during the pandemic, based on the unified theory of acceptance and use of technology 2 (UTAUT-2) mode, and identified four dimensions of user needs in mHealth scenarios: convenience, control, trust, and emotionality. Based on the interview results, we adjusted the independent variables, deleted the hedonic motivation and the habit, and added the perceived trust and perceived risk as the variables. Using a structural equation model (SEM), we designed the questionnaire according to the qualitative results and collected data from 371 participants (above 18 years old, 43.9% male) online to examine the interrelationships these variables. The results show that performance expectancy (β = 0.40, p < 0.001), effort expectancy (β = 0.40, p < 0.001), social influence (β = 0.14, p < 0.05), facilitating condition (β = 0.15, p < 0.001), and perceived trust (β = 0.31, p < 0.001) had positive effects on use intention. Perceived risk (β = −0.31, p < 0.001) harmed use intention, and price value (β = 0.10, p > 0.5) had no significant effects on use intention. Finally, we discussed design and development guidelines that can enhance user experience of mHealth applications. This research combines the actual needs and the main factors affecting the use intention of users, solves the problems of low satisfaction of user experience, and provides better strategic suggestions for developing mHealth applications in the future.
Spatial Accessibility of Primary Care in the Dual Public–Private Health System in Rural Areas, Malaysia
Authors: Ab Hamid Jabrullah , Juni Muhamad Hanafiah , Abdul Manaf Rosliza , Syed Ismail Sharifah Norkhadijah , Lim Poh Ying
Published: February 2023

Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia’s dual public–private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.
Blackland Conservation and Utilization, Carbon Storage and Ecological Risk in Green Space: A Case Study from Heilongjiang Province in China
Authors: Qu Chen , Li Wen , Xu Jia , Shi Song
Published: February 2023

Clarifying the relationship between carbon storage and ecological risks is critical to ensuring regional sustainable development. Land use changes caused by land use policy invariably result in substantial changes in carbon storage and ecological risks. The link between carbon storage and ecological risks in green space is still unknown, even though green space is an essential ecological function carrier. According to the Blackland Conservation Utilization (BCU) policy document and natural exploitation (NP) status, this study compared and projected the carbon storage and landscape ecological risk characteristics of green space in Heilongjiang Province (HLJP) for 2030. It also quantitatively assessed the interactions and synergistic changes of the two variables in terms of coupled coordination relationships, quantitative correlations, and spatial correlations. The results demonstrated the following: (1) the green space evolution of HJLP under the BCU scenario is significantly more drastic than under the NP scenario; (2) In 2020–2030, the NP scenario’s evolution of green space results in the ecosystem losing 323.51 × 106 t of carbon storage, compared to the BCU scenario’s loss of just 216.07 × 106 t. The BCU policy will increase the agglomeration of high-risk ranges in the northeast and southwest will but decrease the overall landscape ecological risk level of green space; (3) BCU policy will prevent the system’s orderly development and benign coupling, but it will increase the interdependence between carbon storage and landscape ecological risks in green space; (4) Green space exchange and loss will result in the simultaneous rise or decrease in both variables. The magnitude of carbon storage increase owing to green space expansion tends to increase simultaneously with the magnitude of landscape ecological risk reduction. To a certain extent, the HLJP black land conservation and utilization policy can improve carbon storage and ensure ecological security, and the matching of dominant regions with the status of the landscape evolutionary process can support future carbon-neutral actions.
Research on Risk Assessment and Contamination Monitoring of Potential Toxic Elements in Mining Soils
Authors: Yang Jie , Wang Yunlong , Zuo Rui , Zhang Kunfeng , Li Chunxing , Song Quanwei , Du Xianyuan
Published: February 2023

Potentially toxic element (PTE) contamination in soils has serious impacts on ecosystems. However, there is no consensus in the field of assessment and monitoring of contaminated sites in China. In this paper, a risk assessment and pollution monitoring method for PTEs was proposed and applied to a mining site containing As, Cd, Sb, Pb, Hg, Ni, Cr, V, Zn, Tl, and Cu. The comprehensive scoring method and analytical hierarchical process were used to screen the priority PTEs for monitoring. The potential ecological risk index method was used to calculate the risk index of monitoring point. The spatial distribution characteristics were determined using semi-variance analysis. The spatial distribution of PTEs was predicted using ordinary kriging (OK) and radial basis function (RBF). The results showed that the spatial distribution of As, Pd, and Cd are mainly influenced by natural factors, while Sb and RI are influenced by both natural and human factors. OK has higher spatial prediction accuracy for Sb and Pb, and RBF has higher prediction accuracy for As, Cd, and RI. The areas with high ecological risk and above are mainly distributed on both sides of the creek and road. The optimized long-term monitoring sites can achieve the monitoring of multiple PTEs.
The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries
Authors: Van Poel Esther , Collins Claire , Groenewegen Peter , Spreeuwenberg Peter , Bojaj Gazmend , Gabrani Jonila , Mallen Christian , Murauskiene Liubove , Šantrić Milićević Milena , Schaubroeck Emmily , Stark Stefanie , Willems Sara
Published: February 2023

The COVID-19 pandemic disproportionately affected vulnerable populations’ access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p < 0.05) or paramedical support staff (p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities.
Musculoskeletal Health Complaints and Associated Risk Factors in Freshmen Music Students
Authors: Ballenberger Nikolaus , Avermann Florian , Zalpour Christoff
Published: February 2023

Background: Evidence concerning the development of musculoskeletal health complaints (MHCs) among music students is limited due to inappropriate study designs. We aimed to assess the occurrences of MHCs and associated risk factors in freshmen music students compared to students from other disciplines. Methods: A prospective cohort study was conducted. Risk factors such as pain-related, physical, and psychosocial variables were measured at baseline. Episodes of MHCs were recorded monthly. Results: A total of 146 music students and 191 students from other disciplines were analyzed. In the cross-sectional comparison, pain-related, physical, and psychosocial variables were significantly altered in music students compared to students from other disciplines. Furthermore, music students with current MHCs differed significantly from music students without current MHCs with respect to physical health, pain, and history of MHCs. Our longitudinal analysis showed that monthly MHCs were higher in music students compared to students from other disciplines. Independent predictors for monthly MHCs in music students were current MHCs and reduced physical function. Predictors for MHCs in students from other disciplines were a history of MHCs and stress. Conclusions: We provided insight into the development of MHCs and risk factors in music students. This may help in the creation of targeted, evidence-based prevention and rehabilitation.
Benefits of Eccentric Training with Emphasis on Demands of Daily Living Activities and Feasibility in Older Adults: A Literature Review
Authors: Cvečka Ján , Vajda Matej , Novotná Alexandra , Löfler Stefan , Hamar Dušan , Krčmár Matúš
Published: February 2023

Aging is associated with a decline in physical capabilities and several other health-related conditions. One of the most common age-related processes is sarcopenia. Sarcopenia is usually accompanied with a decline in skeletal muscle mass and physical functioning. A decrease in these markers usually impacts basic daily living activities (DLAs), which become somewhat harder to accomplish for older individuals. Several research studies have examined the demands of DLA in older individuals with results indicating that activities such as walking, sitting, standing, stair climbing, stair descending, and running generate high demands on older adults. The forces that act on individuals are in most cases equal or multiple times higher relative to their body mass. For instance, it was reported that the GRF (ground reaction force) during stair descent ranged from 1.43 to 1.50 of BW (body weight) in an older population. Even higher demands were recorded during other related activities. These demands of DLA raise the question of appropriate rehabilitative or training management procedures. During the past decades, an eccentric form of resistance training gained popularity due to its effectiveness and lower metabolic demands, which seems to be an appropriate method to develop and maintain a basic level of strength capabilities in higher age. Multiple factors of eccentric training have been examined including modality of exercise, intensity, frequency, and safety of the elderly. Several modalities of eccentric exercise have been shown to be effective including traditional methods, as well as machine-based ones, with or without using some equipment. The studies included in this review varied in intensity from low to high; however, the most frequently used intensity was ≥50% of the maximal eccentric strength during two or three eccentric sessions per week. Importantly, the prevalence of injury of older adults appears to have been low to none, highlighting the safety of this approach. In summary, eccentric training prescriptions for older adults should consider the demands of DLA and the characteristics of the elderly for appropriate management of training recommendations.
Economic Evaluation of Direct Oral Anticoagulants Compared to Warfarin for Venous Thromboembolism in Thailand: A Cost-Utility Analysis
Authors: Niyomsri Siwaporn , Nimworapan Mantiwee , Wongcharoen Wanwarang , Dilokthornsakul Piyameth
Published: February 2023

Background: Direct oral anticoagulants (DOACs) have been used for venous thromboembolism (VTE) in Thailand. However, they have not been listed in the National List of Essential Medicines (NLEM). A cost-effectiveness analysis is needed to aid policymakers in deciding whether DOACs should be listed in the NLEM. This study aimed to assess the cost-effectiveness of DOACs for patients with VTE in Thailand. Methods: A cohort-based state transition model was constructed from a societal perspective with a lifetime horizon. All available DOACs, including apixaban, rivaroxaban, edoxaban, and dabigatran, were compared with warfarin. A 6-month cycle length was used to capture all costs and health outcomes. The model consisted of nine health states, including VTE on treatment, VTE off treatment, recurrent VTE, clinically relevant non-major bleeding, gastrointestinal bleeding, intracranial bleeding, post-intracranial bleeding, chronic thromboembolic pulmonary hypertension, and death. All inputs were based on a comprehensive literature review. The model outcomes included total cost and quality-adjusted life-years (QALYs) with a 3% annual discount rate. A fully incremental cost-effectiveness analysis and the incremental cost-effectiveness ratio (ICER) per QALY gained were calculated at a willingness-to-pay (WTP) of THB 160,000/QALY ($5003). The robustness of the findings was assessed using deterministic and probabilistic sensitivity analyses. Results: All DOACs were associated with a decreased risk of VTE recurrence and intracranial hemorrhage. In the base-case analysis, apixaban could increase 0.16 QALYs compared with warfarin. An ICER for apixaban was 269,809 Thai baht (THB)/QALY ($8437/QALY). Rivaroxaban had a better QALY than warfarin at 0.09 QALYs with an ICER of 757,363 THB/QALY ($23,682/QALY). Edoxaban and dabigatran could also increase by 0.10 QALYs with an ICER of 709,945 THB ($22,200) and 707,145 THB ($22,122)/QALY, respectively. Our probabilistic sensitivity analyses indicated that warfarin had a 99.8% possibility of being cost-effective, while apixaban had a 0.2% possibility of being cost-effective at the current WTP. Other DOACs had no possibility of being cost-effective. Conclusions: All DOACs were not cost-effective for VTE treatment at the current WTP in Thailand. Apixaban is likely to be the best option among DOACs.
We Are Not Islands: The Role of Social Support in the Relationship between Perceived Stress during the COVID-19 Pandemic and Psychological Distress
Authors: Padmanabhanunni Anita , Pretorius Tyrone B. , Isaacs Serena Ann
Published: February 2023

COVID-19 containment measures, including social distancing, quarantine, and confinement, significantly impacted social connectedness and contributed to heightened levels of perceived stress. Prior research has established that protective factors can mitigate emotional distress. This study investigated the protective role of social support in the relationship between perceived stress and psychological distress among a sample of university students. Participants (n = 322) completed the Multidimensional Scale of Perceived Social Support, the Perceived Stress Scale, short forms of the Center for Epidemiological Studies Depression Scale, the trait scale of the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale. The results indicated that high levels of perceived stress were associated with high levels of hopelessness, depression, and anxiety. In terms of direct and mediating effects, social support was significant for depression and hopelessness but not for anxiety. Furthermore, the relationship between perceived stress and depression was higher for those with high levels of social support than for those with lower levels of social support. The findings suggest that in addition to enhancing social support resources, interventions must assist students in managing the uncertainty and anxiety associated with the pandemic. Furthermore, students’ appraisals of support and the extent to which support is experienced as beneficial must also be examined prior to the implementation of interventions.
A Study on the Spatial Pattern of the Ecological Product Value of China’s County-Level Regions Based on GEP Evaluation
Authors: Shen Ping , Wu Lijuan , Huo Ziwen , Zhang Jiaying
Published: February 2023

Gross Ecosystem Product (GEP) is a concept that reflects ecological product value by using geospatial technology. It can demonstrate the spatial distribution of ecological products and provide new perspectives and refined support for spatial planning. China’s county-level regions are important units for the promotion of ecological product value. Based on the concept of GEP, this study evaluated the ecological product value of China’s county-level regions in 2020, used Local Indicators of Spatial Association (LISA) to visualise spatial patterns and conducted a correlation analysis between the GEP indices and economic and land use factors. The study found that the results of evaluation and analysis varied by spatial distribution: (1) county-level regions with high provisioning service indices are concentrated in northeastern China and southeastern China; (2) county-level regions with high regulating service indices are concentrated south of the Yangtze River and in the southern region of the Qinghai-Tibet Plateau; (3) county-level regions with high cultural service indices are concentrated in southeastern China; (4) county-level regions with high composite GEP indices are concentrated in northeastern China. The results have different correlations with different factors, reflecting the complex mechanisms behind ecological value transformation. For example, the composite GEP index for an area has a strong positive correlation with the area’s proportions of woodland area, water area and GDP.
Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review
Authors: Akbari Nilufar , Heinze Georg , Rauch Geraldine , Sander Ben , Becher Heiko , Dunkler Daniela
Published: February 2023

Randomization is an effective design option to prevent bias from confounding in the evaluation of the causal effect of interventions on outcomes. However, in some cases, randomization is not possible, making subsequent adjustment for confounders essential to obtain valid results. Several methods exist to adjust for confounding, with multivariable modeling being among the most widely used. The main challenge is to determine which variables should be included in the causal model and to specify appropriate functional relations for continuous variables in the model. While the statistical literature gives a variety of recommendations on how to build multivariable regression models in practice, this guidance is often unknown to applied researchers. We set out to investigate the current practice of explanatory regression modeling to control confounding in the field of cardiac rehabilitation, for which mainly non-randomized observational studies are available. In particular, we conducted a systematic methods review to identify and compare statistical methodology with respect to statistical model building in the context of the existing recent systematic review CROS-II, which evaluated the prognostic effect of cardiac rehabilitation. CROS-II identified 28 observational studies, which were published between 2004 and 2018. Our methods review revealed that 24 (86%) of the included studies used methods to adjust for confounding. Of these, 11 (46%) mentioned how the variables were selected and two studies (8%) considered functional forms for continuous variables. The use of background knowledge for variable selection was barely reported and data-driven variable selection methods were applied frequently. We conclude that in the majority of studies, the methods used to develop models to investigate the effect of cardiac rehabilitation on outcomes do not meet common criteria for appropriate statistical model building and that reporting often lacks precision.
Nutrition and Hydration for High-Altitude Alpinism: A Narrative Review
Authors: Viscor Ginés , Corominas Jordi , Carceller Anna
Published: February 2023

This report aims to summarise the scientific knowledge around hydration, nutrition, and metabolism at high altitudes and to transfer it into the practical context of extreme altitude alpinism, which, as far as we know, has never been considered before in the literature. Maintaining energy balance during alpine expeditions is difficult for several reasons and requires a deep understanding of human physiology and the biological basis for altitude acclimation. However, in these harsh conditions it is difficult to reconcile our current scientific knowledge in sports nutrition or even for mountaineering to high-altitude alpinism: extreme hypoxia, cold, and the logistical difficulties intrinsic to these kinds of expeditions are not considered in the current literature. Requirements for the different stages of an expedition vary dramatically with increasing altitude, so recommendations must differentiate whether the alpinist is at base camp, at high-altitude camps, or attempting the summit. This paper highlights nutritional recommendations regarding prioritising carbohydrates as a source of energy and trying to maintain a protein balance with a practical contextualisation in the extreme altitude environment in the different stages of an alpine expedition. More research is needed regarding specific macro and micronutrient requirements as well as the adequacy of nutritional supplementations at high altitudes.
Association of Affiliate Stigma with Parenting Stress and Its Moderators among Caregivers of Children with Attention-Deficit/Hyperactivity Disorder
Authors: Lin Pei-Yun , Chou Wen-Jiun , Hsiao Ray C. , Liu Tai-Ling , Yen Cheng-Fang
Published: February 2023

Caring for children with attention-deficit/hyperactivity disorder (CADHD) is stressful for caregivers. Identifying factors related to parenting stress in caregivers of CADHD can facilitate the development of intervention programs. This study aimed to examine the associations between affiliate stigma and various domains of parenting stress among caregivers of CADHD. This study also analyzed the moderating effects of demographic characteristics and the symptoms of childhood ADHD and oppositional defiant disorder (ODD) on the associations between affiliate stigma and parenting stress. In total, 213 caregivers of CADHD participated in this study. Parenting stress was assessed using the Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF). Affiliate stigma was assessed using the Affiliate Stigma Scale. ADHD and ODD symptoms were assessed using the Parent Form of the Swanson, Nolan, and Pelham Scale, Version IV. The results indicated that higher affiliate stigma was significantly associated with greater parenting stress in all three domains of the PSI-4-SF. ODD symptoms increased the magnitude of parenting stress in two domains of parenting stress among caregivers with affiliate stigma. Intervention programs for relieving parenting stress among caregivers of CADHD should take affiliate stigma and child ODD symptoms into consideration.
Eco-Innovation and Its Influence on Renewable Energy Demand: The Role of Environmental Law
Authors: Jafri Muhammad Afaq Haider , Liu Huizheng
Published: February 2023

There is a consensus among the empirics regarding the positive role of renewable energy in mitigating the effects of climate change. Hence, it is vital to search for the factors that can promote renewable energy demand. As a result, this analysis investigates the impact of educational attainment, environmental law, and innovation on renewable energy consumption (REC) in China. From empirical estimates, we confer that the long-run estimates attached to the environment-related taxes and environmental policy stringency are positive and significant, implying that both these factors increase the REC in China in the long run. Similarly, the estimated coefficients of environment-related technologies and patent applications are significantly positive, confirming that environmental and other technologies give rise to REC in the long run. Likewise, the long-run estimates of education are significantly positive in both models, which confer that REC increases along with an increase in average years of schooling. Lastly, the estimates of CO2 emissions are significantly positive in the long run. These results imply that policymakers should invest in research and development activities that are crucial for promoting eco-innovation and renewable energy demand. In addition, strict environmental laws should be introduced to induce firms and businesses to invest in clean energy.
Exploring the Intention to Adopt Sustainable Mobility Modes of Transport among Young University Students
Authors: Rodríguez-Rad Carlos J. , Revilla-Camacho María-Ángeles , Sánchez-del-Río-Vázquez María-Elena
Published: February 2023

This research arises from the need to accelerate the diffusion of sustainable mobility and the call for research on this topic. The Sustainable Development Goal 11 of the 2030 Agenda, the scientific articles on sustainable mobility systems and the advance of micro-mobility, shared mobility, Mobility on Demand (MOD) or Mobility as a Service (MaaS) in recent years manifest the importance of sustainable urban development. Given this reality, this paper explores the elements and factors that condition the adoption of a sustainable mobility mode of transport. An empirical study was carried out in the city of Seville through an electronic questionnaire delivered to university students. Our exploratory approach is an innovative point of view that can help us to better understand the reasons for the successful adoption of sustainable mobility modes of transport. The most relevant results of this study indicate that the user’s perceived impacts on sustainability and customer forces influence the adoption of a mode of transport by citizens, whereas the product forces seem not to influence thTABLEis. Therefore, cities and companies that have put their emphasis exclusively on improving mobility products and services, without taking citizens into account, are less likely to succeed. Additionally, governments should consider that economic issues or environmental concerns of citizens act as drivers of innovation in urban mobility.
Spatial and Temporal Analysis of COVID-19 Cases in West Java, Indonesia and Its Influencing Factors
Authors: Putri Delima Istio Prawiradhani , Agustian Dwi , Apriani Lika , Ilyas Ridwan
Published: February 2023

Coronavirus Disease 2019 (COVID-19) spread quickly and reached epidemic levels worldwide. West Java is Indonesia’s most populous province and has a high susceptibility to the transmission of the disease, resulting in a significant number of COVID-19 cases. Therefore, this research aimed to determine the influencing factors as well as the spatial and temporal distribution of COVID-19 in West Java. Data on COVID-19 cases in West Java obtained from PIKOBAR were used. Spatial distribution was described using a choropleth, while the influencing factors were evaluated with regression analysis. To determine whether COVID-19s policies and events affected its temporal distribution, the cases detected were graphed daily or biweekly with information on those two variables. Furthermore, the cumulative incidence was described in the linear regression analysis model as being significantly influenced by vaccinations and greatly elevated by population density. The biweekly chart had a random pattern with sharp decreases or spikes in cumulative incidence changes. Spatial and temporal analysis helps greatly in understanding distribution patterns and their influencing factors, specifically at the beginning of the pandemic. Plans and strategies for control and assessment programs may be supported by this study material.
How Do Road Traffic Noise and Residential Greenness Correlate with Noise Annoyance and Long-Term Stress? Protocol and Pilot Study for a Large Field Survey with a Cross-Sectional Design
Authors: Dopico Javier , Schäffer Beat , Brink Mark , Röösli Martin , Vienneau Danielle , Binz Tina Maria , Tobias Silvia , Bauer Nicole , Wunderli Jean Marc
Published: February 2023

Urban areas are continuously growing, and densification is a frequent strategy to limit urban expansion. This generally entails a loss of green spaces (GSs) and an increase in noise pollution, which has negative effects on health. Within the research project RESTORE (Restorative potential of green spaces in noise-polluted environments), an extended cross-sectional field study in the city of Zurich, Switzerland, is conducted. The aim is to assess the relationship between noise annoyance and stress (self-perceived and physiological) as well as their association with road traffic noise and GSs. A representative stratified sample of participants from more than 5000 inhabitants will be contacted to complete an online survey. In addition to the self-reported stress identified by the questionnaire, hair cortisol and cortisone probes from a subsample of participants will be obtained to determine physiological stress. Participants are selected according to their dwelling location using a spatial analysis to determine exposure to different road traffic noise levels and access to GSs. Further, characteristics of individuals as well as acoustical and non-acoustical attributes of GSs are accounted for. This paper presents the study protocol and reports the first results of a pilot study to test the feasibility of the protocol.
The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era
Authors: Martinez-Nicolas Ismael , Basaraba Cale , Delgado-Gomez David , Lopez-Fernandez Olatz , Baca-Garcia Enrique , Wainberg Milton L.
Published: February 2023

(1) Background: In the “post-COVID-19 era”, there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The “Electronic Mental Wellness Tool” (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool’s sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.
A Three-Armed Randomized Controlled Trial to Evaluate the Effectiveness, Acceptance, and Negative Effects of StudiCare Mindfulness, an Internet- and Mobile-Based Intervention for College Students with No and “On Demand” Guidance
Authors: Küchler Ann-Marie , Schultchen Dana , Dretzler Tim , Moshagen Morten , Ebert David D. , Baumeister Harald
Published: February 2023

The college years can be accompanied by mental distress. Internet- and mobile-based interventions (IMIs) have the potential to improve mental health but adherence is problematic. Psychological guidance might promote adherence but is resource intensive. In this three-armed randomized controlled trial, “guidance on demand” (GoD) and unguided (UG) adherence-promoting versions of the seven-module IMI StudiCare Mindfulness were compared with a waitlist control group and each other. The GoD participants could ask for guidance as needed. A total of 387 students with moderate/low mindfulness were recruited. Follow-up assessments took place after 1 (t1), 2 (t2), and 6 (t3) months. Post-intervention (t2), both versions significantly improved the primary outcome of mindfulness (d = 0.91–1.06, 95% CI 0.66–1.32) and most other mental health outcomes (d = 0.25–0.69, 95% CI 0.00–0.94) compared with WL, with effects generally persisting after 6 months. Exploratory comparisons between UG and GoD were mostly non-significant. Adherence was low but significantly higher in GoD (39%) vs. UG (28%) at the 6-month follow-up. Across versions, 15% of participants experienced negative effects, which were mostly mild. Both versions effectively promoted mental health in college students. Overall, GoD was not associated with substantial gains in effectiveness or adherence compared with UG. Future studies should investigate persuasive design to improve adherence.
Factors Associated with Suicidal Ideation and Suicide Attempt in Brazilian Transgender Youth
Authors: Chinazzo Ítala Raymundo , Fontanari Anna Martha Vaitses , Costa Angelo Brandelli , Lobato Maria Inês Rodrigues
Published: February 2023

The rates of suicidal ideation and suicide attempts among transgender youths are high. However, in Brazil, there are no studies about these outcomes in this population. The present study aims to investigate the prevalence of suicidal ideation and suicide attempts in Brazilian transgender youths (binary and non-binary), in association with predictor variables, following the Minority Stress Theory. The predictor variables analyzed were depressive symptoms, discrimination, gender distress, deprivation, social support, and gender identity support from parents and friends. Participants were recruited through an online survey. The final sample consisted of 213 participants, aged 13 to 25 years old. Two equal regression analyses were performed, one for each outcome. Out of the total, 103 (48.6%) identified as transgender boys, 44 (20.8%) as transgender girls, and 65 (30.7%) as non-binary. The mean age was 18.53 years (SD 2.50). The study found that 57.6% of the sample had depressive symptoms, 72.3% experienced suicidal ideation, and 42.7% had attempted suicide. In the final model, the variables that were associated with suicidal ideation were deprivation, gender distress, and depressive symptoms. As for suicide attempts, the variables deprivation and depressive symptoms were correlated. Further studies on this population should be conducted to analyze protective factors for these outcomes.
Environmental Stress Symptoms during Heat Acclimatization, Heat Acclimation, and Intermittent Heat Training
Authors: Manning Ciara , Benjamin Courteney , Sekiguchi Yasuki , Butler Cody , Szymanski Michael , Stearns Rebecca , Armstrong Lawrence , Lee Elaine , Casa Douglas
Published: February 2023

Background: Athletes training in heat experience physiological and perceptual symptoms that risk their safety and performance without adaptation. Purpose: We examined the changes in environmental symptoms, assessed with the Environmental Symptoms Questionnaire (ESQ), during heat acclimatization (HAz), heat acclimation (HA), and intermittent heat training (HT). Methods: Twenty-seven participants (mean ± standard deviation [M ± SD], age of 35 ± 12 y, VO2max of 57.7 ± 6.8 mL·kg−1·min−1) completed five trials involving 60 mins of running (60% vVO2max) followed by a 4 km time trial in heat (M ± SD, temperature of 35.5 ± 0.7 °C, humidity of 46.4 ± 1.5%). The trials occurred at baseline, post-HAz, post-HA, at week 4 of HT (post-HT4), and at week 8 of HT (post-HT8). The participants completed HT once/week (HTMIN), completed HT twice/week (HTMAX), or did not complete HT (HTCON). ESQ symptoms, thermal sensation (TS), and heart rate (HR) were measured pre- and post-trial. Results: Post-ESQ symptoms improved post-HA (3[0.40, 4.72], p = 0.02) and post-HAz (3[0.35, 5.05], p = 0.03) from baseline. During HT, symptoms improved in the HTMAX group and worsened in the HTMIN and HTCON groups. Symptoms improved in the HTMAX group versus the HTCON group at post-HT8 (4[1.02, 7.23], p = 0.012). Higher TS and HR values were weakly associated with ESQ symptoms during HT (r = 0.20, p = 0.04), only explaining 20% of variance. Conclusions: ESQ symptoms improved during HAz, HA, and HT 2x/week. ESQ symptoms were not statistically correlated with HR during exercise heat stress. TS was not sensitive to detecting adaptation and did not subjectively change. The ESQ may be valuable in monitoring adaptation and may contribute to performance post-acclimation.
The Role of Weight Suppression in Intensive Enhanced Cognitive Behavioral Therapy for Adolescents with Anorexia Nervosa: A Longitudinal Study
Authors: Calugi Simona , Dalle Grave Anna , Conti Maddalena , Dametti Laura , Chimini Mirko , Dalle Grave Riccardo
Published: February 2023

The study aimed to establish the role of weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E). One hundred and twenty-eight adolescent patients with anorexia nervosa (128 females and 2 males), aged between 14 and 19 years, were recruited from consecutive referrals to a community-based eating disorder clinic offering intensive CBT-E. Weight, height, Eating Disorder Examination Questionnaire, and Brief Symptom Inventory scores were recorded at admission, end-of-treatment, and at a 20-week follow-up. In addition, the developmental weight suppression (DWS, difference between one’s highest premorbid and current z-BMI, i.e., BMI z-scores) was calculated. The mean baseline z-BMI was −4.01 (SD = 2.27), and the mean DWS was 4.2 (SD = 2.3). One hundred and seven patients (83.4%) completed the treatment and showed both considerable weight gain and reduced scores for eating-disorder and general psychopathology. Among completers, 72.9% completed the 20-week follow-up and maintained the improvement reached at the end-of-treatment. DWS was negatively correlated with end-of-treatment and follow-up z-BMI. This indicates that weight suppression is a predictor of the BMI outcome of intensive CBT-E and confirms that this treatment is promising for adolescents with anorexia nervosa.