Developmental Coordination Disorder (DCD) is associated with elevated rates of anxiety and depression, as well as reduced quality of life, yet the mechanisms linking motor difficulties to these outcomes remain incompletely specified. This article presents and critically evaluates the Integrated Stress-Adaptation Framework for DCD (ISAF-DCD), which synthesizes empirical findings on DCD with established stress theories, including the Environmental Stress Hypothesis, the transactional model of stress, and the Conservation of Resources model. Although the framework is presented with reference to comorbid neurodevelopmental conditions broadly, its evidential basis and worked examples concentrate specifically on attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); generalization to other neurodevelopmental conditions is plausible but has not been evaluated here. ISAF-DCD proposes that motor coordination difficulties influence mental, cognitive, and physical health through interacting environmental demands, primary and secondary stressors, appraisal and response processes, and personal and social factors. The framework is bidirectional and developmentally sensitive, allowing outcomes to feed back into subsequent stress and adaptation processes across the lifespan. I examine the model’s conceptual coherence, empirical support, and potential clinical utility, arguing that ISAF-DCD offers a theoretically grounded heuristic for organizing a fragmented literature while remaining provisional. Its proposed contributions include clarifying the multiple roles of resilience and social support, refining the classification of environmental demands, incorporating neurodevelopmental comorbidity as a cross-cutting factor, and representing reciprocal relationships between stress and motor functioning. To improve falsifiability, I specify the temporal and functional roles of key dual-role constructs and derive five core, empirically distinguishable propositions that differentiate ISAF-DCD from an expanded Environmental Stress Hypothesis. Direct empirical support for some components, particularly the proposed corticolimbic mechanisms, remains limited. ISAF-DCD should therefore be treated as a hypothesis-generating framework, focused primarily on ADHD and ASD as comorbid conditions and on mental health as its central but not exclusive outcome domain, that requires rigorous longitudinal and intervention-based evaluation.
Background Benefit finding may be associated with better mental health after the pandemic, but its longitudinal trajectory and its associations with psychosocial resources and mental health symptoms during recovery remain unclear. Objective This study examined trajectories of benefit finding among Chinese college students from approximately 3 to 15 months after COVID-19 restrictions were lifted. We also examined its associations with emotion regulation, social connectedness, depressive symptoms, and anxiety symptoms, together with indirect association patterns involving benefit finding. Methods A three-wave longitudinal study was conducted among 1,155 Chinese college students. Data were analyzed using parallel-process latent growth curve modeling. Results Social connectedness and benefit finding increased linearly over time, whereas depressive and anxiety symptoms decreased. Cognitive reappraisal was positively associated with the benefit finding intercept but negatively associated with its slope, whereas expressive suppression was not significantly associated with either growth factor. Social connectedness showed stronger associations with benefit finding trajectories than the emotion regulation variables. Benefit finding was negatively associated with depressive and anxiety symptoms at both the intercept and slope levels. Indirect association patterns through benefit finding were supported for social connectedness and both depressive and anxiety symptoms at the intercept and slope levels when inference was based on bias-corrected bootstrap confidence intervals. Conclusions Benefit finding increased during the post-pandemic recovery period and was associated with lower depressive and anxiety symptoms. Social connectedness showed relatively strong associations with benefit finding trajectories, while cognitive reappraisal was associated with higher initial benefit finding but a slower subsequent increase. The indirect association patterns linked social connectedness with both symptom domains through benefit finding at the intercept and slope levels. These findings highlight psychosocial resources that merit further study in campus mental health research, while the observational design does not establish causal direction or temporal precedence.
Purpose: The COVID-19 pandemic has increased the workload of medical personnel providing patient care, particularly inpatient nurses. Field interviews with nurses at hospitals in Bandung City indicated increased fatigue and sleepiness during the new normal adaptation period. This study aimed to measure mental workload and sleepiness among inpatient nurses in Bandung City. Methodology: A total of 275 inpatient nurses participated by completing the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire to assess mental workload and the Karolinska Sleepiness Scale (KSS) to measure sleepiness. Results: Mental workload among inpatient nurses ranged from high to very high, with scores between 76.93 ± 13.18 and 81.36 ± 13.53. Hospital characteristics, gender, age, and marital status were identified as factors associated with excessive mental workload. KSS scores indicated that nurses were in the very alert to alert range after completing their duties. Furthermore, 60.73% of nurses experienced very high mental workload, while 68.73% were classified as very alert. Conclusion: The findings indicate the need for hospital management to improve working conditions through better shift scheduling, resource allocation, and equitable distribution of staff support facilities to address the needs of inpatient nurses. Originality: This study examines mental workload and sleepiness simultaneously among inpatient nurses in Bandung City and identifies factors associated with excessive mental workload, providing a basis for improving hospital workforce management during the new normal adaptation period.
Background Perceived social support is an important psychosocial resource for competitive athletes, while perceived stress is closely associated with athlete burnout. Drawing on conservation of resources theory and the cognitive-transactional model of stress, this study examines the relationships among perceived social support, perceived stress, and athlete burnout. Objectives This study aims to investigate the associations among perceived social support, perceived stress, and athlete burnout in competitive athletes, with particular attention to the statistical mediating role of perceived stress. Results Using cluster sampling, questionnaire data were collected from 252 competitive athletes across various sports, including track and field, swimming, and football. The results showed that perceived social support was negatively correlated with perceived stress ( r = -0.478, p < 0.01) and athlete burnout ( r = -0.282, p < 0.01), whereas perceived stress was positively correlated with athlete burnout ( r = 0.421, p < 0.01). Mediation analysis revealed a significant indirect association between perceived social support and athlete burnout through perceived stress ( B = -0.161, 95% CI [-0.240, -0.093]). The direct association was not statistically significant after accounting for perceived stress ( B = -0.095, p = 0.109). Conclusion Perceived social support is associated with lower levels of athlete burnout, both through its overall negative association with burnout and through a significant statistical indirect pathway involving perceived stress. These findings highlight the importance of strengthening athletes’ social support systems and addressing perceived stress in competitive sports settings. Given the cross-sectional design, the findings should be interpreted as associations rather than evidence of causal mediation.
Cognitive flexibility enables individuals to navigate unpredictable situations and rapid changes. Because the prefrontal cortex governs both cognitive flexibility and emotional input, lifetime traumatic experiences may influence its development. Despite this, research examining the impact of childhood trauma on cognitive flexibility in early adulthood remains limited. This study investigates the relationship using a sequential explanatory approach. A total of 275 undergraduate and diploma students (ages 18–25) from Gadjah Mada University completed the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) and the Cognitive Flexibility Scale (CFS). Simple linear regression and thematic analysis indicated that childhood trauma predicts cognitive flexibility in early adulthood. These findings highlight the importance of understanding the long-term impact of childhood trauma on cognitive adaptability, which may inform interventions to enhance resilience in early adulthood. Future research should consider developmental timing, sociocultural environment, education, socioeconomic status, and spirituality, as well as experimental performance measures.
Background Achieving early glycemic control in adolescents with diabetes is associated with improved short- and long-term health outcomes. The aim of this study was to examine the relationship between eating attitudes and glycemic control, as well as the factors associated with eating attitudes and glycemic control, in adolescents with diabetes. Methods This descriptive cross-sectional study included 143 adolescents with diabetes, aged 10–19 years, who attended a research hospital between February and April 2024. The data were collected using a Descriptive Information Form, Eating Attitudes Test (EAT) and an information form questioning the values of some metabolic variables. Results The mean age of the participants was 14 ± 2.3 years and 49.7% had diabetes between 1–5 years. The mean total score of the EAT scale was 16.62 ± 8.30. The mean score of the “Dieting” subscale of the EAT scale was 10.39 ± 5.58, the mean score of the “Bulimia food preoccupation” subscale was 2.33 ± 3.03 and the mean score of the “Oral Control” subscale was 3.79 ± 3.08. There was no significant difference between the mean EAT total score and glycemic control. Conclusions The mean EAT-26 total score was below the commonly used cutoff score, and no significant association was found between EAT-26 scores and HbA1c. Differences in EAT-26 total and subscale scores were observed according to selected demographic and clinical characteristics, including BMI, treatment modality, and treatment adherence. These findings describe self-reported eating attitudes in the study sample and support the inclusion of eating-related assessment within the holistic care of adolescents with Type 1 DM.
Executive function (EF) is foundational for school readiness, mental health, and social adaptation. Although cross-national studies document cultural variation in EF, less is known about whether EF differs across ethnic groups within the same national and educational context. In China, Yi, Bai, and Naxi children may differ in home language, childrearing practices, and educational beliefs, making them informative for examining universal and context-specific patterns of EF development. This study examined Executive Function (EF) development in a sample of 190 Chinese ethnic children (Yi, Bai, Naxi; 115 boys, 75 girls) aged 4–6 years. These findings revealed that, (1) Overall EF scores were highest for Bai children, followed by Naxi children, and than Yi children. (2) For inhibition control (IC), at ages 4 and 5, Bai and Naxi children performed significantly better than Yi children, whereas no significant differences were observed among the three ethnic groups at age 6. (3) For cognitive flexibility (CF), Bai and Naxi children are significantly better than Yi children. On the size, color, and shape sub-dimensions, pass rates were highest for Bai children, followed by Naxi and then Yi children; on the quantity sub-dimension, pass rates were highest for Naxi children, followed by Bai and then Yi children. (4) For working memory (WM), at ages 4 and 6, the ranking of scores across the three ethnic groups showed that Bai children obtained the highest scores, followed by Naxi children and than Yi children; at age 5, Bai children scored significantly higher than Naxi and Yi children. These findings contribute to theories of EF development by revealing both age-related convergence and cross-ethnic variation, and they inform culturally responsive early childhood education and intervention.
Sentiment analysis from video streams requires effective modeling of both temporal dynamics and multimodal cues. This paper presents a lightweight multimodal CNN-LSTM framework, designed for low-latency operation on live video streams, that classifies individuals' affective states as negative, neutral, or positive by jointly exploiting audio and visual information. The proposed system consists of four lightweight deep neural network models that fuse sequences of audio and visual features into a unified temporal stream, enabling the accumulation of sentiment evidence over time for robust prediction. To further enhance discriminative power, dynamic mouth state classification is incorporated, allowing the model to better capture subtle visual cues related to speech and sentiment. Experiments conducted on the Ryerson Audio-Visual Database of Emotional Speech (RAVDESS) demonstrate that the proposed approach achieves a test accuracy of 84.89% on the three-class sentiment recognition task, competitive with substantially larger audio-visual architectures, while using an order of magnitude fewer parameters and maintaining low-latency operation. In addition, we provide a comprehensive comparison with multiple multimodal large language models (LLMs), evaluated under diverse input configurations and prompting strategies. The results offer practical insights into the strengths and limitations of contemporary LLMs for audio-visual sentiment analysis and highlight the continued effectiveness of compact, task-specific neural architectures for streaming audio-visual input.
Background Most person-centered research on exercise motivation has identified static profiles, leaving unclear how motivational configurations change over time, what psychological experiences are associated with those changes, and whether transitions predict subsequent exercise. This study examined the short-term mobility of exercise-regulation profiles, psychological-need predictors of specific transitions, and their prospective associations with later leisure-time exercise. Methods A three-wave prospective study followed 1,780 students from six Chinese colleges at approximately 4-week intervals. Exercise regulation, exercise-specific psychological need satisfaction and frustration, and leisure-time exercise were assessed at each wave. Continuous-indicator latent transition analysis identified longitudinal motivational profiles and transition probabilities. Posterior-probability-weighted models examined origin-wave need satisfaction and frustration as predictors of eligible transitions and tested whether first-interval transitions were associated with final-wave exercise after prior exercise was considered. Results Six profiles were retained: amotivated–controlled, low-regulation, mixed intrinsic–controlled, identified-dominant, intrinsic-dominant, and high autonomous–introjected. Overall profile stability was substantial but incomplete, with 76.9 and 73.8% of posterior transition mass remaining on the stability diagonal across the two intervals. The largest off-diagonal transition was from low regulation to high autonomous–introjected motivation (18.0 and 20.1%). After Holm correction, greater need satisfaction was associated with lower odds of moving from intrinsic-dominant or high autonomous–introjected motivation to low regulation (odds ratios = 0.47–0.49), whereas greater need frustration was associated with lower odds of moving from low regulation to identified- or intrinsic-dominant profiles (odds ratios = 0.41–0.62). In models controlling baseline exercise, movement from amotivated–controlled or low regulation to high autonomous–introjected motivation was associated with greater subsequent exercise, whereas several transitions toward less internalized configurations were associated with lower exercise. After additional adjustment for exercise measured at the transition endpoint, only the low-regulation-to-high autonomous–introjected transition remained significant. Conclusion Exercise motivation was substantially stable yet meaningfully mobile over short periods. Psychological-need experiences were associated with specific, origin-dependent motivational transitions, and selected transitions prospectively differentiated later exercise behavior. The findings support a dynamic and state-dependent view of exercise motivation and suggest that the psychological conditions relevant to maintaining internalized motivation may differ from those involved in moving out of low regulation.
The research aimed to examine the effects of gamification environments on university students' achievement, flow experiences, and emotional states. This study utilized a mixed-methods design, incorporating a quasi-experimental approach for the quantitative phase and a phenomenological approach for the qualitative phase. The study group consisted of 80 students (Quizizz, n = 32; Quizlet, n = 48) enrolled in the Educational Psychology course at a state university. Data were collected through the Achievement Test, Flow Experience Scale, and Positive and Negative Affect Scale. Both groups showed significant pre-test to post-test gains in achievement, with no significant difference between the two groups. Flow experience was positively correlated with positive emotion in both groups, but with achievement only in the Quizlet group. In the Quizizz group, achievement was moderately and negatively correlated with negative emotion, whereas no such relationship was found in the Quizlet group. No significant relationship was found between achievement and positive emotion in either group. Qualitative findings revealed that students actively engaged in both environments, reported higher motivation, and found learning more enjoyable. However, they experienced the platforms differently. Quizizz users emphasized excitement through competition and scoring, whereas Quizlet users highlighted confidence gained from repetition and individual progress. Overall, these results indicate that gamification tools led to similar achievement gains, but through different flow and emotional processes.
This study is motivated by the declining use of sagata, a form of Lampung oral literature, due to the influence of global culture and reduced transmission of the local language to younger generations. It aims to describe the implementation of sagata instruction among fifth-grade students at MIN 10 Bandar Lampung, including planning, implementation, evaluation, and supporting/inhibiting factors. A qualitative descriptive approach was used. The subjects were three participants: one Lampung language teacher, one madrasah principal, and one fifth-grade student selected through purposive sampling. Data were collected through observation, interviews, and documentation, then analyzed through data condensation, data display, and conclusion drawing; data validity was established through triangulation. Findings show that instructional planning was carried out systematically, covering module development, objective formulation, material selection, method selection, media preparation, and evaluation planning. Supporting factors included madrasah support, teachers’ roles, and student enthusiasm, while inhibiting factors included limited sagata-specific teaching materials, varying student vocabulary mastery, and the declining everyday use of sagata. Overall, sagata instruction has been implemented in a structured manner, though further strengthening of materials, media, and practice opportunities is needed to sustain its preservation through formal education. ABSTRAK Penelitian ini dilatarbelakangi oleh menurunnya penggunaan sagata, salah satu bentuk sastra lisan masyarakat Lampung, akibat derasnya arus budaya global serta berkurangnya pewarisan bahasa daerah kepada generasi muda. Penelitian ini bertujuan mendeskripsikan implementasi pembelajaran sastra lisan sagata pada siswa kelas V MIN 10 Bandar Lampung, mencakup perencanaan, pelaksanaan, evaluasi, serta faktor pendukung dan penghambat pembelajaran. Penelitian menggunakan pendekatan kualitatif dengan jenis penelitian deskriptif. Subjek penelitian berjumlah tiga orang, yaitu satu guru Bahasa Lampung, satu kepala madrasah, dan satu siswa kelas V yang dipilih melalui teknik purposive sampling. Data dikumpulkan melalui observasi, wawancara, dan dokumentasi, kemudian dianalisis melalui kondensasi data, penyajian data, dan penarikan kesimpulan. Keabsahan data diuji melalui triangulasi. Hasil penelitian menunjukkan bahwa perencanaan pembelajaran sagata dilakukan secara sistematis melalui penyusunan modul ajar, perumusan tujuan, penentuan materi, pemilihan metode, penyiapan media, dan perencanaan evaluasi. Faktor pendukung meliputi dukungan madrasah, peran guru, serta antusiasme siswa, sementara faktor penghambat mencakup keterbatasan bahan ajar khusus sagata, perbedaan penguasaan kosakata bahasa Lampung, dan berkurangnya penggunaan sagata dalam kehidupan sehari-hari. Implementasi pembelajaran sagata telah terlaksana secara terstruktur, meskipun masih memerlukan penguatan bahan ajar, media, dan kesempatan praktik untuk mendukung keberlanjutan pelestariannya melalui pendidikan formal.
A questionnaire survey was conducted with 1,635 students from two secondary schools in Hunan Province to examine the statistical roles of interpersonal emotion regulation and family functioning in the relationship between anhedonia and depressive symptoms in adolescents. The results showed that (1) after controlling for grade and gender, anhedonia was significantly and positively associated with depressive symptoms; (2) a continuous-variable model based on the full sample indicated a significant partial mediating effect of interpersonal emotion regulation on the association between anhedonia and depressive symptoms; and (3) family functioning moderated the association between anhedonia and interpersonal emotion regulation, such that lower family functioning scores (i.e., healthier family functioning) were associated with stronger conditional indirect effects linking anhedonia to depressive symptoms through interpersonal emotion regulation. When BDI-II-C Items 4 (loss of pleasure) and 12 (loss of interest) were removed from the depressive symptom total score and the analyses were repeated, the main results remained stable. An exploratory sensitivity analysis using the BDI-II-C cutoff revealed a significant mediating pathway in the below-cutoff group, whereas the regression association between interpersonal emotion regulation and depressive symptoms was not significant in the at-or-above-cutoff group. Given that grouping by the cutoff of the same dependent variable narrows the within-group score range and may affect within-group regression estimation, these subgroup results are reported only as exploratory sensitivity analyses. These findings suggest that interpersonal emotion regulation and family functioning are important factors in understanding the statistical association between anhedonia and depressive symptoms in adolescents.
Synchronous video conferencing (VC) has become an established mode of higher education, but sustaining student engagement remains challenging, particularly in practice-oriented disciplines such as graphic design. This study examined the effects of three gamification mechanisms, including animated badges, experience points, and level upgrades, on behavioural, emotional, and cognitive engagement in synchronous VC learning. Guided by Self-Determination Theory (SDT), a quasi-experimental non-equivalent control group design was implemented with 124 first-year graphic design students from three public universities in China. Participants were distributed equally across a non-gamified control condition and three gamified conditions (n = 31 per group). Engagement was assessed before and after a four-week instructional intervention. Significant improvements were observed within the engagement components across all three gamified conditions, with no statistically significant change observed within the control condition. Participant-level total scores for each dimension of engagement were then used to estimate baseline-adjusted regression models. The models accounted for 97.4% of the variance in post-intervention behavioural engagement, 96.6% in emotional engagement, and 98.8% in cognitive engagement. Relative to the control condition and after controlling for baseline engagement, animated badges, experience points, and level upgrades were associated with increases of 40.35, 46.90, and 49.36 points in behavioural engagement; 48.82, 51.76, and 52.48 points in emotional engagement; and 95.86, 105.46, and 107.36 points in cognitive engagement, respectively. The results suggest that gamification mechanisms vary in the strength and direction of their relationship with engagement, with the strongest adjusted relationships being found between progression-based gamification and the cognitive dimension of engagement. The study extends the analysis beyond significance testing by introducing a quantitative, baseline-adjusted model to estimate post-intervention engagement given gamification condition and baseline engagement and offers a more precise basis for the design of gamified VC interfaces.
Introduction This study examined the moderating role of positive emotion in the relationship between trait-like stress reactivity and negative emotion, and whether this moderating effect varies by cognitive performance and cognitive decline across nine years. Methods Using data from 2,041 participants in the Midlife in the United States (MIDUS) study (mean age = 65.52 years), hierarchical regression models were conducted to predict negative emotion from trait-like stress reactivity, positive emotion, and their interaction, controlling for age, gender, years of education, depressed mood, and neuroticism. Simple slope analyses were conducted to test the direction of significant interactions. Analyses were repeated within subgroups of cognitive performance and cognitive decline across 9 years. Results The interaction between positive emotion and trait-like stress reactivity was significant, with higher positive emotion associated with a weaker relationship between stress reactivity and negative emotion. This moderating effect was observed across low, moderate, and high cognitive performance groups; a three-way interaction further indicated that the moderating effect becomes stronger as cognitive performance increases. For cognitive decline, the moderating effect was significant only among individuals with relatively greater cognitive decline, although the three-way interaction was not significant. Conclusion Positive emotion may buffer the relationship between trait-level stress reactivity and negative emotion across the cognitive performance range, although this moderating effect appears weaker at lower cognitive performance. Findings for cognitive decline were less conclusive, as a subgroup-specific association among participants with greater decline was not confirmed when cognitive decline was analyzed as a continuous moderator.
Contemporary international relations are deeply influenced by historical reflection, and how a state deals with its legacy directly affects its international image and identity. Germany’s postwar reckoning with the Second World War serves as a paradigmatic case, where the construction of cultural memory reveals an evolution of historical consciousness shaped largely by official initiatives. Cultural memory, understood as the transmission of historical memory through cultural symbols, in the German context refers specifically to the ongoing critical engagement with Nazi crimes and the Holocaust. This memory is not static but has undergone a tortuous development from initial rejection and silence to active assumption of responsibility, eventually becoming a core component of German national identity. Memorial days, as state-sponsored vehicles, function both as pivot points for historical reflection and as witnesses to the transformation of cultural memory. Focusing on the commemorative date of 8 May (the end of the war in Europe), this paper analyzes the dynamic nature of German cultural memory. The findings show that in the early postwar period, German society resisted the notion of “collective guilt,” and under Adenauer the government maintained a conservative stance. Brandt’s “Warsaw Genuflection” marked a turn toward active remorse. Under Kohl, the concept of a “spiritual‑moral turnaround” was advanced, and the Nazi past gradually became “normalized” in public discourse. Since the beginning of the 21st century, Holocaust memory has been integrated more deeply into national identity, with an increasingly ritualized and educational focus on 8 May. Germany’s experience demonstrates that confronting historical truth is essential for building a peaceful identity. Its path toward reconciliation through cultural memory offers a reference for the international community, promoting a shared commitment to learning from history and cherishing peace.
This study evaluated the implementation and operational viability of the LGU Malay Mental Health Ordinance using the seven-component Project EMBRACE framework. The study addressed a local evidence gap by examining not only whether ordinance activities were implemented but also whether the workforce, referral, infrastructure, monitoring, and partnership conditions required for sustained delivery were present. A convergent parallel mixed-methods design was used. Quantitative data were obtained from 50 program implementers through a validated researcher-developed questionnaire (Cronbach's alpha = 0.962), while qualitative data were collected through Focus Group Discussions with 10 adult mental health service clients from Mainland Malay and Boracay Island. Means and standard deviations summarized five-point viability ratings, and qualitative transcripts were thematically analyzed; the two strands were integrated by comparing convergent, complementary, and divergent findings. The ordinance obtained an overall viable assessment, but component results were uneven. Wellness of Daily Living (M = 3.75), Mental Disorder (M = 3.65), Substance Abuse and Other Forms of Addiction (M = 3.72), and Provision of Services for Mental, Neurologic, and Substance Disorders (M = 3.45) were rated Viable. Extreme Life Experience (M = 3.11), Neurologic Disorders (M = 3.37), and Enhancement of Mental Health Facilities and Partnerships (M = 3.29) were Moderately Viable. Service-user accounts generally supported these patterns and highlighted limited specialist access, psychosocial workforce gaps, dependence on external referrals, and infrastructure constraints. The findings indicate that Malay has established a functional community mental health foundation, but long-term viability requires prioritized investment in crisis-response personnel, neurologic referral capacity, facilities, formal partnerships, continuity-of-care mechanisms, and integrated monitoring.
Objective This study aimed to estimate the prevalence of musculoskeletal symptoms and work-related musculoskeletal disorders (WMSDs) among orthopedic nurses, identify demographic, occupational, and lifestyle characteristics associated with WMSDs, and explore whether routinely collected characteristics could discriminate nurses with WMSDs from those without. Method A single-center cross-sectional study was conducted among nurses at a tertiary orthopedic specialty hospital in China between March and November 2023. Conventional analyses included multivariable logistic regression, modified Poisson regression with robust standard errors, and negative binomial regression. Logistic regression as a benchmark, elastic-net logistic regression, random forest, XGBoost, and support vector machine were compared using repeated 5-fold cross-validation with fold-specific preprocessing. Prediction performance was assessed using AUC with bootstrap 95% CIs, PR-AUC, Brier score, calibration intercept and slope, and descriptive threshold metrics; TreeSHAP was used for model interpretation. Result Among 948 nurses with valid questionnaires, 654 reported musculoskeletal symptoms in the previous 12 months, irrespective of work attribution (68.99%). After excluding 44 participants with uncertain work-related attribution, 604/904 participants were classified as having work-related WMSDs (66.81%). Each 1-point increase in the strict ergonomic risk score was associated with WMSDs in logistic regression (adjusted OR = 2.631, 95% CI 2.039–3.432; p < 0.001) and modified Poisson regression (adjusted PR = 1.283, 95% CI 1.203–1.369; p < 0.001). The highest observed AUC was 0.752 (95% CI 0.721–0.791) for the domain random forest model; the domain XGBoost model had the highest PR-AUC (0.841). Conclusion Musculoskeletal symptoms and WMSDs were common among orthopedic nurses in this single-center sample. Occupational exposure and postural load were associated with WMSDs. The exploratory prediction models showed limited-to-moderate discrimination and warrant prospective multicenter external validation before practical application.
Objectives Cross-cultural equivalence translations of the widely used Implicit Theories of Intelligence Scale (ITIS) into Chinese are limited. Past research has focused on Western educational contexts, and Eastern cultural perspectives have been overlooked. This study aimed to translate and validate the Chinese version of the ITIS, and assess the growth mindset in undergraduate medical students. Methods This study was conducted among final-year undergraduate medical students in Fujian, China. Following forward and back-translation of the Implicit Theories of Intelligence Scale (ITIS), cognitive interviews were conducted with students to assess the clarity and comprehensibility of the translated items, followed by an online survey distributed through medical schools. Construct validity, convergent validity, and discriminant validity were evaluated using confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha and composite reliability (CR), while test–retest reliability was evaluated separately for the Fixed Mindset and Growth Mindset dimensions using the intraclass correlation coefficient (ICC). Results A total of 444 responses were obtained. Confirmatory factor analysis supported a two-factor structure with satisfactory model fit ( χ 2 = 52.293, df = 17, CMIN/DF = 3.076, CFI = 0.984, NFI = 0.977, RFI = 0.962, IFI = 0.984, TLI = 0.974, RMSEA = 0.068, SRMR = 0.059). Standardized factor loadings were satisfactory, while CR values were 0.908 for Fixed Mindset and 0.910 for Growth Mindset, and AVE values were 0.713 and 0.717, respectively, supporting convergent validity. Discriminant validity was supported by the Fornell–Larcker criterion, AVE values exceeding the corresponding maximum shared variance values, and HTMT ratios below 0.90. Test–retest reliability differed between the two dimensions: the Fixed Mindset dimension demonstrated moderate temporal stability (ICC = 0.662, 95% CI: 0.443–0.806), whereas the Growth Mindset dimension showed limited temporal stability (ICC = 0.159, 95% CI: −0.158–0.446). The mean scores for Fixed Mindset items ranged from 2.64 (SD = 1.09) to 2.86 (SD = 1.56), whereas those for Growth Mindset items ranged from 3.81 (SD = 1.16) to 3.96 (SD = 1.21), indicating relatively stronger endorsement of fixed-mindset beliefs in this sample. Conclusions The Chinese version of the ITIS is a valid and reliable instrument for assessing the intelligence mindset of medical students.
Introduction Adolescents’ subjective well-being has been widely studied across different family structures. However, little is known about the role of basic psychological needs in the subjective well-being of adolescents living in different family structures or in residential care. The present study addresses this gap. Methods The sample comprised 5,295 adolescents aged 10 -16 years ( M age =13.20, SD=1.50) living in intact families (65%), single-parent families (21%), stepparent families (12%), or residential care (2%). Participants completed self-report measures of basic psychological need satisfaction at home, subjective well-being (affective and cognitive components), and perceived family affluence. Results Structural equation modeling showed significant indirect associations between family structure and adolescents’ subjective well-being through basic psychological need satisfaction at home, including a sequential indirect association through perceived family affluence and basic psychological need satisfaction. Living in residential care was also indirectly associated with adolescents’ subjective well-being through basic psychological need satisfaction at home, whereas the direct association was not statistically significant. The results show that adolescents living in intact families reported the highest level of basic psychological need satisfaction at home, followed by those in single-parent and stepparent families, while adolescents in residential care reported the lowest level. Discussion The findings provide evidence that the association between family and care contexts and adolescents’ subjective well-being is statistically mediated by basic psychological need satisfaction at home. The results are discussed in light of the value of parental and caregiver support for adolescents’ basic psychological needs in different family types and care.
