BACKGROUND: Occupational stress is a serious problem in veterinary medicine; however, validated instruments to measure this problem are lacking. The aim of the current study was to address this literature gap by designing and validating a questionnaire and establishing the cut-off points for identifying veterinarians with high and low levels of stress.
METHODS: The study involved two sub-studies with two Spanish samples. The first study (N = 30 veterinarians; 66.7% women; 63.33% from small animal clinics) investigated the factors related to the work environment that caused the most stress; the results were analyzed using thematic content analysis. The second study (N = 1082; 70.8% women; 71.4% from small animal clinics) involved designing and validating a questionnaire to measure sources of stress in veterinary medicine, as well as establishing the cut-off points for interpreting the results using receiver operating characteristics (ROC) curve analysis.
RESULTS: The first study showed the main sources of stress and allowed items to be defined for the questionnaire. The second study validated the Sources of Stress in Veterinarian Medicine (SOS-VetMed) questionnaire and confirmed five sources of stress with adequate reliability and validity indices: \"work overload,\" \"work-family conflict,\" \"emotional burden of work,\" \"organizational factors,\" and \"emergency problems.\" Exploratory and confirmatory factor analyses verified a structure of five factors (Cronbach\'s alpha values ranging between 0.92 and 0.69). The five subscales of the SOS-VetMed questionnaire were positively correlated with two indicators of distress: \"psychological complaints\" and \"psychosomatic complaints.\" The cut-off points indicated that 45.83% and 19.95% of the veterinarians surveyed had high and low levels of stress, respectively.
CONCLUSIONS: The results confirmed that the SOS-VetMed questionnaire could be used to determine the stress levels of veterinarians and to design intervention programs to improve their workplace health.

Regression to the mean occurs when an unusual observation is followed by a more typical outcome closer to the population mean. In pre- and post-intervention studies, treatment is administered to subjects with initial measurements located in the tail of a distribution, and a paired sample t-test can be utilized to assess the effectiveness of the intervention. The observed change in the pre-post means is the sum of regression to the mean and treatment effects, and ignoring regression to the mean could lead to erroneous conclusions about the effectiveness of the treatment effect. In this study, formulae for regression to the mean are derived, and maximum likelihood estimation is employed to numerically estimate the regression to the mean effect when the test statistic follows the bivariate t-distribution based on a baseline criterion or a cut-off point. The pre-post degrees of freedom could be equal but also unequal such as when there is missing data. Additionally, we illustrate how regression to the mean is influenced by cut-off points, mixing angles which are related to correlation, and degrees of freedom. A simulation study is conducted to assess the statistical properties of unbiasedness, consistency, and asymptotic normality of the regression to the mean estimator. Moreover, the proposed methods are compared with an existing one assuming bivariate normality. The p-values are compared when regression to the mean is either ignored or accounted for to gauge the statistical significance of the paired t-test. The proposed method is applied to real data concerning schizophrenia patients, and the observed conditional mean difference called the total effect is decomposed into the regression to the mean and treatment effects.

UNASSIGNED: The aim of this study was to classify distinct subgroups of adolescents based on the severity levels of their mobile phone addiction and to investigate how these groups differed in terms of their psychosocial characteristics. We surveyed a total of 2,230 adolescents using three different questionnaires to assess the severity of their mobile phone addiction, stress, anxiety, depression, psychological resilience, and personality. Latent class analysis was employed to identify the subgroups, and we utilized Receiver Operating Characteristic (ROC) curves and multinomial logistic regression for statistical analysis. All data analyses were conducted using SPSS 26.0 and Mplus 8.5.
UNASSIGNED: We classified the subjects into subgroups based on their mobile phone addiction severity, and the results revealed a clear pattern with a three-class model based on the likelihood level of mobile phone addiction (p < 0.05). We examined common trends in psychosocial traits such as age, grade at school, parental education level, anxiety levels, and resilience. ROC analysis of sensitivity versus 1-specificity for various mobile phone addiction index (MPAI) scores yielded an area under the curve (AUC) of 0.893 (95% CI, 0.879 to 0.905, p < 0.001). We also determined diagnostic value indices for potential cutoff points ranging from 8 to 40. The optimal cutoff value for MPAI was found to be >14, which corresponded to the maximum Youden index (Youden index = 0.751).
UNASSIGNED: The latent classification process in this research confirmed the existence of three distinct mobile phone user groups. We also examined the psychosocial characteristics that varied in relation to the severity levels of addiction.
UNASSIGNED: This study provides valuable insights into the categorization of adolescents based on the severity of mobile phone addiction and sheds light on the psychosocial characteristics associated with different addiction levels. These findings are expected to enhance our understanding of mobile phone addiction traits and stimulate further research in this area.

BACKGROUND: The skeletal muscle changes as aging progresses, causing sarcopenia in the older adult population, which affects the respiratory muscles\' mass, strength, and function. The optimal cut-off point of peak expiratory flow rate (PEFR) for respiratory sarcopenia (RS) diagnosis in accordance with sarcopenia identification is needed.
OBJECTIVE: To establish an optimal cut-off point of PEFR for RS diagnosis in community-dwelling Asian older women.
METHODS: Sarcopenia diagnostic indicators were evaluated according to the Asian Working Group for Sarcopenia 2019 (AWGS) criteria. The respiratory parameters composed of respiratory muscle strength and respiratory function were evaluated by assessing maximal inspiratory pressure (MIP), percent predicted forced vital capacity (Pred FVC), and PEFR.
RESULTS: A total of 325 community-dwelling older women were included in this study. PEFR was negatively associated with RS (OR: 0.440; 95% CI: 0.344-0.564). The area under the curve (AUC) of PEFR was 0.772 (p < 0.001). The optimal cut-off point of PEFR for RS diagnosis was 3.4 l/s (sensitivity, 63.8%; specificity, 77.3%). Significant differences were found between the robust, possible sarcopenia, sarcopenia, and RS groups in terms of both sarcopenia diagnostic indicators and respiratory parameters (p < 0.05).
CONCLUSIONS: The cut-off point of PEFR can be used as a reasonable standard for RS diagnosis. This study finding can serve as a cornerstone for developing concrete criteria of RS in older women, supporting clinical judgment, which is crucial for providing appropriate treatment through accurate diagnosis.

UNASSIGNED: Our aim is to investigate the cut-off point of distress and the influencing factors associated with distress in patients with newly diagnosed breast cancer.
UNASSIGNED: A cross-sectional survey of distress was conducted in 167 patients with newly diagnosed breast cancer admitted to the Department of General Surgery of a tertiary care hospital from July 2020 to March 2022. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) questionnaire within 3 days of admission. The HADS ≥15 was used as the gold standard, and the cut-off point of the DT measure was analyzed using the Receiver Operating Characteristic (ROC) curve. The cut-off point obtained by ROC curve analysis was used to analyze the influencing factors of distress in breast cancer patients by univariate and multivariate regression analysis.
UNASSIGNED: A total of 167 patients completed the survey, with an average HADS score of 8.43 ± 5.84 and a total HADS score of ≥15 in 37 (22.16%) patients, the mean DT score was 2.96 ± 1.85. ROC curve analysis showed an area under the curve of 0.885, with a maximum Jorden index (0.723) at a DT score of 4, the sensitivity was 100.0% and specificity was 72.3%. There were 73 (43.71%) patients with DT score ≥ 4. Regression analysis showed that insurance/financial problems, dealing with partner problems, tension, bathing/dressing problems, pain, and sleep problems were independent risk factors for l distress in newly diagnosed breast cancer patients.
UNASSIGNED: A DT score 4 is the cut-off point for distress in patients with newly diagnosed breast cancer. In clinical practice, target intervention should be carried out according to the risk factors of distress of patients.

OBJECTIVE: In China, individuals with substance use disorders (SUD) face severe stigma, but reliable stigma assessment tool is lacking. Therefore, this study aimed to validate the Chinese version of the Substance Use Stigma Mechanism Scale (SU-SMS-C) and set its cut-off point.
METHODS: We recruited 1005 individuals with SUDs from Chinese rehabilitation centers. These participants completed a battery of questionnaires that included the SU-SMS-C, The Multidimensional Scale of Perceived Social Support (MSPSS), Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and Perceived Devaluation and Discrimination (PDD). Confirmatory factor analysis was used to assess the construct validity of the scale. Additionally, the Naive Bayes classifier was used to establish the cut-off point for the SU-SMS-C. We additionally explored the correlation between patient demographic characteristics and stigma.
RESULTS: A confirmatory factor analysis was utilized, revealing a second-order five-factor model. Based on the Naive Bayes classifier, the area under the receiver operating characteristic (AUCROC) of 0.746, the cut-off point for the SU-SMS-C was established at 44.5. The prevalence of stigma observed in the study population was 49.05%. Significant disparities were observed in the distribution of stigma across genders, with males experiencing more pronounced stigma than females. Moreover, patients consuming different primary substances reported diverse levels of stigma. Notably, those primarily using heroin endured a higher degree of stigma than users of other substances.
CONCLUSIONS: The study is the first to identify a cut-off point for the SU-SMS-C by Naive Bayes classifier, bridging a major gap in stigma measurement research. SU-SMS-C may help treat and manage SUDs by reducing stigma.

BACKGROUND: Considering the lack of a standardized definition for weight recurrence (WR), the prevalence and predictors of WR remain inconsistent.
METHODS: The prospective study was conducted on 1939 individuals who underwent bariatric surgery;66.8% underwent sleeve gastrectomy (SG), 33.2%, underwent gastric bypass (GB)[of them 87% one-anastomosis gastric bypass (OAGB), and 13% Rue and Y gastric bypass (RYGB)]. During a follow-up of 72 months, the prevalence of WR ranged from 13.5% to 35.5% according to five different definitions. The generalized estimated equation method was used to assess weight changes, excess weight loss (EWL%), and body composition (fat mass (FM), fat-free mass (FFM)and FFM loss/weight loss% (FFML/WL%)) by a bioelectrical impedance analyzer. Stepwise logistic regression models were applied to determine the independent predictors of WR.
RESULTS: Among 1939 participants followed up for 72 months, WR definitions were applied to 650 patients (75.4% females) with an average BMI of 44.3 ± 5.4 kg/m2,491 (75.5%) and 159 (24.5%) of whom underwent SG and GB, respectively. WR group had relatively higher weights and FM and lower EWL%. A WR turning point was observed at 24 months post-surgery (Ptime before & after 24 months<0.001). The most significant risk factors for WR included SG (in all WR definitions), a younger age (in four out of five definitions), and a higher baseline BMI (in three out of five definitions).
CONCLUSIONS: The prevalence and predictors of WR varied greatly depending on the definition applied. The prominent risk factors of WR included SG, younger age, and a higher baseline BMI.

Background: Generalized anxiety disorder (GAD) often remains undiagnosed in patients with migraine, while comorbidity of GAD with migraine is associated with increased dysfunction and risk of chronic migraine. Generalized Anxiety Disorder Scale 7-item (GAD-7) and Generalized Anxiety Disorder Scale 2-item (GAD-2) are the commonly employed screening measures for generalized anxiety symptoms in different patient groups. The present study aimed to evaluate psychometric properties of the Persian version of GAD-7 and GAD-2 in migraine. Methods: In this cross-sectional study, patients were diagnosed with migraine headaches according to the International Classification of Headache Disorders, 3rd edition (ICHD-3); then they participated in the psychiatric diagnostic interview, and filled out GAD-7, GAD-2, Beck Anxiety Inventory (BAI), Headache Impact Test-6 (HIT-6), and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1). The psychometric properties of GAD-7 and GAD-2 were examined using SPSS and LISREL. Results: Final samples were 186 patients with migraine that 83 patients received a diagnosis of GAD. Confirmatory factor analysis (CFA) indicated that the one-factor model of GAD-7 fit the data well. Internal consistency, test-retest, and Guttman split-half reliability of GAD-7 and GAD-2 were good. Significant correlation results, average variance extracted (AVE), and composite reliability (CR) supported the construct validity of the GAD-7. A score of ≥ 10 in GAD-7 and ≥ 3 in GAD-2 achieved satisfactory sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (GAD-7: 92%, 90%, 88%, and 93%, respectively; GAD-2: 79%, 88%, 71%, and 91%, respectively). Conclusion: Our findings supported GAD-7 and GAD-2 for assessing GAD in patients with migraine. It seems that GAD-7 and GAD-2 accurately diagnosed GAD in this group of patients.

BACKGROUND: The rescue in vitro mature(Rescue IVM) technique allows the use of immature oocytes collected in conventional COH to obtain more mature oocytes for fertilization through in vitro maturation. Some studies have shown that Rescue IVM could improve clinical outcomes in patients undergoing IVF/ICSI, but the effectiveness and the indications for the clinical application of this technique remain controversial. It remains to be studied whether Rescue IVM should be universally applied in all conventional IVF/ICSI cycles.
METHODS: This is a large retrospective cohort study that included a total of 22,135 female patients undergoing their first IVF treatment cycles. The effect of the number of mature oocytes(metaphaseII[MII]) on the cumulative live birth rate was investigated in a population with routine IVF/ICSI first. The receiver operating characteristic curve(ROC) analysis was used to explore the cut-off point of the number of MII affecting CLBR. Secondly, Patients undergoing ICSI with Rescue IVM were included in the analysis with those who underwent ICSI only during the same period, grouped according to the MII cut-off values. Multi-factor binary logistic regression and inverse probability weighting (IPW) were used to investigate whether Rescue IVM influenced the final cumulative live birth rate(CLBR).
RESULTS: The CLBR increased with the number of MIIoocytes (P < 0.001). The ROC analysis showed the cut-off point for the number of MIIoocytes to have a significant effect on CLBR was 9 (sensitivity 0.715, specificity 0.656). Furthermore, 912 patients who underwent ICSI with Rescue IVM were included and compared to those who underwent ICSI only during the same period, and found Rescue IVM significantly increased the number of available MIIoocytes. For patients with MII numbers < 9, Rescue IVM significantly improves their clinical pregnancy rate(55.6% vs. 46.7%, P = 0.001) and CLBR(65.4% vs. 48.1%, P < 0.001), but not for those patients with MII numbers ≥ 9.
CONCLUSIONS: This study further clarifies the candidates for the application of Rescue IVM technique: patients with an MII oocytes < 9 in a conventional IVF/ICSI cycle. In contrast, it is not necessary for patients who already have sufficient mature oocytes(≥ 9), to avoid over-medication.

UNASSIGNED: The Trunk Assessment Scale for Spinal Cord Injury (TASS) and the Trunk Control Test for individuals with a Spinal Cord Injury (TCT-SCI) are highly reliable assessment tools for evaluating the trunk function of individuals with SCIs. However, the potential differences in the validity of these two scales are unclear.
UNASSIGNED: To evaluate the criterion validity of the TASS and the construct validity of the TASS and TCT-SCI.
UNASSIGNED: We evaluated 30 individuals with SCIs (age 63.8 ± 10.7 yrs, 17 with tetraplegia). To evaluate criterion validity, we calculated Spearman\'s rho between the TASS and the gold standard (the TCT-SCI). To determine construct validity, we used the following hypothesis testing approaches: (i) calculating Spearman\'s rho between each scale and the upper and lower extremity motor scores (UEMS, LEMS), the Walking Index for SCI-II (WISCI-II), and the motor score of the Functional Independence Measure (mFIM); and (ii) determining the cut-off point for identifying ambulators with SCIs (≥ 3 points on item 12 of Spinal Cord Independent Measure III) by a receiver operating characteristics analysis.
UNASSIGNED: A moderate correlation was confirmed between the TASS and the TCT-SCI (r = 0.68). Construct validity was supported by six of the eight prior hypotheses. The cut-off points for identifying ambulators with SCIs were 26 points (TASS) and 18 points (TCT-SCI).
UNASSIGNED: Our results indicate that the contents of the TASS and the TCT-SCI might reflect the epidemiological characteristics of the populations in which they were developed.