A study in Nigeria among undergraduates has identified that poor sleep quality was strongly related to poor mental health31. Another meta-analysis in Brazil has reported medical students with low sleep quality to be at an increased risk of mental health problems32. Furthermore, research conducted at the Massachusetts General Hospital in the U.S. indicated that undergraduates with depressive symptoms and sleep disturbances may experience additionally intense and frequent anxiety and poorer physical functioning33. Moreover, structural equation modeling has revealed sleep quality to mediate the impact of traumatic life events on mental health problem and suicidality among undergraduates34. Thus, self-reported sleep quality and mental health may play serial mediating roles in the relationship between chronic diseases and SI.
In recent years, studies on the elderly have found that mental health is a mediator of chronic diseases and SI; further, the former and self-reported sleep quality are the two chain mediators on activities of daily living and SI24,40. However, thus far, no study has explored the association between chronic disease and among Chinese medical students in a comprehensive and detailed manner, to provide a scientific basis for suicide prevention among medical students. Therefore, this study examined the multiple mediating effects of self-reported sleep quality and mental health on chronic diseases and SI among medical students. We proposed three hypotheses (Fig. 1): first, chronic diseases significantly affect lifetime SI and past 12-month SI in medical students (H1); second, both mental health and sleep quality mediate the relationship between chronic diseases with lifetime SI and past 12-month SI (H2); and third, sleep quality and mental health play a serial mediating role between chronic diseases with lifetime SI and past 12-month SI, respectively (H3).
spss statistics 22 serial 44
The serial multiple mediations of sleep quality and mental health were found to be significant in the relationships of chronic disease with the lifetime and the past 12-month SI. The total, direct, and indirect effects are listed in Table 4.
This study found that the prevalence of the lifetime and the past 12-month SI among the medical students in the Shandong Province was 10.0% and 8.4%, respectively. These values were similar to those in previous surveys regarding the past 12-month SI among medical students in the United States and China: 9.4% and 8.2%, respectively4,41; however, they were considerably lower than their lifetime SI values: 29.9% and 17.9%, respectively42. Given the different levels of research background and the time points of definition, the prevalence of SI varies widely. Furthermore, our major findings were as follows: (1) self-reported sleep quality and mental health played a serial mediating role in the relationship of chronic diseases with the lifetime and the past 12-month SI; (2) self-reported sleep quality mediated the association between chronic diseases and poor mental health; however, (3) after adding self-reported sleep quality as a mediator, the direct effect between chronic disease and the past 12-month SI disappeared; (4) mental health mediated the relationship between chronic diseases and the lifetime SI; and finally, (5) the path through the sole mediation of self-reported sleep quality was non-significant.
Medical doctors are a high-risk group for suicide57; furthermore, this problem appears to arise with medical students5. Chronic diseases pressurize them, and being in contact with suffering, confronting death, and caring for vulnerable persons may be potential threats that trigger negative emotions and poor mental health, ultimately leading to SI58. Research on the present situation and the mechanism of the medical students' SI is helpful in drawing the attention of academic, social, school, educational, and government departments to their chronic diseases and mental health. Additionally, this study aimed to explore the serial multiple mediating effects of sleep quality and mental health on the association between chronic diseases and SI. It is the first to comprehensively examine the factors underlying the aforementioned relationship among the Chinese medical students, which was poorly understood thus far. It also provides new and different insights into the problem, which might help in the development of comprehensive plans to reduce the related risk factors, with strong theoretical and practical significance. First of all, the school infirmary should pay more attention to the chronic diseases of medical students, increase the subsidies for their treatment, and dynamically monitor the recovery and physical condition of medical students, so as to detect the rapid aggravation of diseases in time. Second, the monitoring of self-reported sleep quality of these students should be strengthened so that relevant health education can be carried out in schools to improve students' awareness of sleep problems and timely medical treatment can be provided when sleep problems occur. Last of all, and most importantly, the mental health of medical students should be paid attention to. Schools should establish psychological consultation rooms to provide free and regular psychological consultation services for at-risk medical students.
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Descriptive statistics were used to summarize the subject demographic data. One-way repeated measures ANOVA (5 levels) were performed to determine the effect of forearm occlusion duration on volume of ischemia (StO2AUC; a.u.), peak ischemia (StO2peak; a.u.), magnitude of reactive hyperemia-induced shear stress (SS60secAUC; a.u.), peak FMD response (%), and FMD normalized to shear stress (FMD:SSAUC ratio; a.u.). Tukey's HSD procedure was used when a significant F-ratio was found. All data are presented as mean standard error of the mean (SEM). For all statistical tests, the alpha level was set at 0.05. Statistical analyses were performed with SPSS v.15.0. (SPSS, Inc. Chicago, IL, USA).
The major strength of this study is the large sample size, which comprised of 350 COVID-19 patients. Our study had some limitations. First, it is a retrospective analysis. Second, the lack of correlation between CXR severity score and patient comorbidities (such as hypertension, diabetes, cardiovascular disease, and oncologic history). Third, not all the patients could be followed till the final outcome as the course of the disease was truncated in these patients. Fourth, CXR serial follow-up studies were not performed in a uniform pattern as it was dedicated by the clinician as regards the clinical condition. Fifth, for severe cases in the intensive care unit, the portable AP CXR was suboptimal with only few cases performed CT, so we could not judge the sensitivity of CXR.
This was a prospective observational study conducted at the Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, from January 2012 to December 2012. Institutional ethical committee approval was obtained prior to study. Inclusion criteria were low risk singleton pregnancy, starting gestational age of 34 weeks, reliable last menstrual period and dates correlated and confirmed by comparison with first trimester CRL (Crown Rump Length). Once initial criteria were met, those who were subsequently diagnosed to have abnormalities of liquor volume due to conditions such as hypertensive disorders, gestational diabetes, and placental insufficiency were excluded from the study, so as to obtain normative data. Only those patients who delivered at 40 weeks were included in the study as we wanted longitudinal data till term. The final study subjects were 50 low risk pregnant women who underwent serial scans at weekly interval starting from 34 weeks till term.
We have established not only gestational specific normative AFI reference standards for late third trimester (34 to 40 weeks) for our local population but also magnitude of change in AFI values at weekly interval by quantitative analysis using effect size statistics. Strength of present study is that it is based on longitudinal data of normal healthy pregnant women and percentile curves obtained can be used to define what constitutes normal range of AFI for low risk antenatal patients. Though our results are based on required number of patients by sample size determination, larger number of subjects if studied may yield robust reference curves for AFI and identify extreme values to define what constitutes oligo- or polyhydramnios. The same study can be extended to high risk pregnancies such as preeclampsia, chronic hypertension, multiple gestation, and intrauterine growth restriction, in order to determine the frequency of liquor testing for these cohorts.
Background: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging.
Objective: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers.
Conclusions: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. 2ff7e9595c
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