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The present study focused on the relationships between various aspects of self-regulated learning (SRL) and stress among undergraduate health science students in workplace settings. Although both constructs are associated with academic achievement it is still unclear how they influence each other. Employing a longitudinal diary design, the aim of the present study was to examine whether perceived stress in the previous week impacts SRL-aspects in the current week and, conversely, whether SRL-aspects in the previous week impacts stress in the current week. Subjects were 192 undergraduate health sciences students in their workplace placements. SRL-aspects and stress were assessed using scales and previously tested single-item measures. The 21 SRL-aspects used in this study included cognition (learning strategies), motivation, emotion, perception of the learning environment, and regulation of these areas on a metalevel (monitoring and control). Data collected over 15 weeks were analyzed using multilevel vector autoregressive models, with the data nested within weeks and one model dedicated to each SRL-aspect and its relationship with stress. Among the 21 path estimates assessing the impact of prior stress on individual SRL-aspects, 10 were statistically significant. For individual SRL-aspects impacting stress, 7 out of 21 paths were statistically significant ( p  < .05). Notably, no model showed statistical significance of effects in both directions. Except for two results, cross-lagged relationships were negative, indicating that better SRL-aspects from the previous week resulted in reduced stress in the current week and vice versa. The effects for the cross-lagged paths from SRL-aspects to stress were predominantly of medium size, whereas the influence of stress on individual SRL-aspects was predominantly small. The present study highlights a potentially causal and mostly negative relationship between stress and various aspects of SRL, but also that the individual relationships require differentiated consideration. The results can be used to develop targeted interventions in the practical part of the training of health science students to reduce stress and improve specific aspects of SRL. Furthermore, these findings underscore assumptions regarding connections between anxiety and increased stress, negative relationships between stress and motivation, and the importance of effective time management strategies for stress reduction.

School-based aggression prevention programs may not be equally effective for all students and classes, depending on student and class characteristics. This study investigated moderators of a cluster randomized controlled socio-ecological aggression prevention program’s effectiveness (change from pretest to posttest, sample: 2,042 preadolescents, mean age = 11.7 years, SD = 0.09, 47.6% girls) and sustainability (change from posttest to follow-up test, sample: 659 preadolescents, mean age = 12.7 years, SD = 0.08, 47.9% girls). The program worked better in multicultural classes, as greater ethnic diversity strengthened the program’s effectiveness and sustainability. Moderating effects of a positive social class climate and higher baseline levels of aggressive behavior and victimization were also found. These results advance socio-ecological theorizing and can help develop more contextualized interventions.

Purpose Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking. Methods Individuals without eating disorders (comparison group, CG, n  = 85), and patients with BED ( n  = 41), BN ( n  = 50), AN-BP ( n  = 26), and AN-R ( n  = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal. Results Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred. Conclusion The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN.

Purpose Emotional eating (EE) refers to eating in response to (negative) emotions. Evidence for the validity of EE is mixed: some meta-analyses find EE only in eating disordered patients, others only in restrained eaters, which suggest that only certain subgroups show EE. Furthermore, EE measures from lab-based assessments, ecological momentary assessment (EMA), and psychometric measures often diverge. This paper tested whether the covariance of these three different EE methods can be modeled through a single latent variable (factorial validity), and if so, how this variable would relate to restrained eating (construct validity), Body-Mass-Index (BMI), and subclinical eating disorder symptomatology (concurrent validity). Methods 102 non-eating disordered female participants with a wide BMI range completed EE measures from three methods: psychometric questionnaires, a laboratory experiment (craving ratings of food images in induced neutral vs. negative emotion) and EMA questionnaires (within-participant correlations of momentary negative emotions and momentary food cravings across 9 days). Two measures for each method were extracted and submitted to confirmatory factor analysis. Results A one-factor model provided a good fit. The resulting EE lat factor correlated positively with subclinical eating disorder symptoms and BMI but not with restrained eating. Conclusions The one-factor solution shows that the EE construct can validly be assessed with three different methods. Individual differences in EE are supported by the data and are related to eating and weight problem symptomatology but not to restrained eating. This supports learning accounts of EE and underscores the relevance of the EE construct to physical and mental health. Level of evidence II (Evidence obtained from well-designed controlled trials without randomization).

Background We conducted a single-center cohort study of rheumatoid arthritis (RA) patients from 2011 to 2020 to understand their real world treatment and outcomes, especially changes in physical function and quality of life (QOL) in elderly patients, including those aged ≥ 80 years. Methods For RA patients attending our outpatient clinic, we annually recorded tender and swollen joint counts, laboratory findings, therapeutic drugs, and scores from the Japanese Health Assessment Questionnaire and EuroQoL-5 Dimensions questionnaire. We examined changes in treatment and outcomes over time, by age group, in patients enrolled over a 10-year period, from 2011 to 2020. Results One thousand eight hundred thirty RA patients were enrolled and data were recorded once a year, and a total of 9299 patient records were evaluated. The average age of patients increased by 3.7 years during the study period; the patients aged rapidly. Intensive pharmacological treatment was more frequent in younger patients. Disease activity, physical function, and QOL showed improvement in all age groups over the study period. Physical function and QOL showed greater changes with aging, compared with disease activity. This may be due to the effects of accumulated RA damage, disability due to aging, and depression. Conclusions Intensive pharmacological treatment contributes to not only control of disease activity but also the improvement of physical activity and QOL, even in elderly patients. Relieving age-related physical impairment and depression may improve the QOL of very elderly RA patients.

Background Infection prevention and control (IPC) and antibiotic stewardship (ABS) represent promising approaches for reducing the prevalence of healthcare-associated infections (HAI) and antimicrobial resistance (AMR) in different healthcare settings. However, the combined use of IPC and ABS measures and ways to optimize their integrated implementation have been insufficiently considered and assessed. The REVERSE trial, funded by the European Union’s Horizon 2020 program, involves 24 acute care hospitals from four European countries, all with high rates of AMR and HAI. REVERSE aims to investigate whether the sequential implementation of an IPC and an ABS practice bundle is feasible and sustainable and whether externally guided tailoring as an enhanced implementation strategy leads to superior clinical and implementation outcomes compared to a basic implementation condition. Methods REVERSE will be designed as a stepped wedge cluster randomized, hybrid type 2 trial, including an embedded implementation trial. Four cohorts of six acute care hospitals will sequentially enter the trial over 38 months and work to implement first IPC, and, after 1 year, add the ABS practice bundle. Simultaneously, hospitals will be provided basic implementation training and instructed to tailor their implementation, with half of the hospitals being self-guided in their tailoring, whereas hospitals in the enhanced implementation condition will receive time-limited external facilitation in practicing tailoring. Qualitative data will be collected longitudinally to investigate contextual conditions for implementing IPC and ABS locally and how they contribute to tailoring results. IPC and ABS feasibility, fidelity, and sustainability will be assessed together with tailoring fidelity using repeated measures. Retrospective, in-depth, explanatory case studies will be conducted to interpret hospital outcomes. Discussion REVERSE is an extensive and complex effectiveness-implementation trial aimed at investigating tailoring effectiveness. It will contribute to the still scarce evidence base for this adaptive approach to integrating research-supported interventions into routine healthcare settings. By identifying pathways toward strengthening the integration of IPC and ABS practices at European acute care hospitals, REVERSE also has the potential to inform much-needed concerted efforts to combat the growing challenge of antimicrobial resistance in the region. Trial registration In November 2021, the REVERSE study was registered with the “International Standard Randomised Controlled Trial Number” (ISRCTN) register under nr.12956554.

Background This study investigated the characteristics of hypertrophic pachymeningitis (HP) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), using information from a multicenter study in Japan. Methods We analyzed the clinical information of 663 Asian patients with AAV (total AAV), including 558 patients with newly diagnosed AAV and 105 with relapsed AAV. Clinical findings were compared between patients with and without HP. To elucidate the relevant manifestations for HP development, multivariable logistic regression analyses were additionally performed. Results Of the patients with AAV (mean age, 70.2 ± 13.5 years), HP was noted in 30 (4.52%), including 20 (3.58%) with newly diagnosed AAV and 10 (9.52%) with relapsed AAV. Granulomatosis with polyangiitis (GPA) was classified in 50% of patients with HP. A higher prevalence of GPA was significantly observed in patients with HP than in those without HP in total AAV and newly diagnosed AAV ( p < 0.001). In newly diagnosed AAV, serum proteinase 3 (PR3)-ANCA positivity was significantly higher in patients with HP than in those without HP ( p = 0.030). Patients with HP significantly had ear, nose, and throat (ENT) (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.03–2.14, p = 0.033) and mucous membrane/eye manifestations (OR 5.99, 95% CI 2.59–13.86, p < 0.0001) in total AAV. Moreover, they significantly had conductive hearing loss (OR 11.6, 95% CI 4.51–29.57, p < 0.0001) and sudden visual loss (OR 20.9, 95% CI 5.24–85.03, p < 0.0001). Conclusion GPA was predominantly observed in patients with HP. Furthermore, in newly diagnosed AAV, patients with HP showed significantly higher PR3-ANCA positivity than those without HP. The ear and eye manifestations may be implicated in HP development.

Background Undergraduates’ workplace learning is an important part of health sciences education. Educational psychology research considers many different aspects of self-regulated learning at the workplace, including cognition, motivation, emotions, and context. Multivariate longitudinal and diary studies in this field require fewer items than alternatives or even a single item per construct and can reveal the sub-processes of workplace learning and contribute to a better understanding of students’ learning. Short instruments are necessary for application in workplace settings, especially stressful ones, to mitigate survey fatigue. The present study aimed to assess the psychometric properties of single items measuring various aspects of workplace learning. Methods Twenty-nine single items selected from the Workplace Learning Inventory in Health Sciences Education were analyzed for reliability, information reproduction, and relationships within the nomological network. The authors additionally analyzed four generally formulated single items’ relationships with the full Workplace Learning Inventory scales and external criteria within the nomological network. Participants were 214 ninth- or tenth-semester veterinary medicine students in Austria and Germany who were learning at varied workplaces during the winter semester of 2021/2022. Results Of the 29 single items selected from existing scales, 27 showed sufficient reliability, but mixed results were obtained regarding validity. Although the items’ relationships within the nomological network were similar to those of the full scales, information reproduction was insufficient for most items. The four general single items showed acceptable validity, but the reliability of these measures of states could not be assessed. Conclusions This paper reported findings on the psychometric properties of single items for undergraduates’ workplace learning in health science education. The findings are crucial for deciding whether to use scales versus single-item measures in future studies. By applying the findings, researchers can be more economical in their workplace learning data collection and can include more constructs.

The well-known associations of peer status (acceptance and rejection) with prosocial and aggressive behaviors have mostly relied on peer status measures assessed at a single time point. This study adopted a person-oriented approach to examine longitudinal links between stable peer status profiles assessed at two time points and prosocial and aggressive behavior using latent profile analysis and latent transition analysis based on three waves of data collected among 324 Chilean adolescents (56.3% male, M age = 12.31, SD = 0.58). First, latent profile analysis identified four status profiles: moderately accepted, moderately rejected, controversial, and highly rejected. Second, we examined the 6-month stability of these profiles during the same academic year (seventh grade, Waves 1 and 2) with latent transition analysis. Results showed that the moderately accepted group was highly stable, with an 87% chance of remaining accepted at T2, followed by the highly rejected (78%), controversial (69%), and moderately rejected (49%), who had a 35% probability of moving into the accepted group. Third, we tested how stable status profiles at two time points predicted changes in prosocial and aggressive behavior during the transition from seventh to eighth grade (Wave 3). When the new academic year began, prosocial behavior increased for the moderately rejected group but not for the highly rejected group. Aggressive behavior decreased in the highly rejected and controversial groups. Implications for the role of stable peer status in the social behavior of early adolescents in educational settings are discussed, with particular attention to the transition to a new academic year.