The emotion of gratitude as a mediator between subjective happiness, positive and negative affect and satisfaction with life in Spanish adults / La emoción de gratitud como mediadora entre la felicidad subjetiva, el afecto positivo y negativo y la satisfacción con la vida en adultos españoles

El presente estudio investigó si la satisfacción con la vida se predice a partir de la felicidad subjetiva, afectos positivos y negativos, alteración psicológica y emociones de gratitud y si la emoción de gratitud está mediando la relación con la felicidad subjetiva, los afectos y la satisfacción con la vida. Se hicieron correlación de Pearson, pruebas de regresión lineal múltiple y modelos de mediación en una muestra de 1537 adultos españoles, 73.6% mujeres y 26.4% hombres, edad 18-88 años (M = 42.56 años; DT = 16.29). Se halló que las emociones de gratitud median la relación entre felicidad subjetiva y satisfacción con la vida y entre los afectos positivos y la satisfacción con la vida. Los afectos positivos son los que más se relacionan con la satisfacción con la vida, seguidos por la felicidad subjetiva y las emociones de gratitud. Los hombres están más satisfechos con la vida cuando sienten menos afecto negativo. Además, las emociones de gratitud median la relación entre felicidad subjetiva y satisfacción con la vida y entre los afectos positivos y la satisfacción con la vida. La diferencia principal radica en que las emociones de gratitud son más fuertes en las mujeres que en los hombres.(AU)

This study aims to examine the predictability of satisfaction with life on the basis of subjective happiness, positive and negative affect, psy-chological disturbance and emotion of gratitude. It also seeks to assess whether the emotion of gratitude is a mediating variable withsubjective happiness, affect, and satisfaction with life. Statistical analyses of Pearson'scorrelation, multiple linear regression tests, and mediation models were conducted on asample of 1537 Spanish adults, 73.6% were females, 26.4% males, age between 18-88 yearsold (M = 42.56; SD = 16.29). The emo-tions of gratitude were found to mediate therelationship between subjec-tive happiness and satisfaction with life and between positiveaffect and satisfaction with life. Of the variables studied, positive affect is the most related tosatisfaction with life, followed by subjective happiness and emo-tions of gratitude. Maleparticipants are more satisfied with life when they feel the less negative affect. Regardingmediation models, emotions of grat-itude mediate the relationship between subjectivehappiness and satisfac-tion with life and between positive affect and satisfaction with life. Themaindifferenceis thatemotions of gratitudearestronger infemalesthan in males.(AU)

Elite athletes' subjective wellbeing trajectories throughout the retirement transition: an analysis using Ruthven's (2022) transition model.

AIMS: Utilizing Ruthven's (2022) transition model, we explored how identity, voluntariness, and reason for retirement are related to subjective wellbeing throughout an athlete's retirement. METHODS: 541 participants completed an anonymous, online survey and estimated their wellbeing starting before retirement and up to the present. A set of linear mixed models regressed the seven wellbeing outcomes on the three measures, with education, gender, and time since retirement as covariates. RESULTS: Identity: Athletic Identity wellbeing was significantly and consistently lower than Diversified Identity. Voluntariness: Surprise retirement was significantly more difficult and contributed to a sharper decline on the day of transition. Reason for retirement: Pursue Something Else and Right Time experienced no significant wellbeing changes, while Injury had a significant decline on their transition day. Motivation Loss experienced significantly lower wellbeing prior to retirement, and a significant, gradual rise on the day of and throughout their transition. CONCLUSIONS: There are wellbeing benefits for a diverse identity, voluntary retirement, and retiring due to pursuing something else, or feeling ready to retire. At risk groups include retiring due to injury, low motivation, and loss of eligibility/graduation. Findings support the benefit of utilizing a theoretical model to explain elite athlete outcomes.

How grit mediates depressive symptoms with life and job satisfaction in full-time employed adults with congenital heart disease.

BACKGROUND: Technological advancements have extended the lifespan of individuals with congenital heart disease (CHD), but physical and mental health issues can affect their life and job satisfaction. AIMS: This study examined whether grit can protect full-time employed adults with CHD from depression by exploring its mediating role between depressive symptoms and life or job satisfaction. METHODS: A cross-sectional design involved 181 adults with CHD assessed using the Patient Health Questionnaire, Grit-10, Satisfaction with Life Scale, and Basic Psychological Need Satisfaction at Work Scale. Data analysis was conducted with SPSS and Smart PLS software for partial least squares structural equation modeling, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: Indicated that depressive symptoms were negatively correlated with grit, life satisfaction, and job satisfaction, while grit was positively correlated with both satisfaction measures. Grit partially mediated the relationship between depressive symptoms and life/job satisfaction, accounting for 30.70 % and 29.11 % of the variance, respectively. CONCLUSIONS: Grit significantly mitigates the negative impact of depressive symptoms on life and job satisfaction in full-time employed adults with CHD. Nurses should identify signs of depression in adults with CHD and evaluate their grit levels. Interventions to increase grit and reduce depressive symptoms could enhance life and job satisfaction.

Creating arts and crafting positively predicts subjective wellbeing.

Introduction: This study explored whether engagement with Creating Arts and Crafting (CAC) predicted subjective wellbeing and loneliness, above and beyond known sociodemographic predictors. Methods: Secondary data from 7,182 adults living in England from the Taking Part Survey (a 2019-2020 UK household survey of culture and sport participation) were analyzed. Hierarchical Linear regressions were used to explore the predictive effect of engagement with CAC on aspects of subjective wellbeing (anxiety, happiness, life satisfaction and a sense that life is worthwhile) and loneliness. Covariates included gender, Index of Multiple Deprivation (IMD), age group, health and employment status. Results: Engaging in CAC significantly predicted increased life satisfaction, a sense that life is worthwhile and happiness, above and beyond known sociodemographic predictors. Conclusion: Our study provides support for the wellbeing benefits of engagement with creating arts and crafting, and we suggest that this will be a useful tool at a public health level, noting that relative accessibility and affordability creating arts and crafting.

Analysis of the impact of digital literacy on life satisfaction (2019-2022) for older adults in South Korea: a national community-based panel study.

This study analyzed the effects of digital literacy on life satisfaction in older adults aged 65 years and above in modern day Korea. It utilized raw data from the 2019-2022 Report on the Digital Divide, an annual survey conducted by the Korean Ministry of Science and Information and Communications Technology. A total of 4,216 participants were assessed from 2019-2022. Correlation between digital literacy and life satisfaction was analyzed using Pearson correlation analysis and polynomial linear regression analysis. Life satisfaction was significantly positively correlated with digital access, digital competency, and digital utilization in all the years. In 2019, participants' life satisfaction score rose significantly by 0.15 with every one-point increase in digital competency. It further rose by 0.035 in 2020, 0.030 in 2021, and 0.116 in 2022. Digital literacy was consistently positively correlated with life satisfaction in each year from 2019-2022. Of the three main elements, digital competency had the strongest impact and digital information, income, and education level also significantly impacted life satisfaction. While digital competency improved steadily from 2019 to 2022, it remains below 50% for Korea's older adult population. Further efforts are required to improve digital competency and subsequent life satisfaction among Korea's older adult population.

Development and preliminary validation of the South Wales Social Well-being Scale (SWSWBS).

BACKGROUND: Physical, mental and social components of well-being are known to be important to health. However, research on well-being often focuses on physical and mental well-being with little attention paid to social well-being. This research aims to develop and preliminarily validate the South Wales Social Well-being Scale (SWSWBS) to measure social well-being. METHODS: A non-experimental and cross-sectional design was applied with two phases: scale development and preliminary validation. Initially, 24 items were drawn from a Group Concept Mapping study exploring the concept of social well-being. These items were reviewed and reduced to 14 for preliminary validation among 103 university students and staff in health and social care disciplines. Construct validity (exploratory factor analysis and convergent validity) were tested. Reliability was demonstrated by internal consistency. Floor and ceiling effects were also evaluated. RESULTS: A 3-factor structure was identified and explored, which highlight the most important features of the social world a person inhabits: "Safe and inclusive interaction with others" (6 items), "Learning, helping, and feeling useful" (4 items), and "Security, worthwhile activities, family and friends" (4 items). The SWSWBS was correlated to the Warwick Edinburgh Mental Well-being Scale and the Four measures of Personal Well-being Scale to some extent. The Cronbach alpha coefficient was 0.85 for the sum score and 0.83-0.86 for individual items. The item-total correlation coefficients ranged between 0.08 and 0.65. The split half reliability coefficient was 0.78. There is absence of a floor effect, but most items had a ceiling effect. CONCLUSIONS: Preliminary validation of the SWSWBS shows the scale has satisfactory psychometric properties with good validity, reliability, and reasonable variability. This study needs to be replicated with larger and representative populations to explore how the scale can be used alongside the Warwick Edinburgh Mental Well-being Scale to capture a holistic/multi-dimensional understanding of well-being.

Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study.

BACKGROUND: In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. OBJECTIVE: This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. METHODS: This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults' perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. RESULTS: The qualitative study identified the core category of "medical service relief and transformation paths for older adults in the context of digital reform." Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use (ß=.594, P<.001), perceived usefulness (ß=.544, P<.001), and promoted digital medical behavioral intentions (ß=.256, P<.001), while also reducing perceived risk (ß=-.295, P<.001). Additionally, perceived ease of use (ß=.168, P<.001) and perceived usefulness (ß=.508, P<.001) positively impacted behavioral intention, whereas perceived risk (ß=-.05, P=.037) exerted a negative influence. Furthermore, behavioral intention (ß=.641, P<.001) significantly and positively affected older adults' satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables → perceived ease of use → behavioral intention (effect size of 13.9%); (2) external variables → perceived usefulness → behavioral intention (effect size of 38.4%); (3) external variables → perceived ease of use → perceived usefulness → behavioral intention (effect size of 10.1%); and (4) a direct effect (35.5%) from external variables to behavioral intention. CONCLUSIONS: Based on the study's findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal.

Why am I obsessed with viewing mukbang ASMR? The roles of mediated voyeurism and intertemporal choice.

This study investigates the determinants of the obsessive view of mukbang autonomous sensory meridian response (Mukbang ASMR) and examines the moderation role of intertemporal choice and the mediating effect of mediated voyeurism among university students in Malaysia. A quantitative survey was conducted with 408 university students in Malaysia who viewed mukbang channel(s) often on social media. PLS-SEM is adopted to examine the associated paths and effects. The results demonstrate the significant impact of alienation and novelty, vicarious satisfaction, companionship and loneliness on mukbang ASMR obsession. Mediated voyeurism intervenes the effects of alienation and novelty on mukbang ASMR and intertemporal choice positively moderates the relationship between companionship and loneliness and mukbang ASMR. This study constructs a model to estimate Mukbang ASMR obsession by identifying specific motives and relationships among key factors, highlighting loneliness as the most effective determinant of mukbang ASMR among Malaysian younger generation. Research results provide an extended understanding of the mukbang ASMR, offering valuable insights in the areas of lifestyle, social well-being, and social media consumption.

The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China.

Background: Unhealthy lifestyles during adolescence are significant factors leading to chronic diseases in the future. Enhancing health-promoting lifestyles among young adults in China is crucial for preventing and reducing the risk factors of chronic diseases. Objective: This study aims to explore the relationships between life satisfaction, family health, physical activity, and health-promoting lifestyles among young adults in China. It also seeks to confirm the chain mediation role of family health and physical activity in the influence of life satisfaction on health-promoting lifestyles in this population. Methods: This study, conducted from August 2023 to November 2023, employed a random sampling method to recruit young adult participants aged 18-40 in the southwestern region of China. Variables were measured using the Satisfaction with Life Scale (SWLS), the Family Health Scale-Short Form (FHS-SF), the Physical Activity Rating Scale-3 (PARS-3), and the Health-Promoting Lifestyle Profile II Revised (HPLP-IIR). Data analysis was performed using SPSS 27.0 and the PROCESS macro version 4.1. Results: The results indicated that life satisfaction was positively correlated with family health (r = 0.225), physical activity (r = 0.245), and health-promoting lifestyles (r = 0.506). Family health was positively correlated with physical activity (r = 0.320) and health-promoting lifestyles (r = 0.312). Physical activity was positively correlated with health-promoting lifestyles (r = 0.429). Additionally, life satisfaction could influence health-promoting lifestyles directly (effect = 0.369) and through three mediation pathways: (a) family health (effect = 0.033); (b) physical activity (effect = 0.050); (c) family health and physical activity (effect = 0.020). Conclusion: This study supports the mediating role of family health and physical activity in the influence of life satisfaction on health behaviors among young adults in China. Therefore, we recommend that future public health initiatives place greater emphasis on family health and create conditions that facilitate physical activity for this group. This could be an important direction for further enhancing health-promoting lifestyles among young adults in China.

Status and subjective well-being: A conceptual replication and extension of Anderson et al. (2012).

Does the status people possess shape their subjective well-being (SWB)? Prior research that has addressed this question has been correlational. Therefore, in the current research, we provide causal evidence of this effect: In two experiments, we found that individuals reported higher SWB when their own status was higher compared to when it was lower. However, individuals' SWB was not only shaped by their own status, but also by others' status. Specifically, individuals reported higher SWB when others' status was lower than when it was higher. Thus, people have a competitive orientation towards status; they not only want to have high status on an absolute level (e.g., to be highly respected and admired), but also to have higher status than others (e.g., to be more respected and admired than others). A standard self-affirmation manipulation was used in an attempt to mitigate individuals' competitive orientation towards status, but only helped already high-status members feel happier in groups of high-status members, rather than help low-status members feel happier when they uniquely held low status.

Predicting students' satisfaction with academic services at a multicultural engineering university in Bangladesh: A multiple regression analysis.

This empirical study sought to determine the levels of satisfaction among engineering students enrolled at a multicultural international institution in Bangladesh with a reputation for excellence. An assortment of first- and fourth-year undergraduate students participated in the study by completing an online survey. The study focused on selected determinants namely; support services (SS), campus life (CL), economic factors (EF) and University corporate image (CI). The researchers used a survey research design (SRD) to illuminate students' opinions and views. A multiple regression analysis (MRA) was used to regress opinions of 326 respondents who participated in the study. The disproportional stratified random sampling was used to determine the samples. The study was guided by two hypotheses. The study analyzed predictors of student satisfaction with academic services by employing standard multiple regression analysis. The findings showed that the four determinants SS, CL, EF and CI were statistically significant to predict students' satisfaction levels [F(4,321) = 143.786, p < .001]. It was empirically discovered that Support Services had the highest impact to the model [ß = .496, p < .05] followed by university Corporate Image [ß = .365, p < .05]. The findings showed that Campus Life and Economic Factors were not statistically significant (p>.05) in the model of predictors implying that they do not influence students' satisfaction levels on their academic career at the university. The researchers recommend that in order to maintain students' satisfaction levels on their academic experiences, universities should consolidate on support services provided to the students as well as improving their corporate image and world view.

E-portfolio utilization in medical school clinical practice: assessing satisfaction and learning advantages.

PURPOSE: This study aimed to investigate the difference in satisfaction and learning benefits between e-portfolios compared to paper portfolios during clinical practice in medical schools. METHODS: Utilization of and satisfaction with e-portfolios among 40 third-year medical students in the medicine department of Ajou University School of Medicine was collected using an online survey in December 2020. The collected data were analyzed using descriptive statistics and an analysis of variance. RESULTS: Students perceived that e-portfolios were highly beneficial for consistently documenting activities during clinical practice, when compared to paper-based portfolios (mean±standard deviation [SD]=2.60±1.22). However, the least rated aspect was that e-portfolios require less time than paper-based portfolios (mean±SD=1.80±1.14). Additionally, among the various clinical practice courses using e-portfolios, the highest satisfaction was observed with the fewest content items in the e-portfolio. CONCLUSION: To maximize the potential benefits of e-portfolios, improvements in implementation and usability are essential. Additionally, for effective utilization of e-portfolios in clinical practice, it is necessary to clearly define students' required competencies and ultimate goals, and structure content accordingly.

The story of 'us' is the story of 'me': A cross-sectional test of the influence of insecure attachment on narratives of romantic transgressions and high points.

Narratives play an important role in the development of the self-identity. Romantic relationships offer a powerful context in which to develop these narratives about the self through the good and the bad experiences people have with their partners. However, the stories we tell can also be colored by how we already see ourselves. In a secondary analysis, using a prospective longitudinal study of people in established romantic relationships (N = 402), we tested pre-registered hypotheses regarding how attachment anxiety and avoidance lead people to develop narratives about their relationship high-points and transgressions, and whether these narratives influence their relationship satisfaction over time. Relatively higher avoidance, but not anxiety, was related to narrative construction. Those relatively higher in avoidance made more negative event connections about themselves in their transgression narratives, and more positive event connections about themselves in their relationship high-point narratives. Narrative content, however, did not mediate the association between attachment anxiety and avoidance and relationship satisfaction. Despite the lack of support for some of our pre-registered hypotheses, these findings provide valuable insights into how insecure attachment influences the stories people tell about their relationships, and how they link these events back to the self.

General self-efficacy as a moderator between severity of menopausal symptoms and satisfaction with life in menopausal women.

The study aimed to determine whether self-efficacy acts as a moderator between the severity of menopausal symptoms and life satisfaction. The research tools were: The Generalized Self-Efficacy Scale (GSES), The Satisfaction with Life Scale (SWLS) The Menopause - Specific Quality of Life (MENQOL), and a standardized questionnaire comprising questions on the participants' characteristics. 516 women using health care services who had menopausal symptoms took part in the study. Self-efficacy (GSES) (r = -0.176; p < 0.001) and life satisfaction (SWLS) (r = -0.106; p = 0.016) were negatively correlated with the severity of menopausal symptoms (MENQOL). The self-efficacy correlated positively with satisfaction with life (r = 0.278; p < 0.001). A low level of self-efficacy was associated with a significant and negative relationship between the severity of menopausal symptoms and satisfaction with life (p = 0.005), while at a high and moderate level of self-efficacy, the severity of menopausal symptoms was not associated with life satisfaction (p > 0.05). Self-efficacy moderates the relationship between the severity of menopausal symptoms and life satisfaction in menopausal women. The moderating function of self-efficacy is that, at its low level, an increase in the severity of menopausal symptoms reduces life satisfaction, while at medium and high levels, an increase in the severity of menopausal symptoms does not reduce life satisfaction.

Religiosity in adolescence and body satisfaction and disordered eating in adolescence and young adulthood: cross-sectional and longitudinal findings from project EAT.

PURPOSE: This research identified whether adolescent religiosity was associated with body satisfaction and disordered eating in adolescence and early adulthood and explored gender/sex differences in these associations. METHODS: Project EAT (Eating and Activity in Teens and Young Adults) is a longitudinal cohort study following participants from adolescence into young adulthood. For this analysis (N = 1620), religiosity (importance of religion and frequency of religious service participation) during adolescence was examined as a correlate of body satisfaction and disordered eating (binge eating, maladaptive behaviors intended to lose or maintain weight, eating to cope, and dieting) at the same life stage (EAT-II, 2003-2004, Mage = 19.4 years) and during young adulthood (EAT-IV, 2015-2016, Mage = 31.5 years). Analyses used linear and logistic regression models adjusted for demographics and adolescent body mass index. RESULTS: During adolescence, females who placed greater importance on religion had higher body satisfaction, 22% higher odds of binge eating, and 19% greater odds of dieting in the past year, while more frequent attendance of religious services was associated with higher body satisfaction and 37% greater odds of dieting past year. Among males, only frequent attendance of religious services was associated with higher adolescent body satisfaction. Longitudinally, among females, only frequent attendance of religious services in adolescence predicted higher levels of body satisfaction in young adulthood. No significant longitudinal associations were observed among males. CONCLUSIONS: Our findings contribute to understanding the complex interplay between religiosity, gender, and body satisfaction. Further research should explore cultural factors influencing these associations and qualitative aspects of religious experiences to inform nuanced interventions. LEVEL OF EVIDENCE: Level III, cohort study.

Exploring sexual life enrichment: a journey into strengthening well-being for women post- menopause through qualitative study.

BACKGROUND: women post-menopause, are faced with various physical, emotional, and relational challenges. One such aspect that tends to be overlooked is the impact of menopause on sexual well-being. This study aimed to elucidate the concept of enriching the sexual life of women post-menopause. METHODS: A qualitative research strategy was adopted using a conventional content analysis approach. Data collection was conducted through semi-structured interviews with 24 participants (17 women post-menopause and 7 experts), using purposive sampling. RESULTS: The data analysis resulted in the extraction of 341 codes, 24 subcategories, and 8 categories. Ultimately, the following three themes emerged: "maintaining and enhancing the position of sexual relationships," "deepening sexual relationships and expanding intimacy," and "improving communication skills with the spouse ". CONCLUSION: Enriching the sexual life of women post-menopause, as suggested by the themes, involves nurturing their relationships, keeping these connections strong and valued, deepening intimacy, and promoting effective communication to ensure a fulfilling and enjoyable experience during this phase of life. This leads to a sense of security, health, and tranquility, ultimately manifesting positive repercussions on the couple's and family's health.

Owner satisfaction and prognosis for return to work after pancarpal arthrodesis in working dogs in the United Kingdom: a retrospective study (2011-2020).

BACKGROUND: Pancarpal arthrodesis (PCA) is a commonly performed procedure in the UK. However, it is not known whether working dogs in the UK and other European countries with carpal injuries that have undergone unilateral PCA are able to return to working ability as determined by the owner. Medical records from a referral hospital in the UK were reviewed retrospectively for cases of working dogs treated using unilateral PCA. Case files and radiographs were retrospectively analysed for cause of injury, diagnosis, and complications. The ability of the dog to work after surgery and owner satisfaction with the outcome were assessed using telephone questionnaire. RESULTS: 50% (5/10, 50%) owners stated their dog could perform normal duties, 4/10 (40%) could perform most duties with some allowances. Outcome was not as good for dogs working on steep, uneven fell terrain. 80% (8/10, 80%) owners rated the level of post-operative lameness as unaffected with a normal gait. 90% (9/10, 90%) owners were either very satisfied or satisfied with the outcome of the procedure, and 90% owners stated the financial investment was worthwhile. CONCLUSIONS: Unilateral PCA carries a good prognosis for working dogs with high owner satisfaction. Caution should be advised for dogs expected to work on steep, uneven fell terrain.

Relationship power attenuated the effects of gratitude on perceived partner responsiveness and satisfaction in romantic relationships.

There is a gap in whether relationship power affects the association between gratitude and relationship satisfaction in romantic relationships. Based on the relationship maintenance model and the social distance theory of power, the present study adopted a digital questionnaire design on an online platform to test the mediating role of perceived partner responsiveness between gratitude and satisfaction as well as the moderating role of relationship power. A total of 825 subjects (Mage = 27.2, SD = 10.6; female 46.9%) who had been in romantic relationships for more than six months participated in this study. Overall, the results of the moderator-mediator model indicated that, compared to individuals with low levels of relationship power, the relationship between gratitude and perceived partner responsiveness as well as that between perceived partner responsiveness and relationship satisfaction was weaker among those with high levels of power. These findings are revealing for interventions designed to promote satisfaction between couples with power imbalances.

An e-learning platform for clinical reasoning in cardiovascular diseases: a study reporting on learner and tutor satisfaction.

BACKGROUND: Medical students gain essential skills through hospital training and internships, which complement their theoretical education. However, virtual patient platforms have been shown to effectively promote clinical reasoning and enhance learning outcomes. This study evaluates a web-based platform designed for learning clinical reasoning in cardiovascular diseases, detailing its functionalities and user satisfaction. METHODS: The Virtual Patient platform presents medical students with clinically valid scenarios, encompassing stages such as patient description, anamnesis, objective examination, presumptive diagnosis, health investigations, treatment planning, complications, differential and final diagnoses, and prognosis. Scenarios are generated either automatically or manually by professors, based on labeled and annotated clinical data. The Virtual Patient contains two types of medical cases: simple scenarios describing patients with one pathology, and complex scenarios describing patients with several related pathologies. The platform was evaluated by a total of 210 users: 178 medical students, 7 professors, and 25 engineering students, using questionnaires adjusted for each evaluation round to assess satisfaction and gather feedback. The evaluation by medical students was performed in four rounds, each round corresponding to successive enhancements of the platform functionalities and addition of new cases, with a total number of 1,098 evaluation sessions. RESULTS: The platform was evaluated at different implementation stages, involving simple and complex scenarios for various heart diseases. The majority of students found the platform very useful (82.58%), with significant appreciation for its features and functionalities, for example the dialogue module supporting natural language interactions in Romanian and English or the feed-back obtained during interaction. Professors highly valued the platform's flexibility in scenario generation, real-time feedback provision, and data management capabilities. They appreciated the possibility to provide feedback and score student performance in real-time or after the session, though some professors suggested improving the explainability of the scores. CONCLUSIONS: The Virtual Patient platform enables medical students to virtually replicate hospital interactions, diagnose patients, and plan treatments in clinically valid scenarios for cardiovascular diseases. User evaluations demonstrated high satisfaction and appreciation for the platform's features. Future work will focus on expanding medical cases, enhancing the dialogue module, improving scenario generation for complex cases, and extending the synthetic data generation component to produce additional types of medical investigations.

Gender differences in the subjective wellbeing of the older adults and the determinant factors: a case study of Nanjing.

Objective: This paper aims to examine the gendered differences in the subjective wellbeing of older adults and underlying determinant factors which contribute to these differences in China where the unique social and cultural systems, the consequent concept of filial piety and the perceptions towards different living arrangements in later life provide an excellent laboratory for studying the topic. Methods: Hierarchical linear models are employed to analyze the impacts of household structure and built environment on the subjective wellbeing of older adults based on a survey conducted in Nanjing in 2021. Results: There are significant gender differences in the subjective wellbeing of older adults, with older women reporting higher levels of subjective wellbeing (4.95 vs.4.69). Gender differences also exist in how the built environment affects the subjective wellbeing of older adults, with a greater impact on older adult women (33.68% vs. 28.50%). Household structure impacts the subjective wellbeing of older adults through the division of housework and the company of family members. Conclusion: There are three major mechanisms through which gender affects the subjective wellbeing of older adults, including structural mechanisms, socio-cultural mechanisms, and physiological mechanisms. Targeted environmental interventions and urban planning policies are recommended to promote the subjective wellbeing of older adults.