Features of mental deadaptation formation in powder production workers

Objective. The aim was to assess the impact of production and non-production risk factors on the formation of mental health disorders in chemical workers. Materials and methods. 201 employees of the main and 352 employees of the group of control were examined by a clinical method using a clinical structured psychiatric interview; questionnaires to identify additional non-production risk factors; questionnaire of neurotization. The calculations were carried out in the environment of the statistical system R. For modeling dependencies and calculating probabilities, logistic regression models were built, factor analysis was carried out. Results. The dependence of the formation of prenosological mental disorders in workers on the temporal characteristics, the level of material support and the actual production factors was revealed. The proportion of persons with mental deadaptation MD) in the main group 72.5 %) and the group of control 27.5 %) significantly differ from each other p 0.001). Conclusions. 1. The structure and the actual risk of MD formation among workers in the production of gunpowder is determined by harmful labor factors, depends on economic security, evolves depending on time characteristics. 2. For persons working under the influence of a chemical factor of the production environment in combination with explosive and fire hazardous works, the leading is astheno-vegetative symptomatology in combination with the personality type of conversion reaction. In the first 9 years of experience, general neurotic reactions are observed with a pronounced contribution from all scales, indicating the tension of adaptation mechanisms up to the formation of decompensation. With an increase in the length of time, the reactions are transformed into a conversion type of response according to the somato-vegetative type with a phobic radical and obsessions, and subsequently manifest themselves in relative independence from characterological reactions. 3. The degree of severity of reactions is characterized by variability, significantly overlapping the types of disorders that can be considered in the framework of Other mood disorders F38.0 and F38.1), which does not give grounds to classify them as F30-F34, since they are not sufficiently pronounced and severe.

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Abstract 17019: Obesity and Cardiovascular Health in Young American Adults

Circulation ◽

10.1161/circ.142.suppl_3.17019 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sarabjeet S Suri ◽

Vibhu Parcha ◽

Rajat Kalra ◽

Garima Arora ◽

Pankaj Arora

Keyword(s):

Risk Factors ◽

Young Adults ◽

Cardiovascular Health ◽

Piecewise Linear ◽

The United States ◽

Obesity Prevalence ◽

Logistic Regression Models ◽

Prevalence Of Obesity ◽

Adjusted Logistic Regression ◽

The Impact

Background: The growing epidemic of obesity in the United States (US) is associated with cardiovascular (CV) morbidity and mortality. We evaluated the impact of the increasing obesity prevalence on the CV health of young American adults. Methods: The age-adjusted weighted prevalence of hypertension, diabetes, and hypercholesterolemia was estimated from the 2008-2018 National Health and Nutrition Examination Survey (NHANES) in American adults aged 18-44 years, stratified by the presence of obesity. The trends were evaluated using a piecewise linear regression approach. The odds for CV risk factors were estimated using multivariable-adjusted logistic regression models. Results: Among 14,919 young adults, the prevalence of obesity was 33.9% (95% CI: 32.6-35.3%). Obese young adults were more likely to be non-Hispanic Blacks and in lower socioeconomic and educational attainment strata (p<0.05 for all). Obese young adults had a greater risk of having hypertension (adjusted odds ratio [aOR]: 3.0 [95% CI: 2.7-3.4]), diabetes (aOR: 4.3 [95% CI: 3.3-5.6]), and hyperlipidemia (aOR: 1.47 [95% CI: 1.3-1.7]). Among obese, hypertension increased from 36.5% (33.9-39.1%) in 2007-2010 to 39.4% (35.6-43.1%) in 2015-2018 (p= 0.07) and diabetes increased from 4.7% (3.6-5.8%) in 2007-2010 to 7.1% (5.3-9.0%) in 2015-2018 (p=0.11). A modest increase in diabetes was seen in non-obese individuals ( Table ). Hypercholesterolemia prevalence remained unchanged from 12.6% (95% CI: 10.6-14.7%) 2007-2010 to 10.9% (95% CI: 9.0-12.8%) in 2015-2018 (p=0.27) among obese young adults. Non-obese young adults showed a decline in hypercholesterolemia from 9.5% (95% CI: 8.0-11.0%) in 2007- 2010 to 7.1% (95% CI: 5.8-8.4%) in 2015-2018 (p=0.002). Conclusions: Nearly one-in-every three young American adults have obesity, which is accompanied by a two-fold higher prevalence of CV risk factors. The CV morbidity in young adults is expected to increase with an increasing prevalence of obesity..

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Risk Factors for Impaired Patient-Reported Satisfaction and Increased Length of Hospital Stay Following Hysterectomy on Benign Indications in Premenopausal Women: a Study From the Swedish National Register for Gynecological Surgery

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1005-0039 ◽

2019 ◽

Vol 80 (03) ◽

pp. 288-299

Author(s):

Ninnie Borendal Wodlin

Keyword(s):

Risk Factors ◽

Patient Satisfaction ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Premenopausal Women ◽

Gynecological Surgery ◽

National Register ◽

Logistic Regression Models ◽

Patient Reported ◽

The Impact

Abstract Introduction The aims of the study were to evaluate the impact of intra- and postoperative complications on satisfaction one year after hysterectomy for benign conditions, to determine risk factors for low patient satisfaction and to analyze whether complications were associated with the length of hospital stay. Material and Methods A retrospective study of 27 938 women from the Swedish National Register for Gynecological Surgery undergoing hysterectomy for benign conditions between January 2004 and June 2016. Data were obtained from prospectively collected pre-, peri- and postoperative forms. Statistical analyses were performed using multivariable logistic regression models. Crude and adjusted odds ratios and 95% confidence intervals are presented. Results More than 90% were satisfied with the hysterectomy. Dissatisfaction was associated with complications. Pelvic pain as indication, preoperatively having less expectations to get rid of symptoms or being alleviated from surgery, and current smoking were also risk factors for low patient satisfaction. Vaginal and abdominal subtotal hysterectomies were associated with high satisfaction. Occurrence of complications intra- and postoperatively before discharge was associated with increased length of hospital stay, as well as occurrence and severity of complications reported after discharge from hospital. Conclusions Complications were strongly associated with lower patient satisfaction. Preoperative expectations of surgery, indication, mode of surgery and life-style factors had impact on the satisfaction. Patient-centered information to ensure realistic expectations and prevention of complications seem to be essential to gain optimal patient satisfaction with surgery.

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Post-treatment heterogeneity of cardio-metabolic risk in acromegalic patients: The Impacts of GH and IGF-1

10.21203/rs.3.rs-49264/v1 ◽

2020 ◽

Author(s):

Mahshid Heydari ◽

Nahid Hashemi Madani ◽

Zahra Emami ◽

Alireza Khajavi ◽

Mohammad Ghorbani ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Multivariate Analysis ◽

Regression Models ◽

Metabolic Risk Factors ◽

Metabolic Risk ◽

Metabolic Abnormalities ◽

Logistic Regression Models ◽

The Impact ◽

Prevalence Of Diabetes Mellitus

Abstract Background: Metabolic abnormalities are frequently seen in patients with acromegaly. However, it is not clear to what extent GH /IGF-1 contribute to the development of these abnormalities. This study aimed to explore the impact of GH/IGF-1 on different aspects of metabolic abnormalities in patients with acromegaly. Methods: This retrospective, registry-based study conducted on 102 patients with acromegaly. Prevalence of diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DLP) at the time of diagnosis has been explored. Moreover, the impact of GH/IGF-1 on these cardio-metabolic risk factors at 3-12 months after surgery has been investigated using linear and logistic regression models.Results: At the time of diagnosis, the prevalence of cardio-metabolic risk factors was 79.17 % for DLP, 29.41% for DM, and 15% for HTN. Furthermore, each 1 ng/ml increase in the level of GH was significantly associated with 2 mg/dl increase in the level of FBS, 0.54 mmHg increase in the level of SBP, and 0.88 mmHg increase in the level of DBP. Upon multivariate analysis GH, but not IGF-1, significantly increased the odds of DM (OR; 1.17, 95% CI; 1.02-1.35, p= 0.025). Conclusions: Our findings showed at early postoperative stage, GH is significantly associated with the levels of FBS, SBP, and DBP. Moreover, GH, but not IGF-1, appears as a predictive factor for the presence of DM. However, neither GH nor IGF-1 could predict the presence of HTN, or DLP in this study.

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Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1670712 ◽

2018 ◽

Vol 40 (10) ◽

pp. 614-619

Author(s):

Mucio Diniz ◽

Luisa Diniz ◽

Gustavo Lopes da Silva ◽

Agnaldo Filho ◽

Zilma Reis ◽

...

Keyword(s):

Risk Factors ◽

Urinary Incontinence ◽

Short Form ◽

Transobturator Sling ◽

Logistic Regression Models ◽

International Consultation ◽

Surgical Failure ◽

The Impact

Objective To evaluate the long-term subjective cure rate of the transobturator sling, including an analysis of the risk factors and of the impact of increased surgical experience on the results. Methods A retrospective cohort study of women who underwent transobturator sling surgery from 2005 to 2011 was conducted. Patients were evaluated by a telephone survey using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and by subjective questions regarding satisfaction. An ICIQ-SF score of 0 was considered a cure. The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models to identify risk factors for surgical failure. Differences with p < 0.05 were considered significant. Results In total, 152 (70.6%) patients answered the questionnaire. The median follow-up period was 87 months. The urodynamic diagnosis was stress urinary incontinence in 144 patients (94.7%), and mixed urinary incontinence in 8 (5.3%) patients. Complications occurred in 25 (16%) patients. The ICQ-SF results indicated that 99 (65.10%) patients could be considered cured (ICIQ-SF score = 0). Regarding the degree of satisfaction, 101 (66%) considered themselves cured, 43 (28%) considered themselves improved, 7 (4.6%) considered themselves unchanged, and one reported worsening of the incontinence. After the univariate and multivariate analyses, the primary risk factor for surgical failure was the presence of urgency (p < 0.001). Conclusion The transobturator sling is effective, with a low rate of complications and a high long-term satisfaction rate. The risk factors for failure were the presence of urgency and patient age. The increased experience of the surgeon was not a factor that influenced the rate of complications.

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Rates of Nonunion for Different Joints after Foot And Ankle Surgery: A Review of 2301 Fusions

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00452 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0045

Author(s):

Alastair S.E. Younger ◽

Andrea Veljkovic ◽

Kevin Wing ◽

Murray J. Penner ◽

Hong Qian ◽

...

Keyword(s):

Risk Factors ◽

P Value ◽

Foot And Ankle ◽

Repeat Surgery ◽

Logistic Regression Models ◽

Primary Surgery ◽

Union Status ◽

Patients With Diabetes ◽

Potential Risk Factors ◽

The Impact

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Nonunion after fusion results in ongoing pain and a request for repeat surgery in many patients. Nonunion is therefore a failure of the primary surgery. Patients undergoing fusion surgery need to understand the risk for nonunion and the risk for repeat surgery. This is a review of fusions performed at a single institution by 4 foot and ankle surgeons to outline the nonunion rate after foot and ankle fusion for different joints. Methods: Data on fusions performed between January 1, 2010 to July 31, 2006 were retrospectively extracted from database. The records were reviewed to determine the union status of each fusion. Demographic and clinic risk factors of nonunion were recorded. The nonunion rate for each joint (ankle, subtalar, talonavicular, calcaneocuboid, navicular cuneiform, tarsometatarsal and metatssophalengeal joints) was estimated. Due to multiple surgeries performed on individual patient and fusions in the same surgery, random effects logistic regression models were conducted to assess the impact of risk factor on nonunion. The study include 2301 fusions preformed on 1320 patients. The minimum follow up was two years. The majority of patients were female (70%), with mean age of 57 years old and mean body mass index (BMI) of 28. There were 9% of patients with diabetes, 11% being smokers, 18% having lung disease, 8% with renal disease, and 29% with high blood pressure. Results: The risk of nonunion by joint is outlined in figure 1. The ankle showed the highest nonunion rate at 8%, and the calcaneocuboid joint had the lowest rate at 2%. Comparing to ankle, the nonunion rate was significantly lower at Talocalcaneal (Subtalar) joint (Odd ratio [OR]=0.05, p-value= 0.02) and Tarsometatarsal (OR=0.03, p-value=0.01). Across all joints the nonunion rate was higher in males, smokers, having a higher BMI and diabetes Age had a minimal effect. Conclusion: Union rate varied among fusion sites. Patient’s demographic and clinic characteristics might be potential risk factors for nonunion. This paper assists surgeons in determining the risk factors for nonunion after foot and ankle fusions. The ankle joint is at highest risk for nonunion, and the tarsometatarsal joint and the subtalar joints the lowest risk.

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Mental health of chemical workers: violation risk factors

Kazan medical journal ◽

10.17816/kmj2020-550 ◽

2020 ◽

Vol 101 (4) ◽

pp. 550-560

Author(s):

S V Kuzmina ◽

R V Garipova ◽

Z M Berhkeeva ◽

K K Yakhin

Keyword(s):

Mental Health ◽

Risk Factors ◽

Organic Synthesis ◽

Working Conditions ◽

Related Factors ◽

Work Related ◽

Production Factors ◽

Chemical Workers ◽

Fire And Explosion ◽

Fire And Explosion Hazards

Aim. To study the structure of psychosocial maladjustment in chemical workers and assess the contribution of industrial and non-industrial risk factors in the formation of mental illness. Methods. It was analysed of hygienic assessment of the leading harmful production factors chemical, physical, factors of severity and intensity of labor. During the periodic medical examination, the mental health status of 1,226 people was examined, with a focus on professional experience, mental hygiene aspects of production factors, as well as individual and personal characteristics of employees. Confidence intervals and standard errors estimating, the logistic regression models fitting were performed using R Statistical Software with significance level 0.05. Results. The working environment hazards in organic synthesis included chemical risk factor, continuous noise exceeding the permissible exposure limit, emotional stress and life-threatening conditions (fire and explosion hazards in the work). The general assessment of working conditions was performed using clauses 5.15.11 P 2.2.2006-05-harmful working conditions of the second-third degree (3.23.3). Working conditions at all stages of the manufacturing process of pyroxylin powders were assessed as harmful to the third-fourth degree (3.33.4), including the chemical factor, the severity and intensity of work, fire and explosion hazards in the work. It was revealed the dependence of the development of psychosocial maladjustment on non-work-related factors (such as the level of education, marital status), conditional work-related factors (level of material security). Also, the dependence of the structure of pre-existing mental health condition on the work-related and developmental characteristics (work experience) of labor in chemical production was found. Conclusion. Working conditions in the studied industries correspond to the 3rd harmful class, 2nd and 3rd degrees in the production of organic synthesis (3.23.3), while at the production of pyroxylic powders, it is close to dangerous (3.33.4); the structure and risk of the developmental process of employee maladjustment are determined by the feature effect of workplace hazards.

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Abstract P321: Pregnancy Loss is Associated With Subclinical Cardiovascular Disease in Mexican Women

Circulation ◽

10.1161/circ.135.suppl_1.p321 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Sandra A Hartasanchez ◽

Mario Flores ◽

Adriana Monge ◽

Elsa Yunes ◽

Carlos Cantu-Brito ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Pregnancy Loss ◽

Carotid Atherosclerosis ◽

Intima Media Thickness ◽

Cvd Risk ◽

Cross Sectional ◽

Logistic Regression Models ◽

Underlying Mechanisms ◽

The Impact

Introduction: Cardiovascular disease (CVD) in women often develops in the absence of conventional risk factors. Prenatal loss, a common pregnancy outcome, may result in physiologic changes that could affect future risk of myocardial infarction. Little is known about the impact of pregnancy loss on early markers of CVD risk. Hypothesis: Pregnancy loss affects carotid artery intima-media thickness (CIMT). Methods: We conducted a cross-sectional analysis among 1,769 disease-free women from the Mexican Teachers’ Cohort who had been pregnant to evaluate the relation between pregnancy loss and CIMT. In 2008 participants answered a baseline questionnaire on reproductive history, risk factors for chronic disease and medical conditions that was updated in 2011. We defined pregnancy loss as abortion and/or stillbirth. Between 2012 and 2016, CIMT was measured by trained neurologists using ultrasound in three clinical sites. We log-transformed CIMT and defined carotid atherosclerosis as CIMT ≥0.8mm or plaque. We used multivariable linear and logistic regression models to assess the relation between pregnancy loss, CIMT and carotid atherosclerosis. Results: Mean age of participants was 49.8 (SD ± 5.1) years. The prevalence of pregnancy loss was 22% (394 of 1769) , while we observed carotid atherosclerosis in 23% (405 of 1769) of participants. Comparing participants who reported a pregnancy loss to those who did not, the multivariable-adjusted odds ratio for carotid atherosclerosis was 1.52 (95% CI 1.12, 2.06). Women who experienced a stillbirth had 2.32 higher odds (95% CI 1.03, 5.21) of carotid atherosclerosis than those who did not. Mean CIMT appeared to be higher in women who reported a pregnancy loss relative to those who did not, however, in multivariable analyses, pregnancy loss and stillbirth were not significantly associated with CIMT. Conclusions: Abortion and stillbirth may be associated with a higher risk of CVD. Additional investigation on potential underlying mechanisms for this association is required.

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Minimally Invasive Lobectomy Modality and Other Predictors of Conversion to Thoracotomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519849037 ◽

2019 ◽

Vol 14 (4) ◽

pp. 342-352 ◽

Cited By ~ 1

Author(s):

Brandon S. Hendriksen ◽

Christopher S. Hollenbeak ◽

Matthew D. Taylor ◽

Michael F. Reed

Keyword(s):

Risk Factors ◽

Propensity Score ◽

Minimally Invasive ◽

Propensity Score Matching ◽

Thoracoscopic Surgery ◽

Patient Characteristics ◽

Logistic Regression Models ◽

Conversion Rates ◽

Chi Squared ◽

The Impact

Objective Minimally invasive approaches to lobectomy are increasing. Rates of conversion to thoracotomy are well reported but risk factors are poorly understood. This study aimed to determine the impact of surgical modality (video-assisted thoracoscopic surgery [VATS] and robotic) on conversion as well as to identify other risk factors for conversion. Methods The National Cancer Database (NCDB) was used to identify patients who underwent minimally invasive lobectomy between 2010 and 2015. Patient characteristics were compared between VATS and robotic approaches using chi-squared tests and t-tests. Logistic regression models were used to control for covariates and identify factors associated with all minimally invasive conversion, VATS conversion, and robotic conversion. Propensity score matching was used to compare conversion rates of VATS and robotic lobectomy. Results The study included 51,723 patients with lung cancer who underwent minimally invasive lobectomy (VATS or robotic). Conversion was identified in 7,109 (7.3%) operations. The odds of VATS conversions were nearly twice that of robotic conversions (OR 1.94 P < 0.0001). After controlling for VATS and robotic patient imbalances with propensity score matching, there was a 5% difference in conversion rates (14% vs. 9%, P < 0.0001). Other predictors of minimally invasive conversion included community hospitals, tumor size 4.5 cm or greater, and an increasing Charlson comorbidity index ( P < 0.03 for all). Conclusions VATS is associated with nearly twice the odds of conversion as robotic lobectomy. Identifying specific risk factors for both VATS and robotic conversions may aid in appropriate modality selection and reduction of conversions.

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Syndrome of the trephined: clinical spectrum, risk factors, and impact of cranioplasty on neurologic recovery in a prospective cohort

Neurosurgical Review ◽

10.1007/s10143-021-01655-6 ◽

2021 ◽

Author(s):

Lukas Sveikata ◽

Lana Vasung ◽

Amir El Rahal ◽

Andrea Bartoli ◽

Martin Bretzner ◽

...

Keyword(s):

Risk Factors ◽

Brain Structures ◽

Clinical Spectrum ◽

Secondary Outcome ◽

Neurologic Recovery ◽

Logistic Regression Models ◽

Radiologic Evaluation ◽

Cognitive Attention ◽

The Impact ◽

Syndrome Of The Trephined

AbstractSyndrome of the trephined (SoT) is an underrecognized complication after decompressive craniectomy. We aimed to investigate SoT incidence, clinical spectrum, risk factors, and the impact of the cranioplasty on neurologic recovery. Patients undergoing a large craniectomy (> 80 cm2) and cranioplasty were prospectively evaluated using modified Rankin score (mRS), cognitive (attention/processing speed, executive function, language, visuospatial), motor (Motricity Index, Jamar dynamometer, postural score, gait assessment), and radiologic evaluation within four days before and after a cranioplasty. The primary outcome was SoT, diagnosed when a neurologic improvement was observed after the cranioplasty. The secondary outcome was a good neurologic outcome (mRS 0–3) 4 days and 90 days after the cranioplasty. Logistic regression models were used to evaluate the risk factors for SoT and the impact of cranioplasty timing on neurologic recovery. We enrolled 40 patients with a large craniectomy; 26 (65%) developed SoT and improved after the cranioplasty. Brain trauma, hemorrhagic lesions, and shifting of brain structures were associated with SoT. After cranioplasty, a shift towards a good outcome was observed within 4 days (p = 0.025) and persisted at 90 days (p = 0.005). Increasing delay to cranioplasty was associated with decreased odds of improvement when adjusting for age and baseline disability (odds ratio 0.96; 95% CI, 0.93–0.99, p = 0.012). In conclusion, SoT is frequent after craniectomy and interferes with neurologic recovery. High suspicion of SoT should be exercised in patients who fail to progress or have a previous trauma, hemorrhage, or shifting of brain structures. Performing the cranioplasty earlier was associated with improved and quantifiable neurologic recovery.

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The Impact of the COVID-19 Pandemic and Lockdown on Prevalence of and Risk Factors for Neck Pain Among College Students: a Cross-sectional Study

10.21203/rs.3.rs-701878/v1 ◽

2021 ◽

Author(s):

Amira Daher ◽

Ofra Halperin

Keyword(s):

Risk Factors ◽

College Students ◽

Logistic Regression ◽

Regression Models ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Logistic Regression Models ◽

Related Stress ◽

The Impact

Abstract Background: Neck pain (NP), one of the most reported musculoskeletal disorders, is a major cause of illness and absence from university lessons among students. The COVID-19 pandemic affected higher education institutions worldwide. Academic studies shifted to online-learning, changing students’ habits and lifestyle. Data demonstrated that the pandemic and consequent lockdowns can affect people’s physical and mental well-being. Thus, the aim of this study is to evaluate the impact of COVID-19 lockdowns on the prevalence of and risk factors of NP among college students compared to the pre-epidemic period. Methods: A cross-sectional study was conducted in the form of an online questionnaire survey that included sociodemographic data, Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Perceived Stress Scale (PSS). NP was reported at four time points—lifetime, last year, last six months, and current—on a scale ranging from never/seldom to almost every day. Logistic regression models were calculated for all study variables and compared to the (NDI) cut-off score of 15. Results: A total of 295 college students were recruited. Among them, 35.6% reported at least moderate neck-related disability (NDI≥15) and significantly more NP than before the lockdown. NP increased gradually and significantly (on a scale 1-4), from a lifetime mean of 1.80 to a mean of 2.57 last year to 2.73 during the past six months to the current mean of 3.07 (p< .001). Participants’ scores on the PSS were moderate, with 59.3% reporting a high level of study-related stress. Logistic regression models revealed that sitting more than three hours a day, high study-related stress and higher PSS and VAS scores were associated with higher risk of at least a moderate level of neck-related disability (R2=.513, p< .001). Conclusions: The transition from on-campus studies to online learning had negative effects on students. It significantly increased study-related stress and the development of NP. Identifying risk factors at an early stage may prevent NP from becoming chronic and affecting students’ future careers, thereby improving students’ quality of life.

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