Means, standard deviations and intercorrelations for the study variables were calculated. The results revealed a moderate-low level of stress and a moderate-high level of perceived threat. Higher stress was related to higher perceived threat, a greater external locus of control, lower problem-focused coping, higher emotion-focused coping and social support-seeking and higher loneliness. Perceived threat was positively related to both problem-focused coping and emotion-focused coping. The results show that the Arab population in Israel coped as a strong minority group. This study contributes to our understanding of how minority groups cope in the current epidemic and to the identification of effective strategies for reducing stress during this challenging period. The study’s results may help devise intervention programs that foster more effective coping capabilities among this and other minority populations.This study aimed to examine the impact of the locus of control, coping strategies and loneliness on perceived threat and stress among the Arab minority in Israel during the first COVID-19 closure. This was a cross-sectional online study, with 486 participants who completed a questionnaire measuring the study variables during the period of 28–31 March 2020. Statistical analyses included  The World Health Organization has declared the COVID-19 outbreak a global state of emergency, raising concerns regarding public health .Outbreaks of epidemics are known to be extremely stressful events. They are unpredictable, vague, and completely uncertain , and areThe COVID-19 epidemic is associated with feelings of helplessness as well as loss of a basic sense of safety, security, financial stability and the ability to imagine a brighter future. Disease threat is also associated with fear of infection, inability to predict the disease, severe disease complications , high moIn these and other difficult and stressful situations, a sense of control may promote better coping and mental well-being . StudiesTo slow the spread of COVID-19 and reduce the burden on the health system, the Center for Disease Control and Prevention (CDC) has recommended physical  distancing, self-closure and the isolation of infected individuals . As in oSocial distancing is one of the most successful strategies used in the past to slow or prevent community infection during epidemics. Nevertheless, losing the ability to communicate physically, face-to-face, with people, and to maintain social ties, may raise stress levels significantly  and incrCoping is defined as the actual effort made in attempting to render a perceived stressor tolerable and minimize the distress induced by the situation . Coping People’s responses to stress during the pandemic can depend on their background, social support from family or friends, financial situation, health and emotional background, and the community in which they live. Taha et al.  found thResearch shows that social variables, such as race and ethnicity, education and socioeconomic status, can explain variations in how different groups are affected by disasters . DisasteIn Israel, Arab citizens are an ethnic minority, constituting 21% of the population. Ninety percent live in homogeneous peripheral localities ranked in lower socioeconomic clusters , which tThe subjective health status serves as a measure of health in many studies of health-related issues, as it is a good predictor of mortality, morbidity, and use of health services. Arabs tend to evaluate their health as better than Jews, although their life expectancy is lower and their morbidity and mortality are higher .The Arab population in Israel faces major challenges in meeting the Health Ministry’s COVID-19 guidelines. Hence, it is likely to experience more stress due to the onset of COVID-19. Kimhi et al.  found a The current study aimed to investigate the locus of control, coping strategies and loneliness as factors influencing threat perceptions and stress among the Arab minority in Israel at the beginning of the first COVID-19 closure. It seeks to examine how this unique population is coping with COVID-19 and identify the characteristics contributing to the degree of stress they experience. The study will make it possible to learn how minority groups cope in the current epidemic, with the goal of identifying strategies that may be particularly effective in reducing stress during this challenging period.The current study is a cross-sectional online study conducted among the Arab population in Israel during the first COVID-19 closure. The questionnaire was distributed via social networks, mainly Facebook and WhatsApp, during the period of 28–31 March 2020. The questionnaire consisted of 90 questions and took approximately twenty minutes to complete. Participation was voluntary and no permutations were offered . Inclusion criteria were Arabs over 18 years of age and exclusion criteria were non- Arabs or those under the age of 18. The Institutional Review Board and Ethics Committee of The Max Stern Yezreel Valley College approved the study.All questionnaires were translated into Arabic by English-language professionals and then back-translated into English. All questionnaires are validated on the Arab population.Perceived Stress Scale (PSS)—Cohen et al., (1994) : ParticiThe Locus of Control Scale is a valid and reliable Hebrew version of Rotter’s (1966) I-E locus of control scale, which is the final version used in most locus of control studies. The questionnaire includes ten sentences referring to respondents’ level of control over their lives, divided into an ordinal scale of five categories . For example: “From my experience, I know that what is supposed to happen will indeed happen”. Scores range from 10 to 50, with higher scores indicating that the focus of control tends to be internal. The internal reliability index is reversed for items 1, 4, 6, 7 and 10.The coping questionnaire was developed by Carver et al., (1989) . Here, wThe questionnaire examining feelings of loneliness  included 20 items examining social relationship satisfaction. Ten items were positively worded to indicate a lack of loneliness, e.g., “I do not feel lonely”. Ten items were negatively worded to indicate loneliness, e.g., “I have no one to turn to”. Participants responded to each statement on a scale from 1  to 4 (to a large extent). The questionnaire score was calculated according to the sum of scores after reversal of positively worded items. The sum of the scores ranged from 20 (low loneliness) to 80 (high loneliness). Item reliability was tested using Cronbach’s alpha coefficient and found to be very high (α = 0.85).t-tests and analyses of variance. Means, standard deviations and Pearson correlations for the study variables were calculated.Data were analyzed using SPSS ver. 26  Background variables were described using frequencies and percentages, means and standard deviations. Relationships between the dependent variables and the background variables were analyzed using 2, NFI, NNFI, CFI and RMSEA were used as model fit measures. The model was calculated using bootstrapping with 200 samples and bias corrected confidence interval, with 95% confidence level.The study model was examined with a path analysis, using AMOS ver. 26 . Background variables served as control variables and were binary. All continuous variables were standardized. The control variables and the independent variables were allowed to correlate within themselves. χ2 = 0.10, α = 0.05, ten predictors  and power of 0.95, a sample size of 254 respondents was required.The population in Israel consists of 1.995 million Arabs, which constitute 21.1% of the total population. As the questionnaire was distributed through social networks, the distribution was limited and a calculation was made for a proper sample size. Sample size was calculated with G*Power 3.1 . ConsideParticipants in this study were 486 Israeli Arabs, 102 men (21%) and 384 women (79%), all adults of working age, as shown in M = 2.18, SD = 0.47, range 1–4), whereas the perceived COVID-19 threat was moderate-high . Stress was higher for women than for men  (t(483) = 3.98, p < 0.001), as was the perceived threat  (t(141.61) = 2.87, p = 0.005). Stress was higher among younger participants  than older ones   = 8.45, p < 0.001, η2 = 0.034). Further, stress was higher for participants with a high school or professional education  than for participants with an academic education  (t(483) = 3.27, p = 0.001). Moreover, stress was higher for unemployed  than for employed participants  (t(483) = 2.89, p = 0.004).Stress was moderate-low . Control variables were gender , age , education level  and employment status . Independent variables were the locus of control, coping strategies and a sense of loneliness, the mediating variable was perceived threat and the dependent variable was experienced stress.2(20) = 22.45, p = 0.316, NFI = 0.973, NNFI = 0.991, CFI = 0.997, RMSEA = 0.016. As shown in The model was found to fit the data: χSE = 0.016, p = 0.024, 95% CI = 0.004, 0.082) and emotion-focused coping . That is, higher problem-focused coping was associated with higher perceived threat, which was then related to higher experienced stress. Yet higher problem-focused coping was directly related to lower experienced stress. Higher emotion-focused coping was related to higher perceived threat, which was then related to higher experienced stress. The direct relationship between emotion-focused coping and experienced stress was also positive.These results reveal that perceived threat may mediate how problem-focused and emotion-focused coping are related to experienced stress. The two indirect relationships were significant: problem-focused coping (standardized indirect effect = 0.029, To summarize, the direct relationship between the internal locus of control and stress was negative. The direct relationship between problem-focused coping and stress was negative, while the indirect relationship mediated by perceived threat was positive. Both the direct and indirect relationships between emotion-focused coping and stress were positive. Finally, the direct relationships between seeking social support and stress and between a sense of loneliness and stress were positive.The current study sought to examine coping strategies, the locus of control and feelings of loneliness as factors influencing the degree of stress and perceived COVID-19 threat among the Arab population as an ethnic minority in Israel at the beginning of the first COVID-19 closure.The perceived COVID-19 threat was moderate-high. The Arab population in Israel faces many challenges dealing with the COVID-19 epidemic threat in general and with implementing physical and social distancing guidelines in particular, which may increase the sense of threat from the disease and its consequences. In addition, the Arab population suffers from overcrowding and a shortage of housing and most Arab localities are classified as belonging to lower socioeconomic clusters. The average number of persons in an Arab family is 4.6 and about 28% of Arab families number six or more persons. Moreover, these large families include adults, young people and a large proportion of children who come into close contact with many peers every day. The Arab society is marked by multiple family and social events which people find difficult to give up. Finally, the collectivist nature of Arab culture is dominant even at times of crisis. Therefore, the guidelines may be perceived as contradictory to their lifestyle, leading to a tendency to violate them. Their living conditions may increase their risk perceptions and sense of threat that the disease may actually endanger many lives, especially the elderly, chronically ill or risk groups. In addition, we found that feeling threatened by the disease increases feelings of stress. It is also possible that the living conditions in Arab society and the overcrowding in their social relationships lead to reports of a low level of loneliness.A study in Italy during the current epidemic found that a high level of stress was caused, among other things, by fear of infection and worries that a relative would get sick . In outbIn this study, the internal locus of control was moderate-high, as was problem-focused coping. Higher problem-focused coping was related to higher perceived threat, which was then related to higher experienced stress. Yet higher problem-focused coping was directly related to lower experienced stress. Studies found that increased use of emotion-focused coping correlates positively with psychological distress . In contFor many, the uncertainty surrounding COVID-19 is the hardest to handle. People are not sure how they will be affected or how bad things might get, making it all too easy to catastrophize and spiral into a sense of overwhelming dread and panic. People with an external locus of control believe that events are not under their control. These people do not fight to protect themselves from psychological harm, believing they cannot change the situation because someone else is in charge .The Arab population in Israel faces barriers to accessing information and difficulties in adopting social distancing measures. A significant delay in disseminating instructions in Arabic led to severe gaps in the level and scope of the information reaching much of the Arab public. The large numbers of Arab doctors, nurses, pharmacists and other health and welfare providers may help raise public awareness in the Arab sector regarding the importance of following governmental instructions.Stress was moderate-low and was higher among young unemployed women with a high school education only. This is in line with the literature, where individual differences are explained by the degree of stress individuals endure, with women usually more affected by stressors than men . Women aStress was positively connected with perceived threat and emotion-focused coping, which affect feelings associated with the stressor, seeking social support and loneliness. Yet, stress was negatively connected with the internal locus of control and problem-focused coping, which affect the stressor itself. This is in line with other studies that found that social support can only be of help when it conforms to the coping strategies that are most adequate in the stressful situation . People As in other studies, in this study, perceived threat was positively associated with all the coping mechanisms . The perThe study’s limitations include its cross-sectional design and its homogeneous sample. Future studies using a longitudinal design and heterogeneous samples should be carried out to further validate the current results.The present study highlights the importance of specific coping strategies in managing the stress of perceived health threats. Our results expand understanding regarding the use of coping strategies in relation to the internal locus of control. COVID-19 has reminded us that our health can be threatened. Understanding the psychological and behavioral reactions to health threats may inform health messages and inspire more effective and productive campaigns to reduce the damaging consequences of such diseases on our social well-being. The study’s results show how the Arab population in Israel copes as a strong minority group and may help devise intervention programs fostering more effective coping capabilities among this and other minority populations. Moreover, during crises, policymakers need to increase support for minority populations, for example, by promoting mental health and building sensitive and tailored intervention strategies to help reduce stress. Identifying the mental challenges of minority groups during disasters can lead to understanding how to reduce these negative effects and improve coping abilities during disasters.


Pinus bungeana is a native but endangered plant species in China, with high ornamental value and adaptability to drought and cold. The relationship between the soil community structure and endophytic microbes in the tissues of P. bungeana under different health statuses is poorly understood. In this study, the endophytic bacterial and fungal communities of P. bungeana under different health statuses were compared and analyzed in the Xiong'an New Area. Using high-throughput deep sequencing [16S and internal transcribed spacer (ITS) rRNA] techniques, the effect of the health status of P. bungeana on the microbial communities in bulk soil, rhizospheric soil, roots, stems, and leaves was determined in this study. We observed that the diversity of the bacterial and fungal communities of the aboveground parts (stems and leaves) of healthy P. bungeana plants was much higher than that of the unhealthy plants. However, the diversity of bacterial and fungal communities in the belowground parts  showed almost no difference in microbial community richness, indicating that the possible cause of illness was transmitted in a “top-down” manner. Furthermore, there were significant differences in the microbial diversity and community structure in different ecological niches of P. bungeana (P < 0.01). Proteobacteria and Actinobacteria were the dominant bacterial phyla, while Ascomycota, Basidiomycota, and Mortierellomycota were the predominant fungal phyla. Redundancy analysis (RDA) revealed that soil organic matter (SOM), total phosphorous (TP), total potassium (TK), total nitrogen (TN), water content (WC), power of hydrogen (pH), total carbon (TC), and the ratio of carbon to nitrogen (C/N) were significantly correlated with the composition of the microbial communities. Altogether, these results provide a scientific basis for further studies on the mechanism underlying the “aboveground–underground” microbial interactions in plantation forests, which can aid in promoting the healthy and sustainable development of the Millennium Xiulin forest in the Xiong'an New Area. Arabidopsis thaliana  is an endangered tree species and the only three-leaf pine in East Asia. With its beautiful posture and unique bark, the timber of P. bungeana can be used to construct houses, furniture, stationery, and other materials, which have great ornamental and economic value. P. bungeana is an important species for ecological construction, with robust adaptability to dry, cold, calcareous, and mild saline–alkali soils. The plant has exceptional resistance to sulfur dioxide, hydrogen fluoride, and smoke dust pollution and plays a crucial role in forest regeneration, thereby serving as a unique tree species for the creation of environmental protection forests in industrial and mining areas  gene sequencing techniques, for elucidating the complex interactions between microorganisms and the host plant. These findings will provide a scientific basis for further studies on the mechanism of “aboveground–underground” microbial interactions in plantation forests, which can aid in promoting the healthy and sustainable development of the Millennium Xiulin forest in the Xiong'an New Area.Accumulating studies have demonstrated that plants can significantly influence the structure of the plant microbiome  announced by the government of the People's Republic of China on April 1, 2017. As part of the development of the new national region, the Xiong'an New Area is another key area after the Shenzhen Special Economic Zone and the Shanghai Pudong New Area  and unhealthy P. bungeana plants  were randomly selected from each block. In addition, the unhealthy plants in the study area were characterized by the mixed occurrence of brown spots, needle cast, and needle blight, which could have been caused by pathogens, a mild climate, high humidity, or poor management of the barren soil. A total of 30 samples, including healthy bulk soil (HFRS), healthy rhizospheric soil (HRS), healthy roots (HR), healthy stems (HS), healthy leaves (HL), unhealthy bulk soil (UFRS), unhealthy rhizospheric soil (URS), unhealthy roots (UR), unhealthy stems (US), and unhealthy leaves (UL), were collected from the experimental area in the September of 2021, and each sample was collected in triplicate. After removing the surface impurity, the bulk and rhizospheric parts of coniferous P. bungeana plants were collected. Underground root samples with a diameter of ~0.3 cm were extracted from depths of 0–30 cm, and stems with diameters of ~0.5 cm were selected as stem samples. The rhizospheric soil was strictly defined as the soil particles that adhered to the roots. The bulk soil was collected from the topsoil region (0–15 cm) and from regions more than 20 cm away from the roots. The leaf chamber represented all the leaves at the end and sub-end of the stem branch, which were collected using sterile scissors. Disposable gloves were worn and replaced every time different tissues were sampled. The samples were placed in a portable refrigerator, transported to the laboratory at low temperature (~−20°C), and stored at −80°C for further analyses.In total, three blocks were selected in the Millennium Xiulin area, and healthy 2O for 30 s and subsequently rinsed with 70% (v/v) ethanol and sodium hypochlorite (2.5% sodium hypochlorite with 0.1% Tween 80) for 2 and 5 min, respectively. The tissues were then washed with 70% (v/v) ethanol for an additional 30 s to remove the epiphytic bacteria and fungi from the surface, following which the samples were rinsed five times with sterile ddH2O . After sterilization, the plant samples were homogenized and subjected to laminar airflow under sterile conditions. Finally, quadruple aliquots (1.5 mL) of homogeneous plant samples  from each sample were stored at −80°C until DNA extraction , according to the standard operating instructions. All the plant tissues, including roots, stems, and leaves, were cut into fine pieces (<5 mm), and 50 mg of the tissues were ground for 3 min in liquid nitrogen using 5-mm beads. The DNA was extracted from the pulverized tissue using the same kit as previously described. The extraction was repeated two times to obtain sufficient DNA yield. The concentration and purity of the DNA were measured using a NanoDrop 2000 spectrophotometer , and the integrity of the DNA was subsequently examined by agarose gel electrophoresis with 1% agarose gels  and rhizospheric soil (0.4 g) of 2O. The PCR was performed in triplicate. The PCR product was separated on 2% agarose gels and purified using an AxyPrep DNA Gel Extraction Kit , according to the manufacturer's instructions. The purified amplicons were next subjected to the second round of PCR amplification using 799F (5'-AACMGGATTAGATACCCKG-3') and 1193R (5'-ACGTCATCCCCACCTTCC-3') primers to reduce the length of the amplicon (394 bp) for sequencing. The PCR conditions were the same as those used in the first round, with the exception that the number of cycles was reduced to 13. The products were purified using an AxyPrep DNA Gel Extraction Kit  and quantified using a Quantus™ Fluorometer .PCR amplification was performed in our laboratory, and Illumina MiSeq sequencing was performed by Majorbio company . The bacterial 16S rRNA amplicon library was generated by two-step PCR, and the first round of PCR amplification was performed using 799F (5'-AACMGGATTAGATACCCKG-3') and 1392R (5'-ACGGGCGGTGTGTRC-3') primers  and PRJNA821418 (accession numbers: SUB11250928), respectively.The universal primers, ITS1F (5'-CTTGGTCATTTAGAGGAAGTAA-3') and ITS2R (5'-GCTGCGTTCTTCATCGATGC-3'), were selected for generating the fungal ITS amplicon library. The reaction system, purification, and quantification procedures were the same as those used for bacterial PCR. Purified amplicons were pooled in equimolar concentrations and subjected to paired-end sequencing using the Illumina MiSeq PE300 platform  by Majorbio company . Bacterial and fungal raw data were deposited at the National Center for Biotechnology Information Sequence Read Archive database under the BioProject numbers PRJNA821431 . The raw reads were demultiplexed, quality-filtered, and controlled using fastp version 0.20.0  were clustered using UPARSE software, version 7.1. In order to eliminate the redundant computational steps in the intermediate processes of analysis, the non-repetitive sequences were extracted from the optimized sequences, and single non-repetitive sequences were removed. The non-repetitive sequences (excluding single sequences) were clustered based on the OTUs using a similarity threshold of 97%, and chimeras were removed during clustering to obtain the representative OTU sequences Dickie, . Chimerit-test, and post-hoc analyses were conducted using R version 3.5.1 . The post-hoc comparison was performed to measure significant differences in microbial richness and composition among different compartments in healthy and unhealthy plants by Tukey's honestly significant difference (HSD) test. QIIME version 1.9.1 was used to calculate the beta diversity distance, and R version 3.5.1 was used for Bray–Curtis hierarchical clustering and PCoA statistical analysis to identify the similarity or difference of the community structure among different samples. The similarities and differences in the relationships of microbial community structures in different compartments of P. bungeana were investigated with heatmaps generated using the VEGAN package. Linear discriminant analysis (LDA) coupled with effect size measurements (LEfSe) analysis was conducted to identify the statistically different biomarkers between groups . Analysis of variance (ANOVA), Student's m/v) using a Benchtop FiveEasy Plus™ pH Meter . The total carbon (TC), total nitrogen (TN), and the ratio of carbon to nitrogen (C/N) were determined using an elemental analyzer . The soil organic matter (SOM) was measured using the dichromate oxidation method . There was no significant difference in bacterial richness between the HR and UR samples and between the US and UL samples, which showed the lowest bacterial richness (P < 0.01). Bacterial evenness was lowest in the root and UL samples (P. bungeana plants was significantly higher than that of the other samples (P < 0.01). The bacterial diversity was lowest in the US, UL, and all root samples . In addition, there were no significant differences in the endophytic fungal communities in the roots of P. bungeana at two different health conditions, in different tissue niches (P > 0.05). The richness of the OTUs of the HS and HL samples was significantly higher than that of other samples (P < 0.01), whereas that of the HFRS, UFRS, HRS, and URS samples was substantially higher than that of the root samples (P < 0.01). There was no noticeable difference in the richness of the OTUs among all the root samples and among the UL, US, and UL samples (P < 0.01) (P < 0.01), and there were no significant differences in the fungal diversity among all the root samples and the US and UL samples  . The fun samples .P. bungeana were distinguishable, regardless of the health status of the plants. In addition, the US and UL microbial communities were separated from those of the other samples at the OTU and class levels, while the microbial communities in the HFRS, UFRS, HRS, URS, HS, and HL samples were indistinguishable. PC1 and PC2 explained 41.56 and 19.62%, respectively, of the total bacterial variation at the OTU level  revealed general similarities in the structures of bacterial and fungal communities among the samples . The micTU level . PC1 andTU level . HierarcTU level .P. bungeana under different health statuses (P. bungeana was different. The abundance of Actinobacteria was the highest in HR samples (55.95%) and lowest in UR samples (4.27%), while Bacteroidota was the most abundant phylum in all the samples. The abundance of Chloroflexi was higher in the HS (7.00%) and HL (10.26%) samples than in the other samples, while Proteobacteria was the most abundant phyla in the US (55.49%) and UL (79.41%) samples. Of the 80 bacterial classes, Alphaproteobacteria, Actinobacteria, Gammaproteobacteria, and Thermoleophilia had a higher abundance, accounting for more than 60% of the total bacteria. Alphaproteobacteria  and Actinobacteria  were the dominant bacterial classes in the roots. Thermoleophilia was the most dominant in the stems (HS = 22.79%) and leaves (HL = 25.07%) of healthy P. bungeana plants  and the niches in the different compartments  of statuses . Proteoba plants .P. bungeana  and Glomeromycota (3.41%) was higher in the UR samples than in the HR samples, and the abundance of Mortierellomycota was higher in the HS and HL samples than in the other tissues. The abundance of Mortierellomycota (25.12%) was highest in the HL samples. Basidiomycota was the most dominant phylum in the UL samples (68.39%). The differences among the bulk soil samples were insignificant at the class level (P > 0.05). Sordariomycetes, Dothideomycetes, and Eurotiomycetes were the main fungal communities   were shared among the five samples of healthy  tissues . Unique (10.38%) . Unique (10.38%) –E.P. bungeana tissues  were shared among the five samples of healthy  tissues . Unique a plants . Specifia plants –J.P. bungeana at different health conditions was significantly higher than that in the other samples (P < 0.01).The heatmap  and resuBradyrhizobium sp., and Hyphomicrobiaceae were enriched in the UR sample. Gaiellales (from order to genus) was enriched in the HS sample. The enriched bacteria in the US samples were Frankiales, Micrococcales, Acetobacterales , Propionibacteriales, Friedmanniella, Sphingomonas, Oxalobacteraceae, and Armatimonadota . Acidimicrobiia, Thermoleophilia (from class to genus), Tistrellales (from order to genus), and Chloroflexi (from phylum to genus) were enriched in the HL samples. Proteobacteria (from phylum to genus), Corynebacteriales (from order to family), and Myxococcaceae (from class to family) were enriched in the UR samples. Pleosporaceae, Gibberella, Stachybotryaceae, and Aspergillaceae were significantly enriched in the HFRS samples  were significantly enriched in the HRS samples. Hypocreales (from order to family) and Agaricomycetes (from class to order) were significantly enriched in the URS samples, while Ascomycota (from phylum to genus) was significantly enriched in the HR samples. A total of four groups of fungi, namely, Setophoma, Leotiomycetes (from class to order), Helotiales, and Exophiala were significantly enriched in the UR samples. Eurotiales (from order to family) was significantly enriched in the HS samples. Trichomeriaceae and unclassified_p_Ascomycota (from class to genus) were significantly enriched in the US samples. Chaetomiaceae and Mortierellomycota (from phylum to genus) were significantly enriched in the HL samples, while Tremellomycetes (from class to order) and Cystobasidiomycetes (from class to genus) were significantly enriched in the UL samples.LEfSe analyses revealed differences in the composition of the microbial communities in the different plant compartments among healthy and unhealthy plants. Analyses of the bacterial composition revealed that Acidobacteriota was significantly enriched in the HFRS sample . Nocardi samples , while eP. bungeana plants ranged from 8.08 to 8.19, indicating that all the tested soils were alkaline. The SOM, TN, TK, and TP contents in the soil of P. bungeana were at medium levels, according to China Soil Standard protocols for forest regions . The rhizospheric soil of healthy P. bungeana plants had the highest TC content (15.37 g/kg), while the rhizospheric soil of unhealthy P. bungeana had the highest C/N (27.33), and the WC levels were approximately 10 g/kg in the rhizospheric and bulk soils of both healthy and unhealthy P. bungeana plants , and that the bacterial community structure was significantly affected by the SOM content (P < 0.01). However, the TN, TP, TK, and TC had no significant effect on microbial community structures in the rhizospheric and bulk soils of healthy and unhealthy P. bungeana plants  and niches in different plant compartments , with the aim of elucidating the changes in the related microbial communities of trees at different health conditions. The results can provide important insights for preserving the health and promoting the sustainable development of this tree species in plantation forests.In this study, the endangered conifer species, P. bungeana plants was significantly higher than that in the roots of both healthy and unhealthy P. bungeana plants and in the stems and leaves of unhealthy P. bungeana plants. By contrast, there were no significant differences in the bacterial diversity among the rhizospheric soil (HRS and URS), bulk soil (HFRS and UFRS), HS, and HL samples. Fungal abundance in the HS and HL samples was higher than that in the soil (bulk and rhizospheric soil), root (UR and HR), US, and UL samples. The microbial communities in the US and UL samples differed significantly from those of the other samples. The majority of endophytic microorganisms in the HS and HL samples could have been derived from rainwater, air, insects, or the spread of hyphae or spores, in comparison to the microbial communities in the bulk and rhizospheric soil samples and other plant compartments . In addition, the majority of root endophytic communities are derived from the rhizospheric soil and may have experienced strict biological tissue selection prior to colonization in the roots  analysis revealed that the top 20% of fungal genera characterized in healthy plants showed no significant negative interactions . Howeverrelation . The endtans sp. , along wrpon sp. , and othP. bungeana plants selected in this study ranged from 2 to 3 years. Owing to the short period of forest establishment, the plant tissues and the microbial community of the local forest soil are immature, and most of the microorganisms in the tissues may have originated from the caulosphere, phyllosphere, or anthosphere , and niches in the different compartments  of P. bungeana could be attributed to a “top-down” disease, such as needle cast, brown blotch, or Hypoderma desmazieri Duby, suggesting that quarantine and management strategies should be strengthened, combined with biochemical control measures for eliminating pathogens.A number of fungal OTUs shared by all samples from healthy plants were significantly higher than those of unhealthy plants, indicating that the health conditions of the plants had a pronounced effect on the fungal community. Furthermore, few fungal OTUs were shared among the samples collected from the aboveground sites (stems and leaves), while the fungal OTUs in the samples obtained from underground parts  were similar. It is, therefore, speculated that the illness of P. bungeana plants, suggesting that the soils and plant niches are linked in terms of microbial transmission. Microbes also have a certain amount of tolerance and are able to grow and reproduce in different environments, including the phyllosphere, stems, and other compartments. Owing to their high tolerance potential or the need for niche overlap, soil microflora are capable of co-existing in aboveground tissues to a greater extent , or the bacteria may produce siderophores for binding environmental Fe3+ for improving nutrient absorption, thereby promoting healthy growth  and could be related to air transport and root “block”  samples and niches in the different compartments  of healthy and unhealthy P. bungeana plants and were probably vertically transmitted, indicating species conservatism to a certain degree  that is highly effective against the opportunistic fungal pathogen Cryptococcus neoformans and probably protects the health of the plant , which together protected the plant from internal and external stressors via several unknown functional traits.Ascomycota, Basidiomycota, and Mortierellomycota were the dominant fungal phyla in the soil (bulk and rhizospheric soil), and niches in different plant compartments  of healthy and unhealthy P. bungeana plants could allow the invasion of pathogenic fungi, including St. sp. and Pestalotiopsis sp., resulting in the development of resistance to other groups of microorganisms.The microbial diversity and abundance were lowest in the roots, which could be related to the source of endophytic microbes and their growth and expansion. A large number of microorganisms in the soil and rhizosphere were challenged during entry into roots owing to the barrier effect. By contrast, there were abundant microorganisms in the stems and leaves due to the invasion of aerial spores  and pH (P < 0.05). The soil WC was closely related to the expression of certain functional genes of the microbes . SOM is an important soil fertility index, providing crops with required substances and improving the physical and chemical conditions of soils. It is one of the most important soil nutrients that can directly affect the soil structure, air permeability, and other properties. The SOM content was significantly positively correlated with the improvement in microbial activity and developmental potential  of healthy P. bungeana plants was much higher than that of the unhealthy plants. By contrast, there were almost no differences in the richness of the microbial communities in the underground parts , suggesting that the possible cause of illness was transmitted in a “top- down” manner in unhealthy plants. Altogether, the results provided a scientific basis for further studies on the mechanism of the “aboveground–underground” microbial interactions, which can aid in promoting the healthy and sustainable development of the Millennium Xiulin forest in the Xiong'an New Area.This study highlighted the fundamental effects of the health status of https://www.ncbi.nlm.nih.gov/, PRJNA821431; https://www.ncbi.nlm.nih.gov/, PRJNA821418.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: JY: writing—original draft. JY, HL, YG, and AM: methodology, software, data curation, and validation. CW and MW: soil sampling and experiment. ZY and JL: conceptualization, supervision, funding acquisition, and review and editing. All authors contributed to the article and approved the submitted version.This study was supported by the Hebei Science and Technology Innovation Base Project (216Z2903G), the National Key Research and Development Project of China (2018YFC0506900), the National Natural Science Foundation of China (31672365), the National Natural Science Foundation of China (42071257), and the Postgraduate Innovation Foundation of Hebei (CXZZBS2022071).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


To compare the assessment of entheses in subjects with spondyloarthritis (SpA) with patients with gout by the Madrid Sonographic Enthesis Index (MASEI).t-test. An inter-reading US reliability was realized.This cross-sectional study includes videos of entheses evaluated by ultrasound (US) of 30 patients with SpA diagnosed according to the ASAS criteria and 30 patients with gout established by the presence of monosodium urate crystals. Entheses were evaluated for MASEI in 2 Institutes located in two different countries. Demographic and clinical data were registered. Total MASEI score, MASEI-inflammatory, and MASEI-chronic damage were analyzed. Comparisons between groups were obtained by chi-square test and Student's p = 0.07). MASEI-inflammatory was significantly more prevalent at the Achilles tendon in SpA, while the proximal patellar tendon was in gout. Power Doppler was higher in SpA compared to gout (p = 0.005). MASEI-chronic damage related to calcification/enthesophytes predominated in gout (p = 0.043), while calcaneal erosions did in SpA (p = 0.008). The inter-reader concordance was excellent .Patients with gout were older and had significantly more comorbidities than those with SpA. The total MASEI score was not significantly different among diseases (SpA and gout similarly involve entheses according to MASE, however, some inflammatory and chronic lesions differ significantly depending on the underlying disease and tendon scanned. In patients with spondyloarthritis (SpA), enthesitis is one of the cornerstones of the etiopathogenesis of the disease . In axiaOn the other hand, gout is another inflammatory disease that also affects the entheses –15. SeveThis is a cross-sectional and observational study conducted in México and Argentina. Videos of consecutive patients who were sent to realize MASEI from two rheumatology outpatient clinics to ultrasound units at the National Rehabilitation Institute in México and one rheumatology clinic to the Institute of Psychophysical Rehabilitation in Argentina. The study was approved by the local ethical committee, approval number 10/17, and conducted according to the Declaration of Helsinki. All participants gave written informed consent before realizing the US evaluation.We included videos of 30 consecutive patients with axial or peripheral SpA according to the Assessment of Spondyloarthritis International Society (ASAS) classification criteria were included. Also, videos of 30 patients with gout with diagnosis established by the presence of monosodium urate crystals in synovial fluid or tophus were assessed. The diagnosis of all patients was established by the physician who referred the patients to the ultrasound units. All patients with gout were in an inter-critical period clinically. Patients with gout and psoriasis or inflammatory bowel disease were excluded. Patients who had received oral or injected corticosteroids within 4 weeks before inclusion in the study were also excluded. Demographic data such as age, gender, disease evolution time, comorbidities, and current treatment were recorded. BASDAI, BASFI, BASMI, and MASES were assessed in the case of SpA patients. Entheseal involvement was not an inclusion criterion in none of the diseases.® equipment with a 7.5–12 MHz multifrequency linear probe. The vascularization was assessed using PD adjusted with a PRF of 500 Hz and gain from 50 to 55 dB.The videos were obtained and recorded by 2 rheumatologist ultrasonographers (both with more than 10 years of experience), one in each ultrasound unit. The ultrasonographers were blinded to the clinical characteristics of the patients. The videos were recorded. Once all the videos were recorded, they were evaluated by the 5 readers. Triceps brachial, quadriceps tendon, proximal and distal patellar tendon, Achilles tendon, and proximal plantar fascia insertions were evaluated bilaterally, and each enthesis was scanned in longitudinal and transverse planes. The triceps enthesis was examined with the elbow flexed at 90°. Knee entheses evaluation was performed with the patient in supine position and knee flexed at 70° for grayscale and extended for power Doppler (PD). Achilles tendon and plantar fascia were evaluated with the patient in a prone position and their foot flexed at 90°. The US evaluation was blinded and realized independently of the pathology. We used two Esaote MyLab 70According to MASEI, the following lesions were evaluated: pathologic structural change and thickening of the tendon at the site of insertion, calcification/enthesophyte, bursitis, bone erosion, and PD signal. The pathologic structural change was defined as a loss of a fibrillar pattern, hypoechoic appearance, or fusiform thickening; the following criteria were used for abnormal structure thickness: quadriceps tendon thickness >6.1 mm, proximal and distal patellar tendon >4.0 mm, Achilles tendon >5.29 mm, and plantar fascia >4.4 mm. Bone erosion was defined as cortical breakage with bone contour defects in 2 perpendicular planes. Calcification/enthesophyte was scored 0 if absent, 1 for small calcification or ossification with an irregularity of cortical bone, 2 if a clear presence of enthesophytes , or if medium-sized calcifications or ossification were seen and 3 for large calcifications or ossifications . Accordit-test was used to contrast the total MASEI scores between groups. To analyze inter-reader agreement for continuous data we used intraclass correlation coefficient (ICC) with a 95% confidence interval. A p < 0.05 was considered statistically significant. Statistical analysis was performed in SPSS for Windows version 22.Continuous data are described as the mean and standard deviation and categorical variables were expressed as frequencies and percentages. The normality of the continuous variables was probed by the Shapiro-Wilk test. The chi-square distribution was applied to compare categorical variables between groups. The student's Clinical and demographic characteristics are shown in p = 0.001).Inter-reader agreement for total MASEI score was excellent  mice developed chronic enthesitis accompanied by massive enthesophytes by resonance magnetic imaging (In MASEI-chronic damage, the calcifications/enthesophytes were most frequently demonstrated in gout like the other study . It is p imaging . In addi imaging .The total MASEI score was higher in SpA than gout but there were no significant differences. According to the original study, 18 points would be the best cut-off point to differentiate patients with SpA from controls . HoweverFinally, the inter-reading concordance was excellent. The performance of inter-reader exercise has a great influence to improve reliability and our group has carried out this type of exercise periodically , 39. TheOne of the main limitations of our study was a relatively low number of patients, however, 720 entheses is a good number to consider. Another limitation was the age difference which was greater in the gout group; a bias that is difficult to correct given that patients with gout start their disease later. This condition probably accounts for a higher frequency of calcifications in the gout group, however, for the analysis of differences between groups we are not exclusively based on this lesion. Another constraint is that all patients with gout were receiving hypouricemic treatment and more than 40% of the SpA group were receiving immunosuppressive therapy and just over 20% biological therapy, conditions that could reduce the presence of PD in the entheses. Another weakness of the study is that we did not record the physical activity of the patients because it has been described those individuals with a greater demand for physical activity develop more structural and inflammatory changes in entheses. Additionally, the comorbidities observed in patients with gout could have contributed to the entheseal condition. All the same, one of the strengths of the study is that it includes a binational multicenter sample and patients were of real life.The total MASEI could not discriminate between SpA and gout, however, some inflammatory and chronic lesions differ significantly depending on the underlying disease and tendon explored. In the Achilles tendon, this index shows the ability to differentiate SpA from gout due to having a higher prevalence of structural change, thickness, bursitis, erosions, and PD signal. Gout induces the development of calcifications/enthesophytes which increases the total index. Entheseal involvement in gout is almost as frequent as in SpA, therefore its evaluation is necessary.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.The studies involving human participants were reviewed and approved by Research Committee of the National Institute of Rehabilitation. The patients/participants provided their written informed consent to participate in this study.LV-R and EM contributed to study conception, design, data collection, and manuscript drafting. CH-D, TC, SG-N, CG-R, MR, KS-L, PR-H, JV-M, and JC-V participated in data collection and manuscript drafting. EC-A contributed to statistical analysis. All authors read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Little is known about the Quality of Life (QoL) and how QoL is related to the social and economic situation of people with mobility-related disabilities in Sweden. QoL and well-being do not only relate to the absence of impairments but also to the level of social inclusion and the economic situation. The objective of this study was to explore if there were differences in QoL between a group with and a group without mobility-related disabilities in Sweden. Cross-sectional data were collected through self-reported questionnaires. WHOQOL-BREF was used to assess QoL. Recruitment was conducted through social media platforms. Comparisons were made between and within groups using the Welch t-test. Generalized linear models were used to predict score change for the WHOQOL-BREF items and domains accounting for sex, age, education, social inclusion, economic situation, and presence of additional or other disability. Included in the analysis was data from 381 participants, 143 with mobility-related disabilities and 238 without. Participants in the mobility-related disability group scored significantly lower than those without on General Health, General QoL, Health Satisfaction, and the four WHOQOL-BREF domains. The group with mobility-related disabilities also reported a lower Social Inclusion Score (SIS) and a higher proportion of people without a cash margin. An increased SIS indicated higher QoL in the generalized linear model, whereas the absence of cash margin and mobility-related disability negatively influenced the QoL scores. This study indicated that a person with mobility-related disabilities has lower QoL than those without mobility-related disabilities. A lower QoL was also related to a lack of cash margin, a lower social inclusion score, and whether there were additional or other disabilities present. Disability, in general, is a part of the human experience, and all of us will be temporarily or permanently impaired at some point in our life . A persoPeople facing impairments and disabilities are a diverse group often found among the least privileged groups ,5,6. To Disability and poverty are causes and consequences of each other. There is a bidirectional relationship ,8. For pSocial exclusion is associated with low access to fundamental opportunities and social and political participation and directly impacts poverty levels for people with disabilities and their families. Social exclusion is also related to social justice and how minority groups do not have the same opportunities and are discriminated against accessing services, affecting their well-being and QoL . AutonomIn assessing SDG3 achievements, Sweden, Denmark, and the Netherlands ranked as the best countries in the EU between 2010 and 2019. Several indicators were assessed, including healthy life years (HLY), the share of people with good or very good perceived health, smoking prevalence, standardized death rate , standardized preventable and treatable mortality, self-reported unmet need for medical examination and care, obesity rate, people killed in accidents at work, road traffic deaths, noise- and air pollution . DespiteQuality of Life is a marker for understanding a population’s general health and satisfaction. The World Health Organization (WHO) defined health in 1948 as ‘a state of complete physical, mental and social well-being, not merely the absence of disease and impairments’ . With thLittle is known about the QoL and how QoL is influenced by the social and economic situation of people with mobility-related disabilities in Sweden. Only a few studies on mobility-related disability and QoL in the Swedish context have been published within the last ten years ,21,22,23Therefore, the study’s objective was to explore if there were differences in QoL between a group with and without mobility-related disabilities in Sweden. Primary research questions were to assess if there were differences in General Health, General QoL, Health Satisfaction, and the four QoL domains of the WHOQOL-BREF  between the groups. Secondary research questions were to explore if sex, age, level of education, economic situation, social inclusion, and the presence of additional or other than mobility-related disability predicted score change of the QoL items and domains of the WHOQOL-BREF.The study was a comparative cross-sectional study where data was collected in an electronic self-reported questionnaire. Recruitment followed a convenient sampling strategy, and data were collected from 14 February to 31 March 2022. Recruitment advertisement was announced and promoted on various Facebook and social media platforms and was repeated multiple times to increase the number of responses. The advertisement for participants had a link to an electronic platform, QuestionPro . It was possible to read detailed information about the study and find contact information to project management on the start page. Inclusion criteria for the study were: Age over 18 years, willingness and ability to consent to participation (filling in a self-reported questionnaire), and ability to fill in surveys in Swedish. No additional inclusion nor exclusion criteria were applied.This project was conducted following the ethical principles that have their origin in the Declaration of Helsinki  and furtThe questionnaire used for data collection consisted of three main parts, demography and background, Quality of Life assessment, and a section with questions assessing social inclusion and economic situation. The demographic information collected was sex, age, geographical area of residence and living arrangements, foreign heritage, civil status, level of education, employment status, and experience of mobility-related disabilities or other disabilities or impairments. The question relating to the presence of mobility-related disability divided the participants into two main groups for the main comparisons. I.e., having a self-reported mobility-related disability (MOBDIS) or not (No-MOBDIS). The World Health Organization Quality of Life assessment, abbreviated version (WHOQOL-BREF), addressed the QoL. It is a 26-item version of the WHOQOL-100. The WHOQOL was developed by WHO and had a global definition of QoL and measured the perceived effects of disease and health interventions on the individual’s QoL. The WHOQOL and WHOQOL-BREF have been field-tested and validated in multiple countries and contexts. The WHOQOL-BREF produces four domain scores: Physical Health, Psychological, Social relationship, and Environment. Additionally, three items are examined separately: an individual’s overall perception of QoL , their overall perception of their health satisfaction (HS), and a question about the current general health state (GH). Domain and item scores are scaled positively, i.e., each item is answered on a scale from 1 to 5, where a higher score denotes higher levels. The mean score of items within each domain was used to calculate the domain score . The domA Social Inclusion Score (SIS) was calculated to measure community inclusion and participation. SIS was based on seven questions deriving from community-based rehabilitation (CBR) indicators, covering interpersonal relationships and community participation, two domains important for understanding social inclusion . The CBRThe economic situation was assessed by an Economic Situation Score (ESS). This score was created for the study and consisted of five questions concerning lively hood and economic standing. The ESS is positively scaled and ranges between 5 and 25. Two of the questions in ESS originated from CBR indicators . One of In line with the manual of WHOQOL-BREF, statistics were calculated as means and standard deviations of domains and item scores . Datasets were included for analysis if they contained responses that fulfilled the requirements for calculating the WHOQOL-BREF domain scores, i.e., not more than one value was missing in each domain.A two-sided Welch t-test, an unequal variances t-test ,43, was Dependent variables were dichotomized to examine differences. Social inclusion (SIS) was dichotomized to ‘lower’ and ‘higher’ using the median as the value cut. The level of education was dichotomized to ≤12 years of school or >12 years. The individual’s cash margin availability (Yes or No) was used to dichotomize the study participants for comparisons of QoL based on their economic standing. As the variable responses were both continuous and binary, generalized linear models (GLM) were applied to predict score change for the WHOQOL-BREF items and domains ,45,46. OData analyses were made with the computer program ‘R’ version 4.1.3 . p-value less than 0.05 was considered significant. No adjustments were made to the level of significance for the multiple comparisons due to the exploratory design of the study [A he study ,49.The survey was initiated 470 times. Of those, 381 surveys were included for analyses. Eighty-nine were excluded from the analysis. Eighty-five did not have complete datasets for calculating WHOQOL-BREF scores. The incomplete surveys were a combination of on-lookers, i.e., consented but never started, and incomplete surveys. Four surveys were excluded from further analysis. One subject failed the inclusion criteria for age. Three subjects completed two survey rounds, and their last entry was excluded. One hundred forty-three participants reported mobility-related disabilities and were assigned to the group MOBDIS. The most reported reasons for mobility-related disability were chronic pain, neurological injury or disease, and muscular weaknesses. Two hundred thirty-eight participants reported no mobility-related disabilities, and they were assigned to the group No-MOBDIS. The age range for all participants was 20 to 94 years, with a total mean of 52 years. There were 317 female and 61 male participants. Three reported sex as ‘other’. Most of the participants had Swedish heritage. Both groups reported the civil status as ‘married/partner’ most frequently, but the No-MOBDIS group was proportionally larger. A higher proportion of the MOBDIS group reported living alone and reported a lower level of completed education.In the MOBDIS group, 66.4% reported the presence of additional permanent disabilities, with severe pain being the most frequent, followed by chronic diseases and reduced vision. In the No-MOBDIS group, 39.7% reported experiencing disabilities other than mobility-related disabilities. For the No-MOBDIS group, mental ill-health was most frequent, followed by reduced vision and chronic disease. p < 0.05) between the groups for sex, age, presence of other or additional disabilities, civil status, living situation, education, and cash margin. Additionally, there were statically significant differences at p < 0.001 level (Welch t-test (two-sided)) between the groups for SIS and ESS, where MOBDIS scored worse on all items/scores.There were statistically significant differences , Västragötaland (12.7%), Skåne (8.3%), and Östergötland (7%). Most participants in the No-MOBDIS group came from Jämtland/Härjedalen (18.8%), Västernorrland (16.5%), Västragötaland (14.3%), and Stockholm (13.9%).Scores were calculated for General Health (GH), General QoL, Health Satisfaction (HS), and the four domains of the WHOQOL-BREF . Additionally, scores were calculated for SIS and ESS. These scores were compared between the group of MOBDIS and No-MOBDIS. The same set of scores was also compared for the group subset for sex , dichotomized SIS, cash margin (yes or no), educational level (≤12 years or >12 years), and presence of other or additional disability (yes or no).p < 0.001, apart from the Social relationship domain, which was significant at p = 0.002 , dichotomized SIS (lower or higher), Cash margin (no or yes), Education (≤12 years or >12 years), and other/additional disability (yes or no). For the Psychological domain, the differences found remained for sex, education, and the existence of cash margin. In the Social domain, differences were found for sex, lower SIS, the existence of cash margin, and lower education. There were differences for all in the Environmental domain but not for the existence or not of other or additional disabilities . The highest General QoL score (4.26 ± 0.64) was found for No-MOBDIS in the dichotomized SIS higher group. The lowest General QoL score (2.59 ± 1.05) was found in MOBDIS with no cash margin .For within-group associations of both groups, there were statistically significant associations for dichotomized SIS, cash margin, and other/additional disability. The associations reflect those individuals with higher SIS, availability of cash margin, and no other/additional disability reported better mean scores for all items, indicating better perceived QoL  and the four domains of the WHOQOL-BREF . The results of the model are presented in n = 381), an increased SIS indicated higher scores for all items and domains (p ≤ 0.001). Group MOBDIS indicated a lower score for physical health and environmental domain and all items’ scores (p ≤ 0.001). Similar patterns were also seen for the additional/other disability question. Having an additional or other disability than mobility-related disability also had a negative predictive effect (p ≤ 0.001) on all items and all domain scores except the Social domain. The absence of a cash margin also seemed to negatively influence the GH, HS, Psychological domain, and Environment domain scores.Looking at the whole dataset , the scoring was even lower on the different QoL ratings. This finding is in line with previous literature from international studies reporting on lower QoL scores for groups with more or a more severe level of disabilities ,29,31,32Other studies have seen a relationship between QoL and education. Disability was more prevalent in those with lower education ,28, and In this study, the economic situation or absence of a cash margin revealed lower QoL scores for both groups in the within-group comparison. This is consistent with previous studies where lower economic status seems to influence the perceived QoL ,28,33,34Other studies have revealed mixed results for sex and Quality of Life. When comparing the QoL of females with disabilities to those without, primarily the physical QoL domain seems to be affected ,28. A siOther factors that seem to influence the perceived QoL were interaction and social engagement, where those with more social interaction and engagement reported better QoL ,25,33,34Cross-sectional data has design limitations and only reflects a point in time, as the exposure and outcome are simultaneously evaluated. Additionally, findings reflect correlational and not causal links . In thisIn this study, the WHOQOL-BREF was the primary assessment for QoL. The WHOQOL-BREF is a commonly used tool for QoL assessment and is often used interchangeably with the Medical Outcome Study SF-36 (SF-36). Both instruments are used in relation to mobility-related disabilities, such as lower limb amputation, spinal cord injuries, and cervical spondylotic myelopathy (CSM) ,55,56. HSocial media platforms are becoming more used in health promotion activities and recruitment for studies. Research in the US has shown little difference in the proportions of US adults who use these platforms based on education level, income, or developed environment , indicating that this type of recruitment could have a broad reach. Despite its advantages, there are some limitations to social media recruitment, including the need for internet access and the overrepresentation of women. Social media platform recruitment might introduce sampling bias ,58. ThisWith the open recruitment, the end range of the call’s reach for participants is unknown, as the recruitment call on social media platforms was shared multiple times. Therefore, it is difficult to say anything about the general survey response rate. Almost 18% of the initiated surveys were excluded from the data analysis due to incomplete data sets for WHOQOL-BREF score calculations. The non-complete data sets might be related to unwillingness to complete once started. Open recruitment also attracts “on-lookers”, i.e., persons who might be curious about the survey but have no intention of completing or even taking the survey. This study used a self-report questionnaire, which could lead to response bias. As this was an online survey, there was no control for if a respondent indeed had a mobility-related disability or not. It is unlikely that people misrepresent themselves in the survey, as there is no gain for the individual to score higher or lower than their perception of reality.The scores used for assessing social inclusion, SIS, and economic standing, ESS, originated from CBR indicators. There are no validated Swedish versions of the CBR Indicators to the current date. The authors of this article did a translation. The validation of the translation was not within the scope of this project. As the origin of the CBR Indicators came from WHO, the general terms and concepts were similarly phrased to other WHO questionnaires validated for Swedish. Those questionnaires were used as guidance for terminology when translating the CBR indicators. The ESS, used to assess the economic standing, is not a validated instrument but rather questions from different contexts. The questions cover different areas of economic terms that are part of other instruments like the CBR indicators. The utilization of the cash margin as a variable for the economic standing is used in other censuses, for example, Statistics Sweden.The decision to use 0.05 as the level of significance and not adjust that level for the multiple comparisons might introduce the risk of multiplicity. Results must be interpreted with this in mind. Still, the overall risk of multiplicity in these study results is considered low as most of the differences detected were at a significance level of 0.001 or lower. Furthermore, as this study was exploratory, there is no recommendation that adjustments for multiple comparisons are needed .Despite limitations in the cross-sectional design to identify causal links as well as a risk for sampling bias, the result provides valuable explorative information that may guide future research on the topic. This study suggests an association between disability and QoL, showing that people with mobility-related disabilities have lower QoL than those without mobility-related disabilities. QoL was also related to lack of cash margin, a lower social inclusion score, and if there were additional or other disabilities present. Poverty and disability have a known bidirectional relationship. In. addition, this study performed in the welfare state of Sweden, the presence of a disability and a lower economic standing had a negative impact on QoL. Therefore, it is crucial to consider both aspects and facilitate social inclusion for better health equity. In any health promotion and community development-related work, and any related future studies, it is essential to understand and account for the causality, complexity, and relations of economy, social inclusion, and health conditions, even in a high-income country, to improve the health equity and Quality of Life among groups.


The social distancing policies implemented by the health authorities during the COVID-19 pandemic in Mexico and elsewhere led to major changes in teaching strategies for college undergraduates. So far, there is limited data regarding the impact of the lockdown on the academic stress and mental health of these students.To assess the occurrence of academic difficulties, anxiety, depression, and academic stressors resulting in somatization with subsequent coping strategies linked to the pandemic.A cross-sectional study was conducted with 728 medical students (years 1–5). A purposely designed questionnaire to assess academic difficulties associated with the pandemic was administered electronically. The validated Goldberg anxiety and depression scale was also used, as well as the SISCO-II inventory on academic stress.p < 0.001). Somatization symptomatology included drowsiness or increased need of sleep, anxiety, anguish, desperation, chronic fatigue, and sleep disorders. Common coping strategies included practicing a hobby, done always or nearly always by 65% of students with high stress, and 34% of those with low stress (p < 0.001).Screening for anxiety and depression led to a prevalence of 67.9 and 81.3%, respectively. Most relevant stressors, reported always or nearly always, included professors’ evaluations (63.9%), and reading overload of academic papers (50.6%). Factorial analyses showed that women were more prone to stress than men (There was a relevant impact of the mandatory lockdown during COVID-19 pandemic on the mental health of medical students reflected in the high prevalence rates of anxiety, depression, and stressors in the studied population pointing to the need for designing and implementing preventive strategies to deal with the effects of lockdowns. It appeared in December 2019 in Wuhan, Hubei province of China, and since then it spread rapidly throughout the world .As to December 2022, the pandemic has caused more than 6.62 million deaths, and it has had a major economic impact coupled with a transformation of the daily life everywhere . The socAmong students of medicine and other academic tracks, stress  is an important concern , whereasStress affects the lives of many people’s around the world, and it is linked to the psychopathology of various health conditions, and to their inability to adapt to challenging social environments . StressfAdditionally, many university students experience academic stress associated with educational activities  and financial difficulties that have an impact on their learning performance . StudentMedical students are particularly prone to high levels of stress and psychological disorders such as anxiety and depression . StudiesThe social distancing policies implemented by the government and health authorities during the COVID-19 pandemic in Mexico and many other countries led to major changes in teaching strategies, including those for medical students, with internet-based learning becoming the cornerstone of these efforts for more than a year. However, so far there is limited data on what has been the impact of the lockdown on the mental health and academic stress in these medical students. Therefore, this study was undertaken to assess the occurrence of academic difficulties, anxiety, depression, and academic stressors that resulted in somatization and coping strategies linked to the pandemic in medical students from a Mexican university. The study proposal was reviewed and approved by the Ethics and Research Committee at the Academic Unit of Human Medicine and Health Sciences of the Autonomous University of Zacatecas . All participant students provided signed informed consent.2.2.1.This was a cross-sectional study conducted with 728 medical students out of the 928 registered at the Autonomous University of Zacatecas, in the homonymous State in the Central Northern region of Mexico. Male and female students from years 1 to 5 were surveyed. At the time of the survey (early Spring 2021), internet-based learning was the educational modality due to the compulsory lockdown.2.2.2.2.1.This was a purposely designed tool that contained basic sociodemographic data and a number of questions assessing academic difficulties potentially linked to the COVID-19 pandemic.2.2.2.This screening tool consists of two subscales, one for anxiety and the other for depression, each with nine items with dichotomous responses . An indeThe validity and reliability of the Goldberg anxiety and depression scale has been assessed in two Spanish speaking Latin American countries; one with a sample of 548 Cuban adults that showed a good diagnostic performance  , and ano2.2.3.This instrument contains eight questions that assess academic stressors , and another 17 items that measure physical, psychological, and social behavior reactions  in response to academic stress . An additional six questions measure coping strategies  with five possible answers each using a Likert scale  were part of the instrument.The SISCO-II inventory of academic stress has been considered valid and reliable scale for diagnostic use. It was designed and tested in Mexico showing good reliability  . It has 2.3.Students were sent a link where they could access the webpage to participate in the survey, which lasted between 15 and 20 min. Students were sent a reminder email one week after the first contact. All questionnaires were administered electronically using “Google forms.” Participants had to provide informed consent in the first page of the survey to be able to continue. Data was collected anonymously in March 2021. Overall participation rate was 76.1% (728/956), but for the SISCO-II inventory it was 44% (421/956). No data were available for the reasons for not responding.2.4.Percentages were used to describe issues and problems associated with the online teaching modality during the pandemic. Overall prevalence of anxiety and depression was also computed with results stratified by sex an age. Density analysis was used to graph the most frequent responses. An exploratory analysis relating anxiety and depression was done, as these psychiatric illnesses are known to be highly comorbid with each other .2, VSS complexity 1, Velicer’s MAP, TLI, RMSEA, optimal coordinates, parallel analysis, and Kaiser criterion); factors were used to assess whether there were significant differences between clusters based on symptomatology. Correlations between stressors were done using Kendall rank correlation coefficients; item dependency was considered statistically significant with p values below 0.05.Percentages were used to present the response level for the SISCO-II inventory. Clusters were produced to stratify the population based on the stressors assessed. Responses obtained for each stressor were assessed by K-means. Also, an exploratory factorial analysis was used to reduce the number of variables included in the instrument using various methods  were men and 427 women (58.7%). Most students (96%) were aged 18–24 years; differences in sex for grade was not significant  and depression , but no statistical differences were seen by age  showed a Pearson coefficient of 0.529 , and another with high stress , but no statistical differences were observed by mean age  by response level in groups 1 (low stress) and 2 (high stress) is shown in p < 0.01), except for the cratching, nail biting, rubbing, etc. and Unwillingness to perform student duties items.According to sex, the distribution of response level in somatization, we found significant differences in most of the items (3.5.p < 0.001), followed “getting company by a loved one” with 56 and 34% (p < 0.001), respectively. No statistical differences in responses between groups 1 and 2 were seen for strategies such as “ventilation and confidences,” “complimenting oneself,” and “assertive ability.”According to sex, the distribution of the level of response in the strategies, we did not find significant differences in any of the items.4.This study was carried out to assess the presence of academic difficulties, anxiety and depression, and academic stressors that result in somatization and coping strategies linked to the COVID-19 pandemic in medical students in a Mexican university.Stress, in general, is a complex multifactorial process that can result in somatic symptomatology, including gastrointestinal problems, insomnia, insulin resistance and overweight/obesity, as well as adaptative disorders, memory alterations, and depression, among others . When stAcademic stress has been widely linked to several negative effects on academic performance, school homework, exams, and learning.Nearly one out of three students reported difficulties with internet connectivity as the main problem linked to the learning modality, and one in five said that the lack of clinical practice was the main concern. Lack of motivation (24%), concentration (18%), and clinical practice (17%) were the most common academic performance concerns.Research has shown disproportionally higher levels of stress, anxiety, and depression among medical students compared to nonmedical undergraduates . The incScreening for anxiety and depression resulted in an overall prevalence of 68 and 81%, respectively. Results also showed sex differences for both anxiety and depression with higher proportions in women. These results come from data collected in March 2021, right after the second wave of the pandemic, when mortality was at its highest levels. During this period, strict social distancing measures were in place, leading to complete online teaching in all educational system. However, it is important to consider that even before the COVID-19 pandemic, medical students already had relatively high levels of stress and depression . A meta-Whether the COVID-19 pandemic has resulted in higher incidence of anxiety and depression is still a contentious topic. For instance, a recent review concluded that the overall prevalence of anxiety in medical students did not increase with the outbreak, as high levels of resilience and healthy coping systems were put in place along with a reduction of academic load together with available family support . ConversMost relevant stressors, reported as always/nearly always, included professors’ evaluations (63.9%), and reading overload of academic papers (50.6%). Other stressors previously reported include poor academic performance , excessiSomatization resulting from of academic stress was higher in the group with high stress especially for drowsiness or increased need for sleep, anxiety, anguish, or desperation, chronic fatigue, and sleep disorders. An earlier study reported that early closure of academic institutions due to COVID-19 resulted in various psychological issues such as lack of sleep, need of emotional and mental support, and the search for social interactions .Recent research on the psychological impact of the COVID-19 pandemic showed that individuals working in the clinical field had higher stress scores , yet lesIn many settings, including the Mexican, medical students usually live in a high-stress environment, due in part to a rigid system that promotes competition. Thus, the COVID-19 pandemic seemed to aggravate this situation by adding new stress factors, including the concern and fear to the infection to oneself and relatives, and by limiting the benefits to engage in activities such as exercise and social interactions that would have reduced the stress; as a result, the lockdown and social distancing measures have led to radical lifestyle changes that took place in a very short period of time .This study found that the most common coping strategies included practicing a hobby, done always/nearly always by 65% of those with high stress and 34% of those with low stress, followed by getting company of a loved one . Previous research on coping strategies among preclinical medical students highlight personal engagement, positive reinterpretation and expression of emotion, support programs delivered by senior students and extracurricular activities  as valuable mechanisms to reduce anxiety, stress, and burnout . Other e5.The results presented here reflect the impact of the prolonged COVID-19 pandemic in terms of the academic performance, occurrence of anxiety and depression, and stressors among medical students potentially linked to the lockdown accompanied with internet-based learning modality. Therefore, it is important to design and implement preventive strategies to deal with the effects of the online learning modality used during the COVID-19 lockdown.5.1.An important limitation relates to the observational design used which make it difficult to determine whether the COVID-19 pandemic could be indeed associated with the observed outcomes. Another limitation was the use of a non-probabilistic sample, and the fact that even in this sample selection bias is still a potential issue, as response rate went down to 76.1% for the Goldberg scale and to 44% for the SISCO-II inventory. Since reasons for not responding were not obtained, it was not possible to run a non-response analysis to compare participants and non-participants to speculate on the possible direction of the bias.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.via “Google forms.” Participants had to give informed consent in the first page of the questionnaire to be able to proceed with the survey. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Unidad Académica de Medicina Humana y C.S at Universidad Autónoma de Zacatecas .Participation was voluntary. The questionnaire was administered LA-C and MM-F conceptualization. LA-C and DD-A methodology. PV-E, SV-R, JS-G, and AM-G software. AR-L, JM-E, and IG-V validation. AR-L and JM-E formal analysis. AR-L and LA-C data curation and visualization. LA-C and DD-A writing—original draft preparation. JM-E, IG-V, JS-G, and MM-F writing—review and editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The low incidence of diseases such as celiac, anemia, osteoporosis, and obesity in Ethiopia has aroused interest in the study of teff. The primary objective of this study was to determine the effect of regular consumption of teff seeds on hematological findings and anthropometric measurements in overweight and obese individuals. The secondary objective was to compare these effects of teff seeds with the Mediterranean diet.In our study, planned as a cohort study, 28 participants followed the teff seed-containing diet (n=14) and the Mediterranean diet (n=14) for 3 months. To determine nutritional status, a 72-h recall was taken. Anthropometric measurements and hematological findings were recorded at the beginning and end of the study.There was a significant decrease in fasting blood glucose, cholesterol, LDL, and HDL levels in the teff group (p<0.05). The increase in total protein levels in the teff group was significantly higher than in the Mediterranean diet group (p=0.05). With increased intake of carbohydrates (g) in the teff group, fasting blood glucose levels decreased significantly. There was no significant difference between the two groups regarding anthropometric measurements.It has been found that the teff seed has no predominance over anthropometric measurements, as compared to the Mediterranean diet, and that it is more effective in improving hematological findings related to obesity. There is a need for more comprehensive studies that also address physical activity, the different types of teff seeds available, and include increased participant numbers. Teff seed, including white, red, and brown varieties, is of Ethiopian origin and is the smallest among agricultural grains ,2. The cGiven these contents, it is thought that teff seed may effectively improve obesity. Obesity is a major public health problem associated with increased mortality and morbidity. Obesity increases the risk of arterial hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, cerebral vasculopathy, gallbladder stones, arthropathy, polycystic ovary syndrome, sleep apnea syndrome, and some neoplasms .In Ethiopia, 70% of human nutrition comes from teff seeds. The low incidence of diseases such as celiac, anemia, osteoporosis, and obesity in Ethiopia has generated research interest in teff . AlthougThe Mediterranean diet is one of the nutritional models applied to prevent obesity and obesity-related diseases. It includes low-glycemic index carbohydrates, high amounts of dietary fiber, antioxidants, polyunsaturated fatty acids, and plant-based proteins and is characterized by intake of w-3 and w-6 fatty acids at a balanced rate. Thanks to these properties, it protects against obesity and obesity .The primary objective of this study was to determine the effect of regular consumption of teff seeds on hematological findings and anthropometric measurements in slightly fat and obese individuals. The secondary objective was to compare these effects of teff seeds with the Mediterranean diet.Place of study, time, and sampling selection: The study was conducted between October and December 2021, with 28 individuals without chronic diseases, aged between 18 and 55 years. The study consisted of female individuals, and the mean age of the participants was 37.0±12.8 years. This study was approved by the Ethics Committee for Non-Interventional Clinical Studies at Istanbul Medipol University (E-10840098-772.02-5236). After the participants were given the necessary information, participants signed a voluntary consent form.Data collection and evaluation: The survey, which questioned the demographic data, was implemented by face-to-face interview. Body Mass Indexes (BMI) of the participants included in the study was in the range of 25–34.9 kg/m2.According to their diet content, the participants were divided into two groups: the teff seed diet (n=14) and the Mediterranean diet group (n=14). For the participants in both groups, isocaloric diets were planned. They were asked to continue their diet programs for 3 months. After each participant's daily energy requirement was specified by the Schofield equation, the diets were calculated to percentages of energy from carbohydrates 50–60%), protein (15–20%), and fat (25–30%). The daily amount of teff seeds (brown) was determined at 20 g 0%, prote,8 based 2) was calculated from weight and height measurements. The researcher measured length, body weight, waist, hips, and upper-middle arm circumference at the beginning and end of the study. The length was measured with Harpenden Stadiometer, without shoes, heels touching each other, feet open 45°, arms flap to side, while the head was in the Frankfort plane. The values were taken in centimeters. Body weights were measured without shoes using a standard weighing tool sensitive to 100 g. The values were taken in kilograms. The waist circumference was measured by the researcher while standing, with the help of an elastic tape in a plane parallel to the floor, while there was a minimum of clothes on the participant.BMI  developed for Turkey .Statistical analysis: For statistical evaluation of the data obtained, a database was created in IBM SPSS Statistics for Windows . The average deviation was presented for descriptive statistics and continuous data, and numeric values and percentage rates were presented for categorical data.Consistency of continuous data to normal distribution was investigated in statistical comparison of data by Kolmogorov-Smirnov test. Independent two samples t-test for comparing two independent groups in variables that match normal distribution, paired-samples t-test for comparison of dependent variables, and correlation analysis Pearson correlation test was used. Mann Whitney U test for comparison of two independent groups in variables that do not match normal distribution, Wilcoxon Signed Rank Test for comparison of dependent variables, and for correlation analysis, Spearman rank correlation test was performed. Statistical significance was evaluated at a 95% confidence range and p<0.05 level.As shown in As shown in The relationship between intake of macronutrients and hematological findings of the participants is given in The relationship between the participants' macronutrient intake and anthropometric measurements is shown in The incidence and prevalence of obesity increase daily, causing many chronic diseases and negatively affecting people's lives . It is bKnown as a high-energy, nutritious food that helps treat diabetes and cardiovascular diseases, teff has slowly digestible starch and complex carbohydrates content. Complex carbohydrates account for 80%, and starch accounts for about 73% of teff grain . Teff seSimilarly, in this study, there is no significant change in blood glucose levels in the Mediterranean diet group compared with the beginning of the study, while in the teff group, there is a significant reduction in blood glucose levels (p<0.05). Also, a decrease in hunger blood sugar was observed in the teff group when carbohydrates (g) increased. This effect of teff is a privilege compared to other gluten-free cereals, especially in patients with diabetes and celiac progressing together.As a result of this study, it was determined that there was no significant change in total and LDL cholesterol levels in the Mediterranean diet group and significantly decreased in the teff group (p<0.05). In addition, there was an increase in total and LDL cholesterol levels when protein (g) increased in the Mediterranean diet group. A similar result was not encountered in the group that consumed teff seeds. Given the daily consumption of cereals, they can be a good source of essential fatty acids . The preIn this study, a decrease in the level of iron minerals in the blood and an increase in transferrin level was found when the teff group was examined (p>0.05). On the contrary, another study conducted by Alaunyte et al. 2014) showed a decrease in transferrin level . Teff se14 showedGluten-free products, often used by celiac patients, may be insufficient to meet daily vitamin and mineral requirements, and therefore iron supplement is taken. Food supplements can often cause side effects such as constipation, nausea, and diarrhea while increasing the amount of iron taken in the diet. Unlike other cereals, teff is rich in iron content, and there is no need for reinforcement . Teff's The content of both the teff and the Mediterranean diet group is plant-based protein. The Mediterranean diet is rich in unsaturated fats and plant-based proteins, limited in animal-based protein . In thisWhen the teff and Mediterranean diet groups were compared, we found that the change in total protein levels that provide information about individuals' overall health and nutritional status was greater in the teff group. In connection with this, it can be said that teff consumption contributes to raising total protein levels to the reference range. Teff seed has an excellent amino acid composition and, consequently, high protein content, as it contains all 8 essential amino acids for humans . Based oWhile there was no significant difference between the teff and the Mediterranean diet group regarding weight loss, there was a significant decrease in BMI values in both groups (p=0.00). This might be associated with the energy constraints made. There was no positive effect of teff on anthropometric measurements (p>0.05).This study has some limitations. First, healthy eating, regular exercise, weight control, and quitting smoking have increased HDL cholesterol levels . InquirySecond, 28 participants were included in our study. It is recommended that the effects of teff seed on health be supported by studies involving more participants. Finally, this study used only one kind of teff seed. Comparisons with other varieties have not been made due to the major consumption of brown teff seed in Turkey. In other studies, in this field, the effects on health can be compared using different teff seed types.As a result, it has been found that the Teff seed has no predominance over anthropometric measurements, as compared to the Mediterranean diet, and that it was more effective in improving hematological manifestations related to obesity. The effects of regular teff consumption increased total protein levels reducing blood sugar total and LDL cholesterol. There was no effect other than energy constraint when examining its relationship with anthropometric measurements. Teff based diets are recognized worldwide, and the interest of consumers that pay attention to its health benefits increases daily, and hence other studies are required to be carried out in this field to obtain empirical data on the effects of teff seed on anthropometric measurements, biochemical findings, and health.