Regarding weight status and AMD, these were still relevant for the adolescent population, mainly the achievement of optimal AMD, but males continued to present higher values in physical fitness tests (p < 0.001) and lower values in fat accumulation (p < 0.001), regardless of weight status or AMD. Thus, physical activity seems to be the most determining factor that compensates for the differences between adolescent boys and girls.Adolescence is a crucial stage in human development, and differences in psychological, physical and body composition variables between males and females have been amply demonstrated. However, the role played by certain healthy habits, such as the practice of physical activity, adherence to the Mediterranean diet (AMD) or the maintenance of an adequate weight status, in compensating for the differences found between males and females in these variables, is not well known. For this reason, the study aimed to analyze whether the practice of physical activity, optimal AMD, and adequate weight status can compensate for the differences between adolescent males and females in anthropometric variables, psychological state, and physical fitness. The sample was composed of 791 adolescents  aged twelve to sixteen years old, whose anthropometric, psychological , and physical fitness variables  were measured. All measurements were carried out in a single day using the sports pavilion of the four participating schools. The most novel results of this research show that the practice of physical activity was determinant mainly in females, as it reduced the differences found in comparison with males in psychological ( Adolescence is a fundamental stage in the development of individuals and is characterized by physical, hormonal, and cognitive changes before reaching adulthood ,2. HowevWith respect to the differences in the behavior of adolescent females and males, the regular practice of a physical activity is essential for the proper development of adolescents, as it influences their health during all stages of their lives, helping to prevent certain chronic diseases  and favoNutritional habits have also been considered one of the most determining factors in maintaining healthy habits ,18. ThesIn addition, weight status, and mainly, perceived weight status, are some of the most analyzed parameters in recent years due to their close relationship with health . ObesityPrevious scientific literature has shown how differences seem to be evident in the habits of adolescent males and females, to which we must also add the differences found, according to gender, in anthropometry and derived variables , psycholThus, differences in anthropometry and derived variables between adolescent males and females have been noted in previous research . In thisMental health problems are also a determining factor during adolescence due to their influence on the behavior of adolescents , which bIn terms of physical fitness, the differences between adolescent males and females after the maturation period have been previously mentioned , with maTherefore, previous scientific literature has shown that the healthy habits of adolescent boys and girls are different ,8,9 and This question leads to the following general aim for the present study: to analyze whether the practice of physical activity, optimal AMD, and adequate weight status can compensate for the differences between adolescent males and females in anthropometric and derived variables, psychological state, and physical fitness. In order to achieve this general aim, the following four specific objectives were proposed (a) to establish the differences between male and female adolescents in anthropometric and derived variables, psychological state, and physical fitness; (b) to determine whether the practice of physical activity can compensate for the differences found according to gender, in the anthropometric and derived variables, psychological state and physical fitness of the adolescents; (c) to analyze whether optimal AMD can compensate for the gender differences found in the anthropometric and derived variables, psychological state and physical fitness of the adolescents; and (d) to establish whether the maintenance of an adequate weight status can compensate for the differences found according to gender in the anthropometric and derived variables, psychological state and physical fitness of the adolescents.Based on previous scientific literature and the objectives of the present investigation, the following hypotheses are proposed: (H1) males will show higher scores in all variables, except in those related to body fat and flexibility, compared to females; (H2) for females, the regular practice of physical activity will compensate for the differences in anthropometric and derived variables, psychological state and physical fitness with respect to males; (H3) for females, optimal AMD will compensate for the differences in anthropometric and derived variables, psychological state and physical fitness with respect to males; and (H4) for females, maintaining a normal weight will compensate for the differences in anthropometric and derived variables, psychological state and physical fitness with respect to males.The research was carried out using a cross-sectional design, and the sample selection was performed with a non-probability convenience method. The STROBE statement was followed for the design of the research study and for drafting the manuscript . In accoThe sample consisted of adolescents enrolled in four schools in the Region of Murcia, selected from different geographical areas , including the schools with the largest sample of adolescent students in compulsory secondary education, according to data from the Ministry of Education , thus acFor the sample size calculation, the Rstudio 3.15.0 statistical software  was used following the methodology from previous studies based on the standard deviation (SD) . Thus, wThe final sample consisted of 791 adolescents . Participation in the study was voluntary, and all adolescents who met the following inclusion criteria were included: (a) attending compulsory secondary education; (b) completing all the measurements ; (c) participating in body composition measurements; (d) age between twelve and sixteen years old; and (e) not presenting any musculoskeletal injury or illness that would hinder participation in the physical tests or the completion of the questionnaires.The questionnaires used in the present study were the “Physical Activity Questionnaire for Adolescents” (PAQ-A) ,48, KIDMThe PAQ-A, previously validated in Spanish , has an To establish the AMD level, the “Mediterranean Diet Quality Index for children and adolescents” (KIDMED) questionnaire was used. This questionnaire was designed and validated with Spanish adolescents and showed moderate reliability and reproducibility values for use in adolescents (α = 0.79) . It alloThe SWLS assesses the level of satisfaction with life by means of five items that are answered with a Likert scale of 1 to 5 points, with the final score ranging from 5 to 25 ,54. ThisThe anthropometric evaluation was composed of two basic measurements, body mass and height, performed using a TANITA BC-418-MA Segmental  with an accuracy of 100 g and a SECA stadiometer 213  with an accuracy of 0.1 cm, respectively; three skinfolds, triceps, thigh and calf, measured using a skinfold caliper  with an accuracy of 0.2 mm; and five girths, arm relaxed, waist, hips, thigh, and calf, using an inextensible tape Lufkin W606PM  with a 0.1 cm accuracy for it measurements. All the instruments were previously calibrated, and all measurements were performed according to the protocol standardized by the International Society for the Advancement of Kinanthropometry (ISAK) . The meaIt should be noted that all the measurements corresponding to the same subject were performed by the same anthropometrist, who took a minimum of two measurements per variable, with a third measurement being necessary when the difference between the first two measurements was greater than 5% in the skinfolds and 1% in the rest of the measurements. The mean of the values when two measurements were taken, or the median when three measurements were taken, was used as the final value .2), Σ3 skinfolds , corrected arm girth [arm relaxed girth − (π × triceps skinfold)], corrected thigh girth [middle thigh girth − (π × thigh skinfold)] corrected calf girth [calf girth − ], fat mass (%) [With the final values obtained from the anthropometric measurements, the BMI (kg/mmass (%) , and musmass (%)  were calThe intra- and inter-evaluator technical error of measurements (TEM) were calculated in a sub-sample. The inter-evaluator TEM was 1.98% for skinfolds; 0.06% for the girths; and 0.03% for the basic measurements; and the intra-evaluator TEM was 1.21% for skinfolds; 0.04% for the girths; and 0.02% for the basic measurements.2 max.) [To assess the cardiorespiratory fitness of the adolescents, the 20-m shuttle run test was performed, in which the participants had to run 20 m as many times as possible following the incremental running beep set by a sound signal. The test ended when the adolescents were exhausted or when they did not run the 20 m in the time allowed. The last speed at which the adolescent finished the test was used to predict maximal oxygen consumption (VO2 max.) ,62.To measure the upper body strength and the explosive lower limb power, the handgrip strength test  and the The sit-and-reach test was used to assess hamstring and lower back flexibility. The participants were required to sit on the floor with their knees straight, legs together, ankles flexed at 90°, toes pointed upward, and the soles of the feet positioned flat against an Acuflex Tester III box . From this initial position and with palms down, the subject performed a maximum trunk flexion, keeping the knees and arms fully extended, trying to reach the maximum possible distance by sliding the palms of the hands, one on top of the other, across the box .For speed measurement, the 20-m sprint test was performed. To carry out this test, the adolescent had to run 20 m as fast as possible, after which the minimum time required to do so was recorded. At the start, the subject stood on the starting line and decided when to start the sprint . To reduFirst, the adolescents completed the questionnaires on physical activity level, AMD, life satisfaction, and satisfaction of basic psychological needs in a random order. Subsequently, anthropometric measurements were carried out. Once completed, an attempt at the sit-and-reach test was performed prior to the warm-up so that it would not influence the test result . After cAll the measurements were performed on the same day, using the physical education class hour. The covered sports pavilions of the education centers were selected to reduce the polluting variables as much as possible. Given that the assessment of the physical fitness tests was carried out in a single measurement day, the metabolic demands of each test were considered, as well as the time needed for the subject to recover from the fatigue generated, by establishing the order of the tests according to the recommendations from the National Strength and Conditioning Association (NSCA) .2) was performed according to previous research. Thus, the following values were utilized; small: ES ≥ 0.10; moderate: ES ≥ 0.30; large: ≥ 1.2; or very large: ES ≥ 2.0, with an error of p < 0.05 [p < 0.05 was set to determine statistical significance. The statistical analysis was performed with the SPSS statistical package .The Kolmogorov-Smirnov normality test, as well as kurtosis, skewness, and variance, were used to analyze the normality of the data. Parametric tests were used because all of the variables had a normal distribution. First, descriptive statistics were performed for all the variables analyzed . Subsequently, a one-factor ANCOVA was conducted to determine the differences between adolescent males and females, with physical activity status, AMD, and weight status as covariates in the model. Three MANOVA analyses were performed. The first is to establish the differences between active and sedentary males and females; the second is to analyze the differences between normal weight and overweight/obese males and females; the third is to establish the differences between males and females with poor and optimal AMD. A pairwise comparison was then performed using the Bonferroni post-hoc test. The effect size calculation , active females (AF), sedentary males (SM), and sedentary females (SF). Regarding AMD, the classification was poor adherence males (PDM), poor adherence females (PDF), optimal adherence males (ODM), and optimal adherence females (ODF). According to weight status, the classification was normal-weight males (NWM), normal-weight females (NWF), overweight/obese males (OWM), and overweight/obese females (OWF). It should be noted that in the AMD groups, adolescents with a poor AMD and need to improve AMD were pooled so that the sample size of this group would be similar when compared with optimal AMD, as with the weight status group in which overweight and obese adolescents were pooled so that the sample size would be as that of normal weight.The coefficient of variation (CV) and the intraclass correlation coefficients (ICC) were calculated the physical fitness tests that were repeated twice. The results are as follows: for the handgrip right arm test, ICC = 0.940, and CV = 3.14%; for the handgrip left arm test, ICC = 0.953, and CV = 3.10%; for the CMJ test, ICC = 0.892, and CV = 3.35%; and for the 20-m sprint test, ICC = 0.913, and CV = 2.15%.p = 0.659), relatedness (p = 0.185), AMD (p = 0.540), and BMI (p = 0.083). Males showed higher scores in physical activity level (p < 0.001), life satisfaction (p = 0.008), competence (p < 0.001), and autonomy (p = 0.020), all physical condition variables (p < 0.001), except for the sit-and-reach test (p < 0.001); and all anthropometric variables (p < 0.001), except for the sum of 3 skinfolds (p < 0.001) and fat mass (p < 0.001). The inclusion of the physical activity status and the level of AMD in the model significantly affected the differences in relatedness (p < 0.001), with the rest of the variables maintaining the same significant differences. In addition, BMI had a significant effect on hip girth (p < 0.001), with the rest of the variables keeping the same significant differences, except for the case of autonomy, which ceased to be significant when considering this variable (p = 0.066).p < 0.001), autonomy (p = 0.011), and VO2 max. (p < 0.001), and AMD (p = 0.001), while for females with different levels of physical activity (PA vs. SF), the differences were significant in life satisfaction (p < 0.001), basic psychological needs (p < 0.001), and VO2 max. (p < 0.001), sit-and-reach (p = 0.007), CMJ (p < 0.001), 20-m sprint (p = 0.003), and AMD (p = 0.010), with active males and females showing higher scores in all the variables.The differences between AM, AF, SM, and SF are shown in p = 1.000; AM vs. AF: p = 1.000), autonomy , relatedness , AMD , and BMI , as well as life satisfaction (AM vs. AF: p = 1.000) and competence (AM vs. AF: p = 1.000) in the groups of active adolescents, in which no significant differences were found. The males in both groups showed higher scores in the anthropometric , psychological , and physical fitness  values, except for the sum of 3 skinfolds , fat mass  and sit-and-reach test , for which the females showed higher values.When comparing males and females with a similar level of physical activity (SM vs. SF and AM vs. AF), significant differences were observed in both active and inactive groups in all the variables analyzed, except for hip girth (SM vs. SF: p = 1.000) and BMI (p = 1.000), with AM showing higher scores (p < 0.001), except in the sum of 3 skinfolds (p < 0.001), fat mass (p < 0.001) and sit-and-reach test (p < 0.001); while for the AF vs. SM comparison, the differences were significant in all the variables, except for hip girth (p = 1.000), fat mass (p = 0.054), life satisfaction (p = 1.000), and BMI (p = 0.869), with the SM showing higher values in the anthropometric (p < 0.001) and physical fitness variables (p < 0.001), except for the sum of 3 skinfolds (p = 0.004) and-sit-and reach test (p < 0.001), while AF showed higher scores in basic psychological needs  and AMD (p = 0.001).Regarding the comparison of AM vs. SF, significant differences were found in all the analyzed variables, except for hip girth (p = 0.035) and physical activity level (p < 0.001), while in females with different AMD (PDF vs. ODF), the differences were significant in competence (p = 0.049) and physical activity level (p < 0.001), with males and females with optimal AMD showing higher scores.p = 0.604; ODM vs. ODF: p = 0.904), life satisfaction , autonomy , relatedness , and BMI , as well as competence in the optimal AMD group (ODM vs. ODF: p = 0.123), with males in both the poor and optimal AMD groups showing higher scores in all the variables analyzed, except for the sum of 3 skinfolds (p < 0.001–0.003), fat mass (p < 0.001–0.037) and sit-and-reach test (p < 0.001), in which females showed higher scores.Significant differences were also found when comparing males and females with the same AMD (PDM vs. PDF and ODM vs. ODF), finding significant differences in all the analyzed variables, except for hip girth (PDM vs. PDF: p = 1.000) and BMI (p = 0.430), while when comparing PDM vs. ODF, differences were found in all the variables analyzed, except for hip girth (p = 1.000), life satisfaction (p = 1.000), basic psychological needs (p = 1.000), physical activity level (p = 1.000), and BMI (p = 1.000), with the males, independently of their AMD, showing higher values in the anthropometric (p < 0.001), psychological (p < 0.001–0.012) and physical fitness (p < 0.001) variables, except for the sum of 3 skinfolds (p < 0.001), fat mass (p < 0.001) and sit-and-reach test (p < 0.001), where females, independently of their AMD, showed a higher score.Regarding the comparison between PDF vs. ODM and PDM vs. ODF, the differences were significant between PDF vs. ODM in all the variables analyzed, except for hip girth (p < 0.001), except for height , life satisfaction , basic psychological needs , sit-and-reach test , physical activity level  and AMD , in addition to handgrip right arm (p = 0.107), handgrip left arm (p = 0.158) and 20-m sprint (p = 0.119) between NWF vs. OWF, with the OWM and OWF showing higher scores in all anthropometric variables (p < 0.001), as well as higher scores in the handgrip strength test in both arms in the OWM (p < 0.001).p = 0.608), autonomy (p = 0.625), relatedness (p = 1.000), and AMD (p = 1.000), while in the comparison between OWM and OWF, the differences were also significant in all the variables analyzed, except for hip girth (p = 1.000), corrected calf (p = 0.205), fat mass (p = 0.115), basic psychological needs (p = 0.213–1.000), physical activity level (p = 0.272), and AMD (p = 1.000), with males in both groups obtaining higher scores in all the variables (p < 0.001), except for the sum of 3 skinfolds (p < 0.001), fat mass (p < 0.001) and sit-and-reach test (p < 0.001), for which the females showed higher values.Regarding the comparison between males and females with the same weight status (NWM vs. NWF and OWM vs. OWF), the differences were significant in all the variables analyzed between NWM and NWF, except for life satisfaction (p = 0.198–1.000), life satisfaction (p = 0.131), basic psychological needs (p = 0.083–1.000), and AMD (p = 1.000), with the OWF showing higher scores in all anthropometric variables (p < 0.001), except for height (p < 0.001) and muscle mass (p = 0.002), while the NWM showed higher physical activity level (p = 0.004) and physical fitness test scores (p < 0.001), except for the sit-and-reach test (p < 0.001). The differences between NWF and OWM were significant in all variables except for life satisfaction (p = 0.085), basic psychological needs (p = 0.287–0.768), CMJ (p = 0.437), and AMD (p = 1.000), with the score of the OWM being higher in all the variables analyzed (p < 0.001), except for the sit-and-reach test (p < 0.001).As for the differences between males and females with different weight statuses (NWM vs. OWF and NWF vs. OWM), it should be noted that differences were significant between NWM and OWF in all the variables analyzed, except for corrected girths  to establish the differences between male and female adolescents in anthropometric and derived variables, psychological state, and physical fitness; (b) to determine whether the practice of physical activity could compensate for the differences found according to gender in the anthropometric and derived variables, psychological state, and physical fitness of the adolescents; (c) to analyze whether optimal AMD could compensate for the gender differences found in the anthropometric and derived variables, psychological state, and physical fitness of the adolescents; and (d) to establish whether the maintenance of an adequate weight status could compensate for the differences found according to gender in the anthropometric and derived variables, psychological state, and physical fitness of the adolescents. The results of previous research lead us to pose the following hypotheses (H1) males will show higher scores in all the variables, except in those related to body fat and flexibility, compared to females; (H2) in females, the regular practice of physical activity will compensate for the differences in anthropometric and derived variables, psychological state, and physical fitness, with respect to males; (H3) in females, optimal AMD will compensate for the differences in anthropometric and derived variables, psychological state, and physical fitness, with respect to males; and (H4) in females, maintaining a normal weight will compensate for the differences in anthropometric and derived variables, psychological state, and physical fitness, with respect to males.According to the first specific objective, to establish the differences between male and female adolescents in anthropometric and derived variables, psychological state, and physical fitness, the results of the present study are similar to those found in previous studies. Adolescent males showed a higher level of physical activity than females, in line with previous research ,17. WithHowever, these results had already been confirmed in previous research, so the real novelty of this research is that it provides information on whether the existing differences between males and females in anthropometric, psychological, and physical fitness variables increased or decreased when considering the level of physical activity, AMD, or weight status of the adolescents.The second specific objective of the study was to determine whether the practice of physical activity can compensate for the differences found according to gender in the anthropometric and derived variables, psychological state, and physical fitness of the adolescents. Regarding the comparison between AM vs. SM, and AF vs. SF, the results showed no significant differences between AM and SM, or between AF and SF, in the anthropometric variables analyzed. Previous research has shown contrary results, with differences found between active and inactive adolescents , which c2 max. These results partially follow the line of previous research [Regarding the psychological and physical fitness variables, it should be noted that significant differences were found between AF and SF in all the variables, while in the comparison between AM and SM, significant differences were only found in competence, autonomy, and VOresearch  in that research  so that Another relevant result is that between males and females with the same level of physical activity practice, no differences were found in life satisfaction or the satisfaction of basic psychological needs between AM and AF, but the differences were significant between SM and SF, with SF scoring lower. These results partially follow the line of previous research, which indicated that males showed higher scores than females in psychological variables ,27,77, aWhen comparing AM and SF, the differences between males and females were even more remarkable, following the results of previous studies in which males showed higher scores except for the variables related to fat mass and the sit-and-reach test . HoweverThe third specific objective of the present study was to analyze whether optimal AMD can compensate for the gender differences found in the anthropometric and derived variables, psychological state, and physical fitness of the adolescents. The results with respect to the anthropometric variables and the physical fitness tests showed that the differences were not significant in either the comparison of ODM and PDM or ODF and PDF. These results are similar to those from previous research in adolescents, in which no significant differences were observed between poor and optimal AMD in both males and females groups . This coHowever, the results showed that both ODM and ODF had a better level of physical activity and psychological state than PDM and PDF, respectively, with the differences being significant in competence in the case of females and relatedness in the case of males. Regarding the level of physical activity, the results were similar to those from previous research, in which adolescents with a higher AMD showed a higher level of physical activity . This coWhen comparing PDM and PDF, and ODM and ODF, the differences were significant in anthropometric and physical fitness variables, similar to previous research that studied the differences between males and females . HoweverIt should be noted that when comparing PDM and ODF, PDF and ODM, the differences in the anthropometric and physical fitness variables continued to be greater in males, except for the variables related to body fat and the sit-and-reach test. A relevant result is that the differences were only significant in the psychological variables when comparing PDF and ODM, with the score of ODM being higher, but not when comparing PDM and ODF. These results could be explained by the fact that AMD is not the only influential factor in the psychological state of adolescents, with physical activity also playing a determining role . As showThe fourth specific objective was to establish whether the maintenance of an adequate weight status can compensate for the differences found according to gender in the anthropometric and derived variables, psychological state, and physical fitness of the adolescents. When comparing OWM and OWF with NWM and NWF, the results showed higher scores in the anthropometric variables related to fat mass and muscle mass in the OWM and OWF. As for the physical fitness variables, the OWM and OWF adolescents showed a lower score in cardiorespiratory capacity and CMJ, but it should be noted that in the OWM group, the score was higher as compared to the NWM group in handgrip, while in the 20-m sprint test, the NWM group scored better than the OWM one. Previous research has shown similar results ; howeverRegarding the psychological variables, the differences were not significant when comparing NWM and OWM or NWF and OWF. These results are contrary to those found in previous research, in which overweight adolescents showed less satisfaction with life and suffered more social isolation and bullying . This coIt is worth noting that when comparing NWM and NWF, and OWM and OWF, males continued to show higher scores in the level of physical activity performed, in the physical fitness, and anthropometric variables, except for fat mass, the sum of three skinfolds, and the sit-and-reach test, both in the normal weight and overweight/obese groups, as shown in previous research ,10. RegaRegarding the differences in psychological variables in the normal weight and overweight/obese groups, the OWF showed significantly lower scores in life satisfaction, while the NWF showed a lower score in competence compared to OWM and NWM, respectively. These results are similar to those found in previous studies, in which females showed worse life satisfaction and competence than males ,27. A poThe NWF scored significantly lower than NWM in competence. These results are contrary to those found in previous studies, in which females showed higher values in satisfying all basic psychological needs . It mustWith respect to the comparison between NWF and OWM, and NWM and OWF, it should be noted that there were significant differences in the anthropometric and physical fitness variables, although no significant differences were found in any of the comparisons in the psychological variables analyzed. Regarding the anthropometric variables, the comparison between OWM and NWF showed significant differences in all the variables analyzed, with the OWM showing the highest scores. However, in the comparison of OWF and NWM, OWF showed higher scores in all variables related to fat mass, but NWM showed higher muscle mass. Furthermore, no significant differences were found in corrected girths between OWF and NWM, which could be because overweight/obese adolescents develop greater muscle and bone mass , which cBased on the results obtained, which respond to the four specific objectives and the general objective, i.e., to analyze whether the practice of physical activity, optimal AMD, and adequate weight status can compensate for the differences found between adolescent males and females in anthropometric and derived variables, psychological state, and physical fitness, the practical applications of the present study highlight that the promotion of physical activity is fundamental for the entire adolescent population. However, it is even more relevant for females than for males for the improvement of physical fitness and psychological state, as it is a key aspect for the reduction of the differences found between males and females and may even compensate for the differences found based on gender in the accumulation of fat mass and life satisfaction. Regarding AMD, it is noteworthy that there were differences between males and females with low AMD but not between males and females with optimal AMD, with this being a relevant factor to consider for the promotion of healthy habits in this population, as the psychological differences between genders disappear if optimal AMD is achieved. With respect to weight status, it is noteworthy that females, both normal weight and overweight/obese, showed lower scores in various psychological variables than males, although no differences were found when comparing NWF and OWF, so these differences may not be due to weight status alone, but to other variables such as physical activity as well. Therefore, although the promotion of the Mediterranean diet and the maintenance of healthy weight status is important for the adolescent population, physical activity seems to play a more decisive role, so programs aimed at the acquisition of healthy habits, such as AMD, should consider the inclusion of sports practice, as it seems to facilitate the acquisition of the rest of the healthy habits, and to increase the benefits obtained through these programs.This study is not free of limitations. Despite selecting four different geographical areas, the sample was selected conveniently in the educational centers where access was allowed. By dividing the sample into subgroups such as degree of AMD or weight status, the sample sizes were reduced, and although they were similar between males and females, they represented a small part of the total sample. With respect to variables such as the level of physical activity or AMD, these were calculated based on the adolescents’ scores on the questionnaires that collected information on their nutritional and sports habits in recent days, and this aspect must be considered. The maturational status of adolescents should be considered in future research, as it could influence the results obtained, as certain behavioral changes in healthy habits occur as a function of maturation. In addition, weight status was established according to the BMI classification established by the World Health Organization, which must be considered, as it could make it difficult to compare with other research studies using another classification. On the other hand, the use of BMI does not allow differentiation between the components of body composition (muscle mass or fat mass). This should be taken into account, as some adolescents with a high level of muscle mass could be included in the overweight/obese group, although this is not very common.2 max. When comparing males and females with the same level of physical activity , it is important to note that in the psychological variables, differences were only found between SM and SF, with SF scoring lower. Regarding the comparison between males and females with different levels of physical activity , the differences were even more evident in all the variables analyzed between AM and SF, although no differences were found between AF and SM in fat mass or life satisfaction.To conclude, the differences between AM-SM and AF-SF were not significant in the anthropometric variables, while in the physical fitness and psychological variables, the differences were significant between AF and SF in all variables, while for the comparison between AM and SM, significant differences were only found in competence, autonomy, and VORegarding AMD, no differences were found between ODM-PDM and ODF-PDF in the anthropometric and physical fitness variables, although differences were found in the psychological variables, with ODM and ODF scoring higher. In the comparison between PDM-PDF and ODM-ODF, the differences were significant in the anthropometric and physical fitness variables in both groups but only in the psychological variables between ODM-ODF. Another novel aspect is that in the psychological variables, the comparison between PDF-ODM showed significant differences, with higher values in ODM, although no differences were found between PDM-ODF.According to weight status, the OWM and OWF showed higher scores in the anthropometric variables, and lower performance in cardiorespiratory capacity and CMJ. However, only the OWM showed higher performance in handgrip, while the NWM did so in the 20-m sprint. There were no significant differences in psychological variables between NWM-OWM nor between NWF-OWF. When comparing males and females with the same weight status (NWM-NWF and OWM-OWF), differences were more evident in anthropometric and physical fitness variables between genders, while in psychological variables, OWF and NWF showed lower values than males. As for the comparison between NWF-OWM and NWM-OWF, the psychological variables showed no significant differences, while in physical fitness, it is noteworthy that there were no differences between NWF and OWM in the CMJ. Regarding the anthropometric variables, the OWM showed higher scores than the NWF in all the variables analyzed, with this being similar in the OWF with respect to the NWM, except in muscle mass, in which the NWM obtained higher values, and in corrected girths, in which there were no differences between OWF and NWM.


Evidence demonstrates the negative impact of excessive screen-based sedentary time  on mental health in adolescents. However, little is known regarding the associations between different types of SSBs and anxiety symptoms in adolescents. Thus, this study sought to explore the associations between different types of SSBs and anxiety symptoms in a sample of Chinese adolescents.Zung Self-Rating Anxiety Scale, a validated assessment in Chinese youth populations. Generalized linear models were used to explore the associations between different types of SSBs and anxiety symptoms.A web-based questionnaire survey was used to collect data. In total, 1,998 study participants conveniently recruited in Guangdong Province completed the questionnaire. Of them, 1,331 study participants provided valid data for variables of interest. SSB was categorized into television/movie time, video game time, and internet-surfing time. Anxiety symptoms were assessed using p < 0.01). This association was also observed specifically in boys ; however, in girls, there were no associations between different types of SSBs and anxiety symptoms.In adolescents, video game time of 6 or more h was positively and significantly associated with anxiety symptoms (odds ratio = 5.25, 95% CI: 1.86–14.84, Interventions aiming at reducing video games in adolescents, especially in boys, should be designed to prevent anxiety symptoms. This kind of intervention should also take sex differences into consideration. Future studies are encouraged to confirm the veracity of the findings in this study. Anxiety is one of the most common mental health problems in adolescents worldwide . AnxietyScreen-based sedentary behavior (SSB) is an important correlate of anxiety in adolescents . SpecifiTherefore, it is necessary for research to specifically address the abovementioned research gaps to provide more compelling evidence. Accordingly, this study sought to explore the associations between different types of SSBs and anxiety symptoms in a sample of Chinese adolescents (situated in Guangdong Province).This cross-sectional study was designed to assess adolescents' physical and mental health. We randomly selected one middle school (there are three grades in middle school according to China's education system) in each city (11 cities in our study) in the Guangdong Province. In each grade, students from three classes were randomly selected. A total of 3,465 students were invited. Of them, 1,998 students and their parents/guardians completed the survey (response rate = 57.7%). Of the 1,998 study participants, 1,331 study participants provided valid data pertaining to the variables of interest in this study. Prior to data collection, the headmaster of each school, study participants, and their parents/guardians were informed of study aims and instructions. Each study participant provided written consent to take part in this study. To protect study participants' privacy, data were collected and analyzed anonymously. This study was approved by the Institutional Review Board at Shenzhen University.Study participants were asked to self-report the following information, such as sex (boy or girl), grade , ethnicity (Han or minority), residence , height (cm), weight (kg), perceived family affluence , and siblings .Zung Self-Rating Anxiety Scale (Z-SAS). The Z-SAS includes measures of state and trait anxiety based on scoring in four groups of manifestations: cognitive, autonomic, motor, and central nervous system symptoms. Responses to each item range from 1 (a little of the time) to 4 (most of the time) with higher scores indicating more severe anxiety. Standard scores were used in the statistical analysis of our study. We grouped study participants into tested as anxiety or not according to the cutoff point (40 scores) mentioned within the Z-SAS  questionnaire , the queSleep duration was measured by the items derived from the HBSC questionnaire : (1) WheModerate-to-vigorous physical activity (MVPA) was assessed by the HBSC , i.e., qt-test was used to examine the sex difference across all the continuous variables. As the study outcome was a binary variable, logistic regression within Generalized Linear Models (GLMs) was used to assess the associations between different types of SSBs and anxiety. Within GLMs, Maximum Likelihood Estimation (MLE) and Robust Estimator were used to examine the associations between different types of SSBs and anxiety. Adjusted odds ratios with 95% confidence intervals (95% CIs) were reported, and statistical significance was defined, a priori, as p < 0.05 (two-sided).All statistical analyses were conducted using SPSS version 25.0. Descriptive statistics was used to report the frequency and percentage (%) of categorical variables  and the mean and standard deviation (SD) of continuous variables . The chi-square test was used to examine the sex differences across all categorical variables and the Student's n = 683) while 48.69% were girls (n = 648). Most of the samples were from Chinese Han ethnicity (96.69%) and from urban areas (72.43%). In total, 84.3% of samples reported that they have one or more siblings, and the mean BMI in the samples was 18.99 kg/m2 (± 4.08). Overall, the study samples' accumulated days for MVPA was 5.05 (± 2.08), with a statistically significant difference between the sexes . The mean of SLP was 8.42 h (± 1.29) and there was no significant sex difference (p = 0.076). For three different types of SSBs, namely, TV/movie time, video game time, and internet-surfing time, their mean times were 2.29 (± 1.40), 2.41 (± 1.44), and 3.27 (± 1.51) h per day, respectively. The mean score of anxiety  was 40.23 (± 8.71), with a statistically significant sex difference . More details are reported in p < 0.005). However, both TV/movie time and internet time were not associated with anxiety symptoms (both p > 0.05). Sex-stratified results are presented in p > 0.05).The results of the association between different types of SSBs and anxiety symptoms in the overall sample and sample by sex are presented in This study sought to assess the associations between different types of SSBs and anxiety symptoms in Chinese adolescents (from Guangdong Province). The main research findings in this study were, first, that video/games time (6 or more h) was significantly and positively associated with anxiety symptoms; second, associations between different types of SSBs and anxiety symptoms varied by sex, whereas in boys, video/games time (6 or more h) was significantly and positively with anxiety symptoms; while in girls, no specific type of SSB was significantly associated with higher levels of anxiety symptoms. These research findings have notable practical implications for anxiety prevention in adolescents, especially in Chinese adolescents, which, prior to this study, were bereft of evidence.Concordant with previous work , 20, 21,Studies on anxiety symptoms and TV/movie time in adolescents remain scarce , especiaOur study also found that the associations between specific types of SSBs and anxiety symptoms vary by sex. Specifically, in boys, video game time was associated with anxiety symptoms, while in girls, there were not any types of SSBs related to anxiety symptoms. To our knowledge, our study is one of the very few studies to examine the sex differences in the associations between specific types of SSBs and anxiety symptoms. Unfortunately, owing to limited and comparable evidence regarding sex differences in the associations between specific types of SSBs and anxiety symptoms, it is currently infeasible to report an overarching view . DespiteTo better interpret the research findings of this study, some inherent study limitations should be mentioned. First, our study used a cross-sectional design study, which precludes causal inferences from being made. The second limitation concerns measurement in this study, a self-reported questionnaire . This could make our measurement of SSB biased because of recall errors and other wellknown self-report limitations. Third, our study was based on samples recruited from Guangdong Province; so, our research findings may not necessarily be generalized to a broader spectrum of Chinese populations. Fourth, this study did not evaluate what time SSB occurs within a day. Knowing this information may be useful in preventing behavior-related addiction, such as SSB, from a perspective of chronobiology , possiblOur study has some notable practical implications, which may be significant to mental health promotion in adolescents. First, limiting SSB would likely be a beneficial approach to reduce the likelihood of anxiety in adolescents. In this regard, applying multiple strategies to reduce SSB is a feasible, and probably necessary, approach. However, among different types of SSBs, targeting specific types of SSBs for sex-tailored anxiety interventions is urgently needed, because of the significant sex differences in the associations between specific types of SSBs and anxiety symptoms in adolescents. In this regard, interventions that reduce video game time are a behavioral priority for anxiety prevention, especially for boys. In general, from the perspective of practice and policy, it is necessary to examine the efficiency of specific types of SSBs for reducing the odds of anxiety symptoms in adolescents, which could be extended to more clinically focused research.In conclusion, we found that video game time of more than 6 h per day was significantly associated with anxiety symptoms in adolescents, which can be regarded as a risk factor for poor mental health. However, for boys, video game time was associated with anxiety symptoms, while for girls, there were no associations between different types of SSBs and anxiety. Future studies are encouraged to confirm the veracity of our research findings, in an effort to discern more robust evidence. The findings of the present study could be used to inform mental health interventions with specific strategies for controlling SSB.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.SC and ZR: study design, data collection, and analyses. SC and CC: manuscript draft and edit. ZR: manuscript review and project supervision. All authors contributed to the article and approved the submitted version.This research was funded by Philosophy and Social Sciences in Guangdong Province, Grant Number [GD16CTY03], Humanities and Social Science, Shenzhen University, Young Teacher Award, Grant Number [17QNFC59], and Key Project of Shenzhen Education Science in 2018, Grant Number [zdfz18008].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.


Mage = 38.3, SD = 9.14). The latent profile analysis revealed four distinct profiles. The antecedents of teacher burnout (TB) profiles were the stress generated by workload, students' misbehavior, and low professional recognition. The socio-demographic variables, with the exception of gender, were covariates of the TB profiles. The findings implies that career opportunities prospects, classroom management and time-management programs may be useful in preventing teacher burnout.The purpose of this cross-sectional study was to identify distinct burnout profiles of teachers and to examine their association with work-related stressors, such as workload, students' misbehavior, classroom resources, professional recognition needs and poor colleague relations, as well as socio-demographic variables. Survey data were collected from 330 kindergarten and primary school teachers (84 males,  In this very difficult time for people worldwide, teachers are one of the most challenged groups of workers . Being fAfter decades of research confirming that teaching is a stressful profession –8, it haThe burnout phenomenon has been conceptualized as a psychological response to prolonged work-related stress that affects one's health and emotional balance . The COVExtensive previous research on TB has identified several individual and environmental factors that significantly contribute to TB before , 13 and Furthermore, the most popular framework that explains the processes involved in professional stress and burnout is Lazarus and Folkman's  transactAnother model introduced to identify precursors of work burnout due to excessive work is the job demands-resources (JD-R) framework . In thisConcerning environmental stressors in the pandemic context, the literature has often discussed organizational factors as important influences on TB. In this regard, time pressure and workload , 34, theIn terms of measuring teachers' stressors, Boyle et al.  proposedMost of the previous research aimed at profiling TB focused only on clustering it with protective factors, such as self-efficacy, well-being, resilience and coping strategies , 41, 42,The main purpose of the current research was to explore how various types of work-related stress among preschool and primary school teachers impact TB risk profiles. More specifically, we first determined whether there were distinct profiles of exhaustion, inadequacy and cynicism that might capture different patterns of TB. Second, we verified antecedents of profiles, namely various types of teacher stress, such as workload, students' misbehavior, professional recognition needs, classroom resources and poor colleague relations. The research design was developed in the framework of the job demands–resources model of burnout  and the Based on previous studies that highlighted burnout symptoms experienced by teachers in the COVID-19 pandemic , 16, 42,(RQ1) Are there different teacher profiles in terms of experienced socio-contextual burnout consisting of exhaustion, cynicism toward the professional community and inadequacy in teacher –pupil interaction during the COVID-19 pandemic?Furthermore, considering previous studies on the relationship between stressors such as workload , profess(RQ2) Do teachers with the different profiles differ from each other in terms of experienced stressors, such as workload, professional recognition needs, students' misbehavior, classroom resources and poor colleague relations, during the COVID-19 pandemic?Taking into account the previous study that highlighted the association between socio-demographic variables and TB profiles , we dete(RQ3) Are socio-demographic variables—that is, gender, teaching level, professional experience and urban or rural teaching environment—covariates of TB profiles?Mage = 38.3 years, SD = 9.14), of which 108 worked at the preschool level and 222 at the primary school level. Their reported professional experience was less than two years (4.5%), between two and five years (10.9%), between five and 10 years (19.1%), between 10 and 20 years (25.5%) and more than 20 years (40%). Using a convenience sampling method, we selected the teachers from the register of district Teachers Council The total response rate of the e-mail paper survey sent to teachers was 45%. The selection criteria for inclusion in this study were a primary or preschool level of teaching.Our sample included 330 educators . Data were collected during the 2021 spring break via Google Forms, the questionnaires being sent to teachers by e-mail.The Romanian translation of all measures used in the current study was performed according to the recommended forward-backward translation procedures described by Sousa and Rojjanasrirat .With this work pace, I don't think I'll make it to the retiring age”) employed a Likert scale from 1—completely disagree to 7—completely agree. The established three constructs were teacher exhaustion , cynicism toward the teacher community  and inadequacy in the pupil–teacher relationship . There is currently no study in the literature that indicates a cut-off for this scale. Therefore, according to the study of Pyhältö et al. ; (ii) convergent validity (AVE = 0.64); and (iii) construct validity .The Socio-Contextual Teacher Burnout Inventory (STBI)  was usedö et al. , we consLevel of stress concerning noisy pupils”) and uses a Likert scale from 0—no stress to 4—extreme stress to assess teachers' stress in five dimensions—workload , students' misbehavior , professional recognition needs , classroom resources  and poor colleague relations . In our sample, TSI proved good psychometric properties in terms of: (i) internal consistency ; (ii) convergent validity (AVE = 0.53); and (iii) construct validity . Socio-demographic variables such as gender, teaching level, professional experience and urban or rural teaching environment were collected.The Teacher Stress Inventory (TSI) measures work-related teacher stress . This sc2. Lower values for the AIC, BIC and SSA-BIC indicate a better balance between model fit and parsimony, while higher values for entropy (i.e. > 0.80) indicate better classification utility and class separation. Supplementary tests—an adjusted Lu-Mendell-Rubin likelihood ratio test (aLMR) and a bootstrap likelihood ratio test (BLRT)—were performed in order to compare the subsequent models. A statistically significant test result (p < 0.05) indicates that the model with k classes fits the data better than the model with one latent class less, that is, k-1 classes  was performed to identify sets of mutually exclusive and exhaustive latent profiles using continuous indicator variables, that is, the three dimensions of TB—exhaustion, inadequacy and cynicism. LPA is a mixture modeling technique by which groups of people are captured based on similarities in their responses to various research variables, in our study the three dimensions of TB. LPA analysis was conducted using Mplus 8.6 software . The rob classes . AdditioThe descriptive statistics for sociodemographic variables are shown in Furthermore, the profile indicators and predictors of profile membership are depicted in Fit statistics from the LPA models, that is, two-profile to five-profile solutions, are set out in The model best fitted to our data, the four-profile model of TB risk, is depicted in Low burnout risk, included 31.2% of the teachers and was characterized by low levels of exhaustion and very low levels of inadequacy in the teacher–student relationship and cynicism toward the professional community. These results are significantly less than those obtained in all other profiles. The second profile, Mild burnout risk, included 31.2% of the teachers and was defined by moderate levels of exhaustion and cynicism on the one hand and low levels of inadequacy on the other. Therefore, the teachers with this profile have mild burnout risk, especially in terms of exhaustion and cynicism. The third profile, High moderate burnout risk, included 27.3% of the teachers and was characterized by high moderate exhaustion, inadequacy and cynicism. These results reveal a simultaneously increased pattern of all three symptoms of TB risk. The final profile, High burnout risk, included 10.3% of the teachers and was characterized by a similar pattern to the previous one but with higher levels of all three indicators.Parameter estimates for overall item respectively within-profile item means for the four-profile model are set out in Low burnout risk profile, we noticed there was a significant tendency to increase the sources of stress generated by workload and students' behavior but only at the level of the Mild burnout risk and High moderate burnout risk profiles. In other words, these types of stress have a more pronounced impact on the high moderate than the mild burnout risk profile. Our findings revealed an interesting pattern. In the case of the High burnout risk profile, although the odds ratio (OR) for stress generated by workload was > 1, it did not reach the threshold of statistical significance and did not have a significantly higher contribution to this profile membership. The same pattern was obtained in the case of stress related to poor colleagues relations, that is OR > 1, p = 0.64. The stress generated by students' misbehavior did not have a significant impact either . Furthermore, the results showed that the only significant contribution was the stress generated by low professional recognition, as set out in Having as reference the OR = 1.42, 95% CI ) of belonging to the Mild burnout risk profile than to the Low burnout risk profile. Furthermore, our findings show that teachers with high professional experience had higher odds  of belonging to the High burnout risk profile than to the Low burnout risk profile. Comparing teachers according to urban/rural teaching environment, we found that those from rural schools had higher odds  of belonging to the Higher moderate burnout risk profile than to the Low burnout risk profile.The results proved that gender did not have a significant impact on TB profiles. On the contrary, all the other socio-demographic variables were significant predictors of profile membership. In terms of teaching level, preschool teachers had higher odds , represented the teachers who experienced higher levels of exhaustion, cynicism toward the teaching community and inadequacy in teacher–pupil interaction. In examining the High risk burnout profile, we noticed the teachers within it registered a high level of cynicism toward the professional community, unlike those in a study of Finnish teachers . The patients/participants provided their written informed consent to participate in this study.C-MR contributed in conceptualization, developed the questionnaires, and collected the data. ES and C-MR developed the analytical plan, undertook the statistical analyses, interpreted the results of the statistical analyses, and wrote the paper. Both authors have read and agreed to the published version of the 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.


P < 0.05). After treatment, the Lequesne-Mery was 4.78, the VAS was 0.87, and the WOMAC score was 14.89 of the test group, which were reduced (P < 0.05). The KSS and HSS scores of the test group were improved significantly after treatment (P < 0.05). The total effective rate of the test group was 85.48%, and that of the control group was 51.61%; the former was significantly higher than the latter (P < 0.05). In conclusion, acupuncture could improve the clinical effect on KOA patients, and CT scanning under deep learning algorithm could evaluate the clinical effect of acupuncture for KOA.The study was aimed at analyzing the application value of deep learning-based computed tomography (CT) in evaluating the effect of acupuncture for knee osteoarthritis (KOA). Specifically, 124 patients with KOA were selected in the test group (warm acupuncture and moxibustion) and the control group (simple acupuncture), with 62 cases in each group. Deep learning-based CT scanning was performed before and after treatment to compare the Lequesne-Mery, Visual Analog Scale (VAS), Western Ontario and McMaster Universities (WOMAC), Hospital Special Surgery (HSS), and Knee Society Score (KSS) scores as well as the overall effective rate. The results showed that the trabecular thickness, quantity, bone mineral density (BMD), connection density, structural model index, and articular cartilage thickness were different significantly between the two groups ( The Yellow Emperor's Internal Canon of Medicine believes that the combination of wind, cold, and dampness can lead to bone diseases. Knee pain is due to liver and kidney impairment caused by cold and dampness [Knee osteoarthritis (KOA) is a disease characterized by progressive articular cartilage degeneration and plate reactive bone loss . Inflammdampness . The symdampness , 18. Thedampness . Acupuncdampness –22.Computed tomography (CT) is a commonly used method for clinical evaluation of the severity of KOA patients. Compared with X-ray, CT has advantages for its high sensitivity and avoiding the effects of overlap or artifacts during X-ray. In addition, CT can present the specific conditions of bone lesions in a more detailed and perfect manner –25. ClinIn this study, the application value of deep learning-based CT was explored and analyzed in evaluating the effect of acupuncture for KOA. 124 patients with KOA were selected as the research objects, including 62 cases in the test group (warm acupuncture and moxibustion) and the other 62 cases in the control group (simple acupuncture). Deep learning-based CT scanning was performed before and after the treatment, to obtain imaging quantitative parameters. The scores of Lequesne-Mery, Visual Analog Scale (VAS), Western Ontario and McMaster Universities (WOMAC), Hospital Special Surgery (HSS), and American Knee Society Score (KSS) were compared between the two groups. As the total effective rate was also compared, the effect of acupuncture for KOA was evaluated. By studying the evaluation effect of deep learning-based CT on the effect of acupuncture in the treatment of KOA, it was expected to provide treatment options for KOA patients.In this study, 124 patients with KOA who were treated from February 2, 2018, to June 2, 2021, were selected as the research objects. These patients were divided into a test group and a control group, with 62 cases in each group. Those in the test group were treated with warm acupuncture and moxibustion, while those in the control group were treated with simple acupuncture only. The patients included in this study signed the informed consent forms, and the research process had been approved by the ethics committee of hospital.Inclusion criteria: (I) patients diagnosed with KOA per diagnostic criteria of traditional Chinese and Western medicine, (II) the patient was in good condition without other serious organ diseases, (III) patients who cooperated in CT examination, (IV) patients without any test contraindications, and (V) patients who had not accepted related treatment related to this study.Exclusion criteria: (I) patients with knee joint tumor, (II) patients with gouty arthritis, (III) patients with mental diseases unable to cooperate in acupuncture treatment and efficacy evaluation, (IV) pregnant or lactating patients, and (V) patients whose family members did not agree or did not sign the informed consent.CT was performed on all patients using 16-slice spiral CT scanner. The patients were scanned in the supine position, and the scanning range was from the proximal tibia to the distal femur, including the entire knee joint; and an axial scanning was taken. Specific scanning parameters included the tube voltage 120 kV, the tube current 70 mA, the layer thickness 5 mm, and the layer spacing 5 mm. Scannings were performed at 0.37 seconds at 360°, and 20 images were reconstructed per second.ResNet, as an excellent object detection, image classification, and segmentation model, has been widely used in convolutional neural networks. Residual structures in the ResNet model make it easier to optimize. In the propagation process of neural network, the propagation gradient often disappears gradually due to the occurrence of back propagation. However, the residual structure solves this problem, and the gradient information of residual structure is more easily transmitted in the process of back propagation. Its specific structural model is shown in t is output to complete the global average pooling. To reduce the number of t channels and reduce calculation parameters, the results obtained in the previous step will pass through the full connection layer, so as to update the result to T1 × t. Through the assignment of nonlinear layer activation function, the activation function result is output, which is expressed as F. The result is continuously input to the fully connected layer, and another parameter E is introduced to output the result E2F(T1 × t), so as to reduce channel number. Next, the results obtained in the previous step are further delivered to the nonlinear layer, and then, the weight data of the above channels are obtained. Finally, all information parameters are collected in the full connection layer. The corresponding information of two models (ResNet and inception) is superimposed, and the ResNet residual model is only combined with inception in the last step, as shown below. The original convolutional kernel of inception structure is decomposed from 5×5 and 7 × 7 into 5 × 1 and 1 × 5 and 7 × 1 and 1 × 7. To avoid the disappearance of gradient information during back propagation, ResNet residual structure is combined with inception model. Feature information in inception network images is extracted and the result In the test group, patients were treated with warm acupuncture and moxibustion. The patients were in a supine position, with the knee joints naturally bent. The acupuncture sites  were disinfected. Then, 2 cm needle was inserted into the meridians. After qi was invigorated by neutral supplementation and draining, the needle was retained in the appropriate depth. Three acupoints were selected in total. Subsequently, 2 cm moxa stick was lit. Warm acupuncture and moxibustion was given once every two days, with 6 times as a course, a total of two courses. In the treatment process, the patient should stay in a warm environment, have a balanced diet, and avoid fatigue.The control group received simple acupuncture treatment: the needle was inserted directly at the acupoint site with a depth of about 3 cm. After qi was invigorated by neutral supplementation and draining, the needle was retained for 30 min and then removed, and alcohol cotton ball was pressed for disinfection.General basic data, including mean age, male to female ratio, course of disease, and size of tibial plateau, were collected and compared between the two groups.M is calculated according to Equation  test was used to represent enumeration data. P < 0.05 represents statistical difference.SPSS17.0 was applied for statistical analysis of data. Normally distributed data were presented as mean ± standard deviation (P > 0.05), which are shown in The basic data of patients were not different significantly between the two groups, in terms of average age, gender distribution, and course of disease (P < 0.05), indicating comparability between the two groups, as shown in The sizes of tibial plateau and tibial angle were recorded and compared between the two groups, and the results showed no significant difference between the two groups (P < 0.05), but no significant differences in trabecular septum (P > 0.05), as shown in CT imaging scan based on deep learning algorithm was performed to obtain the relevant parameters of patients in the two groups before and after treatment. The results showed that there were significant differences in trabecular thickness, trabecular number, and bone mineral density (BMD) between the two groups after treatment (P < 0.05), which are shown in In addition, compared with those of the control group, the connection density and structural model indicators were remarkably increased in the test group after treatment (P > 0.05). As shown in P < 0.05). Besides, the thickness after treatment was greater than that before treatment in the test group (P < 0.05).Before treatment, articular cartilage thickness comparison results showed no significant difference between the two groups of patients (P < 0.05). The total effective rates were also significantly different between the two groups after treatment (P < 0.05).Lequesne-Mery, VAS, and WOMAC scores were measured before and after treatment, and the effective rate was calculated. As presented in Figures P < 0.05), which could be found in The KSS and HSS scores of patients in the two groups were recorded, mainly in pain, motion, muscle strength, stability, and other aspects. The scores of HSS and KSS in the test group were higher significantly than those in the control group . CT scanning parameters suggested the significant differences in trabecular thickness, trabecular number, and BMD between the two groups after treatment (P < 0.05), but no significant difference was shown in trabecular spacing (P > 0.05). Compared with the control group, the connection density and structural model index of the test group increased notably after treatment (P < 0.05). The articular cartilage thickness of the test group also increased (P < 0.05), and that after treatment was significantly higher than that before treatment (P < 0.05). These indicated that all CT scanning parameters greatly changed after treatment in both groups, and CT scanning deserved the application value in evaluating the effect of acupuncture and moxibustion. Furthermore, the Lequesne-Mery, VAS, and WOMAC scores of the test group were significantly decreased after treatment in comparison with those in the control group (P < 0.05), and the total effective rate of the test group was highly increased (P < 0.05). The KSS and HSS scores of the test group were better than those of the control group, indicating that acupuncture could improve the clinical symptoms of KOA patients, promote deep learning-based CT scanning, and evaluate the clinical effect on KOA. The introduction of CT scanning results into the evaluation system of the severity and treatment effect on KOA patients showed a good application effect. As CT scannings were performed on KOA patients before and after treatment, it was proved that CT scanning parameters could determine the treatment effect comprehensively, which was consistent with the findings of this work [In this work, the application value of deep learning-based CT was analyzed in evaluating the effect of acupuncture for KOA. The imaging quantitative parameters, obtained by CT scanning under deep learning before and after treatment, were compared between the test group (warm acupuncture and moxibustion) and the control group (simple acupuncture). The Lequesne-Mery, VAS, WOMAC, HSS, and KSS scores were compared as well as the total effective rate between the two groups. There was no significant difference between the two groups in average age, gender distribution, course of disease, size of tibial plateau, and tibial angle (his work , 35. In In this work, the application value of deep learning-based CT was analyzed for the effect evaluation of acupuncture in the treatment of KOA. It was demonstrated that acupuncture therapy could improve the clinical symptoms of KOA patients, and deep learning-based CT scanning could evaluate the clinical effect on KOA better. However, the disadvantage of this work lay in the small sample size, so the findings are needed to be further verified. During follow-up, it was necessary to expand the sample size to strengthen the results.


Recent research has shown that gender is an important driver of the risk of mortality and morbidity rates for people with COVID-19, with case fatality rates being higher for women than men. Despite this pattern, research is sparse on gender risk perception and potential coping mechanisms. This study examined the role gender plays in the relationship between COVID-19 risk perception and coping mechanisms among university students. Through the adoption of traditional and online surveys, 859 students from two public universities in Ghana were conveniently selected to respond to the survey instrument. The results from the multivariate regression analysis revealed that COVID-19 risk perception was positively related to active coping. The outcome of the moderation analysis showed that while males were more likely than females to adopt active and emotional support coping with heightened risk perception, a contrary outcome was observed for behaviour disengagement. This result is an indication that female students are likely to be overwhelmed with a high level of risk perception and easily give up trying to adopt effective strategies to reduce the effect of the COVID-19 pandemic situation. The findings highlight the need for different forms of intervention for male and female students for dealing with the effect of COVID-19. The spread of the coronavirus-2019 disease (COVID-19) intensified around the globe since its outbreak. The global situation of COVID-19 confirmed cases as of 4 February 2022 stood at 386,548,962, with 5,705,754 cumulative deaths [The transition from lockdowns, quarantines, and isolations to vaccination and injections of COVID-19 boosters may cause people, including university students, to be worried, feel anxious, and perceive themselves as being at risk of contracting the COVID-19 virus. Perceived risk is defined as an individuals’ psychological evaluation of the likelihood and consequences of a hostile outcome . One of According to the protection-motivation theory, people are more likely to protect themselves in line with their perception of the severity of forthcoming threatening events, their perceived vulnerability and self-efficacy ,22. As aGender has been identified as an important driver of risk for mortality and morbidity rates for people who have been struck by COVID-19 . AvailabTherefore, this study examines the influence of COVID-19 risk perception and coping mechanisms, as well as the role of gender in the relationship between COVID-19 risk perception and coping mechanisms, using a sample of Ghanaian university students. This study has great significance for virus control in educational institutions in the country. The findings could help shape policies and interventions  that may lead to compliance with COVID-19 preventive and management protocols and also promote a safe school environment conducive for learning. Internationally, this study serves as a reference for future COVID-19 studies that focus on risk perception and coping mechanisms.Through a cross-sectional survey, 859 students were sampled from two public Ghanaian universities . The reference population for this study was university students in Ghana. However, the accessible population was limited to students in the two universities  due to the following reasons: (1) Observations made by the investigators as they went about their teaching activities during the COVID-19 pandemic showed that students in these two universities reportedly showed  some level of fear, worry, and uncertainty regarding their safety during teaching and learning activities. Thus, the investigators believed that such a group of students could provide adequate information about the phenomenon being studied. (2) Empirical evidence from two recent studies in the same universities using physical education students also showed that the level of risk perception was on the rise ,36, and β) estimate of 0.95, α error probability of 0.05, and five predictors (including interaction term). This estimation procedure yielded a sample size of 995. However, 136 participants either opted out of the study or did not complete about 90% of the items on the questionnaire, leading to a response rate of 86%. A convenient sampling procedure was used to select the students to participate in the study; participants who were ready, willing, and available at the time of data collection were recruited to respond to the data collection instrument. This sampling approach was used due to the non-accessibility to the sampling frame for the accessible population. Out of the 859 students, 36.2% were below 23 years (n = 311), 47.8% were aged 24 to 30 (n = 410), and the rest were over 30 years old. The study participants were dominated by males , with females constituting 37.6% (n = 323). Christians constituted about two-thirds of the sample , Muslims represented about 26.5% (n = 228), whereas the African tradition religion represented 0.7% (n = 6).The sample size for this research was estimated using G-power software with an effect size of 0.02, power  as risky in terms of contracting and transmitting COVID-19 infections. A set of five items were carefully adapted from Capone et al.’s  COVID-19The coping inventory for university students developed and validated by Quansah et al.  was adopWith approval from the Institutional Review Board (IRB) of the University of Cape Coast, with reference number UCCIRB/EXT/2020/25, data collection commenced in the two public universities selected. With the help of some heads of departments and faculty members, students were sensitized regarding the upcoming data collection exercise. The data collection was carried out using two approaches: traditional face-to-face administration and online administration. Respondents had the opportunity to choose their preferred mode of administration. With the online mode, respondents were required to provide identification indicators  to authenticate that they were students and were eligible to be part of the study. Meanwhile, links were only shared to targeted participants through emails, Telegram, and WhatsApp platforms. The traditional mode of administration was conducted in the lecture halls where copies of the questionnaire were distributed to students through a convenient sampling technique. Throughout the questionnaire administration period, the investigators adhered to ethical standards such as consent, anonymity, confidentiality, protection from emotional harm or discomfort, protection of vulnerable participants, volition, and freedom of withdrawal. For example, participants signed a consent form to declare their endorsement to be part of the study. In addition, none of the information sought from the participants could reveal their identity. The respondents were made aware that they could freely withdraw from responding to the instrument at any point in time without any reason. The entire data collection was done in 2021 and lasted for 2 to 3 months.f2 with the following cut-off points: 0.02 for small, 0.15 for medium, and 0.35 for large effect size.The data collected were checked for correctness and appropriateness before performing the analysis. All of the analyses were performed using SPSS (version 25). The data were first explored to understand the nature of the variables, in terms of the means and standard deviations, as well as the correlations existing among the key variables of the study. Using the multivariate linear regression, the relationship between COVID-19 risk perception and coping mechanisms was examined. A stringent alpha was set to 0.013 (based on the four dependent variables) for this analysis in order to reduce the effect of Type 1 errors. Furthermore, simple moderation analysis was carried out to test the moderating effect of gender in the relationship between COVID-19 risk perception and coping mechanisms. The moderation analysis was carried out using 5000 bootstrap samples and, thus, the bootstrap confidence interval was used for the interpretation. The PROCESS macro by Hayes (add-on in SPSS) was used for the moderation analysis using the Model 1 function. The effect size estimations were computed for all of the inferential analyses conducted using Cohen’s The descriptive analyses of the variables have been presented in M = 0.733, SD = 0.223) (see r = 0.173) and gender (r = −0.125). The analyses showed that religious coping was the top utilized coping strategy , followed by active coping  and emotional support . Religious coping was significantly related to behaviour disengagement (r = 0.204), emotional support (r = 0.339), and gender (r = 0.078). Behaviour disengagement was also significantly related to emotional support (r = 0.325) and gender (r = −0.138).Risk perception, based on the index, showed a high level of risk perception among the participants (223) see . The varThe study examined the influence of COVID-19 risk perception on coping mechanisms. The outcome of the multivariate linear regression analysis is shown in B = 0.573, SE = 0.111, t = 5.138, p < 0.001, f2 = 0.031, indicating that the more university students perceived their environment as being risky in terms of contracting COVID-19, the more they utilized active coping mechanisms. Risk perception failed to significantly predict the other three dimensions of coping mechanisms, namely: religious coping, behaviour disengagement, and emotional support.As shown in Through a single moderation analysis, the role of gender in the relationship between COVID-19 risk perception and coping mechanism was explored. The details of the results are shown in B = −0.979, t = −3.795, BootCI, f2 = 0.175 , f2 = 0.144. Female students adopted high levels of behaviour disengagement strategy when risk perception was high, whereas male students adopted this coping mechanism to a very low extent in the same situation , f2 = 0.202. The results suggested that in the presence of a high level of risk perception, male students adopted more emotional coping, while female students utilized less emotional coping (see In Model 1, the results showed that gender significantly moderated the relationship between risk perception and active coping, .175 see . Probing.175 see a. Meanwhtion see b. The reping see c. HoweveThe core focus of this study was to ascertain the influence of COVID-19 risk perception and coping mechanisms, taking into consideration gender variations among university students, and how likely they are confounding the influence. The findings indicated heightened risk perception among university students. Religious coping was predominantly adopted as a coping mechanism by the students, while behaviour disengagement was the least adopted coping mechanism. Among the four dimensions of coping strategies used in this study, COVID-19 risk perception influenced only active coping. Thus, a high level of risk perception was associated with the increased practice of active coping mechanisms with a positive influence. This finding signifies that the mere perception of the university environment as being unsafe in terms of the transmission and contracting of COVID-19 is associated with high chances of students wearing nose masks, and also adhering to hygiene and management protocols. In line with this finding, Yıldırım et al.  documentThe findings of the current study can be situated within the framework of protection motivation theory . This thThe findings further established that, with the introduction of gender, three of the four coping mechanisms, namely, active coping, behaviour disengagement coping, and emotional support coping, were influenced by risk perception. Meanwhile, only active coping had a direct influence on risk perception without the presence of gender in the model. These findings underscore the idiosyncratic nature of gender in the relationship between risk perception and coping mechanisms. While males were more likely than females to adopt active coping and emotional support coping with heightened risk perception, the relationship was otherwise in the case of behaviour disengagement. This was supported in a study by Alsharawy , who fouThe findings have empirical underpinnings from previous researchers ,28,29,30The present study has some limitations. The study used a cross-sectional design, collecting data from at a single point in time during the pandemic; hence, conclusions drawn from the findings do not guarantee long-term effects. Future studies could use longitudinal studies to evaluate changes in COVID-19 risk perception and coping mechanisms to mirror the dynamic nature of the pandemic using other student populations in the country. Furthermore, participants in this research were selected through a convenience sampling technique and this could provide a biased sample. The generalization of findings to other student populations could be limited. Despite these limitations, the findings provide useful information to key stakeholders of university campuses in Ghana to implement health promotion and prevention interventions essential to boost successful adaptation, especially among females in this challenging pandemic era.The import of our research emphasized the relationship between COVID-19 risk perception and coping mechanisms, addressing the role that gender plays. It was clear that as university students experienced high COVID-19 risk perception, these students were found to adopt an active coping mechanism. This notwithstanding, this relationship existing between COVID-19 risk perception and coping mechanisms appeared not to be the same for both male and female students. In the presence of a high level of risk perception, male students largely adopted the active and emotional coping mechanisms, whereas female students utilized less of these coping strategies. However, female students largely adopted behaviour disengagement coping amid high COVID-19 risk perception. The result is an indication that female students are likely to be overwhelmed with a high level of risk perception and give up easily trying to put in place effective strategies to reduce the effect of the COVID-19 pandemic situation. The findings of the study highlight the need for different forms of intervention for male and female students in dealing with the effect of COVID-19. This research discourages the implementation of wholesale COVID-19 intervention strategies in schools. That is, appropriate intervention packages need to be designed and implemented for students, taking into consideration the diverse ways in which each group responds to the pandemic situation. University students should be sensitized to the risks associated with COVID-19, including varied risk perception and the adoption of active coping strategies, with special emphasis on female students.


The relationship between allergic diseases (AD) and mental disorders (MD) in women has not been fully systematically evaluated. We aimed at validating this correlation.The relevant cohort and case-control studies from the establishment of the database to February 18, 2022 in PubMed, Embase, and Cochrane library were searched by computer. The researchers conducted the quality evaluation of the included articles by reviewing and discussing with reference to relevant standards, and conducted the analysis of the correlation between female patients with AD and MD by using Review Manager 5.4.Six observational studies from 2631 studies (n = 1160858 women) were assessed as medium and high-quality studies. The meta-analysis demonstrated that AD was correlated with MD in female patients , including asthma , allergic rhinitis , and atopic dermatitis in women  were associated with MD. At the same time, subgroup analysis was performed according to region, study design, criteria of AD and MD, and the results demonstrated that both AD and MD were correlated in these different conditions.Allergic diseases in female patients do have an association with mental disorders.https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022311146].[ Allergic diseases (AD) are a series of health issues that are widely concerned worldwide. The incidence rate of AD is increasing year by year. Heredity and environment are the main pathogenic factors, while pathogenesis is mainly “T helper type 2 immune response” . In addiMental disorders (MD) are a global problem, which have a crucial impact on human health. They usually include depression, anxiety, etc. . The preThe association between AD and MD has been controversial in recent years. One study showed a correlation between AR and depression . AnotherThe preferred reporting items for systematic review and meta-analysis (PRISMA) were used in this study . We regiEnglish articles published in PubMed, Embase and Cochrane Library from inception to February 18, 2022, were searched. The combination of subject words and free words is adopted. Search terms include mental disorder terms  and terms of allergy and atopic diseases  and female terms  and related terms . Meanwhile, we also discuss the references in the main study with peer experts for additional reference information.After eliminating the repeated and irrelevant articles, two researchers screened out the articles that met the standard by reading the title, the abstract, and the full text to finally determine the included articles. In case of disagreement and consensus cannot be resolved, a third researcher will assist in the review. Furthermore, if more information is required, we will contact the relevant authors to obtain it. We formulated the following inclusion criteria: (1) the type of study was an observational study (cohort study and case-control study); (2) the subjects were female patients with AD and MD; (3) comparison with the control group was involved; (4) it had scientific disease diagnostic criteria; (5) data such as odds ratio (OR) or relative rate (RR) and 95% confidence interval (CI) could be obtained. We excluded studies under the following circumstances: (1) articles published repeatedly or unable to obtain the full text; (2) data was incomplete or cannot be converted; (3) review, conference abstract, case report, and animal experiments; (4) study design, outcome indicators, and themes were inconsistent with the study; (5) there was no scientific diagnostic criteria for the disease.A researcher extracted the information included in the study, including (1) basic information such as author, year, country, participant, and age; (2) study design and source of case samples; (3) diagnostic criteria for AD and MD. It was subsequently reviewed by another researcher, and differences were resolved through discussion, with the assistance of a third researcher. The quality of the included studies was evaluated by the Newcastle Ottawa scale (NOS) . There w2 test. For low-degree heterogeneity (P < 0.10 and I2< 50%), the fixed-effects model was used. Otherwise, the random-effects model was selected (P < 0.10 and I2≥ 50%). Meanwhile, the source of heterogeneity was determined by subgroup and sensitivity analysis. If more than ten articles were included, the funnel plot was used to analyze the risk of bias.Review Manager 5.4 was used for meta-analysis of the included studies. Effect sizes of OR were pooled using generic inverse variance. Heterogeneity was indicated by IA total of 2631 articles  were initially detected through database retrieval, of which 23 duplicate articles were excluded. After reading the title and abstract, 2564 articles were excluded, and the remaining 44 articles were reviewed in full text. Finally, a total of 6 articles were included for analysis  13, 19––19–23.The 6 articles were published for 2014-2021 years, and all participants were women, with 189-846155 participants, respectively, from North America (Canada and USA) , 21, 23,The quality of included studies was evaluated according to NOS. There were 5 articles of high quality, and the other one  was rateI2 = 81%, P < 0.001). The analysis of random-effects model showed that AD in female patients was correlated with MD     . Conside< 0.001)  was excl= 0.007) . Excludi= 0.007) , 22 with = 0.07) .I2 = 69%, P = 0.01), and asthma was associated with MD . There was heterogeneity in AR group , and the incidence of mental disorders in AR group was higher than that in non-AR control group . There was no significant heterogeneity in the atopic dermatitis group , and atopic dermatitis was associated with MD . Therefore, female patients with AD were correlated with MD  and questionnaire for diagnosis of MD  without significant heterogeneity  . AnotherAt present, the pathogenesis of AD is still being explored. Some theories suggest that inflammatory cytokines  in AD bound to receptors on nerve cells, which can reduce the volume of gray matter in the hippocampus and thus have an impact on depression . BesidesThis systematic evaluation is mainly aimed at the female group at first. The perinatal women and professional women are comprehensive evaluated, so as to explore the impact of disease on women. Secondly, the diseases studied are not limited to a single type, but a larger range of diseases are discussed for AD and MD, and a series of diseases such as AR, anxiety, and depression are comprehensively analyzed. Thirdly, all the included studies were rated as medium and high quality after NOS quality evaluation. Fourthly, compared with the 106813 samples studied by Ye et al. , we analThis study also has the following limitations. First, the observational studies principally focused on cohort studies and involved merely one case-control study. Second, AD was predominant in asthma. The relevant AR and atopic dermatitis solely involved two studies respectively, and the severity of the disease was not analyzed. Third, the OR, RR and 95%CI obtained from the paper failed to completely exclude relevant confounding factors. Fourth, there may be some bias in reviewing only those published in English and excluding other forms of reporting. Fifth, three of the six articles used questionnaire assessment in the criteria of MD.In conclusion, our meta-analysis finds a significant association between AD  and MD in women. Future studies require adjusting for confounding variables and include a larger number of high-quality studies. Additionally, multi-center randomized controlled trials are needed to further explore pathogenesis and clinical prevention and treatment of the disease.The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.LL and SP participated in the design of this study. MZ, XA, and HL discussed and screened the literature. LL was responsible for data analysis and writing. CL and SP were responsible for revising and reviewing the manuscript. All authors contributed to the article and approved the submitted version.