Bifidobacterium and short chain fatty acids (SCFAs)-producing bacteria decreased, and the abundance of lactate-producing bacteria increased. In addition to lowering the blood pressure, losartan increased the abundances of Alistipes, Bacteroides, and Butyricimonas in SHR, reduced the abundances of Ruminococcaceae, Streptococcus, and Turicibacter, reduced the Firmicutes/Bacteroidetes ratio, and rebalanced the gut microbiota. Losartan also increased the abundances of Bifidobacterium and SCFAs-producing bacteria and reduced the abundance of lactate-producing bacteria. However, atorvastatin and aspirin had no significant effect on the gut microbiota in SHR. The above results showed that losartan could change the characteristics of the gut microbiota in hypertension and rebalance the gut microbiota, which may be related to lowering the blood pressure. Atorvastatin and aspirin have no significant influence on the gut microbiota in SHR.Many studies have shown that alterations in the gut microbiota are associated with hypertension. Our study aimed to observe the characteristics of the gut microbiota in hypertension and to further explore whether drug molecules can play a therapeutic role in hypertension by interfering with the gut microbiota. We evaluated the differences in the composition of the gut microbiota in spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY). Meanwhile, three first-line cardiovascular disease (CVD) drugs, losartan, atorvastatin, and aspirin, were used to treat the SHR in order to observe their effects on the gut microbiota in SHR. The 16S rDNA results showed that the diversity and richness of the gut microbiota in SHR were significantly reduced compared with that of the WKY, the Firmicutes/Bacteroidetes ratio was increased, the abundances of  In recent years, the potential importance of the gut microbiota to human health has received extensive attention. Gut microbiota, which is known as the second human genome, has become one of the most popular research fields . The humCardiovascular disease (CVD) is the main public health care project of the World Health Organization (WHO) . With thSome studies have shown that some CVD drugs changed the gut microbiota. Recent studies have shown that irbesartan reduced the F/B ratio in the gut microbiota in the high-altitude pulmonary hypertension rats and improved the disorder of the gut microbiota . Two stup < 0.01). After four weeks of a losartan treatment, the SBP and DBP of SHR were significantly decreased (p < 0.01). After the atorvastatin and aspirin treatments, the SBP and DBP of SHR did not change significantly  of Wistar Kyoto rats (WKY) was maintained at about 140 mmHg, and the diastolic blood pressure (DBP) was maintained at about 100 mmHg. The SBP of SHR was maintained at about 210 mmHg, and the DBP was maintained at about 150 mmHg. The SBP and DBP of SHR were significantly higher than those of WKY (ficantly .p > 0.05). The sequencing coverages of the gut microbiota in all of the rats were above 0.999, which indicated that the sequences had a high probability of being sequenced. In conclusion, the sequencing results could be used for a subsequent bioinformatics analysis.As shown in All of the quality sequences were divided into 606 OTUs based on a 97% similarity level. A Venn diagram was drawn to observe the similarity and overlapping of the five groups of OTUs . Our resp < 0.01). This indicated that the diversity and richness of the gut microbiota in the SHR were significantly reduced. After the losartan treatment, the diversity and richness of the gut microbiota in the SHR were significantly increased (p < 0.01). After the atorvastatin and aspirin treatments, the diversity and richness of the gut microbiota in the SHR did not change significantly , Chao, Simpson, and Shannon indices. ACE and Chao are positive relationship to the richness of the gut microbiota. Simpson and Shannon have a positive relationship with the diversity of the gut microbiota. Our results showed that the ACE, Chao, Simpson, and Shannon indices in the SHR was significantly lower than those in the WKY  and a nonmetric multidimensional scaling (NMDS) analysis were performed based on the Bray–Curtis distance. Our results show that the samples from the WKY and SHR were farther apart and completely separated, indicating that the compositions of the gut microbiota were significantly different between the two groups of samples. The distances between the samples in the SHR, At, and As groups were small, indicating that the three groups of samples were very similar in composition. Excitingly, the samples in the Lo and SHR groups were significantly dispersed, and the distances between the samples in the Lo and WKY groups were smaller. These indicated that the gut microbiota in the SHR was significantly changed after the losartan treatment, and it was very similar to the gut microbiota in the WKY .p < 0.01), while the abundance of Firmicutes in SHR was significantly increased (p < 0.01), and the abundance of Firmicutes was significantly decreased (p < 0.01). Compared with the WKY, the F/B ratio in the SHR group increased 1.3 times (p < 0.01)  B. ComparAlistipes, Bacteroides, and Butyricimonas belonging to Bacteroidetes were significantly enriched in the WKY, while these three genera were significantly decreased in the SHR, At, and As groups  performed at the genus level showed that the abundances of s groups A. Interes groups B. The ab the WKY A. After ecreased B. These Alistipes and Bacteroides in the SHR were significantly lower than those in the WKY (p < 0.01). After the losartan treatment, the abundances of these two genera in the SHR significantly increased (p < 0.01). However, compared with the SHR, the abundances of Alistipes and Bacteroides in the At and As groups did not change significantly. Bifidobacterium, which belongs to the phylum of Actinobacteria, is commonly considered to be a beneficial genus of bacteria, and it plays a key role in the immune system [Bifidobacterium was reduced under multiple disease conditions, which is also a feature of dysbiosis [Bifidobacterium in the SHR was significantly lower than that in the WKY (p < 0.01). This greatly reduced the proportion of Actinobacteria in the SHR, thereby reducing the diversity of the gut microbiota. After the losartan treatment, the abundance of Bifidobacterium in the SHR significantly increased (p < 0.01). However, the abundance of Bifidobacterium in the At and As groups did not change significantly (Butyricimonas in the SHR was significantly lower than that in the WKY (p < 0.01) (Butyricimonas in the SHR significantly increased (p < 0.01). The abundances of Dubosiella and Ruminococcus in SHR were significantly higher than those in the WKY (p < 0.01)  (p < 0.01). It can be seen more intuitively from Alistipes, Bacteroides, Bifidobacterium, and Butyricimonas in the SHR, reduced the abundance of Ruminococcaceae, Streptococcus, and Turicibacter, and rebalanced the gut microbiota.As shown in e system . It is rysbiosis ,20. Our ficantly C. The ab < 0.01) D. After  < 0.01) E,G. Howe < 0.01) F,H,I. AfBacteroides and Butyricimonas. In contrast, a high abundance of lactate-producing bacteria was found in the SHR, including Streptococcus and Turicibacter. To further clarify the changes of short chain fatty acids (SCFAs)- and lactate-producing bacteria in rats of each group, we re-grouped all of the bacterial 16S rDNA reads according to their major metabolic end-products, as described in the methods. Our results showed that the abundances of acetate- (p < 0.01), while the abundance of lactate-producing bacteria (p < 0.01). Obviously, after the losartan treatment, the abundances of acetate- and butyrate-producing bacteria in the SHR significantly increased (p < 0.01), and the abundance of lactate-producing bacteria significantly decreased (p < 0.01).LEfSe also showed a higher abundance of acetate- and butyrate-producing bacteria in the WKY, including acetate- A and butacetate- B in the bacteria C in the CVD is one of the leading causes of death worldwide. With the rapid development of molecular biology and bioinformatics, more and more studies have shown that alterations to the gut microbiota are associated with CVDs such as atherosclerosis, coronary heart disease, and hypertension. Yang found that the diversity of the gut microbiota decreased, and the F/B ratio increased in both the SHR and hypertensive patients . In anotThe richness and diversity of the gut microbiota are important indicators to reflect the composition of the gut microbiota , which cAlistipes, Bacteroides, and Butyricimonas belonging to Bacteroidetes were significantly increased in the WKY, while these three genera were significantly decreased in the SHR. The abundances of Dubosiella, Ruminococcaceae, Ruminococcus, Streptococcus, and Turicibacter, which belong to Firmicutes, were significantly increased in the SHR, while the abundances of these five genera were significantly decreased in the WKY. These changes are the main cause of the F/B increase in the SHR.A large number of studies have shown that the F/B ratio is an important indicator to reflect the disturbance of the gut microbiota . Our resAlistipes is associated with many traditional CVDs, such as hypertension, atrial fibrillation (AF), congestive heart failure (CHF), and atherosclerosis [Bacteroides related to health was significantly decreased [Butyricimonas and anaerobic Corynebacterium [Ruminococcaceae, Streptococcus, and Turicibacter are positively correlated with blood pressure [Bacteroides and Butyricimonas were significantly decreased in SHR, and they were negatively correlated with blood pressure. We also found that the abundances of Ruminococcaceae, Streptococcus, and Turicibacter were significantly increased in SHR, which were positively correlated with blood pressure. These findings are consistent with previous reports. In addition, we found that the abundance of Alistipes was decreased in SHR, which was negatively correlated with blood pressure.clerosis . Howeverecreased . Kim fouacterium . It has pressure ,30,31. OBifidobacterium is commonly considered to be a beneficial genus of bacteria, and it plays a key role in the immune system [Bifidobacterium is reduced in many diseases, which is also a feature of dysbiosis [Bifidobacterium was significantly decreased in the SHR, further indicating that the gut microbiota in the SHR was disordered.e system ,33,34. Iysbiosis . Our stuRoseburia and Faecalibacterium prausnitzii in the feces of hypertensive patients were lower than those of normal people, and the levels of SCFAs in the feces of hypertensive people were significantly higher than those of normal people [Clostrideae and Coprobacillus was strongly negatively correlated with the increasing systolic blood pressure of rats, while the abundance of lactate-producing bacteria such as Lactobacillus was strongly positively correlated with the increasing systolic blood pressure of rats [SCFAs are the main metabolites produced in the colon by the bacterial fermentation of dietary fibers and resistant starch, mainly including acetate, propionate, and butyrate ,37. SCFAl people . Adnan r of rats . Our resAlistipes, Bacteroides and Butyricimonas in the SHR, reduced the abundances of Ruminococcaceae, Streptococcus and Turicibacter, reduced the F/B ratio, and rebalanced the gut microbiota. Losartan also increased the abundances of Bifidobacterium and SCFAs-producing bacteria, and it reduced the abundance of lactate-producing bacteria. The above results suggested that losartan could alter the characteristics of the gut microbiota in hypertension, but more evidence is needed to prove whether it is related to lowering blood pressure. Our study also suggests that the gut microbiota may become a new potential drug target for the treatment of hypertension in the future.After the losartan treatment, the blood pressure of the SHR was significantly reduced, and the diversity and richness of gut microbiota was significantly increased, and the composition of gut microbiota was very similar to that in the WKY. Losartan increased the abundances of Bacteroides, Butyricimonas, and Mucispirillum in an aged mouse model of high-fat-diet-induced obesity, and it demonstrated that this may contribute to hyperglycemia improvement [A recent study showed that atorvastatin could increase the abundances of rovement . Anotherrovement . However® soil DNA Kit and Phusion® High-Fidelity PCR Master Mix with GC Buffer were purchased from New England Biolabs (Beijing) Co., Ltd. . Qiagen Gel Extraction Kit was purchased from Shanghai Yubo Biotechnology Co., Ltd. . Ion Plus Fragment Library Kit 48 rxns was purchased from Thermo Fisher Scientific (CHINA) Co., Ltd. .Losartan was purchased from Merck Sharp & Dohme Co., Ltd . Atorvastatin was purchased from Pfizer Pharmaceutical Co., Ltd . Aspirin was purchased from Bayer Healthcare  Co., Ltd. . E.Z.N.A.Six-week-old male SHR (130–150 g) and five-week-old male Wistar Kyoto rats (WKY) (130–150 g) were purchased from Charles River, Inc  2016-0006). All of the animals were housed under controlled light (12 h/12 h light–dark cycle), a humidity of 55% ± 5%, and a temperature of 22.1 °C ± 0.5 °C, with free access to water and standard chow. There was one week of adaptive feeding before the formal experiment began. All of the experimental procedures were approved by the Biological and Medical Ethics Committee, Minzu University of China .Thirty-two SHRs were divided into four groups: SHR (vehicle), SHR-Losartan , SHR-Atorvastatin , and SHR-Aspirin  ones. All of these drugs and double-distilled water as the vehicle were administrated daily to the SHRs via an oral gavage for 12 weeks. The WKY were treated with double-distilled water as they were a normal control group.The SBP and DBP were measured using a noninvasive computerized tail-cuff system . After a pre-warming period under constant temperature in a quiet environment, all of the rats were placed in a restraining chamber. The blood pulse pressure-sensing device was placed at the base of rat tails. Their blood pressures were measured 5–7 times for each rat. The ones that met the compliance were used for determining the average value.Twelve h after the last administration, fresh feces of all of the rats were collected and placed in sterile EP tubes. The fresh samples were frozen in liquid nitrogen and stored at −80 °C until the analysis.® soil DNA Kit according to manufacturer’s protocols. The quality of the extracted DNA was checked using 1% agarose gel electrophoresis, while the concentration and purity of DNA were measured using a NanoDrop2000 Spectrophotometer. Then, an appropriate sample of DNA was applied to the centrifuge tube and diluted with sterile water to 1 ng/μL. Using the diluted DNA as a template, primers of the v3–v4 region of 16S rDNA with barcode (338F-5′-ACTCCTACGGGAGGCAGCAG-3′ and 806R-5′-GGACTACHVG GGTWTCTAAT-3′) were used, and a Phusion® High-Fidelity PCR Master Mix with a GC Buffer and high-fidelity thermostable DNA polymerase were used for polymerase chain reaction (PCR) to ensure amplification efficiency and accuracy. For the PCR conditions, refer to previous studies [Microbial DNA was extracted from the fecal samples using the E.Z.N.A. studies . The PCRhttps://bioincloud.tech/ accessed on 1 June 2022), and the LDA score screening value was set to 3.5. The bacteria were classified according to the lactate and SCFAs end-product as previously described [Paired-end reads of each sample were merged by FLASH  to obtain raw tags. High-quality clean tags were generated from the strict filtration of raw tags by QIIME . Final effective tags were produced after the removal of chimera sequences in the tags, which were detected by the gold database  and UCHIME Algorithm. Sequences with 97% homology were clustered into identical OTUs by USEARCH . Then, the representative sequence of each OTU was selected for the species annotation. Raw data see escribed ,48. Genep < 0.05 was considered to be significant.The statistical analyses were conducted using SPSS Statistics 25 software. Differences between the groups were identified using a one-way analysis of variance (ANOVA), which was followed by an LSD post hoc test. Comparisons between the 5 groups in this study are presented as mean ± standard deviation (SD). A value of Alistipes, Bacteroides, and Butyricimonas increased, the abundances of Dubosiella, Ruminococcaceae, Ruminococcus, Streptococcus, and Turicibacter decreased, and the F/B ratio increased; (2) the abundance of Bifidobacterium decreased, and the abundance SCFAs-producing bacteria decreased, and the abundance lactate-producing bacteria increased. Losartan is an angiotensin II type 1 receptor (AT1R) antagonist, which can change the characteristics of the gut microbiota in hypertension and rebalance the gut microbiota. However, more evidence is needed to prove the relevance to the role of losartan in lowering blood pressure. On the other hand, 12 weeks of administration of atorvastatin or aspirin had no significant influence on the gut microbiota in the SHR.In conclusion, we used a 16S rDNA high-throughput sequencing technique to provide the characteristics of the gut microbiota in spontaneously hypertensive rats, mainly determining that: (1) the diversity and abundance of the bacteria decreased significantly, the abundances of


The COVID-19 pandemic resulted in tremendous physical and psychological pressure on healthcare professionals, especially on those working in intensive care units (ICUs) and Emergency Departments (EDs). The present study intended to characterize the profile of these professionals which is associated with burnout and determine the potential predictors of such condition.A Prospective cohort study was carried out in a tertiary hospital between March 2020 and March 2021, in Salvador, Brazil. A standardized and validated version of the Oldenburg Burnout inventory (OLBI) was applied to assess risk of burnout together with data forms designed to collect information on sociodemographic characteristics and religious beliefs. ICU and ED healthcare professionals were evaluated during off-hours at two distinct periods of the COVID-19 pandemic, in 2020 and in 2021. Differences in the results obtained from each study participant between the timepoints were compared. A binary logistic regression analysis was performed to identify the predictors of burnout development independent of other confounding factors.n = 56) were enrolled. There were 62 professionals at risk of developing burnout through the OLBI. Those had a median age of 33 (IQR: 31–37) and female predominance . Disengagement and burnout were the only features which frequencies significantly changed over time, with increasing detection at the latest timepoint. Alcohol consumption was found to be an important risk factor for burnout development [adjusted odds ratio (aOR): 10.8 (95% CI: 1.8–64.2)]. Importantly, working in the ICU [aOR: 0.04 (95%CI: 0.01–0.32)] and the habit of praying daily [aOR: 0.07 (95%CI: 0.01–0.41)] were characteristics linked to reduced odds of burnout.Seventy-seven healthcare professionals with a median age of 33 (interquartile range [IQR]: 31–37.5) years and predominantly female (72.7%; Disengagement substantially increased during the COVID-19 pandemic in healthcare professionals. Alcohol consumption favors the onset of burnout whereas habit of praying daily and working in the ICU are protective against such outcome. Institutional policies aimed at minimizing etilism may positively impact mental health of these professionals. StudiesAlthough “staff burn-out” was designated by Freudenberg in the 70’s as an experience of disappointment, physical and emotional exhaustion and loss of interest in work, the discussion about Burnout has substantially expanded over the recent years and robustly intensified during the COVID-19 pandemic. Currently, researchers define this condition as a psychological stress related to work and its main manifestations would be exhaustion and disengagement, but above all, exhaustion . PreviouFurthermore, the insecurity, fear and sadness that permeate the scenario observed during the COVID-19 pandemic have revealed a chain of concepts related to sustaining what is in fact essential to life. Since spirituality has the potential to promote the idea of protection and humanization, by manifesting the character of hope, mastery of resilience and promotion of well-being, some healthcare professionals were able to exercise their belief as a coping strategy . The pri2.2.1.Prospective, descriptive, and analytical cohort, from June 2020 to March 2021, which included all health professionals from the emergency department and ICU, that provided consent, of a large COVID-19 referral hospital located in the state of Bahia, Brazil. Of 102 health professionals, 77 agreed to participate in this work .2.2.A self-administered online data questionnaire was applied at two different timepoints of the COVID-19 pandemic during commencement of off-work hours, first on June 25, 2020 (Q1), then on February 22, 2021 (Q2) . The firBoth questionnaires contained three sections: the first obtained socio-demographic data ; the second section contained the questions that made up OLBI; the third section contained the questions that made up Beliefs. Details of these last two are described below. A copy of the questionnaire translated to English is shown in 2.2.1.A validated Portuguese translation of the standardized OLBI was used to assess burnout risk . It cons2.2.2.Furthermore, the long form of the standardized Beliefs questionnaire was also applied. This questionnaire was published in a report of the Fetzer Institute and the National Institute on Aging Working Group in a compilation of multidimensional measurement tools of religiousness and spirituality for use in health research. It consists in a self-report, not validated, five-point rating scale with seven questions that assess the degree of an individual’s beliefs. Its sum was used to estimate the degree of personal faith. The cognitive dimension of belief is central to religiosity and, despite differences from religion to religion, there is in all of them a search for the meaning of suffering and death, bringing comfort and serving as a coping mechanism .2.3.U test (for two unmatched groups) and the Wilcoxon matched pair test (for two matched groups) were used to compare continuous variables. The categorical variables were compared using the Fischer’s exact test (in 2 × 2 tables) and were presented as number and frequency (%). A binary regression analysis, backwards stepwise method, was used to identify factors independently associated with burnout development. All variables that presented value of p < 0.1 in the univariable analysis were included in the final adjusted model. Differences with value of ps < 0.05 were considered statistically significant. Statistical analyzes were performed in R (version 4.1.1).Median values with interquartile ranges (IQR) were used as measures of central tendency and dispersion, respectively. The Mann–Whitney 3.3.1.n = 56) and the most prevalent self-reported skin color was brown  years, there was a predominance of women . Furthermore, the proportion of exhausted professionals remained similar between the timepoints, the increase in disengaged participants  being responsible for an increase of the same proportion of individuals in burnout. Accordingly, the rate of participants undergoing nutritional and psychological assistance rose slightly, respectively from 13 to 18.2%  and 3.9 to 13% .The 3.3.n = 62). Those had a median age of 33 (IQR: 31–37) and a female predominance . The only variables that showed a significant change in frequency throughout the study were disengagement and burnout . However, there appeared to be an association regarding the area of activity, in which nurses and nursing technicians were differentially predisposed to develop burnout, in line with another study carried out with Swedish health professionals, including nurses, midwives and biomedical technicians who developed burnout . Of noten = 26) were satisfied with their salary, but dissatisfied with the resources available for patient care  necessary to guarantee collective protection , the strent care . These fent care . These cent care . A studyent care .To the detriment of the context of the COVID-19 pandemic, there is a need for these professionals to have coping strategies to attenuate negative symptoms. Therefore, our study had a secondary aim to sought to measure the relationship of faith as a coping strategy through a non-validated questionnaire of religious beliefs and habits. The habit of praying every day was a significant protective factor for burnout, and this may occur through the perception of divine protection, as mentioned by Tavares Quelho, while discussing spirituality as a dimension of protection and humanization, in addition to bringing the character of hope . A diffeSome coping strategies, such as substance abuse, may have positive short-term effects, but can have negative long-term repercussions . Our finImportantly, the present study has some limitations. This was a single-center study that may suffer from unmeasured effects. Due to the small sample size, a more detailed analysis of habits was not carried out, such as the quantification of alcohol consumption, the modality of physical activity or the assessment of personality traits. The latter can influence the associations described in this study. People with higher levels of extroversion and openness are more likely to drink alcohol, and individuals with higher levels of neuroticism may have difficulty managing their emotions and may turn to alcohol as a coping mechanism. Not only that, higher levels of neuroticism can turn a person away from religious beliefs . Regardi5.Among Brazilian healthcare professionals from ED and ICU from a hospital directly affected by COVID-19 pandemic, alcohol use was the strongest factor predisposing to increasing risk of burnout whereas the habit of praying daily and working in the ICU were protective against such syndrome. These findings may guide decision-making strategies to implement institutional measures to reduce risk of burnout in extreme conditions such as the catastrophic scenario caused by the SARS-CoV-2 virus.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by Research Ethics Committee of Federal University of Bahia. The patients/participants provided their written informed consent to participate in this study.RS, RM, IF, SG, HP, NF, and BA: conceptualization, design of study, and manuscript draft. RS, RM, IF, and KA: investigation and visualization. RS, RM, NF, and KA: data acquisition. RS, RM, IF, MA-P, SG, HP, and BA: data analysis and interpretation. RS, RM, IF, SG, HP, and BA: supervision, critical revision, editing and final approval of the manuscript. All authors read and approved the final manuscript.This study was supported by the Intramural Research Program of the Oswaldo Cruz Foundation, Brazil.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.


Although the seasonal variation of motor and non-motor symptoms in Parkinson's disease (PD) has been reported, the association between seasonal change and quality of life in patients with Parkinson's disease remains to be explored.n = 241); group 2: June to August (n = 259); group 3: September to November(n = 273); group 4: December to February (n = 263). The 39-item Parkinson's Disease Questionnaire (PDQ-39) and other clinical evaluation scales for motor and non-motor symptoms were administered. The determinants of the quality of life (QoL) were analyzed by multiple stepwise regression analyses.We recruited 1,036 patients with PD in this cross-sectional retrospective study. The patients were divided into four groups based on their date of assessment, according to the classical four seasons: group 1: March to May (p = 0.002). The Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score was higher in group 1 (spring months) than in group 3 (the autumn months) (p = 0.033). The most severe determinant of QoL was the UPDRS-III score in group 1 and the Geriatric Depression Scale (GDS) score in groups 2, 3, and 4.A significant difference in PDQ-39 was found between group 1 (spring months) and group 3 (autumn months) after correction (The current study reported seasonal fluctuation of QoL in patients with PD, with higher scores during the spring months and lower scores in the autumn months. Since the determinants for QoL also vary by season, clinicians might need to focus on specific factors across seasons before initiating therapy. Parkinson's disease (PD) is a common neurodegenerative disorder characterized by bradykinesia, tremor, and rigidity . Both moSeveral previous studies have also worked on seasonal fluctuations in PD symptoms. Data from 546 patients with PD showed no difference in UPDRS motor scores over the traditional four seasons  is a crucial outcome indicator in PD, and the improvement or maintenance of QoL is an important objective of treatment and care in patients with PD , 8. BothPatients were recruited from the Department of Neurology of Huashan Hospital affiliated with Fudan University, Shanghai, China, from December 2011 to February 2021. Inclusion criteria were as follows: (1) a clinical diagnosis of idiopathic Parkinson's disease (iPD) according to the criteria of the United Kingdom PD Society Brain Bank : March to May; group 2 (summer months): June to August; group 3 (autumn months): September to November; and group 4 (winter months): December to February. Data on mean temperature were collected from the National Meteorological Information Center.The study was approved by the Human Studies Institutional Review Board, Huashan Hospital, Fudan University. All patients provided their written informed consent in conformity with the Declaration of Helsinki to participate in our study.Two physicians specializing in movement disorders performed clinical and neuropsychological tests. The Hoehn and Yahr stage (H&Y)  and the QoL was assessed using the Parkinson's Disease Quality of Life Questionnaire (PDQ-39), including eight subdomains: mobility (10 items), activity of daily living (6 items), emotional well-being (6 items), stigma (4 items), social support (3 items), cognition (4 items), communication (3 items), and bodily discomfort (3 items) , 21. It 2) index was used to determine the proportion of variance explained by the variables. Two-tailed p-values are presented. Differences were considered statistically significant at P < 0.05. The data analysis was conducted by SPSS version 26 .Categorical variables were expressed as frequencies (%), and continuous variables were expressed as the mean ± standard deviation (SD) or median . Among the four groups , the chi-squared test was used for comparing the categorical variables, and the Kruskal–Wallis test or the one-way ANOVA test was used for comparing the continuous variables. The Mann–Whitney U-test was used for comparing the continuous variables between the two groups. For multiple comparison correction, the Bonferroni correction was used for the chi-squared test, and the Dwass, Steel, Critchlow-Fligner multiple comparison procedure (DSCF) was used for the Kruskal–Wallis test. Linear regression was used for correction to eliminate the effect of covariates factors. The correlations between the clinical characteristics and PDQ39 SI were analyzed by Spearman's rank correlation analysis. Multicollinearity test was used to choose relatively independent factors (VIF < 10) and estimate their standardized β regressive coefficient factors to uncover the main determinants of QoL in patients in different seasons with age, LEDD, GDS score, ESS score, MMSE score, NMSS score, and UPDRS-III scores entered. The R-squared (Rp = 0.005). No difference was observed in MMSE, GDS, ESS, and NMSS scores among the four groups . After adjustment for GDS and UPDRS-III scores, PDQ-39 scores were still significantly higher in group 1 compared with group 3 (p = 0.040). For the PDQ-39 subdomains, we observed a significant distinct difference in the mobility subdomain (p = 0.010) and bodily discomfort subdomain (p = 0.028) between group 1 and group 3 , and GDS scores in group 2 , group 3 , and group 4 . For NMSS domains, perceptual disturbances and hallucinations was the most severe determinants in group 1  and group 3 , and gastrointestinal symptoms is the most severe determinant in group 2  and group 4   .To the best of our knowledge, this is the first study to explore the seasonal variation of QoL in patients with PD. We observed that QoL was more impaired in the spring months compared with the autumn months after adjusting for UPDRS-III scores. Furthermore, motor function was considered to be the most crucial determinant for QoL in the spring months, while depression was indicated to be the most vital determinant for the summer, autumn, and winter months .Why was QoL worse in the spring months? Seasonal variations in QoL might be due to the motor and non-motor symptoms . These sFor example, humidity may play a role in seasonal variations. Previous studies found that high indoor humidity makes poor air quality, leading to a higher risk of reduced dopamine levels and dopamine neuron degeneration at home , 25. TheIn addition, spring break activities  dramatically increased during and after the long Spring Festival holiday in China. For patients with PD, the inability to participate in physical activity might lead to psychological discrepancy and aggravate neuropsychiatric symptoms, such as anxiety and depression, thereby worsening QoL. The reason why QoL was worse in the spring months remains to be explored; however, we suggest that worsening Qol in patients with PD might result from a mix of several factors, rather than a single one .Previous studies have focused on the seasonal fluctuation of motor and non-motor symptoms in patients with PD. The seasonal effect was found on non-motor symptoms in 372 patients with PD and worsening conditions in the winter months compared with the summer months . Our stuDiabetes mellitus, as a concomitant disease, was suggested to be a determinant of PD risk and progression according to previous studies . NeverthThe study contained a relatively large capacity of enrolled patients with PD and a full set of clinical and neuropsychological assessments. However, there are still certain limitations in our study. The main limitation of the research is the cross-sectional design, which could not analyze the longitudinal impacts of these factors on QoL and make causal inferences. Furthermore, a prefer study was considered to take place with one patient throughout the year. However, if we follow up on QoL at different times within individual patients with PD, we cannot exclude the possibility that the ameliorating or worsening of QoL resulted primarily from the progression of the underlying disease. Moreover, the enrolled patients in the current study showed no difference in demographic information, which indicates that seasonal changes might play the most important role in QoL fluctuation.Taken together, the current study reported seasonal differences in QoL in patients with PD, with higher scores during the spring months and lower scores during the autumn months. Depression imposed the greatest impact on QoL during the summer, autumn, and winter seasons, while motor symptoms turned out to be the crucial factor in the spring months. The findings need to be confirmed by further research with cohort studies and larger sample populations.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the patients/participants legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.MC and XuL contributed to designing and conceptualization of the study. LW, SL, YT, XiaolL, XiaonL, ZX, and TH were involved in data collection. SL, YT, and XiaonL participated in the statistical analysis of data. LW, SL, MC, and XuL were involved in drafting and revising the manuscript for intellectual content. All authors contributed to the article and approved the submitted version.


Although daily hassles have been of interest since the 1980s, only a few tools have been developed to assess them. Most of them are checklists or open-ended questions that are demanding for participants in panel surveys. Therefore, to facilitate daily hassles integration into large surveys, the aim of this study was to present a new tool assessing daily hassles, the LIVES–Daily Hassles Scale (LIVES-DHS), and to examine its relation to life satisfaction, in a sample of 1,170 French- and German-speaking adults living in Switzerland. In a first random subsample, we conducted a principal axis factor analysis, and the results suggested a five-factor solution. Furthermore, we conducted a confirmatory factor analysis on a second random subsample, and it supported the hierarchical factor structure of the scale. The LIVES-DHS consists of 18 items represented by five factors that describe five sources of daily hassles: financial, physical, relational, environmental, and professional. The bivariate correlations showed that the LIVES-DHS could differentiate the concept of daily hassles from associated concepts. Finally, the hierarchical regression showed that daily hassles negatively predicted life satisfaction and added a significant incremental variance beyond that accounted for by age, gender, household income, education level, and personality traits. Major life events such as marriage, death of a loved one, or unemployment are likely to have an impact on almost all aspects of daily life e.g., . HoweverLIVES–Daily Hassles Scale (LIVES-DHS), for measuring daily hassles. Contrary to other existing tools that tap into the presence/absence, frequency, or intensity of daily stressors . The advantage of checklists is that they are easier and faster to answer, resulting in a lower load of work for the respondents. However, this method may fail to capture certain daily stressors if they are not included in the list, and it is often difficult to assess how important a hassle is for the person from a subjective perspective. Moreover, checklists that are too long may negatively affect respondents’ attention and increase dropout or biased responses e.g., .Almost all existing daily hassles assessments use the checklist methodology, which makes them difficult to implement in large surveys. For example, the 320-item Unpleasant Events Schedule was one of the first checklists developed to assess the frequency and subjective aversiveness of daily events in seven domains: health and welfare, achievement-academic-job, domestic inconveniences, sex-marital-friendship, material-financial, and social exits . At the Open-ended questions to assess daily hassles have also been created as an alternative to checklists  by using half of the sample. Then, we conducted a confirmatory factor analysis (CFA) to cross-validate the structure using the other half of the sample. Given the conceptual considerations outlined above, the scale we developed and previous studies , we hypoHypothesis 1a: A five-factor model of daily hassles would fit better than a one-factor model.Hypothesis 1b: Moreover, based on the stress spillover process, the five sources of daily hassles would be highly correlated so that they form a general higher order factor .In a subsequent step, we examined the concurrent validity of the LIVES-DHS. We examined concurrent validity by computing bivariate correlations (a) between the different sources of daily hassles and theoretically relevant constructs; namely, income adequacy, self-rated heath, social support, and job insecurity; (b) between the overall daily hassles score and overall/global indicators of stress and health such as perceived stress in life and general mental health, and (c) between the overall daily hassles score and personality dimension of neuroticism.Hypothesis 2a: The different sources of daily hassles would yield significant but moderate correlations with income adequacy, self-rated heath, social support, and job insecurity, indicating that LIVES-DHS could differentiate the sources of daily hassles from associated concepts.Hypothesis 2b: Daily hassles  would yield significant but moderate correlations with perceived stress in life and general mental health, indicating that LIVES-DHS could differentiate the concept of daily hassles from general outcomes related to those events.Hypothesis 2c: Daily hassles  would yield significant but moderate correlations with neuroticism, indicating that LIVES-DHS could differentiate the concept of daily hassles from a predisposition to experience daily hassles.Finally, we examined the relation between daily hassles and life satisfaction using a series of hierarchical regressions that assessed whether daily hassles adequately predicted life satisfaction beyond age, gender, household income, education level, and personality traits.Hypothesis 3: Daily hassles, both overall measure and each source of daily hassles, would predict a lower level of life satisfaction controlling for age, gender, household income, education level, and personality traits.https://osf.io/6zvud/. A priori calculations using All data and syntax necessary to reproduce the reported analyses are publicly accessible on the Open Science Framework: N = 1,170), aged between 31 and 61 years , living in Switzerland. Women represented 51.5% of the sample, and German speakers represented 64.6%. Participants were mostly employed (89%), whereas the remaining sample was either unemployed (4.4%) or professionally inactive (6.6%). The majority of participants lived in a couple (71.6%), and 28.4% were single.We conducted the analyses on an adult sample of the French- and German-speaking Swiss population (We implemented the LIVES-DHS in Wave 6 (2017) of a data collection from a 7-year longitudinal study on professional paths conducted at the Swiss National Centre of Competence in Research—Overcoming Vulnerabilities: Life Course Perspective (NCCR LIVES). The aim of this project was to study the direct and indirect impacts of individual characteristics and resources, and sociocultural and economic background on adults’ professional transitions.This panel study was conducted from 2012 (W1) to 2018 (W7) with an annual assessment. Participants were recruited at W1 on the base of a representative sample (26–56 years) of the German-speaking and the French-speaking regions randomly drawn from the National register of the inhabitants and realized by the Swiss Federal Statistics Office. To increase the number of unemployed participants, a second random sample was realized by the State Secretariat for Economic Affairs and was drawn from the national register of unemployed people. In total, 2,469 individuals fully completed the questionnaire at W1.Each year participants completed a research protocol consisting of two steps. The first part assessed the participants’ professional situation and biographical information. Based on the answers to this part, participants were classified into three categories representing their professional situation: active , unemployed, or nonactive on the labor market. The second part, which depended on the participants’ professional situation, assessed aspects of the work environment , personal characteristics and resources  and general outcomes .https://forsbase.unil.ch/project/study-public-overview/16093/0/).Participation in this panel study was voluntary; each participant completing the research protocol could choose one of four gifts for an amount of 20 CHF, yearly. The full description of the study and the data are stored in the FORSbase data repository and are available on request . The initial questionnaire comprised 23 items and tapped five different life domains: finance, health, relations, work, and environment. This version of the scale was subsequently included in two independent surveys  conducted within the NCCR LIVES. The results of EFA conducted with these samples indicated that one item about transportation  from the environmental stress domain should be dropped because it failed to meet the minimum criteria of having a primary factor loading of .4 or above. The results also showed some issues with scale responses, especially for the German version. More precisely, the response category “it does not concern me,” which had to be recorded as missing for the analyses, biased the results of group comparisons. These unsatisfactory results compelled the group of experts to readjust the scale by excluding one item and use a 4-point Likert-type response scale instead . This adjusted 22-item scale was tested again in a third sample of employed Swiss adults aged between 20 and 65 years. Because the scale showed better psychometric properties this time, it was implemented in our 7-year longitudinal study on professional paths.A group of experts (sociologists and psychologists) in life course studies identified different life domains where daily hassles could be perceived based on the aforementioned literature. They then created a pool of items in French and German inspired by existing daily hassles inventories mentioned in the theoretical part. The items were created in French first. The scale was then translated by one native German speaker, and the translation checked and corrected by a second German native speaker. Differences were discussed and resolved between the two translators. Respondents had to indicate the extent to which a series of possible daily hassles concerned them on a 5-point Likert-type scale , we decided to further drop items that were relevant only to people in a relationship . Hence, the final set of items used for the validation study described below comprised 20 items.not at all, 2 = a little, 3 = somewhat, 4 = very much). It covers five sources of daily hassles: financial, physical, relational, environmental, and professional . Respondents had to rate to what extent they worried about a number of different sources of preoccupations on a given day. Items 17 and 18 were only given to employed participants, as they are not relevant to unemployed or professionally inactive people. The Cronbach’s alpha coefficient of this final version was .95 , and it was .87, .87, .81, .88, and .92 for the five sources of daily hassles, respectively.We assessed daily hassles using the LIVES-DHS at W6. After validation and final item reduction described further below, the final version comprises 18 items using a 4-point Likert-type response scale .We assessed perceived income adequacy at W6 with a one-item scale adapted from a similar item in the Eurostat survey . More specifically, participants had to report how difficult it is to get by with their current income using a 4-point Likert-type scale .We measured self-rated health at W6 using one item developed and used by the World Health Organization . We askemuch less than I would like) to 5 (as much as I would like). Cronbach’s alpha coefficient for the total score was .93. The structural validity of this scale was analyzed in a previous study using data from the same panel study , the second item pertains to the fear of job loss in the upcoming 12 months , and the third item taps into a cognitive evaluation of job security . A composite indicator of job insecurity was derived based on the mean score of these items, where a higher score indicates higher job insecurity. Cronbach’s alpha was .82. In a previous study using data from the same panel study, measurement equivalence across different time points and factor loading invariance across the French- and German-speaking subsamples were observed  to 5 (strongly agree). The Cronbach’s alpha coefficients for the five dimensions were .86, .74, .77, .72, and .79, respectively. The structural validity of this scale was analyzed in a previous study using data from the same panel study  to 5 (very often). The Cronbach’s alpha was .71. The structural validity of this scale was analyzed in a previous study using data from the same panel study  to 7 (strongly agree). Cronbach’s alpha was 92. The structural validity of this scale was analyzed in a previous study using data from the same panel study . For the education level, participants had to indicate their education using a list of nine  options at the beginning of the panel study (W1). For the analytic purposes of the current study, we recategorized the responses into 1 (higher education), 2 (secondary education), and 3 (primary education).We used age, gender, household income, and education level as control variables in the hierarchical regression. Male participants were coded as 1 and females were coded as 2 at W6. Household income assessed the annual income of the household and was used as a continuous variable at W6 (1= n1 = 574 and n2 = 596). The two subsamples were similar with regard to gender, t(1168) = 0.08, p = .939, language t(1163.29) = 1.46, p = .146, and age, t(1086) = 1.01, p = .311. In the analyses presented in the current article, we coded language as 1 (German) and 2 (French), whereas we measured age as a continuous variable.For the purpose of cross-validating the LIVES-DHS, we randomly split the participants into two subsamples , we conducted the EFA. More specifically, we conducted a principal axis factor (PAF) analysis with an oblique rotation, to allow covarying multidimensional factors, in R to identify the factor structure of the LIVES-DHS. The extraction of factors was based on Eigenvalues , scree plot, and parallel analysis. We selected the items based on the following criteria (Using the first subsample (criteria : (a) iten2), we conducted the CFA with a maximum likelihood to replicate and assess the structural validity of the solution emerging from the PAF. We tested and compared three different models: unidimensional model, five-factor model, and hierarchical model. We used the following fit indices to evaluate each model fit: the comparative fit index (CFI), the Tucker–Lewis index (TLI), the standardized root mean residual (SRMR), and the root mean square error of approximation (RMSEA). If the CFI was .90 or above, the TLI was above .95 and the SRMR and RMSEA were .08 or less, we considered the model to have a good fit . We then conducted a series of hierarchical regressions to examine the relation between daily hassles and life satisfaction. Hence, in the first block of the model, we regressed life satisfaction on age, gender, household income, and education level. We added personality traits in the second block and daily hassles in the third block. We ran separate hierarchical regressions for the total score of the LIVES-DHS and for each subscale. We reported the nested model comparison using the R2 change F-test, the increments in R2, and whether these were statistically significant.Finally, to examine concurrent validity, we calculated descriptive statistics, reliabilities, and bivariate correlations within the full sample . However, because the item “having to deal with health problems related to my work—for example, exhaustion or back problems” had a loading and a cross-loading of .40 and the item “not being recognized enough for what I do” was quite abstract, we discarded both of them first, keeping the item “having to deal with conflicts with my friends” which content was tangible and general enough. The new solution with 18 items provided a well-defined five-factor structure without cross-loadings (the cross-loading previously found with Item 9 disappeared) and explained 69% of the variance. We grouped the items by their hypothesized dimension, except Item 16. Given its wording (“Need unemployment benefits”), this item unsurprisingly loaded on the professional stress instead of the financial stress factor as originally assumed. Finally, correlations between the factors were inspected. They were moderate to high (between .43. and .63), suggesting the possibility of a higher order factor.We conducted a PAF analysis with an oblique rotation. The Kaiser’s criterion suggested four factors, some of them being heterogeneous in terms of sources of daily hassles, whereas the scree plot and the parallel analysis suggested considering a five-factor solution, which corresponded to what was expected. For this reason, a five-factor solution with 20 items was preferred over the four-factor solution. The five-factor solution provided a well-defined factor structure, explaining 67% of the variance. Most items loaded on a single factor. Only three items showed cross-loadings over .30 , professional , relational , environmental , and financial aspects . Hence, the obtained results showed conceptual support for the hypothesized daily hassles dimensions.1 The tested five-factor model exhibited acceptable fit indices: χ2(125) = 557.18, p < .001; CFI = .941; TLI = .928; RMSEA = .082, 90% confidence interval ; SRMR = .041; BIC = 16971.07. After comparing this five-factor model to a unidimensional model, it appeared that the five dimensions of daily hassles were meaningful sources of daily stress and provided superior fit to the unidimensional model. Factor loadings were also uniformly high in the five-factor model . Results showed support for the equivalence of factor loadings and intercepts across these two groups.r = −.56, p < .001), the physical hassles was negatively correlated with self-rated health , the relational hassles was negatively correlated with social support , and the professional hassles was positively correlated with job insecurity . All of these moderate correlations showed that the subscales of LIVES-DHS could differentiate the concept of daily hassles in a specific domain from associated concepts. Moreover, any given subscale of the LIVES-DHS always showed the highest correlation with the associated concept than with the other concepts. For example, financial hassles showed a higher correlation with income adequacy than with health, social support, and work stress, which also supports the concurrent validity. Concerning the environmental hassles, we lacked a specific construct to examine the concurrent validity. However, it was significantly correlated with all of the aforementioned constructs.r = .36, p < .001) and with perceived stress in life , and negatively correlated with general mental health . It was also negatively correlated with life satisfaction .The total score of daily hassles was positively correlated with neuroticism  and environmental hassles . Similarly, gender was also positively, also weakly, correlated with the same sources of daily hassles: physical hassles  and environmental hassles .It is interesting to note that age was positively, albeit weakly, correlated with daily hassles, and especially with physical hassles (p < .001). Although age, gender, and education level did not predict life satisfaction, household income predicted life satisfaction in the first block (accounting for 13.9% of the variance). Personality traits, especially neuroticism, extraversion, and conscientiousness, accounted for 18.1% of the variance in the second block, and overall score of daily hassles, which we added in the third block, accounted for an additional 4.3% of the variance. Results of hierarchical regressions with each subscales of the LIVES-DHS separately showed that financial hassles accounted for an additional 3.8% of the variance, physical hassles accounted for an additional 2% of the variance, professional hassles accounted for an additional 3.5% of the variance, relational hassles accounted for an additional 5.8% of the variance, and environmental hassles accounted for an additional 0.4% of the variance in the third block.To examine the relation between daily hassles and life satisfaction while controlling for well-known covariates of it, we ran a series of hierarchical regressions in three steps . As all The current study aimed to validate a new scale assessing daily hassles that could be easily implemented in panel studies. The aim of the newly developed LIVES-DHS was to assess how central a hassle is for the person from a subjective point of view. We expected to reveal five sources of daily hassles as represented by a general higher order factor (Hypotheses 1a and 1b).Overall, the LIVES-DHS showed good psychometric and structural properties. Based on the first random subsample, PAF analysis highlighted 18 items representing daily hassles that fell in five factors as expected. Using the second random subsample, CFAs indicated an acceptable fit for the 18-item hierarchical model, which confirmed our first hypothesis. The hierarchical structure with a general daily hassles factor and five sources of daily hassles fits the data well and meets measurement invariance requirements regarding the French- and German-speaking groups. In practical terms, its means that this scale could be used in three ways: by computing a total score, by using specific subscales separately, or all subscales together. The use of the scale would depend on the research question and the outcomes chosen. For example, if the study aims to examine the effect of daily hassles as a generalized source of stress on overall health and well-being beyond the effect of major life events, computing and using the total score could be enough. If the study aims to examine a specific source of daily hassles in a specific context , then the subscale(s) of interest could be used separately. Finally, if the study aims to compare the effect of different sources of daily hassles and/or to examine which source of daily hassles explains the most the variance, then subscales could be considered altogether as long as multicollinearity has been checked and ruled out beforehand.In a subsequent step, the current study aimed to examine the concurrent validity of the LIVES-DHS  by computing bivariate correlations between four out of the five sources of daily hassles and theoretically relevant constructs, namely income adequacy, self-rated heath, social support, and job insecurity, between overall score of daily hassles and stress and health indicators , and between daily hassles and the personality dimension of neuroticism. As expected, the overall score of the LIVES-DHS and each of the LIVES-DHS sources of daily hassles correlated moderately with measures of related constructs. It means that our newly developed scale could differentiate the primary appraisal (importance) of daily negative events from outcomes related to those events  and from the personality trait  associated with experiences of those events. These results show that LIVES-DHS is indeed a scale that assesses daily events through a subjective evaluation of them as being important in the person’s current life and not how much stressful they are. In this way, we also highlight the utility of such a tool that differentiates sources of daily stress from more global and general levels of stress and vulnerabilities. Income difficulties, health issues, lack of social hassles, and job insecurity all relate to daily hassles, even if we cannot say anything about the direction of the causality with this study .This study also aimed to examine the relation between daily hassles and life satisfaction by running a series of hierarchical regressions. Because daily hassles represent important sources of stress that people encounter in everyday life, we expected that they would predict a lower level of life satisfaction controlling for age, gender, household income, education level, and personality traits (Hypothesis 3). The results of the hierarchical regressions supported this third hypothesis: Daily hassles, both the total score and each source of daily hassles, significantly and negatively predicted life satisfaction and added significant incremental variance beyond that accounted for by age, gender, household income, and personality traits. In other words, when the participants were preoccupied by some daily events, they were less satisfied with their lives. These results support previous studies demonstrating the detrimental effect of daily hassles on well-being e.g.,  and are These results, together with those obtained from factor analyses, converge with the stress spillover theory . SpecifiPrevious studies have shown that interpersonal hassles are more stress-inducing than other types of hassles e.g., . SimilarWe believe that this newly validated tool for assessing daily hassles could benefit both research and practice. Its relatively short length makes the LIVES-DHS easier to implement in panel studies than long checklists and open ended questions. Moreover, the multidimensionality of this new scale makes it also a versatile tool for research. Notably, most of the existing tools are designed to assess either general levels of stress in life, measuring how many various situations in one’s life have been appraised as stressful over a given period  contexts. Thus, it would be important to test the hierarchical five-factor structure stability and the measurement invariance of the 18-item solution in other samples or countries. This could be particularly relevant considering this scale focuses on the most salient groups of stressors in a given context; the list might well not be generalizable to other national or cultural contexts. Hence, it is possible that other important groups of stressors or factors exist, and they may be added to the existing ones in the future. It is also important to note that this scale could be subject to retrospective recall and memory biases, although these effects should be less pronounced than those we could expect in checklists as individuals had to report how much they worried about a specific hassle “today.”As the data used in the current study were cross-sectional, there is always a possibility that life satisfaction contributes to changes in concerns about daily hassles and not vice versa. For instance, people with a lower level of life satisfaction might be more easily preoccupied by daily events because they may be more sensitive to negative experiences. Therefore, further research is needed to examine the direction of these effects. We used a score of life satisfaction in this study, which is an indicator of subjective well-being. Future studies may also focus on the relation between daily hassles and well-being using an objective approach and more varied indicators. Similarly, futures studies should also examine the association of the LIVES-DHS with other related constructs, such as major life events, and with other observational measures of minor hassles (e.g., with The Daily Inventory of Stressful Events; In conclusion, the LIVES-DHS appears to be a psychometrically valid instrument to measure daily hassles. Its 18-item version should be suitable for and easily implemented in large surveys, which resolves the issues with long checklists and open-ended questions. Due to its relatively short length, the current scale could also be an interesting supplement for practitioners to assess and follow-up on counselees’ daily hassles in different domains.Click here for additional data file.Supplemental material, sj-pdf-1-asm-10.1177_10731911211047894 for The LIVES Daily Hassles Scale and Its Relation to Life Satisfaction by Shagini Udayar, Ieva Urbanaviciute, Davide Morselli, Grégoire Bollmann, Jérome Rossier and Dario Spini in AssessmentClick here for additional data file.Supplemental material, sj-pdf-2-asm-10.1177_10731911211047894 for The LIVES Daily Hassles Scale and Its Relation to Life Satisfaction by Shagini Udayar, Ieva Urbanaviciute, Davide Morselli, Grégoire Bollmann, Jérome Rossier and Dario Spini in Assessment


This study aimed to adapt the Risk, Pain, and Injury Questionnaire (RPIQ) to Chinese collegiate athletes and examine its reliability and validity.n = 300) and confirmatory factor analysis  were conducted to explore its structure, and convergent and construct validity were investigated by examining the relationships between various factors of the RPIQ, LOC, SIAS and injury risk.Six hundred thirty collegiate athletes aged 17 to 24 years agreed to complete the RPIQ, the Chinese version of the SIAS and an LOC scale. Exploratory factor analysis . The reliability of the scale was satisfactory . Significant associations between the RPIQ factors and LOC and SIAS were found, suggesting the construct validity of the scale was acceptable. Additionally, significant gender differences were found in the RPIQ factors and athletes who participated in individual sports scored higher on tough and rational choice factors than those who participated in team sports.The results of EFA show the Chinese version of the RPIQ contained 12 items and was divided into three factors: tough, pressed and rational choice. CFA confirmed its factorial structure (The Chinese version of the RPIQ has sufficient psychometric properties and can be used as a reliable and effective tool for measuring attitudes of the risk, pain and injury of collegiate athletes. With the development of the worldwide economy and the improvement of living standards, an increasing number of people participate in various sports. However, there is a high risk that many people will become injured upon participating in sports. Statistics show that approximately 750,000 college students in the United States develop sports-related injuries each year . AccordiSports injuries have been the focus of studies for decades. As early as 1983, researchers began to pay attention to sports injuries and studied the subcultural dimension of how professional athletes play with pain and talk about injury . In 1996The RPIQ consists of 31 items that can be divided into three factors: tough, pressed and rational choice. Tough refers to the ability to show resilience in the face of risk, pain and injury, pressed refers to continuing to play in the face of pressure from coaches and spectators after injury, and rational choice refers to an athlete’s willingness to accept the risk of an exercise . The RPIThe construct validity of the RPIQ was further examined in 2005. Walk and Wiersma re-examined the model fit of the original RPIQ and found the results were not satisfactory . CorrespDue to cultural differences, the RPIQ needed to be restructured in the context of Chinese culture and language before it could be used to assess risk, pain and injury in Chinese athletes. Prior studies have demonstrated that Chinese and American athletes differentiate in internal motivations, confidence, motivation and overall mental skills when participating in sports. These differences may be underlying causes shaping the different attitudes toward risk, pain and injuries . ChineseAmong the factors that affect athletes’ risk, pain and injury scores, LOC is an important factor –17. LocuRegarding the associations between demographic factors and RPIQ factors, studies have shown controversial results. A study found that women tend to be more anxious and nervous in the face of risk, pain and injury and usually adopt emotion-centered coping strategies, while men are generally more rational . Other sFurthermore, the RPIQ factors are closely related to injury risk and are affected by sport type. Studies have shown that athletes engaged in high-risk activities tend to be calmer, more rational and better able to control their emotions , 26. AthThe main purpose of the present study is to adapt the 13-item RPIQ  to ChineShanghai University of Sport, Liaoning Normal University and Shenyang Sport University and they agreed to participate in this study. These universities are represented in the field of sports in China. The inclusion criteria were a) to have the professional training for at least one year and, b) to be a college athlete. Overall, six hundred and thirty (96.92% response rate) questionnaires were returned. The data of 20 participants were discarded due to missing responses.The present study was approved by the Logistics Department for Civilian Ethics Committee of Liaoning Normal University. The participants were sampled using a "snowball" technique: questionnaires were distributed to an initial sample of college students, who had friends, classmates and acquaintances with athletic experiences complete them . Six hunn = 3), bludgeon (n = 4), baseball (n = 7), Chinese winter sports (n = 9), rugby (n = 24), golf (n = 4), boxing (n = 5), bicycle (n = 2), fencing (n = 2), fitness (n = 12), basketball (n = 107), softball (n = 8), roller skating (n = 3), volleyball (n = 21), rock climbing (n = 1), kayaking (n = 2), table tennis (n = 22), hockey (n = 3), shooting (n = 2), handball (n = 5), wrestling (n = 3), taekwondo(n = 3), gymnastics (n = 4), sports dance (n = 17), track and field (n = 168), tennis (n = 12), martial arts (n = 61), swimming (n = 15), badminton (n = 31), football (n = 70). A total of 263 athletes (41.75%) participated in team sports. Team sports included cricket, bludgeon, baseball, rugby, basketball, softball, volleyball, kayaking, hockey, handball and football. A total of 367 athletes (58.25%) participated in individual sports. Individual sports included table tennis, Chinese winter sports, golf, boxing, fencing, fitness, roller skating, shooting, rock climbing, wrestling, taekwondo, gymnastics, sport dance, track and field, tennis, martial arts, swimming, badminton and bicycle.The final sample included 471 males (74.76%) and 159 females (25.24%). Most of the participants were students majoring in physical education, and some of them had participated in national and provincial competitions. The participants competed in cricket  were invited to read and evaluate the accuracy of the items. The translated questionnaire was initially distributed to twenty people and asked them to check whether there were any ambiguities or relevant expressions needed to be modified. We compared the differences between the translated questionnaire and the original questionnaire, and some minor revisions were made correspondingly. After the differences in these translations were properly addressed, Higher level of agreement between the two experts (Inter-rater reliability 0.73–0.92) was got an initial 13-item questionnaire was obtained.Rotter’s Locus of Control scale (LOC) , was useThe 28-item Chinese version of the Sport Injury Anxiety Scale (SIAS) measures injury anxiety in athletes . The SIAParticipants were also asked to provide demographic information, including gender, age, risk of injury, years of training and number of injuries during college.Shanghai University of Sport, Liaoning Normal University and Shenyang Sports University, respectively. A pen and paper test was administrated to all the participants. Before the test, participants were informed of the test purpose of the study. After asking for the consent of the participants, participants signed the informed consent form and were required to complete the questionnaires within 30 minutes. Upon completion of the submission, each participant received a small gift (10 RMB).The verbal informed consent was obtained from all participants for inclusion in the study. The RPIQ-C, SIAS and LOC were administrated to 650 collegiate students at Beijing Sport University, The data were analyzed using SPSS 18.0. First, the statistical properties of the items were examined using sample 1, including the mean, SD, corrected item-total correction, factor loading and community. Second, an exploratory factor analysis (EFA) was conducted using sample 1 via SPSS18.0 to explore the factorial structure of the RPIQ. Reliability analysis was conducted to examine the internal consistency of the RPIQ factors, with a Cronbach’s alpha value greater than 0.6 expected . Third, We assessed common method bias using Harman’s single factor method . The firThe descriptive properties of the items were first analyzed. The mean, standard deviations, corrected item-total, Factor loading and Community are shown in p < 0.001). In line with the original questionnaire, the three factors were named tough, pressed, and rational choice. The factor loadings are shown in All 13 items were submitted to an EFA using principal component extraction with varimax rotation using the data of sample 1. The absolute value of the factor loadings is chosen as 0.40. Items with factor loadings below 0.40 are considered inadequate and are generally recommended for elimination. The results showed a three-factor structure that could explain 59.28% of the total variance . The model fit of the 12-item structure was then examined. The model fit was improved this time . According to the criteria proposed by Hu and Bentler [The model fit of the RPIQ-C was assessed by a confirmatory factor analysis via AMOS 23.0 using data from sample 2. The model fit of the original 13-item questionnaire was first examined. The results showed the model fit were not acceptable , and years of training, , were significant. The effect of age,  was not significant. The mean and standard deviation for males and females in RPIQ-C factors are shown in Univariance of MANCOVA was conducted with the factors of the RPIQ as dependent variables, the demographic variables as covariates. The results showed that the effects of gender, .One-way ANOVA was conducted with the factors of the RPIQ as dependent variables, the gender as independent variable. The results showed that males scored significantly lower on tough and rational choice factors than females. No gender difference was found on pressed factor. Pearson correlations showed that the pressed factor was positively correlated with years of training . Post-hoc tests revealed that athletes participating in low-risk sports scored higher than athletes participating in high-risk sports (p < 0.05).One-way ANOVA was conducted with the factors of the RPIQ as dependent variables, the risk of Injury as independent variable. The results showed that differences were found on rational choice factor among the three groups,  and rational choice,  = 6.34, p < 0.05, η2 p = 0.021). Athletes in individual sports scored higher on the tough and rational choice factors than those who participated in team sports.One-way ANOVA was conducted with the factors of the RPIQ as dependent variables, the types of sports as independent variable. The results showed that there were differences in the Risk, Pain, and Injury Questionnaire related to tough,  to Chinese collegiate athletes and assess whether it can accurately assess Chinese athletes’ attitudes toward risk, pain and injury in sports. The findings showed that the reliability and validity of the Chinese version of the RPIQ are satisfactory.First, the results of this study showed that the factorial structure of the RPIQ remained stable across cultures . The finSecond, the RPIQ-C was also significantly positively correlated with the LOC scale, supporting its construct validity, and was significantly positively associated with both “losing athleticism” and “loss of social support” factors of the SIAS, providing support for its convergent validity. More importantly, LOC was an effective predictor of RPIQ-C factors after controlling for demographic variables. These results were partially supported by the findings of previous studies showing that athletes’ sports injuries can be affected by LOC scores and that internal athletes tend to be tough and rational –17.One of the interesting findings of this study was that significant gender differences were found in rational choice and tough factors. This study found that male athletes scored higher on rational choice and tough factors than female athletes. A previous study found that women’s emotions were more intense, lasted longer and expressed in more pronounced forms than men’s and men are more rational than women, can better control their emotions and are not easily impulsive . CompareAnother important finding is that sports type affects RPIQ. Consistent with the findings of previous studies , this stFinally, the relationships between sport risk and the RPIQ factor also provide evidence for its usefulness in assessing athletes’ sport risk, pain and injury. Consistent with those of previous studies , 26, thiThere are limitations in this study. First, the relationships between the RPIQ-C factors and LOC might be underestimated due to self-report method was used. However, the main purpose of this study is to develop a reliable and validate instrument. As in previous studies , 7, 9, sThe findings of this study have some practical implications. This study takes the first step in adapting the RPIQ to the Chinese language. As in previous studies , this stThe Chinese version of the RPIQ has sufficient psychometric properties and can be used as a reliable and effective tool for measuring attitudes of the risk, pain and injury of collegiate athletes. This study not only revealed significant correlations between the RPIQ-C factors, LOC and SIAS but also showed significant differences in the RPIQ-C factors by gender, risk of injury and type of sport. The findings of this study showed that the PRIQ-C is a reliable tool for understanding how Chinese athletes deal with risk, pain and injury and make decisions.S1 Fig(DOCX)Click here for additional data file.S1 File(DOC)Click here for additional data file.S2 File(DOCX)Click here for additional data file.


Specifically, the results of three FMS  and standing long jump significantly improved in children with DD except for the horizontal jump skill. The results of this study is evidence that the ICT-based exergame program for children with DD may be utilized to improve physical fitness and FMS in children with DD.The purpose of this study was to develop an information and communications technology (ICT)-based exergame for children with developmental disabilities (DD) and to examine its impacts on physical fitness and fundamental motor skills (FMS). The ICT-based exergame consisted of visual and auditory demonstrations of diverse locomotor movement and object manipulation activities by the virtual characters. A total of 52 children with DD participated in the present study. The participants were divided into twenty-seven children in the experimental group and 25 children with DD in the control group. The experimental group participants engaged in the exergame program for 12 weeks. All participants’ muscle strength  and four fundamental motor skills, such as the horizontal jump, hop, overhand throw, and dribble, were assessed during the pre- and post-test process. There were significant impacts on physical fitness and FMS ( TM, Microsoft KinectTM , and mobile phone applications, such as Pokémon GoTM, were developed to play exercise and physical activity in multiple forms of exergame. Exergames can be utilized as a potential rehabilitation tool for increasing physical activity and improving health status. The technology of VR  has been initiated to utilize enhancing functional abilities of persons with disabilities due to its impact on functional benefits with joyful engagement in tasks or activities for the past decade [Exergame is a compound word for exercise and game. This term is defined as technology-driven physical activities, such as video game play, that require participants to be physically active or exercise to play the game. These games require the user to apply full body motion to participate in virtual sports, group fitness exercises, or other interactive physical activities. The concept of exergame takes the passion for gaming and turns what was once considered a sedentary behavior into a potentially more active and healthy activity . Virtualt decade ,3. Espect decade ,5, motort decade ,7,8, andt decade ,10.Developmental disability (DD) is an assorted group of conditions that affects the trajectory of the individual’s physical, intellectual, or emotional development, influencing their personal, social, academic, or occupational function ,12. TherMoreover, diverse studies have been implemented to enhance the performance of motor skills required to promote physical activity. In particular, poor performance levels in locomotor and object manipulation skills for actively engaging in physical activity were reported in studies of the development of gross motor skills among children with DD. Children with DD tend to be significantly delayed in their FMS compared with typically developing peers ,15,16. SThe prevalence of ASD is reported to be 1 in 54 people. and research is being focused on improving their physical activity . This waMore specifically, children with ID between the ages of 3 and 10 years engaged in less PA than their typically developing peers . ChildreRecently, exergame has been actively disseminated for physical activity improvement and exercise performance skills development by inducing the disabled to participate in physical activities. Based on the potential goal of health promotion, exergames were utilized to improve physical fitness as well as develop fundamental motor skill performance of the body. However, previous studies pointed out that existing exergames had limitations to engaging and performing properly due to the difficulty of playing for persons with disabilities, especially for moderate and severe cognitive disabilities ,8. The dn = 2), (b) motor learning and control (n = 2), (c) exercise physiology (n = 2), (d) psychology (n = 1), (e) occupational therapy (n = 1), and (f) computer science (n = 2).The development process could be broadly divided into planning, development, and effectiveness verification stages. Reference study reviews related to the behavior and movement characteristics of children with DD as well as exergame implementation for those populations were conducted to arrange findings, considerations, and suggestions for the information and communications technology (ICT)-based exergame program. Ten experts were involved in the research team for developing a new ICT-based exergame program for children with DD. They specialized following areas: (a) adapted physical education , 5 m (length), and 4 m (height). Virtual reality projections, speakers, personal computers, and monitors were used to generate visual and auditory simulations in the space. All walls and the ground surfaces in the room were colored white to show screen effects for simulations in the ICT-based exergame program. All backgrounds of task activities were covered with natural landscapes containing mountains, sky, trees, and rocks to provide a relaxed feeling for children with DD.n = 8, mean age ± SD = 10.15 ± 1.51) engaged in the ICT-based exergame program as the experimental group. For the control group, 25 children with DD  participated in the present study. Twenty-seven participants in the experimental group consisted of 15 children with autism spectrum disorders (ASD) and 12 children with intellectual disabilities (ID). Regarding the control group, children with DD were 15 ASD and 10 ID, respectively. Participants were children with developmental disabilities in South Korea. The inclusion criteria were as follows: (a) diagnosis of developmental disabilities, (b) age 7 to 12, and (c) no limitation to perform physical movement. A priori sample size was calculated using G*Power  to support the detected significance in the results. The required sample size was 36 participants with a power of 95% and an alpha value of 0.05 for the present study. The author recruited participants through website advertisements such as public and special schools, and local welfare centers. After explaining the experimental purpose, procedures, risks, and benefits of this study to the participants and their parents, the author obtained written informed consent from the parents of the participants. A total of fifty-two children with DD participated in the present study see . Twenty-Standing long jump is one of the measurement methods to evaluate explosive strength and is being used in various fields for physical fitness evaluation. Some studies used a standing long jump test to assess muscular strength in physical fitness among individuals with disabilities. Rintala et al. (2016)  measuredThe Test of Gross Motor Development- Third edition (TGMD-3) is widely used to measure the fundamental motor skill development (FMS) of children aged 3 to 10. A total of 13 FMS skills falls under six locomotor and seven object manipulation skills  on the TGMD-3. Previous studies assessed FMS performance in children with ,54,55 anThe primary researcher designed a feasible exergame program considering the characteristics of children with DD. Based on previous studies that evaluated the motor abilities of children with DD, the following items were derived through discussions with the commissioned research director of the motor development and control major, a pediatric psychiatrist, and a professor specializing in physical education. The applicability of the ICT-based exergame program items was verified for children. Then, we evaluated items to examine the impact of the ICT-based exergame intervention on physical fitness and FMS performance among children DD for 12 weeks during a total of 18-month development period in p-value was below 0.05.The mean and standard deviation of the physical fitness and fundamental motor skill scores were calculated for the standing long jump, and two locomotor skills , and two ball skill scores  on the TGMD-3, respectively. The changes between the two groups  from the pre- to post-test were also analyzed using a two-way repeated-measures analysis of variance (Two-way RM-ANOVA) to compare the improvement of physical fitness and FMS in children with DD. All analyses were performed with IBM SPSS Statistics, version 28.0 . The significance level of the p > 0.05; F  = 18.79, p < 0.001). The distance records of the standing long jump changed from 88.3 ± 24.9 cm to 98.8 ± 29.3 cm. About 10 cm was increased on the standing long jump of children with DD using the Kinect and Intel Lidar sensor systems  = 21.71, p < 0.001). Meanwhile, the horizontal jump skill score did not significantly change though it was slightly improved from 4.96 ± 2.11 to 5.76 ± 1.82  = 3.39, p = 0.07). Regarding the ball skill, both skills had significant p-values in the comparison between pre- and post-test of the groups on the TGMD-3  = 27.94, p < 0.001; dribble: F  = 12.95, p < 0.001; see Muscular strength test : The comparison results of the muscular strength test and FMS between the experimental and control groups through pre- and post-test among children with DD are shown in tems see . The hopThe purpose of this study was to develop an ICT-based exergame program for children with DD and to verify its effectiveness on their physical fitness and fundamental motor skills (FMS). In the developing phase of the exergame program, the primary researcher established the proper program content for children with DD and cooperated with the information communication and technology (ICT) research team, which involved various experts in computer science, psychology, biomechanics, adapted physical education, occupation therapy, and motor learning and control. The research team created a feasible ICT-based exergame program for children with DD. The findings in this study provided evidence to meet the suggestions in previous studies ,8,43,63 The ICT-based exergame program which was developed for this study could be utilized for enhancing physical fitness and FMS among children with disabilities, especially DD. As shown in Instead of focusing on fitness as a single contributor to health, physical literacy places emphasis on the variety of components that are integral to being physically active throughout the life course . For chiFundamental motor skills (FMS) play a significant role in not only participating in games, sports, and leisure activities, especially for children  but alsoMany children with DD have greater difficulty with FMS performance than typically developing children ,17,70. IThe limitations of the present study are that it only assessed standing long jump test in muscular strength and four FMS among the thirteen FMS on the TGMD-3. Due to the diverse characteristics of children with DD and usage limits in the experimental setting, this study applied those variables to assess FMS and physical fitness among those participants. Therefore, the present study’s results may be different from previous studies using other exergames or video games. Related to the types of disability, this study only involved children with ASD and ID. Other types of DD among children may have different behavior and movement characteristics according to types of disabilities, such as down syndrome and cerebral palsy. Therefore, there is a limitation to generalizing the result of this study to all children with DD. Lastly, the ICT-based exergame program consisted of a limited number of physical activities, such as jumping, chasing, imitating, throwing, and kicking. Those activity contents had a limitation in offering a variety of movement performance activities, such as sliding, striking, and catching. Future ICT-based exergame programs should be developed to include those skill activities to improve FMS and physical fitness among children with DD.This study had the purpose of developing an ICT-based exergame program for children with developmental disabilities (DD) and verifying its effectiveness on their physical fitness and fundamental motor skills (FMS). There were significantly positive impacts of the ICT-based exergame intervention on muscular strength and FMS in children with DD. The positive results included the following: (a) standing long jump, and (b) three FMS  on the movement assessment. This ICT-based exergame program could improve muscular strength and targeted FMS to promote engagement in a variety of physical activities. However, future research for children with DD should be implemented not only to measure other components of physical fitness and FMS but also to cover the discussed limitations.