Acute dysphonia is a frequent condition in clinical practice. Its treatment, especially in adults, is not well established in the literature. Steroids are the most recommended drug treatment. However, the existing studies are not enough to establish superiority among the different steroids and the best route of administration.This prospective clinical study aimed at comparing the effect of inhaling steroids as a dry powder with the effect of oral steroids to treat acute dysphonia.We assessed 32 adult patients, broken down into two groups of 16 patients in each one of the treatments, before and seven days after the use of the medication. The patients were submitted to videolaryngoscopy and perceptive and acoustic voice assessment.p = 0.012) in the patients treated with the inhalation form of the drug. However, comparing the values of the auditory perceptive analysis and the acoustic measures after treatment between the groups was not statistically significant.Oral and inhalation treatment significantly reduced hyperemia and edema, and improved the muco-ondulatory movement; nonetheless, edema reduction was statistically more significant (There was a significant improvement in the acute laryngitis concerning the assessments carried out in all the patients assessed, concerning the two treatments. The inhalation steroid treatment was significantly more effective in reducing the edema. Acute dysphonia impacts verbal communication and it may lead to numerous types and levels of limitations which have repercussions both in the individual's social as well as professional lives. In such a case, it is increasingly more frequent in clinical practice to have patients who seek medical care, eager for a rapid and effective intervention, which enables voice normalization and return to their activities as soon as possible.Acute dysphonia may stem from various factors, such as: inflammatory processes, trauma, laryngeal paralysis, psychological factors, and others. Laryngitis, inflammation of laryngeal tissues, basically characterized by edema and/or hyperemia, is the most frequent finding in the clinical exam of these patientsVocal rest is paramount in the treatment of acute dysphonia by laryngitisSteroid treatment is described as fundamental in the treatment of acute laryngitis, especially when there is breathing compromise in children and voice involvement in adultsOral steroids have a powerful anti-inflammatory effect and their indication in inflammatory diseases and laryngeal edema is well knowToday, topical steroids are largely used as the treatment of choice for inflammatory processes of the airways, such as rhinitis and asthma. They have a powerful anti-inflammatory action and in reducing edemas. Since they act directly on the inflammation site, they can be used in lower doses. In shorter treatment courses, they have fewer side effects and a better safety profile than systemic steroidsSome studies have described cases of dysphonia and laryngeal lesions in adult patients under chronic use of steroids and other inhalation medication to treat asthma, as well as laryngeal irritation, cough and oropharyngeal candidiasisBased on the side effects, some authors do not recommend the use of inhalation steroids in people who make professional use of their voicesThis lack of studies published, coupled to the demand for cases of adult patients with dysphonia associated with acute laryngitis, to the repercussion of the acute loss of voice in one's social and professional lives and the need for standardization and normalizing of the existing treatments, motivated the development of this study.This study aimed at assessing and comparing the effects of inhalation steroids  as a dry powder, with the effects of oral steroids (prednisone) in the treatment of dysphonia associated with acute laryngitis.This methodology was based on the protocol proposed by Dejonckere et al.Between January of 2007 and September of 2008 we selected 32 adult patients with acute dysphonia caused by laryngitis, seen in a private clinic - specialized in professional use of the voice. We took off the study: smokers, people with mental disorders, those with psychological and motor problems; those with laryngeal paralysis or structural disorders, or those with a past of laryngeal surgery; patients under use of anti-inflammatory medication or drugs to treat gastric reflux. Those individuals with hypersensitivity to fluticasone or prednisolone, or contraindication concerning their use were taken off, as well as those with indications for using other drugs, such as antibiotics, anti-coughing medication, antipyretic or expectorants, to treat laryngitis. We took off the study those patients with vocal fold hematoma, because vocal rest in these cases would be mandatory and vocal rest was not a specific recommendation given to these patients.The patients were randomly broken down into two groups; the first group received 50 mcg of inhalation fluticasone, twice-a-day, and the second group received 20 mg of oral prednisolone, twice-a-day, both for 7 days. No patient was instructed to perform vocal rest. All the patients maintained their vocal activities.th day), all of them were asked to answer a questionnaire.All the patients were assessed by videolaryngostroboscopy, perceptive analysis (GRBAS) and voice acoustics on the first and seventh (last) day of treatment. At the end of treatment : normal or changed. Any alteration in the regularity and/or symmetry of the MOM was considered.After doing the videolaryngostroboscopy exam, a speech and hearing therapist recorded the voice.o and at 5 cm away from the user's mouth. It was then connected to an Eurorack UB502 sound board, directly attached to a Pentium 5 Toshiba laptop with a Sound Blaster 32 soundboard from creative labs. The patient was asked to perform the following phonation activities:•Utter the vowel [a] three times, as long as possible , in a habitual tone to measure the maximum phonation time and for a perceptive assessment utilizing the GRBAS scale.•Utter the sustained vowel [e] for acoustic analysis purposes.The voice was recorded in a silence room, with noise levels below 50 db, by means of a Shure SM 10A, condensed unidirectional microphone, positioned at 45For such acoustic analysis, aiming at doing a quantitative analysis of the sound, we utilized the DR Speech software, version 3.1 and measured the mean values of the fundamental frequency (Fo), jitter, shimmer, neutralized noise energy (NNE) and the harmonic noise ratio (HNR), utilizing a middle stretch of the sustained vowel [e] uttered - such vowel is the basis of the DR Speech program.th day of treatment, the patients from both groups were asked to answer a written questionnaire, reporting whether or not there had been any voice improvements with the treatment (yes or no), which day the voice improved (1st through the 7th) and report treatment-related side effects.On the 7The videolaryngoscopy recordings from each individual were shown to two otolaryngologists with experience in laryngology and in laryngeal exams (blinded as to which group the exam came from), the examiners were also blinded as to pre and post-treatment; and patient and exam dates were randomized.The perceptive analysis of the vocal samples was carried out by three speech and hearing therapists - voice specialists, blinded as to and pre and post-treatment; and patient and exam date of the sustained [a] vowel were randomized. We utilized the GRBAS scale.In order to establish the maximum phonation time, we utilized the mean value, in seconds, of the three samples of the vowel [a] as prolonged as possible , in the patient's regular tone.For acoustic analysis purposes, we utilized the mean values from the measures made by the DR Speech software, version 3.1, from the three samples of the mean utterance of the sustained vowel [e], before and after employing the treatments.The results from the above analysis and the questionnaires were plotted on a table and submitted to statistical analysis.The statistical comparison of the variables: gender, age, profession, videolaryngostroboscopy data, and the auditory-perceptive assessments by the GRBAS scale and voice acoustics from the two groups before treatment, showed that the groups were similar in the beginning.Videolaryngoscopy showed a significant reduction in hyperemia, edema and improvement in the muco-undulatory movement of the vocal folds after treatment. Edema reduction was statistically more significant in those patients treated with inhaled fluticasone .Table 1SIn the perceptive assessment of the voice, both groups showed a significant improvement in voice quality, roughness and breathiness. Tension did not vary significantly between the two groups, and asthenia was not detected in any of the analyzed cases .The computerized acoustic analysis found a significant improvement in shimmer and NNE in those patients treated with oral prednisolone and in the jitter and NNE in those patients treated with inhaled fluticasone. The comparison of the post-treatment measures in both groups was not statistically significant .Table 2Cth day of treatment. The logrank statistical analysis generated a p value = 0.627 indicating that there was no difference between the time to improve for patients using prednisolone and those who used fluticasone  and one of the patients who used fluticasone reported an urge to cough upon drug administration.Acute dysphonia which limits verbal communication and prevents normal day-to-day activities is a common reason to seek medical care, especially in those patients who make a professional use of their voices. Before entering in the discussion part, we have to stress that in this paper we had two groups using the medication  and no control group without medication. This would enable us to answer how much of the development of these cases would be different in non-treated patients. Since this is a sample in which most individuals make professional use of their voices, the use of a placebo group brought about an important limitation in individual compliance towards participation. Patients in need of fast improvement did not feel comfortable with the possibility of being treated with a placebo. Having this difficulty, we decided to study these two treatment modalities, comparing the efficacy of the most-frequently mentioned treatment modalities in the literature.Signs of acute inflammatory process  were present in all dysphonic patients assessed by videolaryngostroboscopy in this study, before and after treatment. Seven days after the treatment with inhaled steroids (fluticasone) and oral steroids (prednisolone), there was an improvement in these signs in all the patients (100%), from both groups. However, edema reduction was greater in the group treated with the inhaled steroid.The efficacy of oral steroids in the treatment of dysphonia caused by acute laryngitis is known in adults and has been described by some authors:Mishra et al.Spiegel et al.Sataloff et al.Klein et al.KlassenThe improvement in vocal quality seen in the global voice assessment parameters, roughness and breathiness, in both groups, after treatment was expected as a consequence to the improvement in the inflammatory process seen upon the videolaryngostroboscopy assessments. The stress parameter improved after treatment in both groups, but such improvement was not statistically significant in any of them. This result may be explained by the acute inflammatory process in the larynx. The stress is associated with the vocal effort caused by an increase in glottal adduction (adductor hyperfunction) which, in cases of acute laryngitis, may be limited because of discomfort and pain.What was expected from the acoustic measures in the patients studied after a reduction in the inflammatory process was an increase in the mean values of the Fo, TMF and HNR, and a reduction in Jitter, Shimmer and NNE values. The expected happened in all the measures, in both treatments, when we analyzed the mean values. However, the changes were statistically significant only for the following variables: NNE in both groups, shimmer in the group with prednisolone and jitter in the fluticasone group.The lack of total remission of the inflammation after treatment in some patients and a possible influence of a recent inflammatory process could justify the non-significant differences. Moreover, it is known that the acoustic assessment reliability depends on the quality of the recordingsOnly a few authors have assessed acoustic measures in patients with laryngitis.Plante et al.Ng et al.Watts et al.th day of treatment, with a peak improvement on the 3rd day, and there was no statistical difference in when the improvement happened between the patients who used the inhalation steroid (fluticasone) and oral (prednisolone). This data makes us rethink treatment duration. Would five days be enough?Upon questionnaire assessment, all the patients studied in both groups reported improvements after treatment, correlated with what was observed in the assessments made by videolaryngostroboscopy and vocal assessment. They all reported improvements by the 5th day; and Franco & AndrusSpiegel et al.In our sample, four (25%) of the 16 patients who used the oral steroid (prednisolone) reported side effects (stomach pain and nausea) and one (6.3%) of the 16 patients who used inhaled steroids reported an urge to cough upon drug administration. These results are in agreement with the reports from Roland et al.In none of the patients who used the inhaled steroid we noticed the laryngeal alterations described for asthmatic patients in chronic use of inhaled steroidsAs to the inhaled steroid means of administration , we agree with Selroos et al.We find it interesting to mention the review made by Mash et al.And finally, we stress the recommendations from Spiegel et al.There was a significant improvement in the acute laryngitis vis-à -vis the assessments made, in all the patients studied, with both treatment modalities after 7 days. Treatment with the inhaled steroids (fluticasone) was significantly more effective in reducing the edema and produced fewer side effects than the treatment with oral steroids in this study.


The aim of this study is to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic Verbal Fluency tasks.The sample consisted of 104 participants divided into four groups . All participants were administered the phonemic (“M” letter-based) and semantic  verbal fluency tasks from the Montreal-Toulouse Language Assessment Battery (MTL-BR).Patients in the LHDa group showed the worst performance  in both types of fluency task. RHD group showed fewer switching productions when compared with controls and LHDna had fewer words productions than controls in the first 30 seconds block.Our findings suggest that the LHDa group obtained lower scores in most measures of SVF and PVF when compared to the other groups. Left-hemisphere damage (LHD), on the other hand, is associated with impairments in phonology, morphology, syntax and semantics, all of which are typical symptoms of classic aphasia. These alterations result in a series of observable linguistic behaviors, including anomia, speech suppression, paraphasia, agrammatism, and neologisms,4.Unilateral brain damage is associated with several types of communicative-linguistic impairment. Right hemisphere damage (RHD) may affect pragmatics, prosody, semantics and even complex discursive skills such as metaphor comprehension,6.Some of the most common tools in the assessment of neurological impairment are verbal fluency (VF) tasks, which allow the clinician to evaluate a number of cognitive domains, including language, semantic memory and executive functioning, in a few minutes or less. Given their speed and ease of administration, as well as their reliability in the assessment of cognitive abilities, VF tasks are widely used in both inpatient and outpatient settings. The SVF tasks are used to verify the functioning of the temporal lobe, while PVF tasks used to verify the functioning of the frontal lobe.Fluency tasks can be either verbal or non-verbal (drawing). Verbal forms of the task usually involve the production of a series of words according to a predetermined criterion, as in the case of semantic (SVF) and phonemic (PVF) verbal fluency. In SVF, the subject must elicit words within a semantic category, such as fruits, animals or items of clothing. In PVF, the participant is asked to elicit as many words as possible starting with a given letter over the course of a pre-established time period, usually of 1 minute,8-11.VF tasks provide quantitative scores, such as the total number of correct words elicited by the individual, excluding repetitions and errors as well as qualitative performance indicators, which relate to the production strategies used by the subject over the course of the task, and are commonly known as clustering and switching measures. Clustering is an executive-linguistic subprocess, in which the cluster is a group of two or more consecutively generated words belonging to the same semantic or phonetic category. Some examples include types of animals from a particular location . It is still possible to form clusters of words that have the same rhyme or that begin with the same letter. On the other hand, switching refers to the ability to shift from one category to another, number of times in which there is a change from one type of cluster to another. Clustering is associated with the cerebral functioning of the temporal lobe that is related to semantic verbal memory and word storage. The switching component is associated with the frontal lobe that is related to cognitive flexibility and word processes search.For proper VF task performance, both clustering and switching components are required. The quantitative interpretation although very classic, is not enough for a deeper analysis of the cognitive-linguistic strategies used by the patients. Furthermore, quantitative analysis may not differentiate patients in the total number of correct words. Thus, there may often be no differences in the total correct word score, but in contrast there may be poorer strategies following a neurological condition such as stroke in the left hemisphere or traumatic brain injury (TBI).Regarding the number of switches and clusters, both are related to each other, because by identifying the number of clusters, you can get the number of switches (corresponds to the number of clusters minus one),10. In addition to contributing to the detection of executive dysfunction in neurological conditions, the qualitative analysis of VF tasks may help develop treatment strategies for patients in need of neuropsychological rehabilitation.The qualitative analysis of VF tasks allows the examiner to investigate several cognitive skills, including executive functioning, initiation, lexical search and retrieval, organization of search strategies, inhibition, working memory, and cognitive flexibility.It is well established that aphasic patients produce fewer words than healthy controls in this kind of task, but there are few researches with regard to the qualitative nature of the performance. In light of these observations, the aim of this study was to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic VF tasks.It is important to highlight that clustering and switching scores can also reveal which aspects of language processing are impaired or unaffected after brain damage, contributing to a final diagnosis. Additionally, measures of performance over time allow for an assessment of faster, automatic processes, as well as those which are slower and require additional cognitive effort, resulting in controlled processes which place greater demands on attentional resourcesThe participants were recruited from hospitals settings and evaluated at the school clinic of a higher education institution or at the hospital's neurology outpatient clinic. All participants were assessed individually in a single session.The sample consisted of 104 adults, were divided into four groups, consisting of the following: 26 participants with LHD and aphasia (LHDa group), 25 with RHD (RHD group), 28 with LHD and no aphasia (LHDna) and 25 neurologically healthy adults (Control group). Groups were matched for age  and education  .; no uncorrected sensory  impairments; and no previous or current psychoactive substance use.This research was carried out at a higher education institution. The following inclusion criteria were applied to the sample: being first-language Portuguese speakers; at least 19 years of age; right-handedness according to the Edinburgh Inventory. None of the patients had previously undergone lexical-semantic treatment. The location of cerebral lesions as per magnetic resonance imaging (MRI) or computed tomography, as well as the classification of patients with aphasia, are described in In addition to these criteria, participants in the control group were screened for neurological disorders. Clinical participants were required to have been diagnosed with a unilateral ischemic stroke at least six months prior to the study. The specific location of the lesion was confirmed by neuroimaging tests. The subjects with aphasia were previously diagnosed by the Montreal-Toulouse Language Assessment Battery (MTL-BR) in order to verify the presence of aphasia. Thus, the participants were divided into two groups: LHDna and LHDa. All participants completed the semantic and phonemic VF tasks from the MTL-BR. The MTL-BR have satisfactory psychometric proprieties,19. MTL-BR was designed to evaluate several components of oral and written language, including oral and written expression and comprehension, praxis abilities, and mathematical skills, in patients with a history of brain damage. The battery contains 20 subtests in addition to the two previously mentioned VF tasks,18,19.Participants with LHD were assessed by the MTL-BR BatteryIn the SVF task, the individual is asked to name as many animals as possible in 90 seconds. In the PVF task, they are asked to elicit the largest possible number of words starting with the letter “M” in a 90 second interval. Proper nouns are not counted as correct responses. The words elicited by participants in each 30-second block of the task are written down by the examiner. The tasks are also audio-recorded for fidelity purposes. This procedure also allows for the analysis of clustering and switching patterns..To form a clustering it was necessary to include at least two consecutive words that belonged to the same semantic subcategory  or first syllable  The switchings were analyzed when the participants alternate the subcategory to another, that is, the number of transitions between clustering In the present study, the number of words elicited in each 30 second interval as well as the instrument as a whole were analyzed for each type of VF task (SVF and PVF).Data were analyzed using SPSS, version 22, for Windows. Data distribution was assessed using Kolmogorov-Smirnov tests. Performance on the VF tasks  was compared between groups using one-way analysis of variance (ANOVA) followed by Bonferroni post-hoc tests. Group differences were considered significant at p < 05.The study was reviewed and approved by a university ethics committee under project number 04908/09. All participants provided written informed consent, as recommended by National Health Council Resolution 466/12.The performance of each participant group on the SVF task is shown in The LHDa performed worse than all other participant groups on the SVF task as a whole. The RHD group made fewer switches than the control group, while the LHDna group elicited a smaller number of words than the control group in the first 30 second interval of the task . The datThe LHDa group performed worse than all other participant groups on every PVF score save for the number of switches, which did not differ between these individuals and the LHDna group. Significant differences were also observed between the RHD group and control participants, whereby the former elicited fewer words than the latter in the second block of the PVF task. The LHDna group also performed worse than control subjects on most PVF scores, save for the number of words elicited in the first and third blocks of the task.The types of cluster formed by each participant group in the SVF and PVF tasks are described in ,18,21,22. LHD is associated with particularly severe linguistic impairments, especially in patients with aphasia. This condition affects all areas of language to varying degrees, but is mainly associated with alterations in verbal expression and comprehension,23. However, linguistic or communication skills are also known to be associated with the executive functions. Studies of patients with aphasia have shown that impairments in executive functions such as initiation, flexibility and planning also affect linguistic abilities. Therefore, VF tasks may play an important role as an early screening measure for patients with aphasia, as they predict cognitive function as pertains to both language and executive processing.As expected, the LHDa group obtained lower scores than all remaining subjects on the majority of FVS and PVF measures. Studies shows that in verbal fluency tasks RHD patients have predominant recruitment of the left hemisphere or bilateral regions. The right hemisphere has a limited participation in language processing.RHD patients can present impairments related mainly to pragmatic, discursive, lexical-semantic and prosodic skills,26. This effect was especially evident in the first 15 seconds of the tasks. These results suggest that commonly used words may be easily available and automatically retrieved when the task begins. Once this set of words is exhausted, additional effort must be invested to retrieve further responses, which tend to be less numerous and more closely related to controlled recall, which relies more heavily on the executive functions,28. However, the LHDna group performed worse than the control group in the first block of the SVF task, with the former producing significantly fewer words than the latter  scores provided by these instruments can help detect language impairments and monitor patient progress, contributing to the diagnosis, follow-up and rehabilitation of patients with neurological damage. These observations underscore the applicability of verbal fluency tasks to patients with these conditions. The aim of this study was to compare the performance and strategies used by different clinical and control groups in verbal fluency tasks, highlighting the differences between these populations.The present findings showed that participants with LHD, especially those with aphasia, experienced the greatest difficulties in both semantic and phonological fluency tasks, producing fewer clusters and making fewer switches relative to other clinical groups and control participants. Therefore, in addition to the language impairments commonly associated with aphasia, these individuals may have alterations in executive functions such as cognitive flexibility, which can also influence performance in this type of task. Furthermore, the results show that regardless of the injury site (left or right hemisphere) the word search strategies are quite similar for both FVS and FVF. Differing mainly only in the amount of words evoked.Nevertheless, the present findings must be interpreted in light of some limitations, including a possible confounding effect of the time since stroke, which was not considered in the comparison between clinical groups. In this study the results are not statistically significant but they were very close to .05. Finally, it was not possible to identify the specific regions of the lesions in the LHDna and RHD cases, which did not allow comparing the data with the literature findings.


The impact of collusion during the bidding processes of Chinese government investment projects is a major concern in academic and policy circles, as collusion breeds corruption and destroys the credibility of governments. Furthermore, it negatively impacts successful project completion, leading to cost overruns and the illegitimate enrichment of colluding agents, regardless of the intended social benefits. Using data from 166 selected regional policy implementations as the research sample, this paper uses the fuzzy set qualitative comparative analysis method to conduct a group analysis of typical cases. The purpose of this study is to identify and better understand the cooperative regional policy implementation environments in China and to identify effective methods to improve the governance quality of collusion controls in construction investment project bidding processes. Five key control paths are identified, covering 94% of the cases. It is also found that in lower social collusion situations, reasonable market competition regulations can directly reduce collusive behavior. The research results will help the government to formulate more adaptive control policies and promote high-quality development of government investment projects. In the domain of engineering construction in China, collusion in the bidding process for government investment projects is forbidden, as doing so breeds corruption and destroys the credibility of the government. In Chinese public projects, collusive behavior includes typical forms such as assisting in the formation of bid-rigging alliances, internalizing bidders, leaking bids, inducing traditional bid evaluation experts, lowering minimum standards, and collusive practices resulting from multiple collaborations. At the same time, due to the natural information asymmetry in the bidding process of government investment projects. In the case of information asymmetry, the bidding participant with more information will gain a greater advantage. Specifically, in the case of vertical collusion, the government side has an inherent information advantage in government investment projects. Therefore, firms that choose to engage in collusion have a greater chance of gaining excess revenue. Furthermore, it negatively impacts successful project completion, leading to cost overruns and the illegitimate enrichment of colluding agents, regardless of the intended social benefits. Nevertheless, collusion continues. Therefore, the development of effective measures to control collusion during the bidding process of government investment projects in China has become a crucial issue.Substantial research into this and similar issues has been accomplished in Western economies, focusing on the emergence of collusion and corruption. Delphi or game theory methods are commonplace, and the examination of internal connectivity between cases is less examined. Notably, the differences of cultural and governmental differences between China and the West render much of the international research non-generalizable to domestic problems. Furthermore, according the findings of scholars in several fields, policy formulation in China must fully consider the domestic regional cultural and economic differences. Thus far, Chinese research on government investment project bidding collusion has focused on the gaming interests of participants, the identification of collusive behaviors, quotation interval measurements, and prevention methods. The integration of specific regional concerns has not been investigated.information demand, whereas actors with an information advantage have an information rent-seeking supply. Hence, they engage in information trading. In the absence of additional costs, collusion is likely to occur between project bidding stakeholders regardless of information asymmetry, and the possibility of collusion is greater when the costs are symmetric. However, in the presence of additional costs, asymmetric costs of collusion become apparent. Hence, vertical collusion is more complex, and it is expected that the attractiveness of collusion will differ, depending on the region in China.Bidding collusion has been divided into vertical and horizontal types, where horizontal collusion occurs at the same hierarchical level among conspirators. In vertical collusion, there are hierarchical differences between conspirators at upper and lower levels. Additionally, owing to the information asymmetry of the different levels, actors with a disadvantage have an Through the summary of the existing research, we can find that the following two problems are still waiting to be solved in the current research:the existing research lacks case-based research on bidding vertical collusion control strategyhow to combine the control strategy with the external environment of the controlled area to make the control strategy more adaptableThis paper examines the quality of vertical collusion controls among 166 regional policy implementation cases in China using the fuzzy set qualitative comparative analysis (fsQCA) method to provide theoretical and practical guidance for seeking reasonable control paths. This article adds to the literature by extending the application of fsQCA to vertical collusion in Chinese government project bidding processes, introducing regional propensity for social collusion as a factor, and proposing five effective control paths for collusion controls.The research objectives of this paper are mainly reflected in the following two points:Building a case-based control strategy for vertical collusion in tenderingTake the external social environment into account in the strategy construction process to enhance the adaptability of the strategyLee was the first to study collusion in engineering cases in China, concluding that it leads to a reduction in the number of effective bidders. Furthermore, it indirectly leads to project failure . CharlesPrincipal–agent and game theories are the main methods used by Chinese scholars when analyzing the causative factors of engineering collusion. Huang Wenjie pointed out that, although collusion is induced by excessive competitive pressures, the root cause is fact that the potential returns far outweigh the punishment. Yu Xiaozhong showed that the information asymmetry caused by multiple entrustment relationships in government investment construction projects and the low costs of collusion are the main reasons for its emergence . Cheng SDetecting and verifying collusion is a prerequisite for managing the problem. Patrick et al. constructed a model for identifying bidder collusion signaling . ChotibhScholars have provided diverse solution paths to controlling collusion in bidding for government investment projects. Wu et al. combined prospect and game theories to establish a collusion deterrence model for government investment projects . Wang etIt can be learned from the current literature that vertical collusion is abundant in the bidding of Chinese government investment projects. However, extant results are limited in that they mainly focus on game and principal–agent theories, which concern themselves predominantly with the influence and relationships of agents. Studies are scant on the effects of factorial combinations of vertical collusion factors in Chinese government investment bidding. Fewer papers have studied real vertical collusion case data, and there is a lack of successful control path studies overall.Qualitative comparative analysis (QCA) is a case-based research method that combines qualitative and quantitative approaches. Compared with traditional research methods, QCA reflects the non-linear relationships between variables and outcomes by examining the multiple influences of social phenomena. It is mainly applicable to small sample cases. Modern QCA methods include fsQCA, crisp set QCA (csQCA), and multi-value QCA (mvQCA). The csQCA method treats full case membership as a binary variable (zero or one), which helps overcome subjectivity to a certain extent. The mvQCA method accounts for multinomial categorical case data. Although many collusion control policies have been advocated in China, relevant laws and regulations are difficult to find. Furthermore, it is difficult for governments beneath the municipal level to obtain relevant data to either detect or deter collusion. To solve the problem of this research, fsQCA is best, as it allows varying degrees of case membership based on affiliation, which is assigned using the relative position between indicators.fuzzy fashion. The technology roadmap of the research is shown in Therefore, the fsQCA method is leveraged to analyze the factors influencing collusion control at different time periods and in different environments. The factors arising from vertical collusion are more diverse than horizontal collusion, and the efficacy of control is influenced by a variety of complex factors. Similarly, the factors change and interact to wildly affect the dependent results in a Accurate and adequate case selection has a significant impact on the reliability of study results, especially with fsQCA. The paper judges the efficacy of collusion controls in terms of their applicability to the prevailing external environment based on the number of changes in administrative cases in the 2 years before and after the changes in relevant management tools and external environment were made.The criteria for selecting cases were as follows. First, to guarantee the reliability of case indicators, public data were collected from the official National Bureau of Statistics website, various Chinese General Social Survey datasets, and the official Judgment Document Network website, which ensures source authenticity and reliability. Second, to ensure the diversity of case sources, those from 31 provinces, municipalities, and autonomous regions across China were collected to ensure data diversity. The sample cases included those with and without effective collusion controls between 2007 and 2021. Third, to ensure the representability of cases, after initial data collation, cases lacking new policies and control measures were discarded to avoid redundancy and bias. Similarly, cases containing obscure indicators or those with differences depending on their source were eliminated. 166 cases were finally included.M documents are recorded. The distribution of topics and words is then found for each document. Specifically, LDA is used in this research to identify the topical semantics of 100 highly cited papers and 40 judgments from collusion cases from 2006 to 2021. Highly frequency words were selected for factor analysis, and Gensim and Numpy libraries were used to construct the LDA model after integrating a specialized thesaurus and deactivating undesirable terms.To construct an evaluation index for the causal factors of collusion, the latent Direchlet allocation (LDA) topic model was applied. LDA is commonly used unsupervised Bayesian machine learning algorithm that automatically extracts topics from large-scale texts without manual processing. By counting the input text, the numbers of words in each of In this research, keywords “government investment projects” and “collusion” were used to search the China National Knowledge Infrastructure database and 100 core papers with high application rates from 2000 to 2021. A total of 21 case judgments were selected as the initial data source, and after manual screening, 43 paper items were retained.Relevant vertical collusion evaluation and influence indicators were obtained from both Chinese and international literature, and the key indicators were refined using interviews. The model perplexity of the analyzed texts is illustrated in The data selected for this paper were obtained from the Chinese General Social Survey and the Chinese National Statistical Yearbook. Among them, the Chinese General Social Survey (CGSS) of China Survey and Data Center is the earliest national, comprehensive, and continuous academic survey project for China, which selects more than 10,000 households in all provinces and autonomous regions of mainland China for continuous cross-sectional surveys. The database is therefore highly credible.degree of social collusion tendency , the degree of government collusion tendency (f241–f245), the degree of judicial impartiality (CGSS2015 f61–f63), the degree of trial impartiality (f71–f76), the efficacy of supervision procedures (f161–f174), the degree of market competition, the state of economic development, and the existence of special actions and laws in the given year. The relevant situation of each province was clarified separately. The dependent variable is quality of control.The finalized key influencing factors include the When using the fsQCA method, each condition and outcome are considered a set, and each case has an affiliation score in the set. The tool was calibrated for variable data according to the level of affiliation of cases with the characteristic variables, and all data were assigned values between  with larger values indicating higher affiliation (apart from control strength). Variables were then assigned based on whether the initial value was greater than the second quartile of all values. If so, it was changed to “1;” otherwise “0.” Control strength was assessed according to whether there was a special control in the given year. The variables were interpreted and categorized as shown in This method converts the data into fuzzy set affiliation scores using direct calibration of antecedent conditions and outcomes based on extant theory .Regarding the evaluation of quality of control Result, , the incThe condition code, hmqxd, refers to the socially complicit atmosphere. Drawing on existing research, this paper applied two variables, degree of social collusion tendency and the degree of government collusion tendency, as descriptors. Data from 31 provinces and municipalities were used alongside questionnaire data based on a five-point ordinal scale. Variables were assigned values based on whether the initial value was greater than the second quartile of all values. If greater, then one; otherwise zero. A value of one represents a local propensity for collusion and a worse external environment for governance than 50% of all cases.The condition code, zfljcd, refers to the degree of government fairness. Drawing on existing research and advance data from the LDA exercise, a five-point scale was used to measure the degree of judicial impartiality, the degree of trial impartiality, and the efficacy of supervision procedures using data from the China Social Survey. Variables were assigned values based on whether the initial value was greater than the second quartile of all values. If greater, then one; otherwise zero. A value of one represents the local propensity for collusion and a worse external environment for governance than 75% of the cases.The condition code, scjjcd, refers to market tightness (competitiveness). This factor has a large impact on whether firms choose to collude. Therefore, the degree of market competition was selected for analysis. The source of the value is the ratio of the total construction output to the number of construction firms. If the value for a case is greater than 50% of all cases, then the local market is considered to be less competitive, and firms have access to a relatively sufficient number of projects, in which case a value of one is assigned; otherwise, a value of zero is assigned.The condition code, gdp, refers to the local state of economic development per year. Variables were assigned values based on whether the initial value was greater than the second quartile of all values. If greater, then one; otherwise zero.The condition code, zxld, refers to control efforts, implying the existence of special actions and laws in the given year. A value was assigned based on the year in which the relevant legislation or special measure was introduced to remedy the problem.Based on the above variable criteria and meaning interpretations, the cases were assigned values, and a final truth table excerpt is shown in Before analyzing the relevant groupings, it is necessary to determine whether a single factor may have affected the variables, changing the quality measure of control. In fsQCA, a necessary condition is one that affects the outcome variable. Generally, one is considered necessary if the consistency is greater than 0.9 . Thus, nBased on a related study by Ragin, 0.8 and 1 were set as the consistency and case thresholds ,42. The From Path P1 (~hmqxd*~scjjcd) reflects a socially complicit atmosphere × market tightness. This path shows that the effective control of vertical collusion in bidding can be achieved when both the willingness to socially collude and the degree of market competition are low. It also shows that market tightness and the society’s tendency to collude can play a complementary role.Path P2 (scjjcd*~gdp*~zxld) reflects market tightness × ~local economic development status × control effort. This path shows that, in the case of insufficient government enforcement and a low overall economic level of society, if the bidding of government investment projects is in a highly competitive market situation, effective control of vertical collusion can be achieved, because the collusion brings sufficient expected benefits neither to either enterprises nor government parties.Path P3 (~hmqxd*~zfljcd*zxld) implies ~ socially complicit atmosphere × ~degree of government fairness × control effort. This path suggests that, with a low propensity for social collusion and a high level of government integrity, and effective government controls, collusion control can be effectively enhanced through the joint regulation of internal control efforts and external environments.Path P4 (hmqxd*zfljcd*scjjcd) reflects a socially complicit atmosphere × degree of government fairness × market tightness. The path illustrates that, in cities with high social collusion and low government integrity, the probability of vertical collusion can be effectively reduced by increasing the degree of market competition and reducing the arbitrage margin of government investment projects so that their profitability is at the conventional market level.Path P5 (zfljcd*~scjjcd*gdp*~zxld) reflects the degree of government fairness × ~market tightness × local economic development status × ~control effort. This path indicates that, in the case of low government integrity and a high level of local economic development, if the degree of competition in the market is low, even if government control is insufficient, a better control effect can be achieved.By examining these five paths, it can be seen that market tightness, the propensity to collude, and the intensity of enforcement are the most important requirements, which further indicates that in an actual control process, the control effect is best for these three indicators.Adjusting for the level of consistency is a common method of determining QCA robustness . According to Schneider et al., the robustness of a method refers to its capacity to remain unaffected by small variations in the methodological parameters. Hence, it can be ascribed to “reliability.”In the case of this research, the consistency level threshold was increased to 0.88, and group analysis was performed again using the same frequencies. These results are shown in Government investment bidding policies in China have made great progress in terms of application areas and methods, but the phenomenon of collusion between governments and enterprises remains a problem, despite its repeated prohibition. Previous studies on vertical collusion in bidding have mostly focused on the classification of collusive behavior, behavioral decisions of bidding participants, and prediction of collusion tendencies. However, the research on vertical collusion control is very limited. Therefore, this study fills this knowledge gap. The main contribution of this paper is the novelty it provides, which is reflected in the incorporation of social collusion tendency into the process of strategy formulation, the use of LDA thematic model into the process of constructing indicators, and the analysis of control cases using the fsQCA method. Prior to the current study, there were no good universal measures in China upon which collusion controls could be built.In this study, the fsQCA method was used on data culled from 166 governance cases in 31 domestic Chinese regions at different periods and under different conditions. Hence, the effects of each variable on the quality of collusion controls were assessed based on their different groupings. From the results of single factor analysis, it was found that a lower degree of market competition is necessary for improving control quality. From a combination of conditions, it was found that several paths affect the quality of vertical collusion control, and improvements depend on choosing different methods for different situations. Based on the five paths ascertained from the analysis, the following three major suggestions are offered to resolve the problem.Reduce the social collusion climate. The social collusion environment occupies a very important position in Chinese business and governance. The degree of government fairness and local economic development are closely related to the overall social climate. First, improvements to related indicators should be used to effectively reduce the social collusion atmosphere and create a good bidding environment. Controlling the indicated phenomena is important, but providing preventative educational measures would also help. Furthermore, notable cases should be used for publicity and to create a catalog of bidding restrictions/recommendations. For cities with a poor collusion environment, the government should strengthen its management efforts and try to reduce the tendency of social collusion and destroy the collusion environment through strong and effective control measures (such as increasing the enforcement of policies and implementing regular inspection measures); and build a social environment in which "collusion is not possible, not daring to collude, and not wanting to collude" in phases. The government should build a social environment in which people cannot, dare not, and do not want to collude [ collude .Play the role of market guidance. Economic development and the degree of market competition influence the attractiveness of collusion. Under conditions of strong market competition, some enterprises are more likely to collude with government officials to ensure their survival. Unfortunately, this destroys fair competition. The degree of competition in the market clearly affects the choice of enterprises. However, in the case of very low competition, the probability that firms will choose to abandon collusion increases. The tendency is to increase collusion at first, followed by a decrease. Path 1, which covers 47% of all cases, showed that with low social collusion, if the degree of market competition can be reasonably controlled, the deterrence of collusion can be better achieved. Therefore, the government should raise the market entry threshold to avoid disorderly competition. When the market competition is too high, even if the projects are obtained through vertical collusion, they cannot obtain enough profits; while when the market competition is too low, the enterprises can obtain enough projects without collusion, and the necessity of choosing collusion is not enough at this time. Therefore, local governments should take the local market environment and project types into consideration and reasonably regulate the competition level of projects for different project types to control the collusion phenomenon. Furthermore, the government’s guiding role should be fully exerted to realize the synergistic control of internal and external environments [ronments –45.Strengthen supervision and control. In the unique market environments of China, the government occupies a key position in controlling collusion. Hence, they should strengthen internal and external supervision and give full play to the role of supervision mechanisms. Additionally, controls should be strengthened and mandated. Furthermore, big data and machine learning methods should be supplied to carry out comprehensive analyses of bidding processes to improve fairness. Penalties should also be increased to improve deterrence. This is would also lead to standardized market management at many different levels. Due to the different administrative capacities of provincial governments across China, consideration should be given to building a bidding management system and payment system based on blockchain technology and BIM technology from the national level. The government should encourage the adoption of blockchain technology and BIM technology in bidding management to enhance the transparency and trustworthiness of the bidding process [ process ,22.Owing to the limited access to data and the existence of data residuals, the sample of this paper only included 166 cases, which small. Thus, the statistical results may show unstable or limited results, despite the model’s robustness. Therefore, the generality of the control measures proposed in this paper deserves further study. In future research, multiple testing methods and results analyses should be used to offer better cross-check validity.


In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers. The Total Worker Health (TWH) Program, defined “as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness-prevention efforts to advance worker well-being” , was lauIn order to promulgate this strategy, NIOSH has set up Centers of Excellence for Total Worker Health to provide the scientific data required to create new solutions for TWH challenges. The research carried out at these centers produces new information and proposes creative solutions to problems currently encountered by modern enterprises. Through nonfunded collaborations with governmental and nonprofit organizations, NIOSH has also established a TWH partnership program that aims to increase the visibility and impact of TWH initiatives by publicly acknowledging the efforts companies make in order to advance THW research and practice.The development and application of TWH principles have been the subject of considerable debate among prevention operators since the new approach can lead to ethical dilemmas. Many believe that decision-making should be based on ethical constructs , but theFurthermore, there is little concrete evidence of the obstacles and enabling factors involved in the acceptance, implementation, and sustained maintenance of TWH initiatives . MethodsThe US initiative has aroused interest in several countries that have tried to adapt the philosophy of TWH to different national conditions. For example, Germany has adopted “workplace health management,” a comprehensive approach to safeguard, advance, and manage employees’ health at work . The modIn Italy, the Ministry of Health, through the National Prevention Plan (NPP) for the 5-year period 2020–2025 , has madWhile there is little doubt that health promotion is part of the occupational health mission and that OPs and GPs share the same public health goals, collaboration between these different professional categories is far from automatic and requires programs, resources, and guidelines. Reports of experiences in the USA showed that resource shortages, the organizational structure of safety and health services, and incompatible techniques were obstacles to an OP–GP partnership, whereas knowledge of TWH methodologies, proximity to TWH Centers of Excellence, and leadership initiatives acted as facilitators .However, a transfer of the US experience to other social contexts must take into consideration differences in health and social care systems. In the USA, healthcare is predominantly private. Companies provide resources for employee healthcare through insurance policies; consequently, they have a vested interest in reducing disease among their employees in order to cut insurance costs. On the contrary, the Italian National Health Service (NHS) guarantees free healthcare for all, and workers’ insurance against accidents and occupational diseases is compulsory. Companies contribute through taxation to the NHS and the National Institute for Social Security (INPS) and pay compulsory insurance to the National Institute of Insurance for Accidents and Occupational Diseases (INAIL). Therefore, they do not have an immediate economic return from a reduction in injuries or illnesses. Furthermore, in Italy, over 92% of active enterprises are small or very small and employ 82% of workers . These cFor many years, our university has developed techniques that enable health promotion programs to be disseminated during health surveillance activities in the workplace. This article describes the workplace health promotion method embedded in medical surveillance (WHPEMS), which has been applied by occupational physicians, also in small companies. By exploiting the unique characteristics of the Italian NHS that offers free and universal access, this method has limited the need for resources and has been able to envisage and implement the integration criteria of prevention and promotion postulated by the NIOSH. The purpose of this article is to provide OPs with a simple, effective, and economical method of promoting health in the workplace. The manuscript aims to present in detail an initiative in the methodology applied in occupational settings.The essential prerequisite for carrying out successful workplace initiatives is the management of occupational risks. In order to implement the integrative approach to the concept of occupational health, which is the basis of the TWH, it is essential, first of all, to provide for the prevention of occupational risks. Only when this is achieved is it legitimate to plan the promotion of workers’ health. Our school adopted the A.S.I.A.  model  for riskWHPEMS interventions are conducted every year in accordance with a proposal based on indications previously provided by the workers. The occupational physician collects this information during visits to the workplace when he/she invites workers to describe their work cycle, identify any critical issues, and by means of participatory ergonomic groups , make proposals for workplace improvement . The G.EOver the years, chosen topics have concerned pathologies with a particular impact on productivity and determinants of well-being. Consequently, headache disorders  , musculoWorkers are invited to participate in WHPEMS action during their regular medical examination in the workplace. There is no sampling because all those undergoing health surveillance are invited to participate. Workers are free to accept or refuse, but the vast majority agree to provide the requested data and are eligible for the promotion. Those who agree to participate sign a consent form and receive a questionnaire made up of three parts: the first investigates the topic of the promotion action; the second measures possible outcomes; while the third measures possible confounders, mediators, and modulators of the relationship observed. For example, since a consistent amount of scientific evidence indicates that increased adherence to the Mediterranean diet is associated with favorable mental and physical health outcomes ,42, the Workers receive immediate health promotion advice from the occupational physician and guidance on where to access NHS facilities for diagnostic tests or necessary treatments. After processing the data contained in the questionnaires, the occupational physician transmits the results in a collective anonymous form to the employer, the protection service manager, and the workers’ safety representatives so that eventual collective promotion measures can be adopted.Over the past 12 years, the occupational physicians in our occupational health unit have conducted the WHPEMS programs reported in Although it was not obligatory to join the programs, most workers participated. In cases where screening revealed a disease, the medical examinations performed immediately after completing the questionnaire were used to expand the workers’ medical history, investigate comorbidities, and evaluate any alterations. Workers were invited to start or continue their diagnostic/therapeutic pathway at the NHS. In these cases, the OP took the opportunity to contact the worker’s GP, to whom he/she sent a letter via the worker, indicating the data emerging from the examination and the patient’s possible needs. The worker was invited to provide information on the evolution of his/her pathology that would, however, be further checked by the OP during the worker’s next routine examination. In most cases, when OPs detected only incorrect habits or risky behaviors, contact with the worker was used to reinforce the salutogenic approach by pointing out the advantages of correct lifestyles.The data collected through questionnaires were processed electronically. The results of each survey were reported to the companies, the corporate prevention service, and the workers’ safety representatives in order to contribute to the growth of the work culture. Besides offering workers advice and providing companies with useful indications, WHPEMS activities have enabled researchers to produce some scientific publications ,61,62,63The experiences conducted by our occupational medicine unit over a period of several years and summarized in this paper indicate that including health promotion in prevention activities required by law presents characteristics worthy of attention. First of all, since this method makes use of an existing health and safety service, it is very economical because it does not require companies to make a significant commitment of economic resources. Furthermore, it does not interfere with the work of OPs. On the contrary, it guarantees an important supply of data for analyzing workers’ health conditions. Usually, a lack of resources is reported to be the most common obstacle to WHP programs, whereas strong management support is held to be the most common facilitator of this type of intervention . The modThe third aspect is the participatory nature of WHPEMS. Workers contribute by proposing topics that become the subject of promotion projects and also by responding to their doctor’s advice. Research has shown that the participatory approach is a good example to follow for promoting health . ChoosinA further interesting characteristic of WHPEMS projects is that they enable researchers to systematically collect interesting occupational medicine variables, such as perceived occupational stress and workplace violence. The latter is considerably underreported in workers’ spontaneous reports ; howeverLastly, by creating a real flow of information between OPs and GPs, the WHPEMS method avoids duplicating activities and wasting resources during public health action. In a health system in which resources are limited, waste is ethically unacceptable. Regular mandatory health surveillance in the workplace makes it possible to evaluate the effectiveness of promotional interventions. Numerous requests have been made to overcome obstacles such as organizational, interpersonal, and structural barriers that can hamper cooperation between OPs and GPs, and suggestions have been put forward in order to successfully achieve this aim .The recent COVID-19 pandemic has shown how important the relationship between OPs and GPs is in disseminating and sustaining good practices. It has been observed that when public health shocks occur, policymakers can encourage pertinent learning processes by supporting knowledge and education to raise people’s understanding of preventive health practices . A changA limitation of the advantageous WHPEMS method is the considerable effort needed to plan the annual project and carry out a statistical analysis of the data collected. To overcome this limitation, the occupational medicine unit of the Catholic University of the Sacred Heart makes its project available to all OPs and provides free data processing to interested researchers. The aim of this work was to introduce a method for carrying out health promotion interventions that would be accessible to OPs, even in small companies. Despite the numerous actions undertaken worldwide, there is still little and inconsistent evidence regarding the effectiveness of strategies for improving the implementation of health-promoting policies and practices in the workplace . We are The aforementioned WHPEMS method, based on continuous health promotion within regular health surveillance activities conducted in the workplace, offers many advantages such as cost-effectiveness, sustainability, and a participatory approach, all of which recommend extensive application. Moreover, it is a valid tool for collecting useful information for the surveillance of workers and for improving work environments. It also provides a solid foundation for creating a two-way information flow between occupational physicians and NHS doctors. The critical issues inherent in this method, as in all health promotion programs, concern the need to analyze evidence, design the survey correctly, and process the results. Our university gives occupational physicians access to experiences gained in over 12 years of promotion activities and aims to create a network for all those interested in promoting health in the workplace.The A.S.I.A. method for risk management and the Participatory Ergonomics Groups (G.E.P.) method are registered trademarks of the author and are freely accessible by all prevention operators who intend to apply them in the workplace.


In this study, the research objective of psychological resilience refers to the emerging professional group of Internet marketers under the background of the COVID-19 pandemic environment. This paper studies the effect of the psychological resilience of Internet marketers on their subjective career success. The result shows that Internet marketers’ psychological resilience has a positive impact on their subjective career success. The work engagement of Internet marketers plays a mediating role in the relationship between psychological resilience and subjective career success. Meanwhile, Internet marketers’ workload positively moderates the mediating effects of work engagement. This study starts from the perspective of positive psychology to investigate the psychological resilience of Internet marketers and broadens the scope of application of positive organizational behavior and psychology. Since the 1970s, the internal and external working environments of organizations have changed rapidly, and the boundaries of their survival and development have increasingly blurred . Hence, In the combination of live broadcast and e-commerce industry, online marketers have experienced the appellation from Internet celebrities to live broadcast anchors. In July 2020, the Ministry of Human Resources and Social Security of China and other relative departments listed Internet marketers as a new occupation. Meanwhile, the professional title of Internet marketer was officially included in the “National Occupational Classification Code” . Based oAdditionally, with the vocational certification of the Ministry of Human Resources of China and Social Security and the State Administration of Market Regulation in China, Internet marketers are being increasingly recognized by the masses. However, the novelty of the work content of Internet marketers, coupled with the fierce changes in the internal and external environment, makes the Internet marketing profession frequently bear various hidden burdens, and psychological–emotional exhaustion often has a negative impact on their personal and work development. The exploration and improvement of the quality of psychological resilience help individuals reflect on the significance and value of life brought by adversity.Psychological resilience is a static situation  wherein Work Engagement (WE) refers to the positive emotional experience that an individual perceives in daily work, which is characterized by long durations and multidimensional divergence to the individual’s work process . AccordiWorkload refers to the index value of an individual’s ability to evaluate workload demand  or the sThe formation and value recognition of psychological capital concept benefit from the deepening of research on organizational behavior. Psychological capital pays more attention to the development of “people” as a whole, and focuses on the characteristics and development of individuals . Like trThe resource conservation theory proposed by When individuals have high psychological resilience, they can show higher engagement at work, are more likely to develop good interpersonal relationships, improve their work remuneration and promotion opportunities, and feel additional work satisfaction. It has confirmed that psychological resilience and job performance show a positive correlation, be it in normal or extreme working environments, such as military combat . In concHypothesis 1: Internet marketers’ psychological resilience has a positive impact on their subjective career success.Nowadays, although the webcast industry is increasingly becoming standardized, there are few ways to pass positive information to the public; some people retain the stereotype of “vulgarization” and “stigmatization” of the group, thus leading to a low degree of social identity for a career as an Internet marketer. For a group of Internet marketers, the relative lack of government-level social security systems and the negative propaganda of public opinion in the media have caused Internet marketers to suffer serious frustrations in the course of their work. In the face of injury or dilemma, individuals with strong resistance to frustration continue to maintain a high degree of daily work engagement, whereas groups with low levels of relative psychological resilience are unable to concentrate on work because of the influence of negative emotions. Empirical research on psychological capital recognizes that psychological capital must be related to an organization’s work results. However, work attitude variables, such as work engagement and satisfaction, also have a positive correlation with job performance outcome variables. Thus, psychological capital and employees’ work engagement are related. Individuals with a high level of psychological resilience can maintain a higher degree of engagement in their own work, which is reflected in the focus, higher work willingness, and high cost in the professional field. Specifically, we propose the hypothesis 2:Hypothesis 2: Internet marketers’ work engagement plays a mediating role in the relationship between psychological resilience and subjective career success.Scholars have debated about the role of workload in the transfer mechanism of empirical research. According to Hockey’s work demand–management control model, when there is psychological and emotional stress in the working environment, employees choose to enhance their subjective initiative, that is, to continue working hard to maintain high performance levels. Thus, the higher the degree of activation of sympathetic nerves in the brain when an individual chooses to strengthen subjective effort, the higher the psychological cost it produces. Hence, in the long term, when individuals face a highly intense working environment, one is more likely to experience situations where one’s own state makes it difficult to meet the needs of work, resulting in job burnout. Scholars have focused on the work demand–management model and believed that individuals appear to deal with highly demanding work requirements in two ways, namely, one is paying a higher psychological cost to adapt to the high requirements and complete the higher target performance and the other is avoiding excessive consumption to maintain normal effort input. However, workload reduces the final level of work performance. Specifically, we propose the hypothesis 3:Hypothesis 3: Internet marketers’ workload positively moderates the mediating effects of work engagement in the relationship between psychological resilience and subjective career success.To sum up, the theoretical model and research hypotheses of the relationship between psychological resilience, work engagement, workload and subjective career success constructed in this paper are shown in In this study, the selection of the survey object is not limited to a fixed platform. The source of the data is mainly live broadcast bases in Lianyungang, Jiangsu, and Shiyan, Hubei, as well as the Internet marketers from many provinces such as Beijing, Shanghai, and Shenzhen. Additionally, an online questionnaire was adopted as the survey method. The questionnaire was distributed and collected primarily through the WeChat platform. Overall, 240 questionnaires were distributed, of which 224 responses were collected. The questionnaire response rate was 93.3%. After inspection, 16 invalid questionnaires were excluded and 208 valid questionnaires were retained. The effective recovery rate reached 92.8%. All research subjects completed the survey independently.In this study, the concept of psychological resilience is defined as a trait or ability. The Connor–Davidson Resilience Scale (CD-RISC)  is used The measurement scale used in this study to assess the level of work engagement is the Utrecht Work Engagement Scale (UWES-9), a simplified version of UWES . The scaRole Overload Scale  is used Subjective career success is an individual’s subjective perception of the success of their own career development. An individual should make a subjective measurement on the basis of their own practical experience and feelings depending on specific measurements. It is difficult to obtain the result through the organization engaged in or relying on external observation of a third party. Based on the conceptual connotation of subjective career success, many scholars have used career satisfaction  or job sIn this study, SPSS25.0 and AMOS 24.0 software were used to analyze the data. Pearson’s correlation analysis method was used to observe the correlation between sex, educational background, and other statistical variables such as psychological resilience, work engagement, workload, and subjective career success. To test the mediation and moderation effects, we adopted a bootstrapping method, used the program in SPSS developed by The questionnaires for this study are mainly from two live broadcast bases in Lianyungang, Jiangsu, and Shiyan, Hubei. We distributed questionnaires to 208 Internet marketers from Beijing, Shanghai, Shenzhen, Anhui, and other provinces. Descriptive statistical analysis is performed on the basis of the data, and the details are shown in In terms of sex, 79 were men and 129 women, accounting for 37.9% and 62.1% of the total sample respectively. The data results show that the proportion of men and women in the survey questionnaire is significantly biased—that is, there are significantly more female Internet marketers than males, which is consistent with the phenomenon observed in real society. In terms of age, none were under the age of 20; 52 aged 21–25 years, accounting for 25% of the total sample; 41 aged 26–30 and 36–45 years, accounting for 19.71% of the total sample; 47 under the age of 31–35 years, accounting for 22.6% of the total sample; and 27 over 46 years, accounting for 12.98% of the total sample. Therefore, in terms of the proportion of age, the age of Internet marketers is at a maximum of 21–25 years, indicating that more youngsters are engaged in this profession, which is consistent with the characteristics of this profession as a representative of flexible employment. In terms of academic qualifications, the number of Internet marketers with college as the highest academic qualification is the highest (154), accounting for 74.04%, followed by undergraduate and high school levels, accounting for 20.19% and 4.81% of the total sample, respectively. There are none with a degree below the high school level or with a doctor’s degree, indicating that the education background of the group currently engaged in this occupation represents a normal distribution, and the number of people with higher and lower education levels is still small. In terms of working hours, the number of people with entry time between 1 and 3 years is the highest, accounting for 28.37% of the total sample proportion, followed by those with entry time between 1 and 6 months and from 6 months to 1 year, with 45 and 38 people, accounting for 21.63% and 18.27% of the total sample, respectively. This indirectly proves that the life cycle of Internet marketers as a new profession has withstood the test of time. In terms of income, 89 people with a salary of less than 6,000 yuan account for 42.80% of the total sample; 58 people with a salary between 6,000 and 10,000 yuan account for 27.89% of the total sample; and 61 people with a salary between 10,000 and 30,000 yuan account for the total sample. The sample proportion is 29.33%. Hence, the income of most groups of Internet marketers remains low, which is consistent with the phenomenon that the top current Internet marketers are still earning maximum resources and traffic in the industry. It also reflects the grassroots Internet. Hence, marketers find it difficult to obtain traffic that attracts the masses.r = 0.444, p < 0.01), psychological resilience and subjective career success , work engagement and subjective career success , work engagement and workload , and workload and subjective career success  are all significantly correlated. The correlation coefficient values of the main research variables in Pearson’s correlation analysis between variables is used in this study to observe the correlation between sex, education, and other statistical variables such as psychological resilience, work engagement, workload, and subjective career success. p < 0.001) after controlling for variables such as sex, age, education, working years, and income. Hypothesis 1 is supported—that is, the psychological resilience of Internet marketers has a positive impact on subjective career success. Additionally, before testing the mediation effect of work engagement, it is necessary to analyze the relationship between the psychological resilience and work engagement, as well as the relationship between work engagement and subjective career success. The results showed that after controlling for the variables of sex, age, education, working years, and income of Internet marketers, a significant positive correlation was found between the psychological resilience of Internet marketers and work engagement ,and between work engagement and subjective career success of Internet marketers .In the process of formal research, linear regression method is used to verify assumptions. The results are shown in p < 0.001). Second, from the results of psychological resilience and work engagement to predict subjective career success, psychological resilience significantly positively predicts subjective career success . Meanwhile, p < 0.001), indicating that the direct effect and the second half of the mediation effect are established. Finally, the subjective career success of dependent variables is predicted using psychological resilience as an independent variable. p < 0.001, indicating that the total effect is true.To test the mediating role of work engagement in Hypothesis 2, we apply bootstrapping methods using the method proposed by To further detect the mediation effect as a complete or partial mediation, and whether it is a partial mediating role, the specific value of the mediation effect is obtained. The random sampling is set to 5,000 times using bootstrap random sampling, and the confidence interval is 95%. Finally, as shown in The method proposed by On the basis of a literature review, this study proposes three related hypotheses and validates them through data analysis using statistical analysis software. The results show that the psychological resilience of Internet marketers has a significant positive impact on subjective career success; the work engagement of Internet marketers plays a mediating role between psychological resilience and subjective career success; and the workload of Internet marketers positively moderates the relationship between psychological resilience and subjective career success. Specifically, it is manifested in the following three aspects.p < 0.001). Psychological resilience is a typical positive psychological resource. Under the effect of this positive psychological trait, individuals show stronger adaptability in the work process, are more likely to develop good interpersonal relationships, and be satisfied with work. The perceived happiness also increases accordingly, which means that it is easier for Internet marketers to achieve subjective career success.First, the psychological resilience of Internet marketers improves their subjective level of career success cognition. This study uses psychological capital theory as the theoretical basis and highlights that individuals with high psychological resilience can overcome internal and external pressures and have a higher sense of self-efficacy and innovative spirit. This enables them to better solve problems, cope with adversity, and actively adapt to the results, which ultimately bring success, satisfaction, and development to the individual. Additionally, the results of the data analysis by SPSS 25.0 statistical analysis software show that the Internet marketers’ psychological resilience has a significant positive impact on subjective career success . Work engagement is derived from the perspective of positive psychology and organizational behavior, because it reflects the positive and full emotions and cognitive patterns of an individual at work and indicates that the individual can perceive the enthusiasm and joy of work when completing the task—that is, it has a higher sense of self-fulfillment. Thus, Internet marketers have a higher sense of job identity when they have a higher level of psychological resilience and are less likely to experience job burnout. The positive forces stimulated by an individual’s internal resilience can promote work engagement, and the results of the work often make the individual more satisfied, which will ultimately help in achieving subjective career success.Third, workload has a positive moderating effect on the relationship between psychological resilience and subjective career success. The empirical research results of data analysis show that workload positively moderates the impact of Internet marketers’ psychological resilience on their subjective career success. According to the literature, challenging stressors, such as high workload, can also bring expectations to employees when they consume a large amount of personal resources, such as material and spiritual returns like salary increases, personal growth, and self-realization. Additionally, the empirical data show that the workload perceived by Internet marketers acts as a challenging source of pressure, which is consistent with the core concept of psychological resilience. Hence, when the level of psychological resilience is low, a relatively low workload increases the level of the Internet marketer’s subjective career success perception. When psychological resilience is maintained at a high level, the increase in workload strengthens the transmission mechanism of psychological resilience to work engagement and then to subjective career success, thus enhancing the positive effect.With the rapid development in digitalization and informatization, the profession of Internet marketers has performed well in absorbing employment, and society should not only focus on the novelty of its job characteristics but also pay attention to their career development process. The difficulties faced by Internet marketers can be used as a direction for future improvement from the perspective of professional psychological quality training and development guarantee, which will ultimately improve the subjective career success cognition level of the Internet marketer group. Thus, based on the research results, it is necessary to provide empirical support for managers to pay attention to fostering Internet marketers’ psychological resilience and, correspondingly, reducing the workload of Internet marketers, and proposing targeted countermeasures to give full play to the positive role of psychological resilience.First, multiple measures to improve Internet marketers’ psychological resilience. Internet marketers have a high level of psychological resilience to improve subjective career success. Relevant studies have proved that correct self-efficacy and self-acceptance can enhance employees’ psychological resilience and promote their deep development in the professional field. Internet marketers can try to improve their psychological resilience in the following three aspects: first, they should improve their professional identity. Internet marketers, as a new profession, play an important role in the new employment army under the economic environment of live broadcasting. They should highly identify with the mission of engaging in the profession and establish a sense of professional belonging and mission. When Internet marketers are faced with difficulties in their daily work, they should learn to establish the correct style of problem attribution, that is, maintain an optimistic and upward emotional state and seek multichannel and high-efficiency methods to deal with stressful challenges and strengthen emotional regulation ability to improve the level of psychological resilience. Moreover, improve the level of achievement motivation. Renewal of professional skills, emotional experience, and professional knowledge of Internet marketers all promote the level of self-acceptance in the mode of self-renewal and then improve achievement motivation to a certain extent.Second, focus on multiple dimensions to enhance the work engagement of Internet marketers. The results show that the degree of work engagement has a significant impact on the subjective career success of Internet marketers. Interviews with successful Internet marketers showed that they love their work and are willing to think about how to improve their current work. Interest is the best teacher in the process of work to find and cultivate their own interest in work, stimulate enthusiasm for work, enhance the degree of professional work engagement, and finally succeed in their respective careers. Additionally, the level of work engagement also depends on the Internet marketers’ own problem-solving ability. Groups with high levels of psychological resilience show strong problem-solving ability in the face of difficulties; specifically, they actively think about various solutions to problems, accumulate successful learning experiences from others, and are good at arranging and solving problems based on the difficulty level. Internet marketers can improve their ability to deal with problems through the dual accumulation of theory and practice, such as reading to accumulate more professional knowledge through the practice process to accumulate more experience, thus broadening their horizons and even career and gradually improving their subjective career success cognitive level.Third, multiple measures to promote rationalization of the workload of Internet marketers. According to this study, when the level of psychological resilience is low, the relatively low workload improves the Internet marketers’ subjective career success cognitive level. By contrast, when there is a high level of psychological resilience, the increase in workload ultimately improves the cognitive level of subjective career success. According to the rule of Yerkes-Dodson, the inverted U between stress and work results means that too high or too low pressure will result in lower work results than expected. For different levels of psychological resilience, a moderate workload can maximize work efficiency. Based on the actual situation, the source of pressure faced by Internet marketers is not only personal but also related to the assessment mechanism of the employment platform and the lack of social security system. Internet marketers can rationally deal with their workload by improving their personal abilities. Because of the novelty of the professional content of Internet marketers, individuals should constantly update their professional skills to cope with the possible working conditions. Hence, Internet marketers can improve their professional abilities, skills, and experience by constantly acquiring new knowledge. Moreover, today’s platform often views the live broadcast time of Internet marketers as one of the work completion standards, although long hours of work bring lower work results. Thus, the employment platform should carefully consider implementing some mandatory evaluation systems and establish a reasonable performance evaluation system for Internet marketers. Additionally, as a new occupation that has just been included in the professional gamut, the workload level of Internet marketers is related to the imperfect security system at the social level. In the future, governments should issue policies related to the professional group to ensure that the group’s basic interests are not hampered at the institutional level.On the one hand, the theoretical significance of this study entails the extension of the research on psychological resilience to the emerging professional group of Internet marketers to deepen the scope of application and improve the theoretical system of psychological resilience. On the other hand, this study creates a new perspective for the career management research of Internet marketers and attempts to use psychological capital theory and resource preservation theory as the theoretical foundation combined with the work requirement–resource model. It aims to clearly define the psychological resilience of Internet marketers and the subjective career success concept’s connotation of flexible employment under the new employment situation and introduce work engagement and workload variables to explore the mechanism based on the psychological resilience of the Internet marketer group to their subjective career success. Additionally, the psychological resilience of the professional group of Internet marketers has important practical significance and value for individuals or employment platforms. It is reflected as follows: first, when the level of psychological resilience of Internet marketers is high, the degree of investment or concentration at work will be higher than that of Internet marketers with low levels of psychological resilience and individual job satisfaction and other work result variables will also increase accordingly; that is, their own subjective level of career success is also correspondingly higher; second, Internet marketers can exercise individual psychological resilience for some workload undertaken by them so that individuals can demonstrate good work behavior.However, the current study has some limitations. First, the subjects may not be motivated to respond because of the large set of questionnaire items in the survey, which has implications on the number of questionnaires. In future research, the number of samples can be further expanded by adding more distribution channels. Second, the questionnaires in this study are self-assessments by Internet marketers, and individual’s subjective perceptions and the actual situation may be different, which may influence the accuracy of the survey data. Future research can collect data in various ways. For example, the psychological resilience part of Internet marketers can also be scored through social network relationships to collect data. Additionally, this study selects work engagement as the mediating variable and workload as the moderating variable in the model. Although it has enriched the relevant research conclusions, studies on the correlation between the two still need to be expanded . Third, The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.TW contributed to the research idea, data analysis, and writing and revising. DG contributed to the data collection, theoretical construction, and writing. Both authors contributed to the article and approved the submitted version.