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IJD® MODULE ON BIOSTATISTICS AND RESEARCH METHODOLOGY FOR THE DERMATOLOGIST - MODULE EDITOR: SAUMYA PANDA
Year : 2016  |  Volume : 61  |  Issue : 3  |  Page : 261-264
Methodology series module 3: Cross-sectional studies


Department of Epidemiologist, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

Date of Web Publication13-May-2016

Correspondence Address:
Dr. Maninder Singh Setia
MGM Institute of Health Sciences, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.182410

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   Abstract 

Cross-sectional study design is a type of observational study design. In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. Unlike in case–control studies (participants selected based on the outcome status) or cohort studies (participants selected based on the exposure status), the participants in a cross-sectional study are just selected based on the inclusion and exclusion criteria set for the study. Once the participants have been selected for the study, the investigator follows the study to assess the exposure and the outcomes. Cross-sectional designs are used for population-based surveys and to assess the prevalence of diseases in clinic-based samples. These studies can usually be conducted relatively faster and are inexpensive. They may be conducted either before planning a cohort study or a baseline in a cohort study. These types of designs will give us information about the prevalence of outcomes or exposures; this information will be useful for designing the cohort study. However, since this is a 1-time measurement of exposure and outcome, it is difficult to derive causal relationships from cross-sectional analysis. We can estimate the prevalence of disease in cross-sectional studies. Furthermore, we will also be able to estimate the odds ratios to study the association between exposure and the outcomes in this design.


Keywords: Cross-sectional studies, design, limitations, strengths


How to cite this article:
Setia MS. Methodology series module 3: Cross-sectional studies. Indian J Dermatol 2016;61:261-4

How to cite this URL:
Setia MS. Methodology series module 3: Cross-sectional studies. Indian J Dermatol [serial online] 2016 [cited 2023 Jun 6];61:261-4. Available from: https://www.e-ijd.org/text.asp?2016/61/3/261/182410



   Introduction Top


Cross-sectional study design is a type of observational study design. As discussed in the earlier articles, we have highlighted that in an observational study, the investigator does not alter the exposure status. The investigator measures the outcome and the exposure(s) in the population, and may study their association.


   Design Top


In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. Unlike in case–control studies (participants selected based on the outcome status) or cohort studies (participants selected based on the exposure status), the participants in a cross-sectional study are just selected based on the inclusion and exclusion criteria set for the study. Once the participants have been selected for the study, the investigator follows the study to assess the exposure and the outcomes.

After the entry into the study, the participants are measured for outcome and exposure at the same time [Figure 1]. The investigator can study the association between these variables. It is also possible that the investigator will recruit the study participants and examine the outcomes in this population. The investigator may also estimate the prevalence of the outcome in those surveyed.
Figure 1: Example of a cross-sectional study

Click here to view



   Examples of Cross-Sectional Studies Top


Antibiotic resistance in  Propionibacterium acnes Scientific Name Search ana et al., 2016)

A study by Sardana et al . evaluated the antibiotic resistance in isolates of Propionibacterium acnes in a tertiary care hospital in India. They recruited 80 patients of acne vulgaris, collected specimen for isolation from open or closed comedones. These specimens were then cultured, the growth identified, and antibiotic susceptibility and resistance were assessed.

They isolated P. acnes 52% of the cases. In these isolates, resistance for erythromycin, clindamycin, and azithromycin was observed in 98%, 90%, and 100% of the isolates, respectively. However, sensitivity for tetracycline, doxycycline, minocycline, and levofloxacin was observed in 69%, 56%, 98%, and 90% of the isolates, respectively. We will discuss this study briefly later in the manuscript as well.

HIV and male sex workers (Shinde et al., 2009)

The authors presented a cross-sectional analysis to assess the prevalence of HIV and risk behaviors in male sex workers. They also evaluated the association between HIV and sociodemographic factors. The data were collected by interviewer-administered questionnaires (for sociodemographic and behavior data), clinical evaluation for sexually transmitted infections (STIs), and serological evaluation for STIs (including HIV).

The authors reported that the prevalence of HIV in male sex workers was 33%. They also found that male-to-female transgendered people were significantly more likely to be HIV-infected compared with males (odds ratio [OR]: 3.5, 95% confidence intervals: 1.0, 11.7). Similarly, they also found that HIV prevalence was higher among those in whom sex work was the main occupation compared with those in whom sex work was not the main occupation (40% vs. 7%, P = 0.02).

There are numerous cross-sectional studies in the literature. We encourage the readers to go through some of these studies to understand the design and analysis of cross-sectional studies.


   Measurements in a Cross-Sectional Study Top


  1. Cross-sectional study designs may be used for population-based surveys

    Example: We are interested to know the prevalence of vitiligo in a village. We design a population-based survey to assess the prevalence of this condition. We go to all the houses that were supposed to be included in the study and examine the population. The total sample surveyed is 5686. Of these, we found that 98 individuals have vitiligo. Thus, the prevalence of vitiligo in this community is: Prevalence = 98/5686 or 17.23/1000 population

  2. Cross-sectional studies may also be used for estimating the prevalence in clinic-based studies.Example: Research question – What is the prevalence of HIV in patients presenting with an STI?

    We evaluate 300 patients with an STI clinic. We record this history, clinical examination, and test them for HIV antibodies (using ELISA) during their first visit to the clinic. We find that 60 of these individuals are HIV infected. Thus, we have detected a prevalence of 20% HIV infection among our STI patients. This type of study will be classified as a cross-sectional study. Kindly note that this being a clinic-based study, it may have all the limitations of a clinic-based study. Thus, the prevalence from these data may have limited generalizability. Nonetheless, this type of study design will be classified as a cross-sectional study.
  3. Cross-sectional studies may also be used to calculate the ORs

    For example, if we wish to understand the association between gender and HIV status, we will able to create a 2 × 2 table for the above-mentioned cross-sectional study. Of the 300 individuals evaluated, we have recruited 200 male and 100 female participants. Of the 60 HIV-infected individuals, 50 are males and 10 are females. The 2 × 2 table will be as follows:



    The OR (as discussed in the earlier methodology series – II case–control studies) is AD/BC or 50*90/10*150. Thus, the OR is 3.0. The interpretation of this OR is that males had a higher odds of being HIV infected compared with females. Since the OR is >1, the outcome is more likely in those exposed (males) compared with those who are not exposed (females). However, we will require confidence intervals to comment on further interpretation of the OR.



   Strengths of a Cross-Sectional Study Top


  1. Cross-sectional studies can usually be conducted relatively faster and are inexpensive – particularly when compared with cohort studies (prospective)
  2. These are studies are conducted either before planning a cohort study or a baseline in a cohort study. These types of designs will give us information about the prevalence of outcomes or exposures; this information will be useful for designing the cohort study
  3. These study designs may be useful for public health planning, monitoring, and evaluation. For example, sometimes the National AIDS Programme conducted cross-sectional sentinel surveys among high-risk groups and ante-natal mothers every year to monitor the prevalence of HIV in these groups.



   Limitations of a Cross-Sectional Study Top


  1. Since this is a 1-time measurement of exposure and outcome, it is difficult to derive causal relationships from cross-sectional analysis
  2. These studies are also prone to certain biases. For example, we wish to study the relation between diet and exercise and being overweight/obese. We conduct a cross-sectional study and recruit 250 individuals. We assess their dietary habits, exercise habits, and body mass index at one point of time in a cross-sectional survey. However, individuals who are overweight/obese have started to exercise more or altered their feeding habits (eat more salads). Hence, in a cross-sectional survey, we may find that overweight/obese individuals are also more likely to eat salads and exercise more. Thus, we have to be careful about interpreting the associations and direction of associations from a cross-sectional survey
  3. The prevalence of an outcome depends on the incidence of the disease as well as the length of survival following the outcome. For example, even if the incidence of HIV (number of new cases) goes down in one particular community, the prevalence (total number of cases – old as well as new) may increase. This may be due to cumulative HIV positive cases over a period. Thus, just performing cross-sectional surveys may not be sufficient to understand disease trends in this situation.



   Additional Points Top


As briefly discussed earlier, multiple cross-sectional surveys are used to assess the changes in exposures and outcomes in a particular population.

  1. The National AIDS Control Organisation's Sentinel Surveillance of HIV is an example of “serial cross-sectional study” or “serial survey.” This may be less expensive compared with a cohort study

    Sentinel Surveillance in Antenatal Clinic: The surveillance recruits consecutive consenting pregnant women, aged 15–45 years in these clinics. The exercise has been in place for nearly two decades. The formal annual sentinel surveillance was instituted in 1998. The surveillance provided data on the prevalence of HIV infection in antenatal women, and thus, the trends of HIV infection in this population

    Such surveys are also conducted in female sex workers, men who have sex with men, and people who inject drugs, migrants, truckers, and male-to-female transgendered people. Repeated cross-sectional surveys provide useful information on the prevalence of HIV in these groups [Figure 2]. It can be seen that the prevalence has, in general, reduced over the past decade in these groups. Thus, repeated cross-sectional surveys are also useful to monitor the trends over a period.
    Figure 2: Data from National HIV Sentinel Surveillance (2003–2011)*. *Graph generated from data in the National HIV Sentinel Surveillance

    Click here to view

  2. We will discuss the previous study by Sardana et al . They conducted one cross-sectional survey to assess the resistance patterns in P. acnes . If the authors conduct the same study consecutively for two more years, they will provide information on the changing resistance patterns in P. acnes. This will be an example of a serial cross-sectional study.



   Summary Top


In a cross-sectional study, the investigator measures the outcome and the exposures in the study participants at the same time. Unlike in case–control studies (participants selected based on the outcome status) or cohort studies (participants selected based on the exposure status), the participants in a cross-sectional study are just selected based on the inclusion and exclusion criteria set for the study. We can measure the prevalence of disease or calculate the OR as a measure of association. These studies are conducted relatively faster and are inexpensive. However, due to the nature of study design, in general, it is difficult to derive causal relationships from cross-sectional analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


   Bibliography Top


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  2. Jewell N. Statistics for Epidemiology. Boca Raton, US: Chapman and Hall/CRC; 2004.
  3. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia, USA: Lippincott Williams & Wilkins; 2008.
  4. Kleinbaum D, Kupper L, Morgenstern H. Epidemiologic Research. New York, US: John Wiley and Sons, Inc.; 1982.
  5. National AIDS Control Organisation. HIV Sentinel Surveillance 2012-13: A Technical Brief. New Delhi, India: Ministry of Health & Family Welfare, Government of India.
  6. Sardana K, Gupta T, Kumar B, Gautam HK, Garg VK. Cross-sectional pilot study of antibiotic resistance in Propionibacterium acnes strains in Indian acne patients using 16s-RNA polymerase chain reaction: A comparison among treatment modalities including antibiotics, benzoyl peroxide, and iso tretinoin. Indian J Dermatol 2016;61:45-52.
  7. Setia MS. Methodology series module 1: Cohort studies. Indian J Dermatol 2016;61:21-5.
  8. Setia MS. Methodology series module 2: Case-control studies. Indian J Dermatol 2016B; 61:146-51.
  9. Shinde S, Setia MS, Row-Kavi A, Anand V, Jerajani H. Male sex workers: Are we ignoring a risk group in Mumbai, India? Indian J Dermatol Venereol Leprol 2009;75:41-6.
  10. Hulley SB, Cummings SR, Browner WS, Grady D, Hearst N, Newman TB. Designing Clinical Research. 2nd ed. Philadelphia, USA: Lippincot Williams & Wilkins; 2001.
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56 Noise Disturbance and Well-Being in the North of Spain
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57 Urbanicity—Perspectives from Neuroscience and Public Health: A Scoping Review
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58 Knowledge, Practice, Compliance, and Barriers toward Ventilator-Associated Pneumonia among Critical Care Nurses in Eastern Mediterranean Region: A Systematic Review
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61 Common Bias and Challenges in Physical and Rehabilitation Medicine Research: How to Tackle Them
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62 Teachers' Perceptions of Ibox Use for Integrated Science Lessons in Secondary Education Improvement Project Schools
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63 Commentary: Association between methylmalonic acid and cognition—A systematic review and meta-analysis
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64 The impact of long-term orientation on compulsive buying behavior: A cross-cultural study
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65 Prevalence and risk factors of diabetic foot disease among the people with type 2 diabetes using real-world practice data from Catalonia during 2018
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66 The Influence of Icts in Promoting Awareness and Climate Change Conscious Activities within the Okavango Delta Community of Shakawe, Botswana
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67 Identifying cow – level factors and farm characteristics associated with locomotion scores in dairy cows using cumulative link mixed models
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68 A machine learning approach using partitioning around medoids clustering and random forest classification to model groups of farms in regard to production parameters and bulk tank milk antibody status of two major internal parasites in dairy cows
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69 Wellbeing and coping of UK nurses, midwives and allied health professionals during COVID-19-a cross-sectional study
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70 Perfectionism and Academic Adjustment among Undergraduates: The Coping Strategy as a Mediator
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71 A roadmap for scientific publications – Part I
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72 Virtual surgical consultation during the COVID-19 pandemic: a patient-oriented, cross-sectional study using telephone interviews
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73 Applicability of the mandibular canine index for sex estimation: a systematic review
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74 Demystifying the effect of social media eWOM on revisit intention post-COVID-19: an extension of theory of planned behavior
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75 Short-chain fatty acid concentrations in the incidence and risk-stratification of colorectal cancer: a systematic review and meta-analysis
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76 Socio-demographic factors associated with medication adherence among People Living with HIV in the Kumasi Metropolis, Ghana
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77 Gait disorders in CKD patients: muscle wasting or cognitive impairment? A cross-sectional pilot study to investigate gait signatures in Stage 1–5 CKD patients
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78 Non-technical dimensions of communal wastewater treatment plant sustainability in peri-urban Yogyakarta, Indonesia
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79 Are adults diagnosed with type 2 diabetes at a greater risk of developing depression? Integrative literature review
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80 Acceptability and associated factors of indoor residual spraying for malaria control by households in Luangwa district of Zambia: A multilevel analysis
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81 Awareness and willingness to use HIV oral pre-exposure prophylaxis among people who inject drugs in Dar es Salaam, Tanzania: A cross-sectional survey
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82 Exploring the eHealth literacy and mobile health application utilisation amongst Malaysian pharmacy students
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83 Resilience: Key Factors Associated With Resilience of Older People in Botswana
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84 Variation in the Use of Basic Behavioral Management Techniques in General and Pediatric Dental Practice: A Cross-sectional Study
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85 Exploring health provider’s knowledge on the home-based maternal and neonatal health care package in Rwanda
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86 Do motorcycle helmets reduce road traffic injuries, hospitalizations and mortalities in low and lower-middle income countries in Africa? A systematic review and meta-analysis
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87 Relationship of Healthy Building Determinants With Back and Neck Pain: A Systematic Review
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89 The predicting effects of professional governance and structural empowerment on job satisfaction among Jordanian nurses: A cross-sectional study
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90 Saudi nursing student satisfaction and evaluation of reflective practice: A cross-sectional study
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91 Obtaining the best value for money through procurement planning: can procurement regulatory compliance intervene?
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92 Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature
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93 Associations between duration and volume of muscle-strengthening exercise and clinically assessed hypertension among 10 519 UK adults: a cross-sectional study
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94 Racial Discrimination and Race-Based Biases on Orthopedic-Related Outcomes
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95 Can Temporal Self-Regulation Theory and Its Constructs Predict Medication Adherence? A Systematic Review and Meta-Analysis
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96 Comparative Analysis of the Impact of Energy Security on Productivity of SMEs in the Accra Metropolis of Ghana
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97 Psychosocial Functioning and Occupational Participation among Adolescent Children of Parents with Mental Illness: A Mixed Methods Study
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98 Prevalence and associated factors of paternal stress, anxiety, and depression symptoms in the early postnatal period
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99 The mediating role of gender in social media shopping acceptance: from the WOM perspective
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100 Prevalence of hypertension and its risk factors among cotton textile workers in low- and middle-income countries: a systematic review
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101 Evidence of in-vivo myofascial force transfer in humans- a systematic scoping review
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102 Choosing a package carrier during COVID-19 pandemic: An integration of pro-environmental planned behavior (PEPB) theory and service quality (SERVQUAL)
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103 Sociodemographic and clinical correlates of cannabis dependence among Israeli combat veterans
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104 Necessary political competences for nurses from the perception of the student body: Cross-sectional study in Spain
Águeda Cervera-Gasch, Desirée Mena-Tudela, Enrique Castro-Sánchez, Azucena Santillan-Garcia, Laura Andreu-Pejó, Víctor Manuel González-Chordá
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105 Hazard characterization of bisphenol A (BPA) based on rodent models – Multilevel meta-analysis and dose-response analysis for reproductive toxicity
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106 Local communities' knowledge and perception of FLEGT -VPA - insights from Ghana
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107 Arsenic concentration in topsoil of central Chile is associated with aberrant methylation of P53 gene in human blood cells: a cross-sectional study
Eva Madrid, Isabel Gonzalez-Miranda, Sergio Muńoz, Carolina Rejas, Felipe Cardemil, Felipe Martinez, Juan Pablo Cortes, Maite Berasaluce, Mario Párraga
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108 Handgrip strength is associated with learning and verbal fluency in older men without dementia: insights from the NHANES
Konstantinos Prokopidis, Panagiotis Giannos, Theocharis Ispoglou, Ben Kirk, Oliver C. Witard, Yannis Dionyssiotis, David Scott, Helen Macpherson, Gustavo Duque, Masoud Isanejad
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109 Responding to social change: innovativeness, entrepreneurial alertness, and entrepreneurial intention in Nigeria: the role of family support
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112 Smog and cognitive issues in the school going children of Lahore and Islamabad, Pakistan
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113 COVID-19 Pandemic Associations on Mental and Physical Health in African Americans Participating in a Behavioral Intervention
J. A. Bernhart, A. W. Fellers, M. J. Wilson, B. Hutto, S. Bailey, G. M. Turner-McGrievy
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114 Holistic Individual Fire Preparedness in Informal Settlements, Bangladesh
Md Mostafizur Rahman, Saadmaan Jubayer Khan, Kamrun Nahar Tanni, Mohammed Sadman Sakib, Masrur Abdul Quader, Ifta Alam Shobuj, Arman Uddin, Komal Raj Aryal
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115 Investigation of the relationships between ADHD risk and digital screen exposure in children aged 4–11: A large population study in Turkey
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116 What is essential remains invisible to the eyes? Blood pressure cuffs colonized by bacterial diversity
José Miguel Garrido-Molina, Verónica V. Márquez-Hernández, Alba García-Viola, Manuel Ángel Rodríguez-Maresca, Javier García del Águila, Lorena Gutiérrez-Puertas
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117 Transdiagnostic vulnerability factors in eating disorders: A network analysis
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118 Acceptability of the Direct Health Facility Financing (DHFF) initiative in Tanzania: A mixed methods process evaluation of the moderating factors
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119 Predictors of Seat-Belt Use among Bus Passengers in Ghana: An Application of the Theory of Planned Behaviour and Health Belief Model
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120 Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008–2016
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121 Medical Students’ Quality of Life and Its Association with Harassment and Social Support
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123 Fear of Falling, Community Participation, and Quality of Life Among Community-Dwelling People Who Use Wheelchairs Full Time
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124 Household Happiness and Fuel Poverty: a Cross-Sectional Analysis on Turkey
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125 Global Prevalence and Associated Risk Factors of Posttraumatic Stress Disorder During COVID-19 Pandemic: A Meta-analysis
Ninik Yunitri, Hsin Chu, Xiao Linda Kang, Hsiu-Ju Jen, Li-Chung Pien, Hsiu-Ting Tsai, Abdu Rahim Kamil, Kuei-Ru Chou
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126 Is there a relationship between nursing students’ smartphone use, their fear of missing out and their care-related behaviour?
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127 Health-related quality of life of nurses caring for hospitalised children and their families: A national cross-sectional study
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128 Differences and Reliability of Linear and Nonlinear Acoustic Measures as a Function of Vocal Intensity in Individuals With Voice Disorders
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129 Emotional burden and care of adults with type 1 diabetes during the COVID-19 pandemic in Brazilian regions
Mônica S.V.M. Silveira, Elizabeth Joăo Pavin, Edimariz Buin Cardoso, Paulo Fanti, Samereh Abdoli
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130 How can socio-psychological factors be related to water-efficiency intention and behaviors among Iranian residential water consumers?
Seyyed Ahmadreza Shahangian, Massoud Tabesh, Masoud Yazdanpanah
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131 Student-generated PowerPoint animations: a study of student teachers’ conceptions of molecular motions through their expressed models
Guspatni Guspatni
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132 eHealth Literacy of Medical and Health Science Students and Factors Affecting eHealth Literacy in an Ethiopian University: A Cross-Sectional Study
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133 Prevalence of Alcohol Consumption among Indian Female Adolescents
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134 Evaluation of a front-of-pack food labeling intervention on a college campus
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135 Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey
Haleluya Moshi, Gunnevi Sundelin, Klas-Göran Sahlen, Ann Sörlin
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136 Prevalence of extended high-frequency hearing loss among adolescents from two rural areas in Colombia
Daniel Peńaranda, Lucía C. Pérez-Herrera, Diana Hernández, Sergio Moreno-López, Ilene Perea, Mario Jacome, Nancy Suetta-Lugo, Juan Manuel García, Augusto Peńaranda
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137 Examining the Convergent Validity of the Test of Visual Perceptual Skills – Fourth Edition (TVPS-4) in the Australian Context
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138 Climate change-mediated heat stress vulnerability and adaptation strategies among outdoor workers
Stephen T. Odonkor, Samuel Adams
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139 A policy feedback and socio-technical approach to e-participation (PFSTEP): A cross-national analysis of technology and institutions to explain e-participation
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140 Excessive daytime somnolence in a sample of Ecuadorian undergraduate medical students and its relationship with academic performance.
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141 Factors influencing community participation in the implementation and monitoring of FLEGT-VPA in Ghana
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142 Towards sustainable cities: the role of residential satisfaction in facing COVID-19 in Makkah City in Saudi Arabia
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143 Job characteristics theory and mentoring: the influence of cognitive tasks and educational leadership on mentoring provided
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144 Marriage and business performance: the case of women-owned micro and small businesses in Tanzania
Hawa Petro Tundui, Charles Stephen Tundui
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145 An analysis of groupthink and decision making in a collectivism culture: the case of a public organization in Tanzania
Crecencia Godfrey Tarmo, Faisal H. Issa
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146 Procurement professionals' perceptions of skills and attributes of procurement negotiators: a cross-sectional survey in Tanzania
Leonada Raphael Mwagike, Ismail Abdi Changalima
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147 A reprise of TQM practices among construction enterprises in Nigeria
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148 Mapping the implications and competencies for Industry 4.0 to hard and soft total quality management
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149 The impact of on-demand metacognitive help on effortful behaviour: A longitudinal study using task-related visual analytics
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150 Occupational therapy in oncology palliative care for adolescents and young adults: Perspectives of Australian occupational therapists
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151 Awareness of traditional knowledge and attitudes towards wildlife conservation among Maasai communities: The case of Enkusero Sampu Conservancy, Kajiado County in Kenya
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152 Exploring mediating effects between nursing leadership and patient safety from a person-centred perspective: A literature review
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153 Nurses' perception of teamwork and its relationship with the occurrence and reporting of adverse events: A questionnaire survey in teaching hospitals
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205 Multiomics Analysis Coupled with Text Mining Identify Novel Biomarker Candidates for Recurrent Cardiovascular Events
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