Cross-sectional Comparison Research Articles

Cross-Sectional Comparison of Structural MRI Markers of Impairment in a Diverse Cohort of Older Adults.

Neurodegeneration is presumed to be the pathological process measure most proximal to clinical symptom onset in Alzheimer Disease (AD). Structural MRI is routinely collected in research and clinical trial settings. Several quantitative MRI-based measures of atrophy have been proposed, but their low correspondence with each other has been previously documented. The purpose of this study was to identify which commonly used structural MRI measure (hippocampal volume, cortical thickness in AD signature regions, or brain age gap [BAG]) had the best correspondence with the Clinical Dementia Rating (CDR) in an ethno-racially diverse sample. 2870 individuals recruited by the Healthy and Aging Brain Study-Health Disparities completed both structural MRI and CDR evaluation. Of these, 1887 individuals were matched on ethno-racial identity (Mexican American [MA], non-Hispanic Black [NHB], and non-Hispanic White [NHW]) and CDR (27% CDR > 0). We estimated brain age using two pipelines (DeepBrainNet, BrainAgeR) and then calculated BAG as the difference between the estimated brain age and chronological age. We also quantified their hippocampal volumes using HippoDeep and cortical thicknesses (both an AD-specific signature and average whole brain) using FreeSurfer. We used ordinal regression to evaluate associations between neuroimaging measures and CDR and to test whether these associations differed between ethno-racial groups. Higher BAG (pDeepBrainNet = 0.0002; pBrainAgeR = 0.00117) and lower hippocampal volume (p = 0.0015) and cortical thickness (p < 0.0001) were associated with worse clinical status (higher CDR). AD signature cortical thickness had the strongest relationship with CDR (AICDeepBrainNet = 2623, AICwhole cortex = 2588, AICBrainAgeR = 2533, AICHippocampus = 2293, AICSignature Cortical Thickness = 1903). The relationship between CDR and atrophy measures differed between ethno-racial groups for both BAG estimates and hippocampal volume, but not for cortical thickness. We interpret the lack of an interaction between ethno-racial identity and AD signature cortical thickness on CDR as evidence that cortical thickness effectively captures sources of disease-related atrophy that may differ across racial and ethnic groups. Cortical thickness had the strongest association with CDR. These results suggest that cortical thickness may be a more sensitive and generalizable marker of neurodegeneration than hippocampal volume or BAG in ethno-racially diverse cohorts.

Prescription of commonly used drugs in patients with functional bowel disorders. A cross-sectional comparison with the general population

Objectives Comorbidity with other conditions is common in functional bowel disorders. We aimed to investigate the prescription patterns of commonly used drugs in patients with irritable bowel syndrome (IBS) and functional unspecific bowel disorder, compared to the general population. Material and methods Prescriptions of commonly used drugs in 2022 were compared between patients and the general population from the same age group and region in Sweden. Results Of 526 patients, 317 were followed up in 2022 (219 women and 98 men) and were compared to 51,001 women and 55,571 men in the general population. The median follow-up time from the first visit to 2022 was 8 years (25th–75th percentile 6–11 years). Female patients were significantly more likely than controls to be prescribed PPIs, antibiotics, NSAIDs, paracetamol, opioids, muscle relaxants, antimigraine drugs, antidepressants and asthma medications. Male patients were significantly more likely than controls to be prescribed PPIs, opioids, antidepressants, and asthma medications. In the year prior diagnosis and through 2022, female patients showed a significant decline in the use of PPIs (38% vs.10%; p < 0.001), antibiotics (27.5% vs. 20.1%; p = 0.0426), NSAIDs (23.3% vs.14.6%; p = 0.012), opioids (20.6% vs. 7.5%; p < 0.001), and a significantly increase in the use of asthma medications (15.5% vs. 24.2%; p = 0.0088). Male patients showed a significant decline in the use of PPIs and NSAIDs. Conclusion Patients with functional bowel disorders are more likely to be prescribed medications for conditions other than IBS. Over time, there was a decline in the prescriptions of most drugs, except for antidepressants and asthma medications.

Relative validity of bioelectrical impedance analysis in estimating body composition in women with overweight and obesity 2 weeks and 6 months postpartum

Objective: To investigate the relative validity of bioelectrical impedance analysis (BIA) in estimating fat mass (FM) and fat free mass (FFM) with dual-energy X-ray absorptiometry (DXA) as reference method in women with overweight and obesity 2 weeks and 6 months postpartum (pp). Methods: Body composition of 94 women with overweight and obesity was assessed using Seca mBCA 515 and GE Healthcare Lunar iDXA. Agreement between the two methods for FM and FFM at 2 weeks and 6 months pp, as well as the changes in FM and FFM between the two timepoints, were tested using paired t-test, Bland–Altman plots and regression analyses. Results: The mean (standard deviation [SD]) body mass index (BMI) at 2 weeks pp was 30.6 (2.6) kg/m2 and mean (SD) weight loss at 6 months pp was 4.7 (4.8) kg. BIA underestimated FM at both 2 weeks pp and 6 months pp by mean (SD) 0.7 (1.4) kg and 0.3 (1.3) kg and overestimated FFM at both timepoints by 1.2 (1.5) kg and 0.7 (1.4) kg, with proportional bias for FFM. BIA underestimated changes in FM by mean (SD) 0.5 (1.1) kg and overestimated changes in FFM by 0.5 (1.0) kg, with proportional bias for change in extracellular water by total body water. Agreement was generally high for both cross-sectional and longitudinal comparisons. Conclusions: At group level, BIA was a valid tool for assessment of FM and FFM in women with overweight and obesity at 2 weeks and 6 months pp when compared to DXA. We also consider it valid for following changes in FM and FFM over time when fluid distribution is stable

The differential fading of disgust and fear reactions to a personal trauma in a non-clinical population

ABSTRACT Persistent negative emotions are a key post-traumatic stress (PTS) symptom. Disgust occurs during/following traumatic events and predicts PTS symptoms, but is overlooked relative to other negative emotions like fear. Here, we investigate how trauma-related disgust fades—or persists—in memory (i.e., a person's recollection of how they felt during a traumatic event vs. their current feelings), and over time, relative to fear. In a cross-sectional (Study 1; N = 471) and longitudinal (Study 2; N = 160) study, participants rated their disgust and fear reactions to a recent stressful/traumatic event, at the time the event occurred (peritraumatic; “then”) and at present (posttraumatic; “now”). Study 2 participants provided additional “now” emotion ratings 3 months later. Cross-sectional comparisons showed that whilst participants’ disgust and fear reactions were lower in intensity “now” relative to “then”, fear faded to a greater degree than disgust. Time since the traumatic event and PTS symptom severity were not related to disgust's relative persistence. In contrast, disgust and fear similarly persisted longitudinally. We conclude disgust and fear similarly persist over time, but disgust persists in memory more than fear. Understanding how to reduce feelings of disgust following trauma is clinically important, since disgust is more resistant to PTSD treatments than fear.

Talent identification and development in judo: A systematic review

This review synthesizes the existing literature about talent identification and development in judo and provides evidence-based suggestions to help researchers and practitioners in this area. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies (n = 45). The mean quality of the evidence was 94.0%. Most of the studies were published between the years 2014 and 2021 with cross-sectional designs and group comparisons or performance prediction. Studies used batteries of tests focused on expert or advanced samples and measured individual constraints. Few studies examined female samples, psychological skills or biological maturation. Only 20% of the studies used multivariate analyses. On closer examination, there was a high degree of variability in the indicators that were found to discriminate between skilled and less-skilled judo athletes, predict performance and/or predict career pathway. Research in talent identification and development in judo has generally focused on individual constraints related to anthropometric and physiological characteristics, and technical skills in cross-sectional designs. Very little is known about what talent indicators discriminate high skilled judo athletes or predict actual performance or future success. Future research should adopt multidimensional and longitudinal approaches that integrate existing findings about the maturational, psychological and environmental aspects of judo for tracking the most talented judo athletes, especially in female samples.

Theory of mind in trichotillomania: A cross-sectional comparison with healthy controls

Background Theory of mind (ToM) is the ability to make correct inferences from one’s own or another person’s mental states, such as thoughts, beliefs, desires, and intentions. Although there are a limited number of studies in the literature examining the social cognitive functions of patients with trichotillomania (TTM), no studies have evaluated ToM. This study aimed to compare the ToM skills of patients with TTM and healthy controls. Method The study included 40 patients who were diagnosed as having TTM according to DSM-5 criteria and 40 healthy controls matched for age, education, and sex. A Sociodemographic and Clinical Data Form, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Massachusetts General Hospital Hairpulling Scale (MGH-HPS), Toronto Alexithymia Scale (TAS-20), Reading the Mind in the Eyes Test (RMET), and the Dokuz-Eylül Theory of Mind Scale (DEToMS) were administered to the participants. Results Patients with TTM performed statistically significantly worse than healthy controls in terms of ToM, metaphor concept, empathic understanding, and faux pas scores. No statistically significant difference was found between the groups in terms of first-degree false belief, second-degree false belief, and irony concept scores. Depression, anxiety, and alexithymia scores of patients with TTM were statistically significantly higher than the control group. No significant correlation was found between ToM tests and anxiety, depression, alexithymia, disease severity, and disease duration in the TTM group. Conclusion Our findings show that there is an impairment in ToM skills in patients with TTM and that this impairment is independent of clinical features. Studies with larger samples are needed on this subject.

Growing up without violence (GWV): Study protocol for a cluster randomised trial and process evaluation of a school-based intervention preventing adolescent sexual exploitation in Brazil.

Sexual exploitation of children and adolescents (SECA) is a mostly invisible phenomenon, having negative impacts on adolescents' health and well-being.. There is increasing awarenessof preventative strategies to reduce sexual exploitation of children and adolescents, but limited evidence on their effectiveness and mechanisms. This project addresses this gap through the impact and process evaluation of 'Growing Up Without Violence' (GWV), the largest intervention in Brazil tackling SECA. We will conduct a two-arm cluster randomised trial (CRT) with parallel assignment in the municipalities of Cabo de Santo Agostinho and Jaboatão dos Guararapes, in Brazil. We will randomly allocate 30 schools to intervention and 30 to wait-list control arms. In each of these schools, we will randomly select independent samples of seventy students (aged 12 to 17) to participate in baseline and endline surveys. We will invite students to self-complete pre-programmed questionnaires in a private school space, under the supervision of trained researchers. Our main analysis is a cross-sectional comparison between control and intervention schools of students' levels of basic knowledge for identifying appropriate and inappropriate sexual advances and acts (primary outcome). Secondary outcomes include knowledge of risks of online sexual exploitation, willingness to report incidents of sexual abuse and exploitation, and recall of exposure SECA preventive training content. To our knowledge, this is the first large-scale rigorous evaluation of an intervention to prevent SECA in Brazil. Findings will inform our strategies and future interventions to prevent SECA.

Relating mental health, health-related quality of life and well-being in the aftermath of the COVID-19 pandemic: A cross-sectional comparison in 14 European countries in early 2023.

To understand country-level differences in the population's health and well-being in Europe in the aftermath of the COVID-19 pandemic, while also investigating the internal relationships among health and well-being outcomes. Cross-sectional study. We collected representative panel-based samples of 1000 adult respondents per country across 14 Western European countries in early 2023. The survey used standardised instruments to assess health and well-being, including EQ-5D-5L, GHQ-12, PHQ-9, general satisfaction, the Brief Resilience Scale and the ULS-6 (Loneliness) Scale. Summary statistics of the aggregate scores for each country were calculated and ranked. Multidimensional unfolding was used to visualize the rank relationships across countries and the indices, whereby a closer distance between a country and an index indicated a higher/better rank. Additionally, two key objective country-level indices (GDP growth rate and excess mortality rates) were integrated into the analysis. Austria was found to report better status on most of the indices, while Sweden and the UK ranked consistently worse than the other countries. The loneliness, EQ-VAS and satisfaction scores were plotted further from the mental well-being scores and EQ-5D utility scores. Countries that did well in controlling excess mortality and maintaining economic growth tended to exhibit lower performance in self-reported well-being. This study presents the variability in health and well-being across 14 West-European countries. Discrepancies between countries in self-reported outcomes reveal the complex interrelationship among different aspects of well-being. The study also highlights the complexities and challenges in optimising policies to maximize the overall well-being of society.

What Parkinson’s Disease Patients Say in Their Own Words about their Mood and Anxiety Symptoms

ObjectiveTo understand what Parkinson’s Disease (PD) patients report in their own words about their mood and anxiety problems using the Parkinson’s Disease Patient Report of Problems (PD-PROP). MethodsPatient-reported data from the PD-PROP (reporting most bothersome problems due to PD in their own words), Geriatric Depression Scale, MDS-UPDRS II, and the Euro-Q0L from the Fox Insight research database https://foxinsight.michaeljfox.org/ were examined using cross-sectional comparisons and logistic regression analyses to characterize non-depressive mood symptoms and anxiety. ResultsWe identified 21,487 participants who completed at least one PD-PROP questionnaire. Four categories of non-depressive mood symptoms (Anxiety/Worry, Loneliness/Isolation, Negative Emotions NOS (Not Otherwise Specified), Death/Suicidal Ideation) were identified. Women were much more likely than men to report non-depressive mood symptoms as a bothersome PD-related problem. The frequency of Anxiety/Worry reporting decreased with longer duration of PD while Loneliness/Isolation increased. More severe PD motor impairment, as measured by the MDS-UPDRS II, was associated with increased reporting of Negative Emotions and Loneliness/Isolation. Higher Euro-QoL, indicating better quality of life, was associated with decreased reporting of Loneliness/Isolation. Death/Suicidal Ideation was only reported by a small number of participants (<0.5%). ConclusionsWomen were more likely than men with PD to identify Anxiety/Worry, Negative Emotions, and Loneliness/Isolation as problems. This finding and the higher prevalence of bothersome loneliness/isolation as PD duration increases can guide monitoring for these issues.

N03 The impact of IBD on sexual health: a gender-based cross-sectional comparison with a non-IBD population

N03 The impact of IBD on sexual health: a gender-based cross-sectional comparison with a non-IBD population

Neural correlates of basketball proficiency: An MRI study across skill levels.

Basketball is an attractive sport required both cooperative and antagonistic motor skills. However, the neural mechanism of basketball proficiency remains unclear. This study aimed to examine the brain functional and structural substrates underlying varying levels of basketball capacity. Twenty advanced basketball athletes (AB), 20 intermediate basketball athletes (IB) and 20 age-matched non-athlete individuals without basketball experience (NI) participated in this study and underwent T1-weighted MRI and resting-state fMRI scanning. Voxel-mirrored homotopic connectivity (VMHC), amplitude of low frequency fluctuations (ALFF), and gray matter (GM) density were calculated and compared among the three groups. The VMHC in the bilateral postcentral gyrus, middle temporal gyrus, and superior temporal gyrus, as well as the GM density in the right precentral gyrus, exhibited a hierarchical structure of AB>IB>NI. Compared with NI group, AB and IB groups showed strengthened VMHC in supplementary motor area, paracentral lobule and superior frontal gyrus. Additionally, the ALFF of left middle occipital gyrus and right hippocampal and the GM density of left medial superior frontal gyrus exhibited differences in AB-IB and AB-NI comparisons. By conducting the cross-sectional comparison, this study firstly identifies the varying levels of basketball proficiency related brain resting-state functional and structural plasticity. Especially, the regions associated with motor perception and control, including bilateral postcentral gyrus, middle and superior temporal gyrus and right precentral gyrus, are involved in the key neural mechanisms of basketball proficiency. Future longitudinal studies are necessary to further validate these findings.

The Prevalence of Disability Among Adolescents and Young Adults in Low and Middle-Income Countries: A Cross-sectional Comparison of Two Measures

The Prevalence of Disability Among Adolescents and Young Adults in Low and Middle-Income Countries: A Cross-sectional Comparison of Two Measures

Comparison of Logistics Level Between China and ASEAN

As a dialogue partner of the Association of Southeast Asian Nations (ASEAN), China has engaged in economic and trade cooperation with ASEAN for over a decade. The process of trade liberalization and facilitation between China and ASEAN has significantly influenced logistics operations while also posing new demands. To meet the requirements of expanding trade, it is imperative to comprehensively elevate logistics capabilities. This paper undertakes a longitudinal and cross-sectional comparison of China's and ASEAN's logistics capabilities, focusing on three primary dimensions: logistics performance index, logistics infrastructure, and logistics service quality. It analyzes six specific indicators, including the quality of trade and transport-related infrastructure, transport frequency, customs efficiency and border management clearance, tracking and positioning capabilities, logistics service quality, and timeliness. The findings indicate that, in longitudinal terms, Singapore has emerged as a leading logistics power, China's logistics performance surpasses the average of the ten ASEAN member states, while the other nine ASEAN countries still have substantial room for improvement in their logistics capabilities. In cross-sectional terms, from 2016 to 2023, China's various logistics performance indicators have remained stable or seen only limited enhancements. To further elevate its logistics capabilities, China should adopt measures such as enhancing customs efficiency, promoting widespread adoption of logistics internet technologies to strengthen logistics intelligence, reducing logistics costs, expanding logistics infrastructure investments, and broadening avenues for cultivating specialized logistics talent.

Do public attitudes on gender equality affect candidate selection in proportional representation systems? Evidence from European Parliament elections

A shift in public attitudes towards gender equality may explain improvements we have witnessed in women’s descriptive representation. However, existing studies rely on cross-sectional comparisons, likely beset with confounding problems. To examine the causal effect of public attitudes on candidate selection, we draw on data from more than 10,000 candidacies across four European Parliament elections (1999–2014). Using a difference-in-differences approach, we compare nomination decisions in countries with major attitude changes between elections to those in the control group. We find no evidence that shifts towards more egalitarian gender attitudes lead to an increase in women candidates, neither overall nor in subgroups by electoral system or socio-cultural party positions. The heterogeneity of effects across time and space appears to be a plausible explanation for our findings.

A comparison of role-related physical fitness between British Army trainees and trained soldiers.

British Army basic training (BT) and initial trade training (ITT) enable personnel to develop role-related physical capability to perform in-service job-roles. The study aimed to compare physical performance of trainees (completing ITT) and trained soldiers, on a series of gym-based fitness tests and representative military tasks. A total of 316 British Army personnel [68 trainees (63 men: 22±3years, 71.6±8.4kg and 1.74±0.07m) and 248 trained soldiers (225 men: 27±6years, 78.7±12.7kg and 1.76±0.08m)] completed two sessions. Session 1; body mass, stature, age and gym-based tests (2km run, broad jump, seated medicine ball throw, hex bar deadlift, 100m shuttle sprints, pull-ups and mid-thigh pull). Session 2; representative military tasks (loaded carriage [stage 1, 4km, 35-40kg and 4.8kmh-1 fixed pace and stage 2, 2km, 20-25kg and individual best-effort speed], tactical movement, casualty drag, stretcher carry, vertical lift, repeated carry and incremental lift). Independent sample t-tests were employed to examine group differences. Compared to trainees, trained soldiers were older (p<0.001), heavier (p<0.001) and scored higher on broad jump (p=0.024), medicine ball throw (p=0.007) and mid-thigh pull (p=0.048), but were slower on 2km run (p=0.047), loaded carriage (p<0.019), tactical movement (p<0.001) and casualty drag (p<0.001). Overall, trainees achieve higher scores on aerobic/anaerobic tests, whereas trained soldiers outperform trainees in strength/power-based tests. Although a cross-sectional comparison does not provide strong evidence, the results may indicate that cardiovascular fitness is developed during BT, whereas muscle strength/power develops post BT/ITT. These findings would need confirming by a longitudinal study and could inform the development/management of role-related fitness during BT, ITT and through career.

A longitudinal study among female college students' eating behaviors and food group intake based on the change in eating habit stages

Objectives This study aimed to longitudinally determine the eating behavior and food group intake of female students to examine the relationship between eating behaviors and intention to improve eating habits (change in eating habits stages) and help health education use the behavior change theory.Methods This one-year longitudinal study included 130 female students from Japanese colleges. The stage at which eating habits and behaviors (skipping breakfast, eating out, instant food intake, and snacking) and intake of food groups rich in protein, calcium, vitamins, minerals, carbohydrates, and fats and oils were assessed. The stages were as follows; pre-contemplation or contemplation (lower group), preparation (middle group), and action or maintenance (upper group). A self-assessment questionnaire was administered to evaluate eating behaviors and food group intake frequencies using a 5-point Likert scale. P-values of <.05 were considered statistically significant.Results A cross-sectional comparison of eating behaviors and food group intake scores demonstrated significant differences between the stages only in snacking behavior. The upper group consumed snacks significantly less frequently than the middle and lower groups. After one year, a longitudinal comparison of eating behaviors and food group intake scores revealed significant differences in the intake of food groups rich in vitamins and minerals (green and yellow vegetables), fats and oils in the pre-contemplation stage, intake of food groups rich in vitamins/minerals (green and yellow vegetables) and frequency of skipping breakfast in the preparation stage, and frequency of eating out and snacking in the action stage. Each stage demonstrated a decreasing trend in food intake and an increasing trend in the frequency of skipping breakfast, eating out, and snacking. The percentages of students whose eating habits stage dropped during the second year were 49.0%, 100%, and 77.8% in the preparation, action, and maintenance stages, respectively. This indicates that there are cases in which readiness reverses in stages with improved eating habits.Conclusion In health education on eating habits, it is vital to understand the changes in eating habit stages for each eating behavior and details of actual eating behaviors and habits. Thus, health education should align to the needs of each individual to support them in transforming and maintaining a higher stage of change in their eating habits.

Long-term cognitive effects of menopausal hormone therapy: Findings from the KEEPS Continuation Study.

Findings from Kronos Early Estrogen Prevention Study (KEEPS)-Cog trial suggested no cognitive benefit or harm after 48 months of menopausal hormone therapy (mHT) initiated within 3 years of final menstrual period. To clarify the long-term effects of mHT initiated in early postmenopause, the observational KEEPS Continuation Study reevaluated cognition, mood, and neuroimaging effects in participants enrolled in the KEEPS-Cog and its parent study the KEEPS approximately 10 years after trial completion. We hypothesized that women randomized to transdermal estradiol (tE2) during early postmenopause would show cognitive benefits, while oral conjugated equine estrogens (oCEE) would show no effect, compared to placebo over the 10 years following randomization in the KEEPS trial. The KEEPS-Cog (2005-2008) was an ancillary study to the KEEPS (NCT00154180), in which participants were randomized into 3 groups: oCEE (Premarin, 0.45 mg/d), tE2 (Climara, 50 μg/d) both with micronized progesterone (Prometrium, 200 mg/d for 12 d/mo) or placebo pills and patch for 48 months. KEEPS Continuation (2017-2022), an observational, longitudinal cohort study of KEEPS clinical trial, involved recontacting KEEPS participants approximately 10 years after the completion of the 4-year clinical trial to attend in-person research visits. Seven of the original 9 sites participated in the KEEPS Continuation, resulting in 622 women of original 727 being invited to return for a visit, with 299 enrolling across the 7 sites. KEEPS Continuation participants repeated the original KEEPS-Cog test battery which was analyzed using 4 cognitive factor scores and a global cognitive score. Cognitive data from both KEEPS and KEEPS Continuation were available for 275 participants. Latent growth models (LGMs) assessed whether baseline cognition and cognitive changes during KEEPS predicted cognitive performance at follow-up, and whether mHT randomization modified these relationships, adjusting for covariates. Similar health characteristics were observed at KEEPS randomization for KEEPS Continuation participants and nonparticipants (i.e., women not returning for the KEEPS Continuation). The LGM revealed significant associations between intercepts and slopes for cognitive performance across almost all domains, indicating that cognitive factor scores changed over time. Tests assessing the effects of mHT allocation on cognitive slopes during the KEEPS and across all years of follow-up including the KEEPS Continuation visit were all statistically nonsignificant. The KEEPS Continuation study found no long-term cognitive effects of mHT, with baseline cognition and changes during KEEPS being the strongest predictors of later performance. Cross-sectional comparisons confirmed that participants assigned to mHT in KEEPS (oCEE and tE2 groups) performed similarly on cognitive measures to those randomized to placebo, approximately 10 years after completion of the randomized treatments. These findings suggest that mHT poses no long-term cognitive harm; conversely, it provides no cognitive benefit or protective effects against cognitive decline. In these KEEPS Continuation analyses, there were no long-term cognitive effects of short-term exposure to mHT started in early menopause versus placebo. These data provide reassurance about the long-term neurocognitive safety of mHT for symptom management in healthy, recently postmenopausal women, while also suggesting that mHT does not improve or preserve cognitive function in this population.

Characteristics of VA hospitals by participation status in a large pragmatic embedded clinical trial

BackgroundThe Diuretic Comparison Project (DCP) was a multi-center, embedded pragmatic trial conducted within the VA healthcare system comparing chlorthalidone and hydrochlorothiazide in preventing major adverse cardiovascular events and non-cancer deaths in hypertensive patients. Study procedures were decentralized, and facility leadership first had to agree and accept study procedures before staff approached participants. Recent evidence suggests facilities that choose and choose not to participate in trials may differ and this study considered such differences within DCP. MethodsA cross-sectional comparison of facilities participating in DCP was conducted with data from the study start (June 2016) including: 2016 American Community Survey, 2016 Strategic Analytics for Improvement and Learning reports, star ratings, and 2014 hospital complexity. Characteristics of participating and non-participating centers were compared using logistic regression, including county-level socio-economic features and hospital-level performance. ResultsOf 144 VA medical centers, leadership at 75 centers (52 %) initiated participation. Facilities in highly-urban and higher median income counties were more likely to participate, as were higher-complexity facilities. Facilities with research experience were 2.18 times as likely to participate. No other hospital performance metrics or county-level demographics were associated with participation. ConclusionsOverall, this study suggests research exposure and quality care metrics may impact a facility's decision to participate. These results highlight key considerations for recruitment to multi-site, and particularly pragmatic, clinical trials. Consideration of supporting facilities that have not historically participated in research may be fruitful for recruitment. These results emphasize the importance of education about pragmatic study design and its integration with clinical care.

A cross-sectional comparison of the association between self-reported sources of stress and psychological distress among Canadian undergraduate and graduate students

Objective: This study aimed to (1) descriptively compare stressors experienced by postsecondary students at the undergraduate versus graduate levels of study, and (2) evaluate the relationship between stressors and psychological distress, controlling for the effects of level of study. Participants: Undergraduate (n = 3774) and graduate (n = 889) students across 15 Canadian universities who completed the Post-Secondary Student Index electronic survey in October of 2020. Methods: Mean severity score for stressors were compared between level of study. Regression analyses evaluated the association of student specific stressors and overall stress. Results: Undergraduate students generally had higher levels of perceived stress compared to graduate students, notably in areas of academics, the learning environment, and campus culture. Multiple stressors were associated with an increase in stress; a prior mental health diagnosis was the main predictor in increased stress. Conclusions: Stressors differed between level of study. Results can inform supports, particularly regarding exams/assignments weighing and communication of expectations for institutions.

Measuring service quality based on consumers’ evaluation of services in competitive markets

Previous research recommends using measurement models of service quality such as SERVQUAL and SERVPERF. However, these models may be insufficient for measuring service quality in competitive markets, as they do not account for comparisons between competitive services. This paper proposes a new model for measuring service quality based on two comparison processes that consumers use: internal and longitudinal comparison versus external and cross-sectional comparison. The former involves comparing the experienced quality to the expected quality of a focal firm, while the latter involves comparing the experienced quality of the focal firm and that of other firms. This paper shows that internal and longitudinal comparison significantly influences customer satisfaction through external and cross-sectional comparison. It also highlights the advantages of the new model and advocates for its use in competitive markets. By comparing these dual comparison processes, the proposed model offers a more comprehensive and nuanced understanding of service quality assessment in competitive market environments.