Growth Mixture Modeling Research Articles

Structural modeling of clinical factors for simultaneous validation and prediction of future conversion to mild cognitive impairment

AbstractBackgroundIdentifying risk factors of future conversion from cognitively normal to mild cognitive impairment is crucial for dementia prevention and understanding the clinical processes that result in the development of cognitive deterioration. One challenge which is faced with this task is that, when identifying these factors, not only the individual contribution but also its coherency with other indicators must be measured.MethodTo map the relationship between clinical risk factors and conversion to mild cognitive impairment, we created and validated a set of structural equation and growth mixture models based on input from clinical experts in the field of dementia research. These models are powerful as they allow the researcher to test hypotheses between observed variables and their underlying latent constructs. In addition to verification of the factor structure, we integrated a method for predicting individual factors, such as mild cognitive impairment, on out‐of‐sample converters and controls directly on the structural model, a feature which is normally uncommon in structural equation modeling partly due to its sensitivity for model misspecification.ResultIn a study of 1213 elderly participants we found that these structural models perform similar to current state‐of‐the‐art logistic regression models in terms of Area‐Under‐the‐Curve (AUC) score on a 1‐year prediction (AUC > 0.9), yet offer a significant increase in flexibility and insight into the direct and indirect effects of endogenous variables on conversion to mild cognitive impairment. We also observe a substantial increase in predictive power for models fitted with baseline data compared to baseline with follow‐up visit for both 5 and 9‐year prediction on neuropsychological and demographic data alone (AUC increase +‐ 0.05), allowing us to monitor the development of cognitive health in subjects over time.ConclusionThe results from this study suggest a powerful technique for creating structural models with the ability to perform robust path analysis, longitudinal monitoring of cognitive health and prediction of future conversion to mild cognitive impairment. We expect that clinical experts can use this method to continue testing and validating new hypotheses in dementia research.

성장혼합모형을 활용한 초등학생의 수학 학업성취도 변화 유형화 및 영향요인 분석

This study was to identify latent profiles of changes in elementary school students’ mathematics achievement and to test whether their influencing factors had significant effects on classifying the latent profiles. Panel data (1,632 elementary school students) of the first year of 4th grade in 2018 to the third year of 6th grade in 2020 from the Jeonnam Education Longitudinal Study (JELS) were analyzed using a growth mixture model. The findings of this study were as follows: First, four distinct latent profiles were categorized as high level, medium-high level, medium-low level and low level. Second, both the initial value and change rate of each latent profile were positively significant, indicating that the mathematics achievement of the four profiles improved as they progressed through the grades, with the highest change rate for the high-level profile. Third, the main influencing factors for the latent profiles in mathematics achievement were academic self-concept, instructional attitude, parents’ academic support, and relationship with the classroom teacher. Based on the findings of this study, we proposed policy implications for improving mathematics achievement of elementary school students.

Types and Predictors of Young Children’s Problem Behaviors Following the Birth of a Sibling

Objectives: To verify the predictors that affect problem behavior trajectories, this study examines how the problem behavior patterns of young children change over time before and the birth of their younger sibling, and the types of trajectories they are classifien into.Methods: The participants were 202 pregnant mothers who had a child over 18 months old. Questionnaires on the child’s problem behaviors were conducted one month before, one month after, and the three months after childbirth. A growth mixture model and logistic regression analyses were performed for classification and predictive analytics.Results: A total of three latent groups of children’s internalizing and externalizing problem behaviors were identified: group at low risk for problem behaviors, group at potential risk for problem behaviors and group at high risk for rising problem behaviors. Logistic regression analyses revealed that children’s temperamental emotionality and sociality, mother’s warm and encouraging behaviors, and depression were significantly associated with trajectory classes of problem behaviors.Conclusion: Our results suggest that to mediate problem behaviors in young children when a younger sibling is born, a variety of supports that consider their individual characteristics and provide affectionate parenting behavior are needed.

20-Year trajectories of six psychopathological dimensions in patients with first-episode psychosis: Could they be predicted?

Patients with first-episode psychoses (FEP) exhibit heterogeneity in clinical manifestations and outcomes. This study investigated the long-term trajectories of six key psychopathological dimensions (reality-distortion, negative, disorganization, catatonia, mania and depression) in patients diagnosed with FEP.A total of 243 patients were followed up for 20 years and the trajectories of the dimensions were analysed using growth mixture modelling. These dimensions showed varied course patterns, ranging from two to five trajectories. Additionally, the study examined the predictive value of different factors in differentiating between the long-term trajectories.The exposome risk score showed that familial load, distal and intermediate risk factors, acute psychosocial stressors and acute onset were significant predictors for differentiating between long-term psychopathological trajectories. In contrast, polygenic risk score, duration of untreated psychosis and duration of untreated illness demonstrated little or no predictive value.The findings highlight the importance of conducting a multidimensional assessment not only at FEP but also during follow-up to customize the effectiveness of interventions. Furthermore, the results emphasize the relevance of assessing premorbid predictors from the onset of illness. This may enable the identification of FEP patients at high-risk of poor long-term outcomes who would benefit from targeted prevention programs on specific psychopathological dimensions.

Mathematical game performance as an indicator of deliberate practice

The traditional classroom setting presents challenges when it comes to strengthening adaptive expertise in mathematics education through deliberate practice. This study aimed to investigate whether the Number Navigation Game (NNG) could help promote deliberate practice, and whether students’ performance in the game was related to their development of Adaptive Number Knowledge, perceived challenge, flow, and math interest. NNG is a game-based learning environment that requires students to progress by solving increasingly complex arithmetic problems, which is crucial for promoting adaptive number knowledge. Game performances of 214 Finnish students were analyzed and compared to the best possible performance for each game level. A growth mixture model based on the students' relative performance levels was used to gain insight into how students' game performance changed throughout the game, and how this related to their knowledge gains, perceived challenge, math motivation, and flow. There were four different profiles of students' game performance. The largest profile consisted of students who steadily improved their performance in the game, despite initially having lower-than-average performance. This group experienced lower levels of flow but achieved larger learning gains than the other groups, suggesting that their engagement may be more aligned with deliberate practice.

Examining trajectories of marital satisfaction to represent the resilience process among Indonesian married individuals

AbstractMarriage is an important milestone for many adults, and notably in Indonesia, where marriage is also considered a personal accomplishment and social obligation. Research has found being married is associated with greater well‐being, but marriages also face challenges. Resilience, defined as successfully adapting to challenges, is a potential concept to help married individuals maintain or regain adaptation despite challenges in marriages. This is the first relationship study in Indonesia to examine resilience trajectories as represented by marital satisfaction. A weekly repeated measure design was conducted among 135 Indonesian married individuals. Participants reported their experiences of intradyadic and extradyadic stress, and marital satisfaction over 6 weeks. Growth mixture modeling and multinomial logistic regression were used to examine unobserved marital satisfaction trajectories and to estimate the impact of intradyadic and extradyadic stress on trajectory membership. Results suggested three unobserved trajectories: high, moderate, and low levels of marital satisfaction. Higher levels of intradyadic and extradyadic stress increased the probability of belonging to lower satisfaction trajectories. This evidence could be invaluable in helping Indonesian married individuals to better adapt to challenges they face. Future studies can explore protective factors associated with a high satisfaction trajectory to assist married Indonesians in successfully adapting to stress.

Latent trajectories of DSM-5-TR-based Prolonged Grief Disorder: findings from a data pooling project MARBLES

ABSTRACT Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria. Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories. Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6–12, 13–24, and 25–60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership. Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory. Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual’s functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.

Heritage culture and national identity trajectories: Relations to classroom cultural diversity climate and socioemotional adjustment for adolescents of immigrant descent

Adolescents’ heritage culture and national identities are potential developmental assets for socioemotional adjustment. The school context can support the development of such identities. Therefore, the aims of our study are to (1) identify patterns of heritage and national identity trajectories across mid-adolescence, (2) test whether they are predicted by classroom cultural diversity climate, and (3) test whether they are linked to socioemotional adjustment. Adolescents of immigrant descent in Germany (N = 431, 50.3% female, Mage = 12.36 at T1) filled out surveys at the beginning (T1) and end of 7th grade (T2), and end of 8th grade (T3). Using latent growth mixture models, three trajectories were identified, which had stable, moderate national identities but varied in heritage identity: “high decreasing heritage identity”, “moderate stable identities”, and “low increasing heritage identity”. At the classroom level (but not individual level) diversity climate at T1 predicted a “moderate stable identities” trajectory, compared to a “low increasing heritage identity” trajectory. Further, adolescents in the “moderate stable identities” trajectory reported higher life satisfaction at T3 compared to those in the “low increasing heritage identity” trajectory. Overall, the findings suggest heterogeneity in identity trajectories with implications for socioemotional adjustment.

Anti-suicidal effects of IV ketamine in a real-world setting

The current study evaluated the effectiveness of intravenous ketamine treatment for suicidality in a community-based clinical sample of 295 outpatients (mean age= 40.37; 58.6 % male). We conducted growth mixture modeling to estimate latent classes of changes in symptoms of suicidality measured by the Concise Health Risk Tracking – Self-Report (CHRT-SR) across five infusions in a two-week course of treatment. Best-fit indices indicated three trajectory groups demonstrating non-linear, quadratic changes in CHRT-SR scores during ketamine treatment. The largest group of patients (n= 170, 57.6 %) had moderate CHRT-SR scores at baseline and showed gradual improvement during treatment. The other two groups of patients had severe CHRT-SR scores at baseline and diverged into one group with no improvement throughout treatment (n = 63, 21 %) and one group with rapid improvement (n = 62, 21 %). Of the clinical and demographic variables available and tested, only higher scores pertaining to active thoughts of death and/or plan were found to predict which of the patients with severe CHRT-SR scores at baseline would not benefit from treatment. The present study provides an important contribution to the knowledge of ketamine's effects on symptoms related to suicide over time. providing support for the possible effectiveness of ketamine in a proportion of patients.

Trajectories of Blood Lipids Profile in Midlife Women: Does Menopause Matter?

It remains controversial whether changes of lipids over menopause transition (MT) are more age-related or more menopause-related. We aimed to classify women into different trajectory groups based on pattern and level of total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB), high-density lipoprotein cholesterol (HDL-C), triglyceride, and apolipoprotein A-I over the MT, as well as examine the effect of MT-related factors on lipid trajectory groups and levels. The cohort included 2582 subjects from the Study of Women's Health Across the Nation. Different trajectory patterns of lipids during the MT were determined using the latent class growth mixture model. The predictors of distinct blood lipids trajectory groups were determined by multiple linear regression models and multinomial logistic regression models. Women were categorized into either inverse U-shape or progressing trajectory group in each blood lipids measurement. The inverse U-shape total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, high-density lipoprotein cholesterol, log(TG), and apolipoprotein A-I trajectories showed an increasing trend before menopause but a decreasing trend after menopause. The U-shape total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B trajectories started to rise 5 years before menopause. Age at menopause, follicle-stimulating hormone, vasomotor symptoms, and estradiol predicted the shape and level of the women's lipids over the MT. Distinct lipid trajectories were identified during the MT, and the existence of at least 1 trajectory in each lipid parameters suggested a contribution of menopause. Our study highlights the need for earlier and continuous surveillance of lipids during the MT.

Identifying trajectories and predictors of chemotherapy-induced peripheral neuropathy symptoms, physical functioning, and falls across treatment and recovery in adults treated with neurotoxic chemotherapy: the PATTERN observational study protocol (NCT05790538)

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and dose-limiting side effect of systemic cancer therapy. In many cancer survivors, CIPN persists after treatment ends and is associated with functional impairments, abnormal gait patterns, falls, and diminished quality of life. However, little is known regarding which patients are most likely to develop CIPN symptoms that impair mobility and increase fall risk, when this risk develops, or the optimal timing of early intervention efforts to mitigate the impact of CIPN on functioning and fall risk. This study will address these knowledge gaps by (1) characterizing trajectories of symptoms, functioning, and falls before, during, and after treatment in adults prescribed neurotoxic chemotherapy for cancer; and (2) determining the simplest set of predictors for identifying individuals at risk for CIPN-related functional decline and falls.MethodsWe will enroll 200 participants into a prospective, observational study before initiating chemotherapy and up to 1 year after completing chemotherapy. Eligible participants are aged 40–85 years, diagnosed with stage I-III cancer, and scheduled to receive neurotoxic chemotherapy. We perform objective assessments of vibratory and touch sensation (biothesiometry, tuning fork, monofilament tests), standing and dynamic balance (quiet stance, Timed-Up-and-Go tests), and upper and lower extremity strength (handgrip dynamometry, 5-time repeated chair stand test) in the clinic at baseline, every 4–6 weeks during chemotherapy, and quarterly for 1 year post-chemotherapy. Participants wear devices that passively and continuously measure daily gait quality and physical activity for 1 week after each objective assessment and self-report symptoms (CIPN, insomnia, fatigue, dizziness, pain, cognition, anxiety, and depressive symptoms) and falls via weekly electronic surveys. We will use structural equation modeling, including growth mixture modeling, to examine patterns in trajectories of changes in symptoms, functioning, and falls associated with neurotoxic chemotherapy and then search for distinct risk profiles for CIPN.DiscussionIdentifying simple, early predictors of functional decline and fall risk in adults with cancer receiving neurotoxic chemotherapy will help identify individuals who would benefit from early and targeted interventions to prevent CIPN-related falls and disability.Trial registrationThis study was retrospectively registered with ClinicalTrials.gov (NCT05790538) on 3/30/2023.

Comorbid Prolonged Grief, PTSD, and Depression Trajectories for Bereaved Family Surrogates

Family surrogates of patients who die in an intensive care unit (ICU) are at risk of cooccurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depressive disorder during bereavement, but symptom trajectories are often explored individually. To simultaneously examine and determine co-occurrence of PGD, PTSD, and depressive symptom trajectories. This cohort study was conducted in ICUs of 2 Taiwanese medical centers from January 2018 to March 2020, with follow-up through July 2022. Participants included surrogates responsible for decision-making who provided data 6 to 24 months after the death of their loved one. Data were analyzed from August to December 2022. PGD was assessed with the 11 grief symptom items of the PG-13; PTSD, the Impact of Event Scale-Revised; and depressive symptoms, the depression subscale of the Hospital Anxiety and Depression Scale at 6, 13, 18, and 24 months after the death. Latent growth mixture modeling was conducted to identify distinct trajectories, and joint latent class analysis was used to assess joint patterns of trajectories. A total of 303 participants were included, with most younger than 56 years (207 participants [68.3%]), female (177 participants [58.4%]), and married (228 participants [75.2%]), and their relationship with the patient was mostly spouse (88 participants [29.0%]) or adult child (166 participants [54.8%]). Three trajectories were identified each for PGD, PTSD, and depressive symptoms. A resilience trajectory was predominant across PGD (253 participants [83.5%]), PTSD (250 participants [82.5%]), and depressive (200 participants [66.0%]) symptoms. Second most common was a recovery trajectory identified for PGD (36 participants [11.9%]) and PTSD (41 participants [13.5%]) symptoms, while for depressive symptoms, a moderate trajectory (72 participants [23.8%]) signified persistent moderate distress. A chronic trajectory characterized by persistently high distress was identified for PGD (14 participants [4.6%]) and depressive (31 participants [10.2%]) symptoms, whereas a unique delayed-onset trajectory (12 participants [4.0%]) was identified for PTSD symptoms. Most family surrogates (228 participants [75.2%]) experienced cooccurring PGD, PTSD, and depressive symptom trajectories, but multiple patterns were discordant. Symptom trajectories cooccurred in joint patterns: resilient (247 participants [81.5%]), recovered (43 participants [14.1%]), and distressed (14 participants [4.5%]). These patterns were characterized by high conditional probabilities for the resilience (PGD, 0.999; PTSD, 0.999; depressive, 0.804), recovery (PGD, 0.854; PTSD, 0.890; depressive, 0.588), and chronic (PGD, 0.921; PTSD, 0.789; depressive, 0.980) symptom trajectories. In this cohort study, grief-related psychological symptoms evolved in complex ways during ICU bereavement, as characterized by heterogeneous trajectories. Some ICU bereaved surrogates experienced persistent elevated PGD, PTSD, and depressive symptoms individually or conjointly, underscoring the importance of early screening to identify this population at high risk of comorbid psychological distress trajectories.

Longitudinal Associations Between Multiple Types of Adverse Childhood Experiences and Depression Trajectories in Middle-Aged and Older Chinese Adults: a Growth Mixture Model

Longitudinal Associations Between Multiple Types of Adverse Childhood Experiences and Depression Trajectories in Middle-Aged and Older Chinese Adults: a Growth Mixture Model

Abstract 12816: Changes in Self-Care and Quality of Life After Hospitalization for Coronary Heart Disease

Background: Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we know little about how CHD self-care influences quality-of-life (QOL) over time. Hypothesis: Changes in CHD self-care would be associated with changes in QOL. Aims: Identify distinct trajectories of change in self-care following a hospitalization for CHD that were associated with significant differences in QOL over time. Methods: Longitudinal study (Iceland). Patients completed surveys at hospital discharge and 6 months later. Self-care was measured with the Self-Care of CHD Inventory (maintenance and management scores = 0-100, higher=better) and QOL was measured with the SF-12 (physical and mental QOL = 0-100, higher=better). Growth mixture modeling was used to identify trajectories of CHD self-care behaviors. Results: A total of 373 patients (mean age 64.3±8.9, 79% male) completed the study. Two trajectories of CHD self-care were identified. The first one (57.2% of the sample - solid line - “Inadequate and Worsening”) had comparatively worse self-care at both timepoints; maintenance improved but management got significantly worse over time (-6.3±24.4 points, p=0.005). The second trajectory (42.8% of the sample - dashed line - “Adequate and Maintaining”) had comparatively better self-care at both timepoints; maintenance improved significantly (+5.0±16.2 points, p<0.001), and management was unchanged over time (+0.8±21.9 points, p=0.713). Participants in both trajectories had significant improvements in their physical and mental QOL (both p<0.001) over time ( Fig. 1 ). Participants in the first trajectory had comparatively worse physical and mental QOL at both timepoints (all p<0.05). Conclusion: Two distinct trajectories of self-care were identified and linked to significant differences in QOL following a hospitalization for CHD. Care models that focus on improving self-care skills might also improve QOL of patients with CHD.

Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study.

To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories. Recently diagnosed nonmetastatic breast cancer survivors (n= 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories. Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F= 4.13; p= 0.0006) and tangible (F= 2.86; p= 0.01) social support over time, was associated with recovery from depressive symptoms. Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes. Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

Grief trajectories after loss in pregnancy and during the neonatal period

Distinguishing patterns of grief over time in parents with a loss in pregnancy or during the neonatal period is important for identification of parents with severe grief symptoms, who may need additional support. Our aim was to describe grief in this population and to examine variations by type of loss in a large prospective cohort. We used questionnaire data from the Danish longitudinal cohort, Life After the Loss, which contains information on parents with a loss in pregnancy (from 14 weeks) or during the neonatal period. Parents completed the Prolonged Grief-13 scale at 1, 7, and 13 months after their loss. We applied Latent Growth Mixture Modelling to identify prolonged grief trajectories and used multinomial regression models to assess factors associated with class membership. Three distinct trajectories were identified in 676 parents: resilience (73.1%), recovery (16.9%), and chronic (10%). The distribution varied by type of loss, and the chronic group were overrepresented by parents with stillbirths (16.2%) and neonatal deaths (16.1%) in contrast to parents with spontaneous abortions (8.2%) and termination of pregnancy due to fetal anomalies (6.2%). Furthermore, not having a living child or being a woman was associated with following the chronic trajectory. These results underline that, while most bereaved parents are resilient, 10% experience consistently high levels of grief symptoms during the first year after the loss. Information on type of loss, gender, and whether the parent has living children are meaningful indicators of grief class membership.

Post Intensive Care Syndrome in Swiss Paediatric survivors and their Families (PICSS-PF): a national, multicentre, longitudinal study protocol

IntroductionPaediatric intensive care units (PICUs) survivors and their families often experience widespread morbidity and psychosocial consequences after discharge, known as post-intensive care syndrome in paediatrics (PICS-p). In Switzerland, more than...

Reaching out to big losers: Exploring intervention effects using individualized follow-up.

Previous research suggests that a brief duty-of-care telephone call to high expenditure customers was associated with lower gambling over the subsequent year. The current aim was to assess effects on individual trajectories rather than overall group effects reported previously. The objective was to identify different patterns of individual change over the follow-up year and explore differential responses of subgroups of individuals. A matched pair design contrasting the outcome for telephone intervention with a no-intervention control condition. Five hundred and ninety-six statistical pairs randomly drawn from the top 0.5% of customers based upon annual expenditure at Norsk Tipping, Norway. Primary outcome measure was gambling theoretical loss (TL), derived from the Norsk Tipping gambling data warehouse. Player trajectories across time were identified using growth mixture modeling to assess differential intervention effects on homogenous subgroups of individuals. Relatively low, medium, and high TL subgroups were identified. The telephone intervention was associated with greater reductions than the control condition for all three subgroups but showed the strongest effect for the subgroup with the highest TL. The intervention was most effective for casino and sport gamblers, male, young, and middle-aged. A brief duty of care telephone contact with high expenditure customers showed sustained effects over 12 months, in particular for individuals showing the highest level of TL. Examining trajectories using advanced statistical models identified customer characteristics most strongly associated with reduced TL. These findings can guide prevention strategies with evidence-based knowledge about differential effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Workplace Harassment and Health: A Long Term Follow up.

We examine relationships between workplace harassment (WH) and onset of health conditions over a 23-year period. Participants were surveyed at seven points between 1997-2006 and again in 2020. Regression analyses (n = 921) assessed effects of chronic WH exposure on onset or recent health conditions by 2020. Growth mixture modeling revealed infrequent and chronic classes of generalized workplace harassment (GWH; 33.39% chronic) and sexual harassment (SH; 32.32% chronic). Prevalence of health conditions ranged from 3.71% for myocardial infarction to 43.06% for hypertension. Analysis via propensity score matching showed chronic WH class membership increased odds of coronary heart disease (GWH, odds ratio [OR] = 3.42, P < 0.05), arthritic/rheumatic conditions (SH, OR = 1.56, P < 0.05), and recent migraine (SH, OR = 1.68, P < 0.05). Workplace harassment is associated with coronary heart disease, arthritic/rheumatic conditions, and migraine. Worker health can be protected through strengthening and enforcing organizational and social antiharassment policies and laws.

Remnant Cholesterol in Young Adulthood Is Associated With Left Ventricular Remodeling and Dysfunction in Middle Age: The CARDIA Study.

Recent studies have shown that remnant cholesterol (RC) is associated with incident heart failure; however, its association with left ventricular (LV) structure and function is unclear. We aimed to evaluate the association between RC levels in young adulthood and LV structure and function in middle age. We included 3321 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults) at baseline. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus calculated low-density lipoprotein cholesterol, and the RC trajectories that followed a similar pattern of change over time were identified using the latent class growth mixture model. LV structure and function were assessed using echocardiography at CARDIA study year 25. Multivariable linear regression models were performed to assess the associations of both baseline and trajectories of RC levels with LV structure and function. Among 3321 participants, the mean age was 24.99±3.62 years: 1450 (43.90%) were male, and 1561 (47.00%) were Black. After multivariate adjustment, higher baseline RC (per SD in log-transformed) was associated with higher LV mass index (β=1.29; P=0.004), worse global longitudinal strain (β=0.19; P<0.001), worse global circumferential strain (β=0.16; P=0.014), lower septal e' (β=-0.26; P<0.001), lower lateral e' (β=-0.18; P=0.003), and higher E/e' (β=0.15; P=0.003). Three RC trajectories were identified during follow-up: low increasing (42.4%), moderate increasing (45.5%), and high increasing (12.1%). Similarly, compared with the low-increasing group, the high-increasing RC trajectory group was related to higher LV mass index, worse global longitudinal strain, lower septal e', lower lateral e', and higher E/e'. Elevated RC levels in young adulthood were related to adverse LV structural and functional alterations in midlife. Long-term trajectories of RC levels during young adulthood help identify individuals at a higher risk for adverse LV remodeling and dysfunction. URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005130.