Hierarchical Linear Regression Models Research Articles

Preventative self-regulatory primary care leadership in urban China: impact on physician well-being and medical service quality.

The study aims to address the gap between leaders' preventative self-regulatory focus and its impact on Chinese primary care physicians (PCPs) well-being, measured by work-family spillover stress and work exhaustion and on healthcare quality, measured by preventive service delivery and clinical guideline adherence. This paper conducted a cross-sectional in-person survey with 38 leaders and 224 PCPs in 38 primary health centers (PHCs) in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the regulatory focus theory, this paper built hierarchical linear regression models to examine the association between the leadership's regulatory focus and physician burnout, work-family conflict, clinic guideline adherence and preventive service delivery. This paper added the knowledge of leadership's regulatory focus impact on the well-being and medical service quality of PCPs. Prevention regulatory focus of leaders was significantly associated with work exhaustion and physicians' reported work-family conflict. There is no significant association between leadership's prevention regulatory focus and PCPs' preventive service delivery or clinical guideline adherence. Data on the regulatory focus of PCPs were not collected. Future studies should collect longitudinal data, allowing for exploration of the mechanism. This paper revealed that PHC leaders should restructure their leadership focus away from preventive regulatory behavior, promoting a team atmosphere and enhancing PCP attitudes, behaviors and well-being. To improve the well-being of PCPs and the quality of medical services, our results recommend a focus on establishing a positive organizational culture and addressing the emotional and professional needs of PCPs. To achieve these aims, policymakers should implement measures that promote a more comprehensive and balanced regulatory focus within PHC institutions. These measures should aim to create an environment that supports physician well-being and enhances the quality of healthcare services. Providing ample resources and support, promoting a collaborative team atmosphere and encouraging open communication are vital to empowering PCPs. This study examined the preventive regulatory focus of PHC leaders on the well-being and medical service quality of PCPs in China.

Preparing adolescents and young adults with epilepsy for transitioning health care (PATH) study: The important role of age and self-efficacy

BackgroundAt least 30 % of youth with epilepsy will require transition from pediatric to adult neurology care. Many adolescents and young adults (AYAs) with epilepsy are inadequately prepared for health care transition, which may contribute to health care disruptions and decreased quality of life. The current study aimed to add to the growing body of literature on health care transition in epilepsy by characterizing a sample of AYAs with epilepsy and assessing the relationship between pre-existing and behaviorally modifiable factors and epilepsy-specific transition readiness. Methods103 AYAs (Mage = 17.56; range = 14–21; 54 % female; 85 % White) with epilepsy and 84 of their caregivers were enrolled from two pediatric hospitals in the United States. Participants provided sociodemographic and medical information and completed questionnaires assessing functioning, epilepsy management, and transition readiness. Data were analyzed using a two-step hierarchical multiple linear regression model with epilepsy-specific transition readiness as the outcome: 1) pre-existing factors (i.e., age, insurance, seizure severity); and 2) behaviorally modifiable factors (i.e., cognitive functioning, medication self-management, epilepsy self-efficacy). ResultsOnly 44 % of AYAs had discussed health care transition with their pediatric neurologist. The final model was significant, ΔF (3, 90) = 13.45, p < 0.001. Older age and greater epilepsy self-efficacy were associated with greater epilepsy-specific transition readiness. ConclusionAYAs with greater epilepsy self-efficacy may be better prepared for the transition from pediatric to adult neurology care. Routine assessment of epilepsy self-efficacy and transition readiness starting in early adolescence may help to identify individuals who could benefit from targeted interventions.

Characterizing autogenous and reactive obsessions using theta and beta oscillations under inhibitory demands.

Obsessive-Compulsive Disorder (OCD) is a heterogenous mental health condition that causes significant impairment and is often associated with poor treatment outcomes. The aim of the current study was to examine the association between electroencephalographic (EEG) oscillatory power during inhibitory task performance and obsessive-compulsive symptoms (OCS). OCS was assessed using the well-established the Autogenous-Reactive Obsession (AO-RO) model as the main framework to address its heterogeneous clinical manifestations. The severity of AO and RO, as primary outcome measures, was indexed using the Revised Obsessive Intrusion Inventory (ROII). Cognitive- and behavioral inhibition (CI; BI) tasks were administered while EEG data were recorded from an analogue sample of 63 undergraduate students with OCS assessed along a dimensional spectrum. Oscillatory power was computed from frontal-central electrodes Fz and Cz for theta and beta frequency bands, using event-related spectral perturbations (ERSPs), which were entered into two hierarchical linear regression models to predict the severity of AO and RO, respectively, while controlling for covariates (i.e., sex, age, ethnicity, anxiety, depression, worry, and behavioral task performance). Theta power during CI (Theta-CI) was the only significant EEG predictor of AO severity, whereas beta power during BI (Beta-BI) was the only significant EEG predictor of RO severity. These results suggest that AO severity is primarily associated with an overactive neural correlate of cognitive control, whereas RO severity is primarily associated with an overactive neural correlate of behavioral cancellation. These results agree with previous literature suggesting overactive band power representing the dysfunction within OCD. Theta-CI and Beta-BI may serve as potential biomarkers differentially associated with AO and RO among undiagnosed individuals displaying varying levels of OCS, which warrants further investigation.

Understanding the Impact of Upper Extremity Musculoskeletal and Comorbid Health Conditions on Physical and Mental Health and Quality of Life in 956 Adults Aged 50 to 65

The objective of the study was to examine the relationship and impact of comorbidity, pain, and function on quality of life in people aged 50-65 with upper extremity musculoskeletal disorders (UED), controlling for sex, occupational status, and age. This was a cross-sectional study. We performed hierarchical linear regression models to assess the extent that comorbidity and injury-related pain and disability affected overall health-related quality of life measured by the SF-36. We included 956 patients, of whom 601 were female. Physical and mental disability were associated significantly with lower levels of UE functional capacity (effect &lt;sub&gt;physical health &lt;/sub&gt;&amp;#61; 0.24, SE &amp;#61; 0.10, &lt;i&gt;P&lt;/i&gt; &amp;#60; 0.001; effect&lt;sub&gt; mental health&lt;/sub&gt; &amp;#61; 0.17, SE &amp;#61; 0.09, &lt;i&gt;P&lt;/i&gt; &amp;#60; 0.05). Comorbidity, pain, and occupational status have indirect relationships with UED, such that greater pain, a larger burden of comorbid health conditions, and less participation in the workforce, is associated with poorer physical and mental health. Mobility is key in promoting health and quality of life while contributing towards a successful transition into retirement.

A Comprehensive Model of Community Violence Exposure Outcomes Using an Ecological Systems Framework.

Community violence (CV) is associated with negative psychosocial outcomes, such as posttraumatic stress symptoms (PTSS) and anger; however, many individuals also exhibit resilience. Considering the multifinality of outcomes following CV and guided by Bronfenbrenner's ecological systems framework, the current study sought to examine individual, microsystem, and exosystem level factors in relation to PTSS, anger, and resilience. Participants were 536 emerging adults (Mage = 20.13; SD = 1.81, range = 18-25) recruited from two universities. Three hierarchical linear regression models were conducted, one for each dependent variable (i.e., PTSS, anger, resilience). Block 1 included the covariates of recruitment site and age. Block 2 added individual-level factors (i.e., gender, race, income, CV exposure, other trauma exposure, code of the streets [COS] beliefs, religiosity), Block 3 added microsystem-level factors (i.e., parental monitoring, social support), and Block 4 added exosystem-level factors (i.e., community cohesion, community disorder). Identifying as female, higher levels of CV and other trauma exposure, and lower levels of social support were associated with greater PTSS. Recruitment site, more cumulative trauma, stronger endorsement of COS beliefs, lower levels of social support, and higher levels of community disorder were associated with higher levels of problematic anger. Higher income, identifying as a racial minority, higher levels of CV, more religiosity, higher levels of social support, and greater community cohesion were associated with more resilience. These findings highlight the importance of examining ecological systems concurrently. Individual- and microsystem-level variables may be key targets and should be considered in intervention and prevention services for emerging adults exposed to violence.

Mental Health in China: Social Change in Life Course Trajectories

AbstractKnowledge about life course trajectories and intercohort changes in mental health is limited mainly to Western populations. To address this gap, our study analyzes mental health trajectories in China, drawing on data on depressive symptoms from the China Family Panel Studies over the period 2012–2020 (N = 31,700 individuals aged 16–70; N = 87,787 person‐years). Employing hierarchical linear regression models, our findings reveal moderate increases in depressive symptoms over the life course and across cohorts. Subgroup analyses indicate that women, people with lower educational attainment, and people with rural hukou experienced more depressive symptoms and a more pronounced increase in depressive symptoms with age. These disparities narrowed across cohorts. We discuss these patterns in the context of Chinese cultural dynamics, including son preference, the impact of education and hukou on the accumulation of stress over the life course, family policy and equity policy transitions, and the changing stigma of mental health.

Pathways to health: A longitudinal examination of protective factors in children with and without preschool anxiety.

Preschool anxiety is highly prevalent and well known to predict risk for future psychopathology. The present study explores whether a diagnosis of an anxiety disorder in preschool interacts with (a) social skills and (b) cognitive ability to longitudinally predict psychopathology, two well-known protective factors, among a sample of 207 children measured at preschool (Mage = 4.34 years) and early childhood (Mage = 6.61 years). To assess social skills and cognitive ability, we utilized the Social Skills Rating Scale and the Differential Abilities Scale, respectively. To assess psychopathology, we utilized the parent report of the Preschool Age Psychiatric Assessment. Hierarchical linear regression models revealed significant interactions between both social skills and cognitive ability with preschool anxiety. We observed that social skills protected against emergent psychopathology for both children with and without anxiety, although this association was stronger for children with preschool anxiety. Contrastingly, cognitive ability served as a protective factor against future psychopathology primarily among children without preschool anxiety. Results from this study identify targets for future intervention and inform our understanding of how preschool anxiety, a common disorder among young children, shapes future psychopathology risk in childhood.

Assessing Barriers and Difficulties to Healthcare Access Among Syrian Refugees in Jordan: An Observational Study.

(1) Background: Worldwide, refugees may have some difficulties in accessing healthcare services. However, little is known about the factors that may predict the level of accessibility to the public healthcare system in the host countries. (2) Aim: To examine the level of accessibility of Syrian refugees to the public healthcare system in Jordan and further to identify the prediction of socioeconomic factors and barriers to healthcare access. (3) Methods: A cross-sectional study was conducted with a convenient sample of 356 Syrian refugees residing outside camps (Irbid, Ajloun, and Jarash). Data were collected using the Access to Healthcare Services Scale instrument (adopted from the Canadian Community Health Survey), which is composed of 2 sections: the general access scale (8 items) and the difficulties scale (20 items). One-way ANOVA test and independent t-test were used to examine epidemiological correlations among variables, whereas a hierarchical linear regression model was used to examine the predictability of socioeconomic factors and barriers to overall access to the public healthcare system by exploring the incremental impact of additional predictors. (4) Results: the mean age of the 356 participants was 35.22 years old, 56.5% were female, 67.4% were married, most of them 46.1% have secondary education, and non-employed 69.9%. Significant associations were observed among participants with different marital status (p < 0.001), educational level (mean 11.85 vs. 19.85, p < 0.001), working status (15.47 vs. 17.93, p < 0.001), family household number (16.42 vs. 17.0, p < 0.001), and health insurance (none: 15.50 vs. governmental 24.50, p < 0.001). Multivariate analysis revealed that the most important factors that may predict the overall access to healthcare services were: family monthly income (beta -0.19, p < 0.001), household family number (beta 0.17, <0.001), health insurance (beta -0.09, p = 0.047), and barriers (beta -0.43, <0.001), even after adjusting for potential confounding effects: sex, age, educational level, and place of residence. (5) Conclusions: Our findings indicate that socioeconomic factors and barriers may considerably predict overall access to public healthcare in Jordan. It is crucially important, therefore, for the Jordanian government and international organizations to create and develop strategic plans and programs that enhance refugees' access to health services, positively impacting their health and wellness.

The harmful side of absent leaders: Multifactor leadership and employees’ job-stress-related presenteeism

Abstract This study tests the role of the full range leadership model’s leadership styles in employees’ job-stress-related presenteeism (JSRP). Further, the study tests a model that introduces mediating variables in the relationship between absent leaders and JSRP. Employees from four different types of organizations: police (N = 148), public service (N = 479, not-for-profit (N = 96), and construction (N = 214) completed the Multifactor Leadership Questionnaire on their direct supervisor, as well as a self-report measures of JSRP, psychological distress, and work–life balance. Correlations and hierarchical linear regression models showed that laissez-faire leadership had the strongest influence on JSRP for all four organizations. The parallel mediation model results showed that both employee psychological distress and work–life balance partially mediated the relationship between laissez-faire leadership style and employees’ JSRP. These results underscore the importance of looking at absent leaders and how they affect employees negatively.

Development of a work systems stress questionnaire to predict job burnout: A mixed methods study based on a macroergonomics approach

Job burnout is a stress-related phenomenon that is a significant threat to the health and performance of organizations and employees. Interventions to ameliorate potentials for burnout have been limited by the lack of a comprehensive tool that considers work system stressors. Thus, the aim of this study was to develop a questionnaire for predicting job burnout based on the macroergonomics work system approach. The setting was a petrochemical company in South Iran. In the qualitative phase of this sequential exploratory mixed methods research, 971 meaning codes were extracted from fourteen one-to-one and seven focus group interviews (n = 59). The codes were subject to Directed Content Analysis, which yielded three themes and 15 dimensions, which were used to inform the development of reliable and valid questionnaire. Items for each of the dimensions were sourced from exiting scales. To test the developed Work System Stress Questionnaire (WSSQ) in terms of its ability to predict burnout, a survey which included demographic items, the WSSQ, and the Maslach Burnout Inventory was completed by 359 employees. Hierarchical linear regression modelling of the data indicated that Task Significance, Job Demands, Work-Life Conflict, and Work Schedule predicted Emotional Exhaustion, and altogether explained 58 % variance. Task Significance, Violence and Harassment, Work-Life Conflict, and Job Insecurity predicted the Depersonalization and explained 29 % variance. Decision Latitude, Welfare and Financial Facilities, Task Significance, and Structural Problems predicted Personal Accomplishment and explained 26 % variance. All 15 dimensions were valid (CVI range .73–.90) and reliable (Cronbach's alpha range .71–.93). The results confirm the ability of the WSSQ to explain more variance regarding job burnout than previous studies. In turn, the WSSQ will enable remedial actions to be put into place. It may also be useful for understanding the consequences associated with other organizational ergonomic variables that are related to job stress.

Rapid Zooplankton Assessment: Evaluating a Tool for Ecosystem‐Based Fisheries Management in the Large Marine Ecosystems of Alaska

ABSTRACTEcosystem‐based fisheries management (EBFM) remains an aspirational goal for management throughout the world. One of the primary limitations of EBFM is the incorporation of basic lower trophic level information, particularly for zooplankton, despite the importance of zooplankton to fish. The generation of zooplankton abundance estimates requires significant time and expertise to generate. The rapid zooplankton assessment (RZA) is introduced as a tool whereby nontaxonomic experts may produce rapid zooplankton counts shipboard that can be applied to management in near real time. Zooplankton are rapidly counted shipboard and placed into three broad groups of zooplankton relevant to higher trophic levels: large copepods (&gt; 2 mm), small copepods (&lt; 2 mm), and euphausiids. A Bayesian, hierarchical linear regression modeling approach was used to validate the relationship between RZA abundances and laboratory‐processed abundances to ensure the rapid method is a reliable indicator. Additional factors likely to impact the accuracy of the RZA abundance predictions were added to the initial regression model: RZA sorter, survey, season, and large marine ecosystem (Bering Sea, Chukchi/Beaufort Sea, and Gulf of Alaska). We tested models that included the random effect of sorter nested within survey, which improved fits for both large copepods (Bayes R2 = 0.80) and euphausiids (Bayes R2 = 0.84). These factors also improved the fit for small copepods when the fixed effect of season was also included (Bayes R2 = 0.65). Additional RZA data were used to predict laboratory‐processed abundances for each zooplankton category and the results were consistent with model training data: large copepods (Bayes R2 = 0.80), small copepods (Bayes R2 = 0.64), and euphausiids (Bayes R2 = 0.88). The Bayesian models were therefore able to predict laboratory‐processed abundances with an associated error when accounting for these fixed and random effects. To demonstrate the utility of zooplankton data in management, zooplankton time series from the Bering Sea shelf were shown to vary in relation to warm and cold conditions. This variability impacted commercially important fish, notably Walleye Pollock (Gadus chalcogrammus), and these time series were used by managers using a risk table approach. The RZA method provides a rapid zooplankton population estimation in near real time that can be applied to the management process quickly, thus helping to fill a gap in EBFM.

Psychosocial Work Factors, Job Stress, and Self-Rated Health Among Hotel Housekeepers.

Hotel housekeeping is widely recognized as a poor-quality job due to its high demands and limited resources. Hotel housekeepers (HHs) face both hard physical work and mentally demanding conditions, yet psychosocial factors in this feminized and precarious occupation remain under-researched. To address this gap, this study examines HHs' exposure to psychosocial factors at work and their impact on job stress and self-rated health. A cross-sectional survey of a random sample of 926 HHs in the Balearic Islands (Spain) assessed job stress, self-rated health, psychosocial factors (job demands and resources), and sociodemographic variables using the Copenhagen Psychosocial Questionnaire II (COPSOQ-II) and the National Health Survey. Descriptive analysis and hierarchical linear regression models were applied. The prevalence of job stress was 61.1% (95% confidence interval [CI] = [57.8%, 64.1%]), while the prevalence of poor self-rated health was 59.9% (95% CI = [56.6%, 62.9%]). Hotel housekeepers were highly exposed to job demands such as intense work pace, job-specific stressors, work-life conflict, and emotional demands; highly available job resources were role clarity, task meaning, and social support. Regression models revealed work pace, work-life conflict, nationality, and weak leader support as key predictors of job stress; and work-life conflict and leadership quality as key predictors of self-rated health. Although considered an eminently physical job, psychosocial work factors play a key role in explaining HHs' job stress and self-rated health. Occupational health professionals should design workplace interventions to reduce work pace, mitigate work-life conflict, and enhance resources such as leader support, sense of community, and leadership quality.

Factors Associated with Dietary Diversity in Community-Dwelling Brazilian Older Adults.

Older populations are at high risk of nutritional inadequacy and monotonous diets, and assessing dietary diversity can be a practical measure to indicate groups at nutritional risk. We aimed to explore the dietary diversity of older adults enrolled in primary health care services in Brazil and to evaluate its associated factors. In this cross-sectional study, we evaluated the dietary diversity score (DDS) of 581 participants (≥60 years) registered in primary care services. All foods mentioned in a 24 h food recall were classified into 10 groups, and factors associated with the DDS were analyzed using hierarchical linear regression models in two blocks: (1) sociodemographic and (2) health conditions and lifestyle. The mean DDS was 5.07 (±1.34), and 67.5% of the sample reached the minimum dietary diversity (≥5 groups). In the final model, income, previous diagnosis of cancer, and sporadic intake of alcohol were positively associated with DDS. In contrast, cognitive decline, sedentary lifestyle, and anorexia of aging were negatively associated with DDS. These findings show that the entire structural, economic, and social system needs to facilitate access to quality food, adequate places and conditions for the practice of physical activity, and policies regarding tobacco and alcohol abuse, in addition to nutritional guidance.

Sources of perceived social support and cognitive function among older adults: a longitudinal study in rural China.

Studies have shown the positive impact of perceived social support on cognitive function among older adults in rural areas. However, existing studies often overlook the impact of different support sources. This study aimed to explore the relationship between the diverse sources of perceived social support and cognitive function. Participants were drawn from the Guizhou Rural Older Adults' Health Study (HSRO) in China. We included 791 participants who participated in a baseline survey in 2019 and a 3-year follow-up survey. Perceived social support was investigated from the six main sources (friend, relative, children, spouse, sibling, and neighbor). Hierarchical linear regression models were used to observe the effects of diverse sources of perceived social support and their combinations on cognitive function. Cognitive function was positively associated with perceived support from children, friends, and neighbors. A positive association was found between cognitive function and increases in each additional source [β = 0.75 (95%CI: 0.51, 0.98), p < 0.001]. Older adults who perceived support from both children and friends showed better cognitive function [β = 2.53 (95%CI: 1.35, 3.72), p < 0.001]. The perception of support from spouse, siblings, and relatives did not show a statistically significant association with cognitive function among older adults in rural areas. This study found that the association between different sources of perceived social support and cognitive function was varied. This study provides scientific evidence that personalized support strategies may benefit in promoting cognitive health in rural older adults.

User Engagement with Interactive Educational Videos: Relations with Task Value, Cognitive Load, and Learning Satisfaction

Interactive educational videos have grown in popularity in the higher education setting over the last two decades. This exploratory study investigates the mediating and moderating effects of user engagement (UE) on the relationships between the antecedents of UE (i.e., intrinsic load, extraneous load, germane load, and task value) and learning satisfaction. A cross-sectional survey study was conducted in June 2023. We conveniently sampled 49 year-one undergraduate students, who completed a self-report questionnaire consisting of items pertaining to cognitive load, task value, user engagement, and learning satisfaction. Data was analysed using hierarchical linear regression models. Findings revealed that reward fully mediated the relationship between germane load and learning satisfaction. In addition, reward was also found to moderate the relation between (a) germane load and learning satisfaction, and (b) task value and learning satisfaction. These findings highlight the importance of creating rewarding experiences when designing interactive educational videos.

Associations between sensory impairment and functional limitations among older Chinese adults: mediating roles of social isolation and cognition

BackgroundThe high prevalence of sensory impairment and functional limitations in older adults is a significant concern, yet there is limited understanding of the relationship between these two conditions. Therefore, the objective of this study was to investigate the pathways connecting sensory impairment and functional limitations by examining serial multiple mediating effects of social isolation and cognition in older adults.MethodsUsing the China Health and Retirement Longitudinal Study dataset, a sample of 4871 older adults was selected. The study variables included sensory impairment, functional limitations, social isolation and cognition, and other covariates. A hierarchical multiple linear regression model was used to assess the association between sensory impairment and functional limitations. Mediation analysis was conducted to explore the sequential multiple mediating effects of social isolation and cognitive function in the relationship between sensory impairment and functional limitations.ResultsOur findings revealed a significant and positive association between sensory impairment and functional limitations (B = 0.615, 95% CI: 0.397, 0.834). After adjusting for social isolation and cognitive function, the impact of sensory impairment on functional limitations accounted for 87.19% of the total effect. Additionally, approximately 12.81% of the significant relationship between dual sensory impairment and functional limitations was mediated by social isolation and cognitive function. A serial multiple mediating pathway (sensory impairment → social isolation → cognition → functional limitations) was identified, with a coefficient of 0.013 (95% CI: 0.006, 0.020).ConclusionsOur study provides evidence for the mediating effects of social isolation and cognition in the relationship between sensory impairment and functional limitations. Given the prevalence of functional limitations among older adults with sensory impairment, it is crucial to consider social isolation and cognitive function in efforts to reduce the burden of disability care. Future validation of these findings through longitudinal studies is necessary.

Use of open fires or closed solid fuel appliances for residential heating and cognitive decline in older adults

ObjectivesUse of solid fuel appliances is a major contributor to air pollution. Indoor solid fuel burning for cooking and heating in lower-middle income countries is associated with lower cognitive function and faster decline. Less is known, however, about the potential risk to brain health from burning solid fuels in open fires and closed appliances for heating purposes only, particularly in higher income countries. The current study aimed to investigate the association between burning solid fuels for home heating and cognitive decline in older Irish adults, also testing whether results differ by sex/gender. Design and ParticipantsThe sample consisted of 4,537 participants aged 50 and older from The Irish Longitudinal Study on Ageing, a population-based cohort study. Participants were surveyed every two years between 2012 and 2018. Solid fuel use in 2012 (Wave 2) and cognitive function (word recall and verbal fluency) at waves 2, 3, 4 and 5 were analysed. Hierarchical linear mixed effects regression models were used to examine the association between solid fuel use and cognitive decline, controlling for multiple confounders. ResultsThere was a significant main effect of solid fuel use on cognitive function, such that individuals who reported using a solid fuel appliance or open fire as a main source of heating had lower cognitive scores than those who did not report such use at all waves, but there was no difference in the slope of the trajectory over time and no clear sex differences. ConclusionsOlder Irish adults who reported burning solid fuels (in an open fire or closed appliance) as a main way source of home heating had lower observed cognitive function across 6 years in TILDA but no evident faster decline than non-users. These findings further expand the evidence base on indoor air pollution and brain health.

Age Modifies the Interactive Effect of Loneliness and Social Support on Financial Exploitation Vulnerability in Older Adults.

Social support and loneliness have been identified as important correlates of financial exploitation vulnerability (FEV) in older adults. However, the potential combined effect of these social factors on FEV remains unclear. Moreover, given that social support and loneliness may become more important as age increases, age may have a moderating effect on the loneliness-social support interaction. Participants were 342 community-living Israeli older adults aged 60 or over (M age = 73.37, SD = 7.82, 69.1% female) who responded to questionnaires assessing FEV (Financial Exploitation Vulnerability Scale), perceived social support (The Multidimensional Scale of Perceived Social Support), loneliness (UCLA Three-item Loneliness Scale), and sociodemographic characteristics. Two hierarchical linear regression models covarying for demographic variables examined study hypotheses. In a first model, a significant interaction between social support and loneliness was discovered such that high levels of perceived social support attenuated the positive loneliness-FEV association. In a second model, a significant three-way interaction between social support, loneliness, and age was discovered. Probing the interaction revealed that the attenuating effect of social support on the loneliness-FEV link increased with increasing age. Findings suggest that effects of social factors on FEV may interact with each other and with age to predict FEV, and provide insights into when social support may be most relevant in mitigating FEV.

Organizational resilience and primary care nurses' work conditions and well-being: a multilevel empirical study in China.

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being.

Legitimacy and transparency in dyadic supply chains: Does competition intensity matter?

Working only with suppliers that meet certain social and environmental standards has become a new norm in the selection of business partners for many firms, which encourages suppliers to become more transparent to gain a competitive advantage. This study investigates whether buyer legitimacy is associated with supply chain transparency from an environmental, social, and governance (ESG) perspective. Using a dataset of 605 dyadic relationships from Chinese listed firms for the period 2011–2019, we empirically examine our conceptual framework using hierarchical linear regression models. We demonstrate that buyer legitimacy is positively associated with supplier ESG transparency in dyadic supply chains. We further find that the supplier's competition intensity negatively moderates the positive relationship between buyer legitimacy and supplier ESG transparency. Overall, our findings contribute to a better understanding of organizational legitimacy and the buyer–supplier relationship and offer practical guidelines for enhancing supply chain transparency.