Hierarchical Logistic Regression Analysis Research Articles

Evaluation of Cesarean Rates for Term, Singleton, Live Vertex Deliveries in China in 2020 Among Women With No Prior Cesarean Delivery

Substantial regional variation in cesarean delivery rates has been reported in China, but there is a lack of reports on hospital-level variation in these rates among low-risk deliveries. To evaluate hospital variation in cesarean rates in China for term, singleton, live vertex deliveries among women with no prior cesarean delivery and to estimate contributions of individual and hospital factors. This nationwide cross-sectional study used data from maternal patient discharge records collected by the Hospital Quality Monitoring System in China from January 1 to December 31, 2020. Pregnant female individuals aged 15 to 49 years (referred to hereafter as women) with at least 1 live birth were included, and low-risk deliveries were defined as term, singleton, live, vertex deliveries with no prior cesarean delivery. Birth by cesarean delivery. The main outcome was cesarean delivery rate by hospital. Hierarchical logistic regression analysis was used to calculate the adjusted cesarean rate and to estimate the percentage of hospital variation in low-risk deliveries explained by individual and hospital factors. Among the 7 635 149 deliveries identified from 4359 hospitals in 31 provinces of mainland China, 6 599 468 (86.4%) were considered low risk. Of overall and low-risk deliveries, 3 400 162 and 2 638 097 were cesarean deliveries, corresponding to mean rates of 44.5% and 40.0%, respectively. The mean (SD) maternal age for overall and low-risk deliveries was 29.1 (4.0) and 28.8 (4.8) years, respectively, and mothers were more likely to be of Han ethnicity (89.5%). Cesarean rates varied widely among hospitals, with absolute differences between the 5th and 95th percentiles of 53.5% (19.4%-72.9%) for overall deliveries and 56.8% (14.3%-71.1%) for low-risk deliveries. Large absolute differences remained after adjusting for maternal characteristics, with rates of 47.4% (19.1%-66.5%) for overall deliveries and 52.6% (15.0%-67.6%) for low-risk deliveries. Among low-risk deliveries, hospital factors (eg, hospital province location) explained 31.3% of the hospital variation in cesarean rate and individual factors explained an additional 2.0%. The findings of this cross-sectional study suggest that cesarean rates varied markedly among hospitals in China in 2020, which may be attributable to hospital rather than individual factors. Future work is needed to design hospital-level initiatives to optimize cesarean use, particularly among low-risk deliveries.

Prevalence and associated factors of depressive and anxiety symptoms among healthcare workers in the post-pandemic era of COVID-19 at a tertiary hospital in Shenzhen, China: A cross-sectional study.

Healthcare workers were at high risk of psychological problems during the COVID-19 pandemic, but it remains not well-investigated in the post-pandemic era of COVID-19, with regular epidemic prevention and control embedded in burdened healthcare work. This study aimed to investigate the prevalence and potential risk factors of the symptoms of depression and anxiety among healthcare workers at a tertiary hospital in Shenzhen. Our cross-sectional study was conducted among 21- to 64-year-old healthcare workers in December 2021 at a tertiary hospital in Shenzhen, using a simple random sampling strategy. A wide range of socio-demographic characteristics, individual information, and psychological condition of the subjects were extracted. Healthcare workers' psychological conditions were tested with the Center for Epidemiologic Studies Depression (CESD-10), General Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), Work-Family Conflict Scale (WFCS), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and 17-item of Maslach's Burnout Inventory-Human Services Survey (MBI-HSS-17). Data were collected based on these questionnaires. Descriptive statistics were used to assess the difference between healthcare workers with depressive and anxiety symptoms among different groups. Hierarchical logistic regression analyses were conducted to investigate the association between focused variables and mental health outcomes. A total of 245 healthcare workers were enrolled. The proportion of depressive symptoms, anxiety symptoms and their co-occurrence were 34.7, 59.6, and 33.1%, respectively. Logistic regression showed that for the three outcomes, no history of receiving psychological help and self-rated good or higher health were protective factors, whereas more severe insomnia and job burnout were risk factors. Junior or lower job title and higher psychological resilience were related to a lower prevalence of depressive symptoms, while relatively longer working hours and larger work-family conflict were positively associated with the anxiety symptoms. Psychological resilience was inversely associated with the co-occurrence of depressive and anxiety symptoms. Our study revealed a high proportion of psychological problems and proved that several similar factors which were significant during the pandemic were also associated with the symptoms of depression and anxiety among healthcare workers in the post-pandemic era of COVID-19. These results provide scientific evidence for psychological interventions for healthcare workers.

Reduction in COVID-19 related resource loss and decline in prevalence of probable depression in Chinese adults: an application of the Conservation of Resource Theory

BackgroundThe levels of resource losses due to coronavirus disease 2019 (COVID-19) and mental distress may change during the pandemic period. Based on the Conservation of Resource (COR) Theory, this study investigated such changes and the mediation between survey time (Round 2 versus Round 1) and depression via resource losses.MethodsTwo serial random population-based telephone surveys interviewed 209 and 458 Hong Kong Chinese adults in April 2020 and May 2021, respectively. Probable depression was defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10. The validated Conservation of Resources Scale for COVID-19 (CORS-COVID-19) scale was used to assess resource losses due to COVID-19. Multivariable logistic regression analysis, hierarchical logistic regression analysis, and structural equation modeling (SEM) was conducted to test the association, interaction, and mediation hypotheses, respectively.ResultsThe prevalence of probable depression declined from 8.6% to 1.0% over time, together with reductions in losses of financial resource (Cohen’s d = 0.88), future control (Cohen’s d = 0.39), social resource (Cohen’s d = 0.60), and family resource (Cohen’s d = 0.36) due to COVID-19. All the overall scale/subscales of the CORS-COVID-19 were positively and associated with probable depression [adjusted odds ratio (aOR) ranged from 2.72 to 42.30]. In SEM, the survey time was negatively associated with the latent variable of resource loss (β = − 0.46), which in turn was positively associated with probable depression (β = 0.73). In addition, the direct effect of survey time on probable depression was statistically non-significant (β = − 0.08), indicating a full mediation effect of resource losses.ConclusionsThe lessening of the resource losses might have fully accounted for the significant decline in probable depression from Month 3 to 15 since the first COVID-19 outbreak in Hong Kong, China. The level of depression might have increased during the first phase of the pandemic, but might decline in the later phases if resources losses could be lessened. All stakeholders should hence work together to minimize individuals’ COVID-19-related resource losses to prevent depression in the general population, as COVID-19 might be lasting.

Association between childhood trauma and white matter deficits in first-episode schizophrenia

ObjectiveThis study aimed to investigate the relationship between childhood trauma (ChT) and white matter (WM) deficits in first-episode schizophrenia (FES). MethodsA total of 103 individuals with FES and 206 healthy control individuals (HCs) were enrolled and assessed based on ChT Questionnaire (CTQ) and Positive and Negative Symptoms Scale (PANSS). Diffusion tensor imaging was acquired on a Signa 3.0 T scanner. Map of fractional anisotropy (FA) was analyzed using Tract-Based Spatial Statistics. Hierarchical logistic regression analyses were used to examine associations of sociodemographic characteristics, total CTQ scores, and WM deficits. ResultsCompared with the HCs group, the FES group showed significantly lower FA in several WM bundles (left anterior thalamic radiation, left inferior frontal-occipital fasciculus, left cingulum, forceps major, and forceps minor), and the mean FA value in these WM bundles was inversely related to the total CTQ score. In addition, a higher CTQ score may increase the risk of schizophrenia, while higher FA values may decrease the risk of schizophrenia. ConclusionThis study demonstrates that individuals with FES evince widespread cerebral WM abnormalities and that these abnormalities were associated with ChT. These results provide clues about the neural basis and potential biomarkers of schizophrenia.

The association of pet ownership and sleep quality and sleep disorders in United States adults

Abstract Prior studies on the association between pet ownership and sleep quality and sleep disorders have varied results. Pet ownership may be beneficial for an owner’s quality of sleep due to the social support that pets provide. Pets offer a sense of security and companionship, which may result in improvements in levels of anxiety, stress, and depression. Alternatively, pets may disrupt their owners’ sleep. Therefore, this cross-sectional study aimed to determine if there is an association between dog and cat ownership and sleep quality and sleep disorders using data from the National Health and Nutrition Examination Survey (NHANES) conducted in 2005–2006. Separate multivariable logistic regression models were built to assess the association between pet ownership and sleep quality outcomes, which included the following: snoring, snorting, sleep disorder diagnoses, trouble sleeping, trouble falling asleep, waking up during the night, waking up too early, feeling unrested, feeling sleepy, not getting enough sleep, needing pills to sleep, leg jerks and cramps, taking longer than 15 minutes to fall asleep, and getting less than 6 hours of sleep on average. Demographics and body mass index (BMI) were adjusted in a series of hierarchical logistic regression analyses. Our results indicated that having a dog was associated with greater odds of having a sleep disorder and having trouble sleeping. Having a cat was associated with greater odds of having leg jerks. While the causal nature of pet ownership on sleep quality and sleep disorders was unable to be established, the results of this study are consistent with previous studies that found that pet ownership has a negative impact on sleep quality. The results of this study can inform randomized controlled trials for patients with poor sleep quality.

Psychological and somatic manifestations of dissociation: The role of childhood trauma, attachment, and alexithymia

ObjectivesDissociation refers to disrupted integration of conscious awareness, emotions, memories, body representation, and motor control (American Psychiatric Association [APA], 2013). Despite the burden of unexplained somatic symptoms on individuals, and on healthcare providers, research to date has focused on the use of the Dissociative Experiences Questionnaire (DES-II) which measures the psychological components of dissociation, with measures of somatic manifestations of dissociation, such as the Somatoform Dissociation Questionnaire (SDQ-20) often being overlooked. The aim of the current study was to examine how attachment, alexithymia and childhood trauma relate to symptoms of psychoform and somatoform dissociation based on self-report measures. Additionally, the study sought to examine the mediating role of self-reported attachment-style and alexithymia in the relationship between childhood trauma and dissociation. MethodsA cross-sectional survey of 220 adults in the general population, aged 18 – 76, was carried out. Participants completed a number of self-report measures online. Hierarchical logistic regression and mediation analyses were conducted. ResultsResults indicated that the difficulty identifying feelings component of alexithymia significantly predicted an increased likelihood of scoring above the clinical cut-off for somatoform dissociation. Difficulty identifying feelings also partially mediated the relationship between physical neglect and somatoform dissociation scores. Avoidant attachment style and difficulty identifying feelings significantly predicted an increased likelihood of scoring above the clinical cut-off for psychoform dissociation. Both avoidant attachment style and difficulty identifying feelings partially mediated the relationship between emotional abuse and psychoform dissociation scores. ConclusionThe findings of the current study suggest that it may be of relevance to consider the role of both traumatic experiences and dissociative processes in persistent somatic presentations. Findings also suggest that treatments which support emotional awareness and are informed by attachment theory may relevant for those that self-report debilitating somatic symptoms

Level of Psychological and Somatic Symptoms Predict Perimenopausal Syndrome Severity Better Than Obstetric and Psychiatric History Do Among Korean Women.

Menopause symptoms can vary in type, duration, and severity. The purpose of this study was to investigate the key factors predicting severe symptoms among Korean perimenopausal women with various demographic data, obstetric and psychiatric histories, and menopausal symptoms screening scale scores. Data were collected from 1,060 women, and 4 latent classes were identified using latent profile analysis, with 6 major categories of menopausal complaints. Among the 4 classes, we selectively used data from the "all unimpaired" and "all impaired" groups. Menopause rating scale (MRS), sociodemographic, obstetric, and psychiatric factors were assessed, and hierarchical logistic regression analyses were conducted with the "all impaired" group as a dependent variable. Marital status and scores on the psychological and somatic subscales of the MRS were statistically related to being in the "all impaired" group. Otherwise, family history of menopausal symptoms, menarche age, and history of other psychiatric disorders were not statistically significant predictors of being in the "all impaired" group. The psychological and somatic subscales of the MRS predict the severity of perimenopausal syndrome better than obstetric and psychiatric history do among Korean perimenopausal women. Psychological and somatic symptoms as well as genitourinary symptoms in menopausal patients should be closely evaluated.

Development and Validation of the Cognitive Attentional Syndrome Scale 1 Revised–Japanese Version1

AbstractThe Cognitive Attentional Syndrome Scale 1 Revised (CAS‐1R) is a 10‐item self‐report measure designed to assess dysfunctional metacognition, a transdiagnostic predictor of psychological disorders (e.g., generalized anxiety disorder, major depression disorder). Dysfunctional metacognition is classified into “cognitive attentional syndrome” and “metacognitive beliefs,” and the latter in turn into negative and positive beliefs. We translated the CAS‐1R into Japanese (CAS‐1R‐J) and examined its reliability and validity in a Japanese community sample. We recruited 552 participants via the Internet and received responses from 552 individuals (Time 1) and 112 individuals (Time 2). Of these, the data of 87 individuals were used to examine test–retest reliability. Confirmatory factor analysis indicated that the factor structure (three‐factor model) of the CAS‐1R‐J was appropriate. Each subscale showed good internal consistency. Hierarchical logistic regression analysis showed discriminant and incremental validity for anxiety and depressive symptoms, meaning the CAS‐1R‐J is valid to assess state cognitive attentional syndrome and metacognitive beliefs among Japanese individuals.

Analyzing Factors Enabling Prostate Cancer Screening Behaviors Among African American Males in the South Region Using the Andersen's Behavioral Model of Healthcare Services Utilization.

Prostate cancer is the second leading cause of cancer death among men in the United States, and African American men especially represent a high risk population for prostate cancer. Although the overall prostate cancer incidence rates have been declining since 1992, the average annual prostate cancer incidence rates among African American men were still higher than any other racial groups, and the mortality rates were 2.1 times higher than that of Caucasian men. This study examined what factors including cultural mistrust were related with the prostate cancer screening behaviors among African American males in the South East region. Out of 496 prostate educational seminar attendees, 304 volunteers completed the survey about the behaviors of prostate cancer, cultural mistrust for health providers and general health beliefs and health behaviors. Using Anderson's Behavioral Model of Health Services Use, hierarchical multivariate logistic regression analysis was conducted to identify which predisposing, enabling, and need factors could predict prostate cancer screening behaviors and whether there was any interaction effects among these predictors. Findings revealed that annual household income and annual health check-up were significantly related with the prostate cancer screening behaviors while the effect of health insurance was diminished among older African American males. Overall, results highlight the importance of financial resources as a determinant of prostate cancer screening behaviors among African American males implying the need of substantial support to overcome the obstacles from financial adversity.

Prevalence and correlates of subjective cognitive concerns in Australian university students during the COVID-19 pandemic.

Coronavirus (COVID-19) instigated unprecedented global effects on healthcare systems, economies, employment, education, travel, and social lives. In addition to increased mental health challenges, pandemic restrictions have triggered emerging cognitive concerns. University students are at particularly high risk of adverse lockdown-related effects, yet despite the substantial adaptions to learning necessitated by COVID-19, limited research has so far focused on the cognitive consequences of the pandemic among university students. This study aimed to comprehensively examine the nature, prevalence, and correlates of subjective cognitive concerns among 972 students (Median age = 22 years, 70% female) enrolled at Monash University, Australia, in December 2020. Students completed the online THRIVE@Monash survey, 5 weeks following prolonged lockdown in Melbourne. Using group comparisons and hierarchical binary logistic regression analyses, we examined associations between demographic and enrolment characteristics, COVID-19-related experiences and impacts (author-developed questions), self-reported anxiety and depression symptoms (PROMIS Anxiety and Depression scales), and students' perceived changes in everyday cognitive functions (author-developed questions). Over 60% of students reported subjective cognitive concerns (SCCs). After controlling for anxiety and depression symptoms, students reporting more SCCs were more likely to be younger, from White/European ethnic backgrounds, and in their first year of undergraduate study. No differences in SCCs were found between male and female students. Greater worry, anxiety, or stress related to COVID-19 (e.g., infection, leaving the house, hygiene and exposure prevention, impact on physical and mental health), and time spent reading or talking about COVID-19, were generally not associated with SCCs after controlling for anxiety and depression symptoms. These findings highlight vulnerable subgroups of students who might benefit from regular monitoring, education, and interventions to support their cognitive health during the pandemic and beyond. In addition, cognitive concerns may provide additional insight into mental health problems among students, and emphasize the importance of understanding factors that impact students' long-term academic and career success.

Sleep disturbance and psychotic-like experiences among urban adolescents with and without parental migration.

Sleep disturbance was closely associated with an increased risk of psychotic-like experiences (PLEs). This study aims to explore the association between sleep disturbance and PLEs among urban adolescents with and without parental migration. A total of 67, 532 urban Chinese adolescents were recruited in a large web-based survey during April 21st to May 12th, 2021. In our study, sleep disturbance, PLEs, family function, school climate, and a series of socio-demographic were assessed. And hierarchical logistic regression analyses were performed to examine influential factors associated with PLEs. Urban left-behind children (LBC) had a higher prevalence of sleep disturbance and PLEs than non-LBC. After controlling for confounders, parental migration was associated to PLEs with weak significance (OR = 1.19). Meanwhile, sleep disturbance was found to be a robust risk factor for PLEs (OR = 3.84 and 4.09), with or without the effect of parental migration. In addition, better family function and school climate has significant association with decreased risk of PLEs. Adolescents with sleep disturbance are more likely to report PLEs. Adolescents' PLEs preventive strategies could focus on reducing sleep disturbance related symptoms as well as improving family function and school climate.

Reduced upper and lower limb muscle strengths without reduced skeletal muscle in elderly patients with heart failure.

Objective: This study aimed to characterize the muscle strength and skeletal muscle mass of patients with heart failure by investigating hand-grip strength, five times sit-to-stand (5STS) results, and skeletal muscle mass index (SMI). Materials and Methods: Muscle strength was assessed based on hand-grip strength and 5STS, while skeletal muscle mass was assessed using a bioelectrical impedance analyzer. Hierarchical logistic regression analysis was performed to explore the association between patients with heart failure and healthy elderly individuals. Results: Hierarchical logistic regression analysis was performed to examine the muscle strength and skeletal muscle mass characteristics in patients with heart failure. Hand-grip strength and 5STS responses but not SMI outcomes differed significantly between the two groups. The results of the hierarchical logistic regression analysis revealed that the hand-grip strength and 5STS were significant predictors of heart failure. The odds ratios for hand-grip strength and 5STS were 1.44 and 0.53, respectively. Conclusion: Our results suggested that upper and lower limb muscle strengths (handgrip strength and 5STS) in elderly patients with heart failure worsened significantly without a decrease in skeletal muscle mass.

Factors Influencing the COVID-19 Vaccination Intentions in Parents for Their Children Aged 5~11: Korea, April 2022

This study aimed to investigate COVID-19 vaccination intentions in Korean parents for their children aged 5 to 11 years and the factors influencing them. A cross-sectional online survey of 363 parents of children aged 5 to 11 years was conducted in Korea in April 2022. Data were analyzed using independent t-test, χ²-test, Fisher's exact test, and hierarchical logistic regression analysis using SPSS/WIN 26.0 and MedCalc software version 20.113. Of 363 Korean parents with children aged 5 to 11, 42.4% intended to vaccinate their children. Significant factors influencing vaccination intention were the second or third birth order of children (OR = 3.45, 95% CI = 1.45~8.21), vaccine hesitancy-confidence (OR = 2.00, 95% CI = 1.51~2.65), vaccine hesitancy-collective responsibility (OR = 1.57, 95% CI: 1.10~2.25), and COVID-19 anxiety-avoidance (OR = 1.55, 95% CI = 1.13~2.11). Findings suggest that COVID-19 vaccine campaigns based on reliable information and evidence from health authorities are needed to increase COVID-19 vaccination. Well-designed health communications for the target population may help to increase parental vaccine acceptance.

Determining the factors for individual credit approval by applying logistic regression and hierarchical logistic regression

There has been a rapid increase in applications made to lending institutions due to the inadequacy of individuals' savings to meet their growing demands and needs. However, specific criteria are expected from individuals for the approval of these applications. Various methods have been developed to accurately determine these criteria and facilitate the loan approval process efficiently and promptly. Despite being the most used method, binary logistic regression has its limitations. These include the simultaneous inclusion of all variables in the analysis, the oversight of control variables that could be determined by decision-makers, and the evaluation of each event within the group of the same variables. In an attempt to address these limitations, hierarchical logistic regression analysis was performed alongside binary logistic regression analysis. The study incorporated variables indicating individual characteristics, such as age, socio-demographic characteristics like occupation and account status, and loan attributes, including duration and installment rate. The study obtained 1000 loan applicants, and the models were evaluated based on the goodness of fit results and the explanatory power of the models. Although the study produced similar results in determining the influential variables and evaluating the models, it highlighted that hierarchical logistic regression provides more flexibility to decision-makers by allowing the evaluation of nested models formed by sub-variable groups separately. This approach can offer valuable insights to decision-makers in lending institutions, as it allows for the separate evaluation of various sub-variable groups, contributing to a comprehensive understanding of the key determinants of loan approval. By prioritizing specific variables or groups of variables, this methodology facilitates a more comprehensive analysis of the complex relationships between different factors, leading to more informed and data-driven decision-making. It is crucial, however, to ensure the appropriate application of the methodology and the continuous validation and testing of the hierarchical logistic regression models with new datasets to maintain their effectiveness and relevance in the dynamic lending landscape.

Life Satisfaction in a Clinical and a Nonclinical Group of Older People: The Role of Self-Compassion and Social Support.

Despite the health-promoting role of life satisfaction, little is known about its determining factors in older people with mental health problems compared to nonclinical participants. This study provides preliminary data into the role of social support, self-compassion, and meaning in life on older people's life satisfaction within both clinical and non-clinical populations. In total, 153 older adults (age ≥60) completed the Satisfaction With Life Scale (SWLS), the Self-Compassion Scale (SCS), the Meaning in Life Questionnaire (MLQ), and questions for relational variables. Hierarchical logistic regression analysis revealed that determinants of life satisfaction were self-kindness (B = 2.036, p = .001) and intimate friends' network (B = 2.725, p = .021), while family relationships were found to be significant among the clinical group (B = 4.556, p = .024). Findings are discussed in relation to incorporating self-kindness and rapport with family in clinical work with older adults to better promote their well-being.

The Study on the Identification of Musical Passages for an Emotion Perception Scale for People With Developmental Disabilities.

Emotion recognition is essential to the social adjustment and social interaction of people with intellectual and developmental disabilities (IDDs). Given that music is a medium for expressing and conveying human emotion, we conducted this preliminary study to identify musical passages representing the basic human emotions of happiness, sadness, and anger, with the goal of developing a music-based emotion perception scale for IDDs. To identify musical passages for emotion perception, 20 certified music therapists evaluated 100 selected musical passages and established 60 pieces that yielded the highest agreement for each emotion category. During the second phase of this study, 300 neurotypical participants rated 60 passages in terms of the perceived type and intensity of emotions expressed. The 60 passages showed high reliability and were statistically classified into three factors: happiness, sadness, and anger. The k-means cluster analysis yielded a cut-off score of 41 for the low emotion perception group (F = 1120.63, P < 0.001). The hierarchical logistic regression analysis revealed that only model 3 (musical passages) was significantly associated with low emotion perception (step χ² = 227.8, P < 0.001). The selected musical passages demonstrated high reliability and established three factors for identifying perceptions of happiness, sadness, and anger. Neither psychological status nor individual demographic characteristics affected the emotion perception results.

Association between Fathers' and Mothers' Parenting Styles and the Risk of Overweight/Obesity among Adolescents in San José Province, Costa Rica.

Parenting styles are a risk factor for adolescents overweight/obesity worldwide, but this association is not well understood in the context of Latin America. This study examines the association between the parenting styles of mothers and fathers and the risk of overweight/obesity among Costa Rican adolescents. Data are cross-sectional from a sample of adolescents (13-18 years old) enrolled in ten urban and eight rural schools (n = 18) in the province of San José, Costa Rica, in 2017. Hierarchical logistic regression analyses were performed to assess the likelihood of adolescents being overweight according to the mothers' and fathers' parenting styles. A significant association was found between the risk of adolescent overweight/obesity and the paternal authoritarian style only in rural areas (B = 0.622, SE = 0.317, Wald = 3.864, ExpB = 1.863, p = 0.04), and between said risk and the paternal permissive style only in male adolescents (B = 0.901, SE = 0.435, Wald = 4.286, ExpB = 2.461, p = 0.038). For maternal parenting styles, no associations reached significant levels once logistic regression models were adjusted for the fathers' parenting styles. These findings underscore the importance of further studying the role of fathers' paternal parenting styles on Latin American adolescent weight outcomes. Expanding our understanding of the parenting styles of fathers has important implications for the design and implementation of culturally- and gender-appropriate family interventions.

Implementation of minimally invasive Ivor Lewis esophagectomy: learning curve of a single high-volume center.

Open esophagectomy is considered to be the main surgical procedure in the world for esophageal cancer treatment. Implementing a new surgical technique is associated with learning curve morbidity. The objective of this study is to determine the learning curve based on anastomotic leakage (AL) after implementing minimally invasive Ivor Lewis esophagectomy (MI-ILE) in January 2015. All 257 patients who underwent MI-ILE in a single high-volume center between January 2015 and December 2020 were retrospectively included in this study. The learning curve was evaluated using the standard CUSUM analysis with an expected AL rate of 11%. Secondary outcome parameters were postoperative complications, textbook outcome, and lymph node yield divided by the year of operation. Hierarchical binary logistic regression analysis was used to check for potential confounding variables. The CUSUM analysis showed a learning curve of 179 cases. The mean AL rate decreased from 33.3% in 2015 to 9.5% in 2020 (P = 0.007). There was an increase in the mean lymph node yield from 21 in 2018 to 28 in 2019 (P < 0.001) and textbook outcome from 37.3% in 2015 to 66.7% in 2020 (P = 0.005). A newly implemented MI-ILE has a learning curve of 179 patients based on a reference AL rate of 11% using the CUSUM method. Whether future generation surgeons will show similar learning curve numbers, implicating continuous development of different introduction programs of new techniques, will have to be the focus of future research.

The role of openness and cultural intelligence in students' intention to study abroad

PurposeHigher education performance is boosted through cross-border cooperation and increased transnational mobility of students. In addition, exchange students have better employability skills after staying abroad compared to the students' peers. A number of studies have investigated factors that determine whether a student studies abroad. In this study, the authors focused on the role of personality trait openness to experience and cultural intelligence (CI) in explaining Croatian students' experience with and/or intention to travel abroad for studying purposes.Design/methodology/approachThe authors analyzed results from 482 students (M = 22.61, standard deviation (SD) = 2.24, 66% female), of whom 35% reported that they studied abroad or intended to study abroad. They filled in The Cultural Intelligence Scale and openness facets items from the International Personality Item Pool (IPIP-300) questionnaire.FindingsThe authors conducted a hierarchical binary logistic regression analysis and found that students who were younger, had higher adventurousness and higher motivational CI were more likely to study abroad. Results of the mediation analysis showed that the association between openness to experience facet adventurousness and intention to study abroad was partially mediated by the motivational aspect of CI.Originality/valueThis study contributes to the better understanding of complex interrelations between personality traits and CI in the context of higher education internationalization processes. This study offers unique insight into the mediating role CI has in the association between personality and mobility behavior.

Prevalence of eviction, home foreclosure, and homelessness among low-income US veterans: the National Veteran Homeless and Other Poverty Experiences study

ObjectivesHousing stability is essential for health and social well-being, and the United States is focused on preventing homelessness among veterans, so this study examined the prevalence of different events related to housing instability among low-income US veterans. Study designThis was a nationally representative survey. MethodsUsing a sample of 1004 low-income veterans in 2021, this study examined the lifetime prevalence and characteristics associated with eviction, home foreclosure, and homelessness among low-income US veterans. ResultsIn the total sample, 10.9% reported a lifetime history of eviction, 8.0% reported a lifetime history of home foreclosure, and 19.9% reported a lifetime history of homelessness. Among those with a history of homelessness, 39.2% also reported a history of eviction, and 13.9% reported a history of home foreclosure. Hierarchical logistic regression analyses found that for eviction, sociodemographic characteristics (e.g. being Hispanic, having private insurance, and being from the Northeast was associated with lower risk of eviction) together explained 26% of the variance, and clinical characteristics explained an incremental 12% additional variance. For homelessness, sociodemographic characteristics explained 18% of the variance, and clinical characteristics explained an incremental 20% (e.g. diagnosis of schizophrenia or bipolar disorder, any history of suicide attempt, and lower physical health scores were associated with higher risk of homelessness). For home foreclosure, sociodemographic, clinical, and psychosocial variables together only explained 14% of the variance. ConclusionEvictions, home foreclosures, and homelessness are discrete events and occur at relatively high rates among low-income veterans. In addition, homelessness was more associated with biosocial dysfunction, whereas eviction was more closely associated with socio-economic vulnerability, which may inform intervention efforts for both events.