Hierarchical Multivariate Regression Analysis Research Articles

Mono- and poly-therapy with benzodiazepines or Z-drugs: Results from a tertiary-care Addiction Unit study.

Using benzodiazepines (BZDs) or Z-drugs in poly-therapy is a critical issue. Identifying factors influencing the use of BZDs/Z-drugs in poly- vs mono-therapy in patients with or without substance use disorders (SUDs). 986 inpatients were analysed. Socio-demographic and clinical variables were collected. BZD/Z-drug doses were compared via the Defined Daily Dose (DDD) and standardized as diazepam dose equivalents. Mann-Whitney, Chi-square, Fisher test, hierarchical multivariate regression analyses were run referring to the whole sample and to subjects with current SUDs, lifetime SUDs, current and lifetime SUDs, non-SUDs. In the whole sample the variance of being mono- vs poly-therapy users was explained by BZD/Z-drug formulation, DDD, duration of treatment, age of first BZDs/Z-drugs use (ΔR2 =0.141, p <0.001). Among those with current SUDs (ΔR2 =0.278, p =0.332) or current and lifetime SUDs (ΔR2 =0.154, p =0.419), no variables explained the variance of being mono-vs poly-therapy users. Among lifetime SUDs subjects, the variance of being mono- vs poly-therapy users was explained by BZD/Z-drug formulation and age of first BZD/Z-drug use (ΔR2 =0.275, p <0.001). Among non-SUDs subjects, the variance of being mono- vs poly-therapy users was explained by DDD and duration of treatment (ΔR2 =0.162, p =0.001). Tablets, high drug doses, long duration of treatment, and early age of first use were more likely associated to poly- than mono-therapy. This suggests that patients have different clinical features and a pharmacological prescription should be tailored to them also based on the variables here analysed.

The Performance Impact of New Ventures in Working Environment and Innovation Behavior From the Perspective of Personality Psychology.

A new venture barely makes a profit in its initial stage, and its success depends on innovation. Innovation is related to the work environment, and the innovation behavior of employees is of great significance to the performance improvement of new venture. Based on the previous research, in this study, hypotheses on the correlation between work environment, employee innovation behavior, and corporate performance are put forward first. Then, with team cooperation, organizational incentive, leadership support, sufficient resources, and work pressure as the factors of the work environment, the bosses, middle and senior managers involved in entrepreneurship, and the main members of the entrepreneurial team of 202 newly established enterprises in developed regions are surveyed online or in scene. Multivariate hierarchical regression analysis is performed to analyze the data collected from the questionnaire. The results show that the effective recovery rate of the questionnaire is 86.4%; the number of traditional enterprises is 108 (53.47%), and that of R&D enterprises is 68 (33.66%); teamwork, leadership support, and work pressure are all correlated with employees’ innovative behavior (P < 0.05), while organizational motivation and sufficient resources are not correlated with employees’ innovative behavior (P > 0.05); employee innovation behavior is positively correlated with enterprise performance (β = 0.375, P ≤ 0.01); the working environment and employee innovation behavior promote enterprise performance (β = 0.433, P ≤ 0.01); and the working environment affects the relationship between employee innovation behavior and enterprise performance (β = 0.399, P ≤ 0.05). The study theoretically enriches the research on the relationship between innovation behavior, work environment, and enterprise performance of new ventures. In practice, it is suggested that start-up enterprises provide good working environment for employees and attach importance to innovation activities at the individual level of employees, which provides useful guidance and reference for the development of Chinese start-up enterprises.

From Green Spaces to Squares: Mapping the Distribution of Taijiquan Organizations in London.

Contributing to Taijiquan studies, this research uses spatial analysis tools in ArcGIS 10.3 and SPSS 23.0 to map out the spatial distributional pattern of the Taijiquan organizations in London, and then explores factors attributing to the spatial distribution of Taijiquan culture. The result shows that the distribution of Taijiquan organizations in London generally presents a spatial distribution structure of “dense center + sparse periphery”; the spatial distribution is unbalanced, showing a cohesive distribution; the directional distribution tends to be obvious in areas that are proximate to urban traffic arteries and afforestation in London. Through multivariate hierarchical regression analysis, the study explores the influential factors for the spatial distribution of Taijiquan organizations in London. The results show that: population size, economic level, and education level have little influence on the spatial distribution of Taijiquan organizations; however, the population density of people over 65 years old, the accessibility of public service facilities such as green spaces, and public urban traffic has a significant impact on the spatial distribution of Taijiquan organizations.

Comparison of the work ability index and the work ability score for predicting health-related quality of life.

To compare the relationship of the 7-item Work Ability Index (WAI) and the single-item Work Ability Score (WAS) with individual and work-related factors, and to investigate the predictive role of these two work ability assessments for health-related quality of life (HRQOL). This is a cross-sectional study. 407 of 445 employees working on a construction project in Shiraz, Iran consented to participate in an anonymous survey. 381 surveys were returned completed. Correlation analyses were used to evaluate relationships between WAI and WAS, and the total score and four domains of the WHOQOL-BREF, our measure of HRQOL, and individual and work-related variables. Hierarchical multivariate linear regression analyses were performed to compare WAI and WAS in predicting HRQOL and its four dimensions. WAI and WAS were both significant predictors of HRQOL and its four dimensions and the explained variance was very similar. The WAI and WAS explained 46% and 44% of the variance related to the HRQOL, respectively. WAI and WAS explained 36-38% and 35-37% of the variance related to dimensions of the HRQOL, respectively. There were significant relationships of both WAS and WAI with job type, work schedule, smoking, and exercise habit. The WAS and WAI showed a very similar relationship with participants' individual and work-related factors and HRQOL. The Work Ability Score is a valid and suitable measure for assessment of work ability among Iranian workers. Use of this simple measure could be advantageous to reduce demands on research participants and in workability assessments.

Is Higher Subjective Fear Predictive of Post-Traumatic Stress Symptoms in a Sample of the Chinese General Public?

Background: COVID-19 has taken a huge toll on medical resources and the economy and will inevitably have an impact on public mental health. Post-traumatic stress disorder (PTSD), as the most common mental illness after an epidemic, must be seriously addressed. This study aimed to investigate the subjective fear of the Chinese general public during COVID-19 and to explore how it affected the development of PTSD.Methods: An online questionnaire survey was conducted among 1,009 people from January 30 to February 14, 2020 (about 1 month after the COVID-19 outbreak). The subjective fear was measured by a self-reported single-choice question. Four items from the Pittsburgh Sleep Quality Index (PSQI) were selected to measure the subjects' sleep quality. Their post-traumatic stress symptoms (PTSS) were measured by the PTSD Checklist for DSM-5 (PCL-5). Pearson correlation, hierarchical multivariate regression analysis, multiple mediator model, and bootstrapping were used in statistical analyses.Results: Different people showed different levels of subjective fear in response to the outbreak. There was a significant positive correlation between subjective fear and the total score of PCL-5 (R = 0.513, P < 0.01), meaning that the higher the degree of subjective fear, the more severe the symptoms of post-traumatic stress are. Subjective fear was an important predictor of PTSS, accounting for 24.3% of the variance. The total effect of subjective fear on PCL-5 scores was significant (total effect = 7.426, SE = 0.405, 95% CI = 6.631–8.221). The total indirect effect of subjective fear on PCL-5 scores through sleep quality was also significant (total indirect effect = 1.945, SE = 0.258, 95% CI = 1.436–2.470).Conclusions: Subjective fear has an important predictive effect on PTSS. In addition to the direct effect, our findings firstly demonstrate the mediating role of sleep quality in the relationship between subjective fear and PTSS.

Associations of severity of liver damages with physical function and prognosis in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, which adversely affects prognosis. However, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. Purpose We evaluated the associations of severity of liver damage and physical function and prognosis in patients with HF. Methods The study population consisted of 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-minute walking distance [6MWD]). The associations between MELD-XI score and physical function were assessed by multivariate linear regression model analysis. Moreover, we investigated the prognostic value of coexistence of liver dysfunction and physical dysfunction. The endpoint was all-cause mortality. Results After adjusting for covariates, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (P &amp;lt; 0.001). In addition, hierarchical multivariate linear regression analysis revealed that adding MELD-XI scores or BNP explained additional variance in the physical function measures. The MELD-XI score added to the clinical model was significantly more predictive of physical function (grip strength, change in F: 27.105, P &amp;lt; 0.001; leg strength, change in F: 33.980, P &amp;lt; 0.001; gait speed, change in F: 22.826, P &amp;lt; 0.001; 6MWD, change in F: 59.193, P &amp;lt; 0.001) than BNP added to the clinical model. Eighty-six deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62 – 3.04). Patients with high MELD-XI score and reduced physical function were found to have significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR] = 3.80 [95% confidence interval (CI) = 2.04 – 7.08], P &amp;lt; 0.001; leg strength, HR = 4.65 [95% CI = 2.47 - 8.75], P &amp;lt; 0.001 and gait speed, HR = 2.49 [95% CI = 1.43 - 4.33], P = 0.001; 6MWD, HR = 5.48 [95% CI = 2.88 - 10.41], P &amp;lt; 0.001). Conclusions Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF. Abstract Figure. Kaplan–Meier survival curves

Analysis of Ovarian Injury Associated With COVID-19 Disease in Reproductive-Aged Women in Wuhan, China: An Observational Study

Objective: This study was intended to investigate the relationship between COVID-19 disease and ovarian function in reproductive-aged women.Methods: Female COVID-19 patients of reproductive age were recruited between January 28 and March 8, 2020 from Tongji Hospital in Wuhan. Their baseline and clinical characteristics, as well as menstrual conditions, were recorded. Differentials in ovarian reserve markers and sex hormones (including anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], the ratio of FSH to luteinizing hormone [LH], estradiol [E2], progesterone [P], testosterone [T], and prolactin [PRL] were compared to those of healthy women who were randomly selected and individually matched for age, region, and menstrual status. Uni- and multi-variable hierarchical linear regression analyses were performed to identify risk factors associated with ovarian function in COVID-19 women.Results: Seventy eight patients agreed to be tested for serum hormone, of whom 17 (21.79%) were diagnosed as the severe group and 39 (50%) were in the basal level group. Menstrual status (P = 0.55), menstrual volumes (P = 0.066), phase of menstrual cycle (P = 0.58), and dysmenorrhea history (P = 0.12) were similar without significant differences between non-severe and severe COVID-19 women. Significant lower serum AMH level/proportion (0.19/0.28 vs. 1.12 ng/ml, P = 0.003/0.027; AMH ≤ 1.1 ng/ml: 75/70.4 vs. 49.7%, P = 0.009/0.004), higher serum T (0.38/0.39 vs. 0.22 ng/ml, P < 0.001/0.001) and PRL (25.43/24.10 vs. 12.12 ng/ml, P < 0.001/0.001) levels were observed in basal level and the all-COVID-19 group compared with healthy age-matched control. When adjusted for age, menstrual status and parity variations in multivariate hierarchical linear regression analysis, COVID-19 disease was significantly associated with serum AMH (β = −0.191; 95% CI: −1.177–0.327; P = 0.001), T (β = 0.411; 95% CI: 11.154–22.709; P < 0.001), and PRL (β = 0.497; 95% CI: 10.787–20.266; P < 0.001), suggesting an independent risk factor for ovarian function, which accounted for 3.2% of the decline in AMH, 14.3% of the increase in T, and 20.7% of the increase in PRL.Conclusion: Ovarian injury, including declined ovarian reserve and reproductive endocrine disorder, can be observed in women with COVID-19. More attention should be paid to their ovarian function under this pandemic, especially regarding reproductive-aged women.Clinical Trial Number: ChiCTR2000030015.

Contemporary Trends in Hospital Admissions and Outcomes in Patients With Critical Limb Ischemia: An Analysis From the National Inpatient Sample Database.

Critical limb ischemia (CLI) morbidity and mortality rates have historically been disproportionately higher than for other atherosclerotic diseases, however, recent trends have not been reported. In patients admitted with CLI, we aimed to examine trends in in-hospital mortality, major amputations, length of stay, and cost of hospitalizations overall and stratified by type of revascularization procedures. Using 2011 to 2017 National Inpatient Sample data, we identified CLI-related admissions based on International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification codes. Primary outcomes of interest were in-hospital mortality and major amputations. Secondary outcomes were the length of stay and cost of hospitalization. We stratified outcomes based on endovascular or open surgical interventions. We also performed hierarchical multivariable regression analyses of outcomes based on age, sex, race, hospital size, type, and location. We identified 2 643 087 CLI-related admissions between 2011 and 2017. CLI admissions increased from 0.9% to 1.4% Ptrend<0.0001 as well as overall peripheral artery disease admissions (4.5%-8.9%, Ptrend<0.0001). In-hospital mortality for the entire CLI cohort decreased from 3.3% to 2.7%, Ptrend<0.0001, and major amputations decreased from 10.9% to 7%, Ptrend<0.0001. A decline was also noted for the length of stay from 5.7 (3.1-10.1) to 5.4 (3.0-9.2) days (Ptrend<0.0001), whereas admission costs increased from USD $11 791 ($6676-$21 712) to $12 597 ($7248-$22 748; Ptrend<0.0001). Endovascular interventions increased (Ptrend<0.0001) against a decline in surgical interventions (Ptrend<0.0001). Black race, female sex, and age ≥60 years were associated with higher in-hospital mortality, whereas Black race, male sex, and age<60 years were associated with higher major amputations. A relatively small decrease in absolute numbers for mortality and major amputations were observed against a backdrop of increasing CLI admissions over recent years. Patients with CLI received more endovascular interventions than surgical interventions over time. However, admissions for endovascular interventions were characterized by higher risk patient profiles and a higher risk of major amputations as compared with surgical interventions.

The Effect of Social Media/Smartphone Addiction and Sleep Quality on Academic Success in Medical Faculty Students

Objective: The aim of this study was to evaluate the effects of smartphone / social media use and sleep related variables on academic achievement in pre-clinical medical students. Material and Methods: 226 students receiving pre-clinical medical education at the same institution were included in the study. All participants completed the Pittsburg Sleep Quality Index (PSQI), Social Media Addiction Scale - Adult Form (SMAS-AF), Smartphone Addiction Scale (SAS) and Personal Information Form prepared for the study. All participants were questioned Average Academic Marks (AAM). The participants were categorized as low / medium / high risk according to the scores of smartphone addiction scale. Results: According to the risk of smartphone addiction, the mean score of AAM of the group with low dependency risk was 71.8 ± 8, the mean score of AAM of the group with the middle risk dependency risk was 68.4 ± 8.77, and the mean score of AAM of the group with the high dependency risk was 67.4 ± 9.75. The mean scores of AAM of the low-risk group in terms of smartphone addiction were significantly higher than the high-risk group (p = 0.035). Similarly, when the total scores of the participants' social media addiction are examined; the average of the low-risk group was 40.4 ± 11.17, the average of the medium-risk group was 51.7 ± 9.2, and the average of the high-risk group was 50.8 ± 12.9. Social media addiction total scores of the high risk group in terms of smartphone addiction were significantly higher than the medium and low risk group (p <0.001). There was no significant difference between sleep times and PDQI total scores between groups. When the factors associated with AAM were analyzed by Pearson correlation analysis, a positive statistically significant relationship was detected with sleep efficiency (r = 0.19, p <0.001), while a significant negative correlation was observed with total SAS score and hours spent in bed (r = -23, p <0.001; r = -27, p <0.05, respectively). A multivariate hierarchical regression analysis model suggested that gender, sleep efficiency, SAS and SMASAF scores affected AAM. Conclusion: Use of social media / smartphone by medical students can affect sleep habits and academic success during the period of pre-clinical education. Inclusion of training on conscious use of social media and smartphone and emphasizing the importance of sleep habits in medical education have the potential to contribute to the development of better-equipped physicians.

Current status of depression among workers in a petrochemical enterprise in Liaoning Province, China and related influencing factors

Objective: To investigate the influencing factors for depression among workers in a petrochemical enterprise and the association of occupational stress and occupational environment with depression, and to provide a scientific basis for the improvement of mental health and the prevention and treatment of depression among workers in petrochemical enterprises. Methods: A cross-sectional study was performed in March 2018, and cluster sampling was used to select 1888 workers from a petrochemical enterprise in Liaoning Province, China for a questionnaire survey. A total of 1888 questionnaires were collected, among which there were 1521 usable questionnaires, with an effective recovery rate of 80.56%. The general status of the workers in this petrochemical enterprise was investigated, and Center for Epidemiologic Studies Depression Scale (CES-D) , Effort-Reward Imbalance (ERI) , and Perceived Work Environment (PWE) were used to evaluate depression, occupational stress, and occupational environment. Constituent ratio was used to describe the distribution of different demographic features, work conditions, and lifestyles among the workers in this petrochemical enterprise. One-way analysis of variance and the t-test were used to compare the scores of depressive tendency between the workers with different features. Pearson correlation analysis was used to investigate the correlation of occupational stress and occupational environment with depression. Multivariate hierarchical regression analysis was used to investigate the influencing factors for depression. Results: The score of depression tendency was 18.94±9.21 in the workers in this petrochemical enterprise, and the incidence rate of depression symptoms was 59.8% (909/1521) . The workers who were aged <35 years, lived alone or in widowhood, or had an income of ≤4000 yuan tended to have a high score of depression tendency. And ordinary workers, oil-refining workers, workers with night shift and non-fixed shift, and workers with a lack of physical exercise and low sleep quality tended to have a high score of depression tendency (P<0.05) . The dimensions of extrinsic and intrinsic efforts of occupational stress and severity of occupational environment were positively correlated with depression (r=0.254, 0.242, 0.274, P<0.01) . And the dimension of reward was negatively correlated with depression (r=-0.348, P<0.01) . The multivariate hierarchical regression analysis showed that occupational stress and occupational environment had a marked predictive effects on depression, with an explained variance of 18.4% and 12.1%, respectively. Conclusion: There is a high level of depression tendency among workers in petrochemical enterprises, and demographic features, work conditions, lifestyle, occupational stressors, and occupational environment factors are influencing factors for depression.

Circadian variation of in-hospital cardiac arrest

BackgroundOut of hospital cardiac arrests, especially those due to ventricular tachyarrhythmias, have higher incidence in the morning. It is unknown whether in-hospital cardiac arrests follow a similar pattern. Aim of the studyThe purpose of this study was to analyze the circadian variation of in-hospital cardiac arrest incidence. MethodsThis retrospective review of data from the multicenter Get With The Guidelines-Resuscitation registry between 2000 and 2014 used multivariable hierarchical logistic regression analysis to examine circadian rhythm of in-hospital cardiac arrest over a 24-h cycle, stratified by initial shockable versus non-shockable rhythm. ResultsAmong 154,038 patients, initial rhythm was recorded as asystole or pulseless electrical activity (non-shockable) in 124,918 (81%), and ventricular fibrillation or ventricular tachycardia (shockable) in 29,120 (19%). Among non-shockable events, the highest relative proportion occurred during 0400−0759 (17.9%), followed by 0000−0359 (17.1%). For shockable rhythms the greatest relative proportion occurred between 2000−2359 (17.0%), followed by 1200−1559 (16.9%). Multivariable analysis showed that the relative risk of non-shockable compared to shockable arrest was slightly higher from midnight through 0359 (aOR 1.13; 95% CI 1.06–1.20, p < 0.001) and from 0400 through 0759 h (aOR 1.14; 95% CI 1.07−1.22, p < 0.001). Although statistically significant, the magnitude of difference in incidence by time of day was small in both groups. ConclusionsAlthough small differences in the relative frequency of in-hospital cardiac arrest (both shockable and non-shockable rhythms) were noted during different time intervals, in-hospital cardiac arrest occurs with nearly equal frequency throughout the day. Our findings have important implications for hospital staffing models to ensure that quality of resuscitation care is consistent regardless of time.

Depressive symptoms and insecure attachment predict disability and quality of life in psoriasis independently from disease severity

Psoriasis is a multisystemic inflammatory disease with a significant burden in terms of disability and reduced quality of life. The interrelations between disease severity, psychological well-being, and disability and/or health-related quality of life (HRQOL) of psoriatic patients are not fully understood. The aim of the study was to assess the relative role of disease severity, depressive symptoms, and insecure attachment in predicting disability and HRQOL in 105 patients with psoriasis. Objective measures of disease severity included the Body Surface Area (BSA), the Psoriasis Area and Severity Index (PASI), and the Pain Visual Analog Scale (pain-VAS). The Sheehan Disability Scale (SDS). The Dermatology Life Quality Index (DLQI). Multivariate hierarchical regression analysis showed that a preoccupied style of attachment and the presence of depressive symptoms were predictors of disability and HRQOL over and above the contribution of demographic and clinical variables. The inclusion of attachment and depression into multivariate regression models improved substantially the prediction of disability and HRQOL. Conversely, the predictive utility of objective indicators of disease severity was scarce and only the pain-VAS emerged as a significant predictor of disability whereas there were no significant correlations between HRQOL and any of the objective indicators of disease severity. Measures capturing patients’ perspectives of the functional impact of disease should be routinely included in the clinical assessment of psoriasis.

Concurrent and Predictive Validity of the Depression Anxiety Stress Scale-21 in Multiple Sclerosis: A Cross-Sectional Study with Controlling the Confounding Factors

Background: The assessment of psychological symptoms in multiple sclerosis (MS) patients could play a key role in identifying the adverse effects of the disease. Objectives: This study aimed to assess the concurrent and predictive validity of the Depression Anxiety Stress Scale-21 (DASS-21) in patients with MS. Methods: In a cross‐sectional study in 2010, 162 patients were selected by a consecutive method. Depression Anxiety Stress Scales-21 (DASS-21), the Fatigue Severity Scale (FSS), and the Short-Form Health Survey (SF-36) Questionnaire were used in this study. Data were analyzed using Pearson’s correlation coefficient and multivariate hierarchical regression analyses. Results: The findings of the present study revealed that DASS-21 subscales have a strong correlation with the constructs of fatigue and SF-36 components (r = 0.29 to -0.71; P &lt; 0.01). In addition, each of the symptoms of depression, anxiety, and stress independently predicted a significant proportion of the variance in the scores on fatigue and eight aspects of health (P ≤ 0.006) even after controlling the confounding factors. Conclusions: The present study has highlighted the concurrent and predictive validity of DASS-21 in MS. Thus, this study suggests that therapeutic interventions for reducing psychological symptoms can lead to an improvement in different dimensions of health.

Factors associated with intimacy and sexuality among young women with multiple sclerosis

BackgroundPatients with multiple sclerosis (MS) especially those with younger age experience an alteration in physiological and emotional lifestyle that can affect intimacy and sexuality. The aim of this study was to determine demographic and disease related determinants of intimacy and sexuality in young women with MS.MethodsThis was a cross sectional study carried out in Tehran, Iran. A convenience sample of young women aged ≤35 years old with MS attending to outpatient clinics in a teaching hospital affiliated to Tehran University of Medical Sciences was entered into the study. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) was used to evaluate how the disease influences sexual function and satisfaction in these patients. Multivariable analysis using hierarchical method was performed to identify variables that are associated with intimacy and sexuality.ResultsIn total 117 young women with confirmed diagnosis of MS were included in the study. Participants mean was 25.7 (SD = 8.07) years. A multivariable hierarchical regression analysis was performed using demographic variables entered in step one, relevant neurological variables in step two, and psychological variables in step three. Furthermore, we loaded antidepressant use in the last step. Overall, the seven variables accounted for 39% of total variance observed for the MSISQ score (P < 0.001). At step one the demographic variables accounted for 13% of the variance in the MSISQ score (P < 0.001). At step two the inclusion of relevant neurological variables increased the R2 significantly and explained 27% of variance for the MSISQ (P < 0.001). However in the third step the inclusion of psychological factors increased R2 significantly (adjusted R2 increased to 0.39, P < 0.001).ConclusionsThe findings indicated that psychological, disease-related and demographic factors (education and employment status) contributed to intimacy and sexuality in young women with multiple sclerosis. Appropriate interventions, especially psychological interventions, appear to be essential immediately following a definite MS diagnosis in young women.

HIV stigma, resilience and depressive symptoms among older adults living with HIV in rural Namibia

In sub-Saharan Africa, HIV-positive older adults aged 50 years and older experience complex psychosocial issues in addition to dealing with their HIV status and the ageing process. This study focused on the association between HIV stigma, resilience, and depressive symptoms among 147 older adults from the Oshana and Ohangwena health facilities in rural Namibia. The study used the hierarchical multivariate regression analysis method to reveal that there was a positive association between HIV stigma (negative self-perceptions) and depression as well as a negative relationship between resilience and depression. In addition, being female and higher education were protective factors, and disclosure of HIV status was a risk factor to predict depressive symptoms among the target population. In order to reduce HIV stigma and enhance resilience among older adults living with HIV in Africa, this study suggests the need to develop evidence-based interventions to increase coping strategies and resilience.

Relationship between aerobic fitness, blood pressure and life satisfaction

Background: ‪The aim of this work was to examine the extent to which cardiorespiratory fitness, blood pressure, and optimism/pessimism predict adults’ satisfaction with life. Material and methods: ‪Sixty-eight adults seeking cardiovascular health screening in a private clinic were tested. Participants’ blood pressure, optimism/pessimism, and satisfaction with life were recorded. The YMCA cycle ergometer test was used for estimating participants’ aerobic fitness (VO2 max). Based on 140/90 mm Hg blood pressure cut-off value, participants were classified into two groups. Results: ‪A bootstrapped hierarchical multivariate regression analysis revealed that VO2 max, systolic blood pressure, optimism, and pessimism jointly accounted for 46% of the variance (R2 = 0.501, R2 adjusted = 0.462) in life satisfaction. Furthermore, a bootstrapped multivariate analysis of covariance indicated that Stage 2 hypertensives reported lower life satisfaction (p = 0.007) than the others with lower blood pressure readings. Conclusions: ‪This study is the first to reveal that almost half of the total variance in life satisfaction is accounted by cardiorespiratory fitness, systolic blood pressure, optimism, and pessimism. The present work also shows that individuals in Stage 2 hypertension are less satisfied with their lives than individuals with lower blood pressure values. These preliminary findings should stimulate both epidemiological and longitudinal research in the area.

Roditeljski nadzor, problemi u ponašanju i školsko postignuće beogradskih srednjoškolaca

Differences in student school achievement are associated with many factors, the most significant ones being: family, school, and personal characteristics of students. Social relations within the family, especially between parents and children, are often associated in the literature with various aspects of school adjustment and the level of student achievement. The aim of this research is to investigate the correlation between school achievement, parental monitoring and externalising behavioural problems of Belgrade high school students. The sample consists of 507 students aged 15 to 18, of both sexes. The data on externalising problems were collected using ASEBA YSR / 11-18, and on parental monitoring by using the Parental Monitoring Scale. The mid-term scores of high school students were taken as a criterion for school achievement. Hierarchical multivariate regression analysis showed that the examined variables explain 13.9% of the examined variance of school achievement, with the most significant effects were observed regarding age (b = 0.165) and self-disclosure (b = 0.210). The results of the research are indicative of the need for improving the cooperation between the family and the school.

Relationship Between Dispositional Mindfulness and Living Condition and the Well-Being of First-Year University Students in Japan.

The present study was conducted to examine how dispositional mindfulness and living conditions are related to well-being among first-year university students in Japan. Participants were 262 Japanese first-year students (156 females and 106 males; Mage = 18.77 years, SDage = 0.85). Dispositional mindfulness was measured using the Mindful Attention Awareness Scale (MAAS), and living condition was operationalized as living at home or living alone after having left their home. Hierarchical multivariate regression analysis was used to analyze whether the factors of living condition and dispositional mindfulness had predictive effects on well-being. The results showed that dispositional mindfulness positively correlated with well-being in first-year university students; however, living condition had no significant correlation. On the other hand, the interaction between living condition and dispositional mindfulness significantly correlated with well-being. Simple slope analysis revealed that higher levels of dispositional mindfulness had a protective effect in the relationship between living condition and well-being. These results suggest that an intervention to promote dispositional mindfulness could be effective in protecting the well-being of first-year university students, especially for those who have left their home and are living alone. Further research will be necessary to examine, longitudinally, how mental health changes depending on the level of dispositional mindfulness of first-year university students.

Depression, anxiety and stress among caregivers of adolescents with cerebral palsy in rural Bangladesh

Purpose Prior studies indicate high risk of mental health problems among caregivers of adolescents with cerebral palsy although limited consideration is given to caregivers in low- and middle-income countries. This study aimed to compare the burden of depression, anxiety and stress among caregivers of adolescents with cerebral palsy to caregivers of adolescents without disability in rural Bangladesh; and to identify factors unique to low- and middle-income countries that predict caregiver’s mental health. Methods Observational study comparing caregivers of adolescents with cerebral palsy identified through the Bangladesh Cerebral Palsy Register and caregivers of adolescents without disability from neighboring dwellings. Caregiver mental health was assessed using the Depression, Anxiety and Stress Scale-21, adolescent mental health using the Strengths and Difficulties Questionnaire and adolescent health-related quality of life using Kidscreen-27. Hierarchical multivariable regression analysis was performed. Results Participants were 154 caregivers of adolescents with cerebral palsy and 173 caregivers of adolescents without disability, matched on adolescent age and sex. Caregivers of adolescents with cerebral palsy reported significantly higher risk of depression and stress than caregivers of adolescents without disability (Effect Size 0.1 to 0.2, p < 0.05) although no difference on anxiety. Caregiver age, adolescent mental health, household overcrowding and adolescent hearing impairment were significant predictors of depression, anxiety and/or stress (0.1 to 2.2, p < 0.05). Conclusions Caregivers of adolescents with cerebral palsy in rural Bangladesh are at high risk of depression and stress. Initiatives to improve caregiver mental health are required; we recommend initiatives address adolescent mental health problems and include poverty reduction measures to improve social and economic capital. Improved understanding of the factors predicting caregiver depression, anxiety and stress unique to low and middle-income countries are necessary to guide policies and public health infrastructure development. Implications for rehabilitation Caregivers of adolescents with cerebral palsy in rural Bangladesh are at significantly higher risk of depression and stress than caregivers of adolescents without disability. We recommend interventions to improve caregiver mental health give specific consideration to older caregivers, those whose adolescent report mental health problems, families living in crowded households, and/or whose child has hearing impairment. We recommend interventions include poverty reduction measures to improve social and economic capital and target both caregivers and adolescents with CP to enhance long term outcomes.

Eating Jet Lag: A Marker of the Variability in Meal Timing and Its Association with Body Mass Index.

The timing of food intake has been associated with obesity and adverse metabolic outcomes, independently of the amount or content of food intake and activity level. However, the impact of the variability in the timing of food intake between weekends and weekdays on BMI (body mass index) remains unexplored. To address that, we propose to study a marker of the variability of meal timing on weekends versus weekdays (denominated as ‘eating jet lag’) that could be associated with increments in BMI. This cross-sectional study included 1106 subjects (aged 18–25 years). Linear regression models were used to examine the associations of eating jet lag with BMI and circadian related variables (including chronotype, eating duration, sleep duration, and social jet lag). Subsequently, a hierarchical multivariate regression analysis was conducted to determine whether the association of eating jet lag with BMI was independent of potentially confounding variables (e.g., chronotype and social jet lag). Moreover, restricted cubic splines were calculated to study the shape of the association between eating jet lag and BMI. Our results revealed a positive association between eating jet lag and BMI (p = 0.008), which was independent of the chronotype and social jet lag. Further analysis revealed the threshold of eating jet lag was of 3.5 h or more, from which the BMI could significantly increase. These results provided evidence of the suitability of the eating jet lag, as a marker of the variability in meal timing between weekends and weekdays, for the study of the influence of meal timing on obesity. In a long run, the reduction of the variability between meal timing on weekends versus weekdays could be included as part of food timing guidelines for the prevention of obesity among general population.