Longitudinal Data Research Articles

Active Rheumatoid Arthritis and Scoliosis: A Mid-Term Cohort Study.

Retrospective cohort study. To elucidate the factors related to progression of scoliosis in patients with rheumatoid arthritis (RA) using longitudinal cohort data. Thirty percent of patients with RA have lumbar scoliosis. However, the effectiveness of current treatment methods in preventing the progression of scoliosis is not well-understood due to a lack of longitudinal studies. We enrolled 180 patients with RA who were followed up for over two years, all of whom underwent standing spinal X-rays. These patients were categorized based on their disease activity score-28 with erythrocyte sedimentation rate (DAS28-ESR) into two groups: those in remission (n=76) and those in non-remission (n=104). We evaluated various radiographic measures, including C7 center sacral vertical line (C7-CSVL), pelvic obliquity, major Cobb angle, and curve location. Fifty-three (29.4%) patients presented progression of scoliosis during a mean follow-up period of 4.8 years. Patients in the non-remission showed larger Cobb angle at baseline and final follow-up, compared to those in remission. The annual progression rate of the curve was also greater in the non-remission group (1.04 degree /year), than in the remission group (0.59 degree /year, P=0.001). There was no difference in the incidence of new vertebral fractures. The presence of a baseline cobb angle of 10 degree or more (OR: 3.14; 95% CI: 1.38-7.13; P=0.006), glucocorticoid use (OR: 2.88; 95% CI: 1.18-7.06; P=0.021), and non-remission at baseline (OR: 2.83; 95% CI: 1.25-6.41; P=0.012) were significant risk factors for progression of scoliosis. RA disease activity is linked to progression of scoliosis in patients with RA. Patients with RA who present with an initial scoliosis of 10 degrees or greater, require glucocorticoids for treatment and are in non-remission at baseline may be at high risk for scoliosis progression.

How does intergenerational coresidence affect the physical health of middle-aged children? Evidence from China

ABSTRACT Due to increasing longevity and decreasing fertility, the middle-aged generation has emerged as the primary caregivers for their elderly parents in China. Using the China Health and Retirement Longitudinal Survey, this study employs an endogenous treatment effect model to estimate the causal impact of intergenerational coresidence on the physical health of middle-aged children. The findings reveal that coresidence significantly deteriorates the physical health of middle-aged children. Notably, this effect is more pronounced in employed individuals compared to unemployed ones. Marginal effect analysis uncovers that coresidence has adverse effects on middle-aged children who are either particularly healthy or particularly unhealthy, while the marginal impact of coresidence on children in average health conditions is insignificant.

Cognitive Trajectories and Alzheimer Disease Biomarkers: From Successful Cognitive Aging to Clinical Impairment.

Cross-sectional definitions of successful cognitive aging have been widely utilized, but longitudinal measurements can identify people who do not decline. We performed this study to contrast maintenance with declining trajectories, including clinical conversion. We included baseline cognitively unimpaired Alzheimer's Disease Neuroimaging Initiative participants with 3 or more cognitive testing sessions (n = 539, follow-up 6.1 ± 3.5 years) and calculated slopes of an episodic memory composite (MEM) to classify them into two groups: maintainers (slope ≥ 0) and decliners (slope < 0). Within decliners, we examined a subgroup of individuals who became clinically impaired during follow-up. These groups were compared on baseline characteristics and cognitive performance, as well as both cross-sectional and longitudinal Alzheimer disease (AD) biomarker measures (beta-amyloid [Aβ], tau, and hippocampal volume). Forty-one percent (n = 221) of the cohort were MEM maintainers, and 33% (n = 105) of decliners converted to clinical impairment during follow-up. Compared to those with superior baseline scores, maintainers had lower education and were more likely to be male. Maintainers and decliners did not differ on baseline MEM scores, but maintainers did have higher non-MEM cognitive scores. Maintainers had lower baseline global Aβ, lower tau pathology, and larger hippocampal volumes than decliners, even after removing converters. There were no differences in rates of change of any AD biomarkers between any cognitive trajectory groups except for a higher rate of hippocampal atrophy in clinical converters compared to maintainers. Using longitudinal data to define cognitive trajectory groups reduces education and sex bias and reveals the prognostic importance of early onset of accumulation of AD pathology. ANN NEUROL 2024.

Co-occurrence of depressive and anxious symptoms and their influence on self-rated health: a national representative survey among Chinese older adults.

The prevalence of the co-occurrence of depressive and anxious symptoms (CO) and their influence on perceived overall health were not clear in community dwelling Chinese older adults. The aims of the study were to investigate the prevalence of CO and to explore its influence on self-rated health (SRH). This study included 12301 individuals aged ≥65 years from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative survey of older adults in mainland China. Participants received face-to-face interviews and assessments of depressive symptoms and anxious symptoms via 10-item of the Center for Epidemiologic Studies Depression Scale (CES-D-10) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), respectively. SRH was measured by self-reported. A logistic regression model was used to examine the association between CO and SRH after adjusting for confounding variables. The average age was 83.4 (SD: 11.0) years and there were 6576 (53.5%) females. The age- and sex-standardized prevalence of depressive symptoms only (DSO) was 38.6%, anxious symptoms only (ASO) was 1.5%, and CO was 10.8%. Compared with those without depressive and anxious symptoms, the older adults with DSO or ASO were more likely to have significant influence on SRH. And particularly, CO was likely to produce the greatest decrement in the level of SRH. CO was not rare in Chinese older adults nationwide. The older adults having CO had increased risk for lower level of SRH than having DSO or ASO. More attention should be given to CO among the older adults.

Classifying Self-Reported Rheumatoid Arthritis Flares Using Daily Patient-Generated Data From a Smartphone App: Exploratory Analysis Applying Machine Learning Approaches.

The ability to predict rheumatoid arthritis (RA) flares between clinic visits based on real-time, longitudinal patient-generated data could potentially allow for timely interventions to avoid disease worsening. This exploratory study aims to investigate the feasibility of using machine learning methods to classify self-reported RA flares based on a small data set of daily symptom data collected on a smartphone app. Daily symptoms and weekly flares reported on the Remote Monitoring of Rheumatoid Arthritis (REMORA) smartphone app from 20 patients with RA over 3 months were used. Predictors were several summary features of the daily symptom scores (eg, pain and fatigue) collected in the week leading up to the flare question. We fitted 3 binary classifiers: logistic regression with and without elastic net regularization, a random forest, and naive Bayes. Performance was evaluated according to the area under the curve (AUC) of the receiver operating characteristic curve. For the best-performing model, we considered sensitivity and specificity for different thresholds in order to illustrate different ways in which the predictive model could behave in a clinical setting. The data comprised an average of 60.6 daily reports and 10.5 weekly reports per participant. Participants reported a median of 2 (IQR 0.75-4.25) flares each over a median follow-up time of 81 (IQR 79-82) days. AUCs were broadly similar between models, but logistic regression with elastic net regularization had the highest AUC of 0.82. At a cutoff requiring specificity to be 0.80, the corresponding sensitivity to detect flares was 0.60 for this model. The positive predictive value (PPV) in this population was 53%, and the negative predictive value (NPV) was 85%. Given the prevalence of flares, the best PPV achieved meant only around 2 of every 3 positive predictions were correct (PPV 0.65). By prioritizing a higher NPV, the model correctly predicted over 9 in every 10 non-flare weeks, but the accuracy of predicted flares fell to only 1 in 2 being correct (NPV and PPV of 0.92 and 0.51, respectively). Predicting self-reported flares based on daily symptom scorings in the preceding week using machine learning methods was feasible. The observed predictive accuracy might improve as we obtain more data, and these exploratory results need to be validated in an external cohort. In the future, analysis of frequently collected patient-generated data may allow us to predict flares before they unfold, opening opportunities for just-in-time adaptative interventions. Depending on the nature and implication of an intervention, different cutoff values for an intervention decision need to be considered, as well as the level of predictive certainty required.

Physician and informal care use explained by the Pediatric Quality of Life Inventory (PedsQL) in children with suspected genetic disorders.

To examine associations between Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL Infant Scales with formal health care resource utilization (HCRU) and informal caregiver burden. We studied a pediatric cohort of 837 patients (median age: 8.4 years) with suspected genetic disorders enrolled January 2019 through July 2021 in the NYCKidSeq program for diagnostic sequencing. Using linked ~ nine-month longitudinal survey and physician claims data collected through May 2022, we modeled the association between baseline PedsQL scores and post-baseline HCRU (median follow-up: 21.1 months) and informal care. We also assessed the longitudinal change in PedsQL scores with physician services using linear mixed-effects models. Lower PedsQL total and physical health scores were independently associated with increases in 18-month physician services, encounters, and weekly informal care. Comparing low vs. median total scores, increases were 10.6 services (95% CI: 1.0-24.6), 3.3 encounters (95% CI: 0.5-6.8), and $668 (95% CI: $350-965), respectively. For the psychosocial domain, higher scores were associated with decreased informal care. Based on adjusted linear mixed-effects modeling, every additional ten physician services was associated with diminished improvement in longitudinal PedsQL total score trajectories by 1.1 point (95% confidence interval: 0.6-1.6) on average. Similar trends were observed in the physical and psychosocial domains. PedsQL scores were independently associated with higher utilization of physician services and informal care. Moreover, longitudinal trajectories of PedsQL scores became less favorable with increased physician services. Adding PedsQL survey instruments to conventional measures for improved risk stratification should be evaluated in further research.

Reactive religiosity? The longitudinal relationship between ethnic harassment, religious identity and wellbeing in the UK

ABSTRACT Ethnic harassment is a common experience among ethnic and religious minorities in the UK and can reduce wellbeing. However, previous research on ethnic minorities suggests that experiences of harassment could increase identification with religious minority groups, and that a strong religious identity may buffer against some of the negative effects of harassment. Using panel data from the UK Household Longitudinal Survey (2009–2021), we investigate whether people who experience ethnic harassment have a subsequent increase in religious identification or practice, and to what extent this affects their wellbeing. We find evidence for a religious buffering effect which reduces distress following ethnic harassment for Christians. Similarly, we observe an increase in religiosity among Christians, but not other religious groups following ethnic harassment. Finally, we examine whether stronger religious identification would increase the likelihood of harassment experiences, and find only partial evidence for this reverse effect.

Modifiable lifestyle factors and lifetime risk of atrial fibrillation: longitudinal data from the Korea NHIS-HealS and UK Biobank cohorts

BackgroundThe reason for higher incidence of atrial fibrillation (AF) in Europe compared with East Asia is unclear. We aimed to investigate the association between modifiable lifestyle factors and lifetime risk of AF in Europe and East Asia, along with race/ethnic similarities and disparities.Methods1:1 propensity score matched pairs of 242,763 East Asians and 242,763 White Europeans without AF were analyzed. Modifiable lifestyle factors considered were blood pressure, body mass index, cigarette smoking, diabetes, alcohol consumption, and physical activity, categorized as non-adverse or adverse levels. Lifetime risk of AF was estimated from the index age of 45 years to the attained age of 85 years, accounting for the competing risk of death.ResultsThe overall lifetime risk of AF was higher in White Europeans than East Asians (20.9% vs 15.4%, p < 0.001). The lifetime risk of AF was similar between the two races in individuals with non-adverse lifestyle factor profiles (13.4% vs 12.9%, p = 0.575), whereas it was higher in White Europeans with adverse lifestyle factor profiles (22.1% vs 15.8%, p < 0.001). The difference in the lifetime risk of AF between the two races increased as the burden of adverse lifestyle factors worsened (1 adverse lifestyle factor; 4.3% to ≥ 3 adverse lifestyle factors; 11.2%). Compared with East Asians, the relative risk of AF in White Europeans was 23% and 62% higher for one (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.16–1.29) and ≥ 3 adverse lifestyle factors (HR 1.62, 95% CI 1.51–1.75), respectively.ConclusionsThe overall higher lifetime risk of AF in White Europeans compared with East Asians might be attributable to adverse lifestyle factors. Adherence to healthy lifestyle factors was associated with the lifetime risk of AF of about 1 in 8 regardless of race/ethnicity.

Language anxiety does not affect the growth of L2 reading achievement: The latent growth curve model approach

Abstract Second language (L2) anxiety has been proposed to play a causal role in L2 achievement. However, most studies have failed to acknowledge confounding variables that may be relevant to the study of anxiety and L2 achievement or to investigate the causal effect of L2 anxiety using longitudinal data. For these reasons, we investigated the effect of L1 reading achievement, L2 aptitude, and L2 anxiety as covariates on the growth of L2 reading achievement across three time points. We used the latent growth curve model (LGCM) to estimate the growth trajectory of US secondary school students’ L2 reading growth in Spanish (N = 307) over three school years. The findings showed that students’ L1 reading achievement and L2 aptitude strongly and significantly predicted L2 reading achievement growth. However, L2 anxiety did not predict L2 reading achievement growth. Findings suggest that growth in L2 reading achievement depends on the language-related skills used for L1 reading and the language skills that comprise L2 aptitude, but not on anxiety. Similar to past cross-sectional studies, L2 anxiety related only to initial levels of L2 reading achievement, suggesting that anxiety reflects students’ initial experience of L2 reading but not their L2 achievement.

Association of cooking oil and incident of frailty in older adults: a cohort study

BackgroundStudies examining the potential association between cooking oil and frailty risk in older adults have produced conflicting outcomes. Therefore, our objective was to explore the relationship between cooking oil (vegetable and animal fat oils), changes in oil usage, and the risk of frailty in older adults.MethodsWe included 4,838 participants aged ≥ 65 years without frailty (frailty index < 0.25) from the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey. Follow-up occurred in the 2014 and 2018 waves. Cox proportional hazard models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to examine the association between cooking oil and frailty. Additionally, we evaluated the effect of switching cooking oil on frailty during the follow-up period.ResultsDuring a median follow-up of 3.0 (2.8–6.9) years, 1,348 individuals (27.9%) developed frailty. Compared to those using vegetable oil, users of animal fat oil had a lower risk of frailty (HR = 0.72, 95% CI: 0.61–0.85). Participants who switched from vegetable oil to animal fat oil, as well as those consistently using animal fat oil, had lower risks of frailty with HRs of 0.70 (0.52–0.95) and 0.63 (0.51–0.77) respectively, compared to those who consistently used vegetable oil. Conversely, individuals who switched from animal fat oil to vegetable oil experienced an increased risk of frailty (HR: 1.41, 95% CI: 1.01–1.97).ConclusionsThe utilization of animal fat oil in cooking exhibited a reduced frailty risk among older adults. Conversely, transitioning from animal fat oil to vegetable oil may elevate the risk. These findings propose that substituting vegetable oil with animal fat oil in the diet may safeguard against frailty.

A longitudinal study of breastfeeding relationships at home during the COVID-19 pandemic: A grounded theory method.

To describe the process of breastfeeding relationships among stay-at-home mother and infant dyads at 1, 3, 5 and 6 months. A longitudinal qualitative online survey design was used. Data were obtained at 1, 3, 5 and 6 months from 26 breastfeeding mothers who stayed home with their infants and directly breastfed at least once a day for the first 6 months between June 2022 and August 2023. Mothers' written responses to 3 open-ended questions were analysed to assess breastfeeding experiences at home, thoughts/comments while directly breastfeeding and breastfeeding concerns/problems and strategies they used. Based on grounded theory, inductive content analysis was used to analyse the data. Trustworthiness of results was established by coding to consensus, formal peer debriefing and maintaining an audit trail. 'Breastfeeding Relationships at Home,' the core construct, was identified and organized the process of breastfeeding relationships into 5 domains: (1) mothers' emotional well-being while breastfeeding, (2) infant-led feeding, (3) alternatives to breastfeeding, (4) evaluation of breastfeeding and (5) changes in breastfeeding as infants grow older. Breastfeeding is not simply about feeding breast milk but also involves nurturing and developing a relationship between mother and infant. Across the domains, mutual responsiveness, a central element of the breastfeeding relationship was clear. Mothers who were committed to breastfeeding with embedded infant suckling reached emotional well-being in return for their engagement which has potential to reduce maternal stress and prevent postpartum depression. Findings from the current study add to nurses' knowledge about the relationship building process between stay-at-home mothers and their infants in the first 6 months of breastfeeding during the COVID-19 pandemic. Nurses must remain sensitive to aid the development of breastfeeding relationships in the home environment to maximize mutual responsiveness. No patients or public involved.

The influence of residential Environment and residential experience on psychological depression in older adults: Evidence from China and Europe

This cross-national study examined the influence of residential environment and experience on depression in older adults in China and Europe to address existing research gaps. Using data from the China Health and Retirement Longitudinal Study (CHARLS) and Survey of Health, Ageing, and Retirement in Europe (SHARE) and employing ridge regression, it was found that residential environment and experience have a significant influence on older adults' depression. The influence of residential experience aligns with the sensitivity period hypothesis. The environment in which older adults live during specific age periods leaves an imprint on their psyche. This imprint is activated when specific environments are encountered in old age, thereby influencing the level of depression. This study examined how their influence on depression contributes to understanding older adults’ housing preferences and can guide housing-related policies.

Crowding in or Out？National Public Pension, Inter-Generational Contract, and Family Support to Empty-Nest Older Parents in Rural China

ABSTRACT Evidence to date has been inconclusive on the effects of public pension on family support to older adults, and the underlying mechanism behind such effects remains unclear. This study examines the effects of the New Rural Social Pension Scheme on family support to empty-nest older parents in rural China, where family care is traditionally favored for older adults. Using data from the China Longitudinal Aging Social Survey, the findings reveal that pension receipt promotes bidirectional financial transfers and intimate relationships between generations, thus increasing (or crowding in) children’s financial and care support to their empty-nest parents. On the other hand, receiving pensions may discourage parental care support to children and partially decrease (or crowd out) children’s financial and care support. This crowding-out effect, however, is limited and thus insufficient for counteracting the crowding-in effects from other pathways. Overall, these findings indicate that national welfare, such as pensions, can encourage family support through inter-generational contracts and intimacy, strengthening familial bonds and facilitating mutual assistance within families. For policy implications, government should prioritize improving benefit levels of public pensions to harness the caregiving potential of families and providing essential services that assist families in addressing care burdens.

The bi-directional relationships between diversified leisure activity participation and cognitive function in older adults in China: separating between-person effects from within-person effects

ObjectiveTo examine the bi-directorial association between diversified leisure activity participation and cognitive function over a 7-year period.MethodsData analyzed was from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a large-scale longitudinal national study. The baseline survey was conducted in 2011 with follow-up every three years. We traced a total of 2718 participants over a period of 7 years. We used adjusted random intercept cross-lagged panel models (RI-CLPMs) to examine the bi-directorial associations between diversified leisure activity participation and cognitive function.ResultsWe observed bi-directorial associations between diversity of leisure activity and cognitive function across waves at the between-person and within-person levels. The adjusted random intercept cross-lagged panel models fitted the data appropriately, and the 3-year cross-lagged effects of prior diversified leisure activity participation on cognitive function (β = 0.058, p < 0.01) and cognitive function on subsequent diversified leisure activity participation (β = 0.047, p < 0.05) were significant. The results remained after adjusting the model for baseline sex, age, educational level, marital status and current residence, the number of chronic diseases, ADL, depressive symptoms, sleep quality, smoking, and drinking.ConclusionThis study suggests that a reciprocal causality relationship between diversified leisure activity participation and cognitive function, indicating a “positive circle” that further promotes cognition over time.

Antecedents and outcomes of firm internet-interactive capability in interfirm relationships

Purpose This study aims to explore whether and how the two potential antecedents (i.e. relationship quality at the dyadic level and network density at the network level) affect firms’ internet-interactive capability (FIIC), referring to the capability of a specific firm to communicate and interact with the relevant partner firms on the basis of internet-interactive technologies in the internet environment and, at the same time, the following influence of FIIC on collaborative activities (i.e. joint planning and joint problem-solving). Design/methodology/approach This study designed a questionnaire and collected data on-site from 400 manufacturers. SmartPLS is used to validate the research model. Findings The results suggest that the dyadic relationship quality and network density of the partner group are both positively connected with a firm’s FIIC. Besides, FIIC is positively related to collaborative activities with its partners. Research limitations/implications Given the nature of our data (i.e. cross-sectional), the authors can collect longitudinal or experimental data to retest the hypotheses. Practical implications This study gives certain guidance for firms to be aware of the factors that motivate FIIC and use their FIIC to influence their employees’ collaborative activities in their relationships with partners, thereby promoting cooperation performance. Originality/value This study attempts to extend the resource-based theory based on the logic of motivation-capability by exploring the potential antecedents of FIIC and makes contributions to the current studies on the antecedents of FIIC, which provides actionable insights for firms to play the role of FIIC in interfirm interactions.

Linked lives: intergenerational transmission of labour-market pathways between parent dyads and children

While a vast number of studies confirm the transmission of labour-market disadvantages from one generation to the next, less is known about how parents’ interconnected labour-market pathways co-evolve and shape the opportunities and obstacles for their children’s future careers. This study uses a multidimensional view of intergenerational transmission by describing the most typical pathways of parents’ occupational careers and assesses how these patterns are associated with their children’s labour-market outcomes. Drawing on Swedish longitudinal register data, we used multichannel sequence analysis to follow a cohort of people born in 1985 (n = 72,409) and their parents across 26 years. We identified four parental earning models, differentiating between (1) dual earners with high wages, (2) dual earners with low-wage, (3) one-and-a-half-earners and (4) mother as the main breadwinner. Regression analysis shows strong intergenerational transmission among the most advantageous trajectories, with education as a key determinant for young people to become less dependent on family resources. This study stresses the importance of intra-couple perspectives in life course research to understand how inequalities are shaped and preserved across generations.

Effects of Exposure to Conflicting Health Information on Topic-Specific Information Sharing and Seeking Intentions

ABSTRACT Despite considerable evidence that exposure to conflicting health information can have undesirable effects on outcomes including public understanding about and trust in health recommendations, comparatively little is known about whether such exposure influences intentions to engage in two communication behaviors central to public health promotion: information sharing and information seeking. The purpose of the current study is to test whether exposure to conflicting information influences intentions to share and seek information about six health topics. We analyzed data from two waves of a longitudinal survey experiment with a nationally representative sample of U.S. adults (N = 3,920). Participants were randomly assigned to either a conflict or no-conflict message condition, in which they read news stories and social media posts about three (of six) randomly selected health topics at Time 1 and the remaining three at Time 2. The dependent variables, which were measured at Time 2, asked participants whether they intended to share or seek information about the three topics they had just viewed. Linear mixed effects models showed that exposure to conflict reduced intentions to share and seek information, regardless of health topic. These findings suggest that exposure to conflicting health information discourages two important types of health information engagement, thus adding to the growing evidence base documenting the adverse consequences of conflicting information for public health.

Slow to launch: Young men's parental coresidence and employment outcomes

AbstractObjectiveThe authors investigate the potential early career consequences of parental coresidence for young men and whether they vary by duration of coresidence.BackgroundYoung adult coresidence with parents is becoming more common, particularly since the Great Recession and the recent pandemic. Although many studies have investigated the factors that predict coresidence, few examine the consequences. Some prior research suggests that coresidence may directly reduce career opportunities and indirectly shape employment through its effects on mental health and family formation. Yet, the consequences may be milder if coresidence is short‐term.MethodUsing data from the National Longitudinal Survey of Youth 1997, the authors examine the associations between parental coresidence after the age of 24 and employment status (n = 3915) and occupational standing (n = 3613) for young men in their early 30s in the United States. They explore how this association varies by the duration of coresidence, testing several model specifications and controlling for factors that select young men into parental coresidence.ResultsShort‐term coresidence of about 1 year is marginally associated with an improved likelihood of full‐time employment, but longer‐term parental coresidence of 4 to 6 years is negatively associated with occupational standing.ConclusionParental coresidence may be beneficial for young men in their peak ages of career growth if it is only for a few years. However, just as long‐term unemployment can have a scarring effect on employment outcomes, long‐term parental coresidence might negatively impact career growth.

A tale of two paths to vaccine acceptance: self-interest and collective interest effect, mediated by institutional trust, and moderated by gender

Coronavirus and other prevailing viruses continue to remain a health threat and challenge the efforts of institutions to promote vaccination acceptance. The current study’s aim is to propose a conceptual framework explaining the role of individual motivators (such as self-interest and collective interest) in shaping attitudes toward vaccination while emphasizing the pivotal role of institutional trust as a mediator and gender as a moderator. Data were collected via an online panel survey among Israelis (N = 464), and SEM statistics were used to test the model empirically. The path analysis model supports the positive direct effect of collective interest and the negative effect of self-interest. Additionally, it shows an indirect effect through the mediation effect of institutional trust and gender moderation. Therefore, institutional trust may significantly influence self-interest people’s attitudes toward vaccines. Furthermore, since females process information more comprehensively, their developed trustworthiness in institutions has an increased impact on vaccine acceptance. Theoretical and practical implications are discussed.

Influence of hydrometeorological risk factors on child diarrhea and enteropathogens in rural Bangladesh.

A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change. Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change. We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters. Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null. Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measures like all-cause diarrhea. Our results suggest that preventive interventions targeted to reduce enteropathogens just before and during the rainy season may more effectively reduce child diarrhea and enteric pathogen carriage in rural Bangladesh and in settings with similar meteorological characteristics, infrastructure, and enteropathogen transmission.