Hierarchical Multivariate Regression Analysis Research Articles

Comparison of Causes and Associated Costs of 30-Day Readmission of Transcatheter Implantation Versus Surgical Aortic Valve Replacement in the United States (A National Readmission Database Study)

Our current knowledge about comparative differences in 30-day readmissions and the impact of readmissions on overall costs after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is largely derived from clinical trials. The objectives of this study were to compare readmissions and costs for TAVI and SAVR in a nationally representative population-based sample. The Healthcare Cost and Utilization Project's National Readmission Database was used for the study. Hierarchical multivariable regression analyses were used to examine differences in the propensity score 1:1 matched cohort. The matched cohort included 4,682 patients who survived index procedures done from January through November 2013. Compared with SAVR, the rate of 30-day readmission was not significantly different for endovascular TAVI (16% vs 18%; p = 0.19); and was higher for the transapical TAVI (22% vs 17%; p <0.01) group. The 30-day cumulative costs were higher for the 2 endovascular TAVI ($51,025 vs $46,228; p = 0.03) and transapical TAVI ($59,575 vs $45,792; p <0.01). In multivariable analyses, the risk of 30-day readmission was similar for endovascular TAVI (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.78 to 1.12) and was 27% higher for transapical TAVI (OR 1.27; 95% CI 1.02 to 1.57). Cumulative costs (index plus readmission costs) were 13% (β 0.13; 95% CI 0.10 to 0.15) and 19% (β 0.19; 95% CI 0.16 to 0.23) higher for the endovascular TAVI and transapical TAVI, respectively. In conclusion, the rate of readmissions was similar for endovascular TAVI and SAVR but the costs were 26% higher for TAVI than for SAVR.

Self-efficacy as a predictor of patient-reported outcomes in adults with congenital heart disease

Self-efficacy is a known predictor of patient-reported outcomes in individuals with acquired diseases. With an overall objective of better understanding patient-reported outcomes in adults with congenital heart disease, this study aimed to: (i) assess self-efficacy in adults with congenital heart disease, (ii) explore potential demographic and medical correlates of self-efficacy and (iii) determine whether self-efficacy explains additional variance in patient-reported outcomes above and beyond known predictors. As part of a large cross-sectional international multi-site study (APPROACH-IS), we enrolled 454 adults (median age 32 years, range: 18-81) with congenital heart disease in two tertiary care centres in Canada and Switzerland. Self-efficacy was measured using the General Self-Efficacy (GSE) scale, which produces a total score ranging from 10 to 40. Variance in the following patient-reported outcomes was assessed: perceived health status, psychological functioning, health behaviours and quality of life. Hierarchical multivariable linear regression analysis was performed. Patients' mean GSE score was 30.1 ± 3.3 (range: 10-40). Lower GSE was associated with female sex ( p = 0.025), not having a job ( p = 0.001) and poorer functional class ( p = 0.048). GSE positively predicted health status and quality of life, and negatively predicted symptoms of anxiety and depression, with an additional explained variance up to 13.6%. No associations between self-efficacy and health behaviours were found. GSE adds considerably to our understanding of patient-reported outcomes in adults with congenital heart disease. Given that self-efficacy is a modifiable psychosocial factor, it may be an important focus for interventions targeting congenital heart disease patients' well-being.

The Effects of Internal Marketing on Turnover Intentions in Knowledge Workers in the IT Sector

This study suggests applying the concept of internal marketing to combat turnover intentions in knowledge workers in the IT sector. Internal marketing sees all employees as the firm's customers. The major hypothesis examined here is that when employees feel that a firm considers and treats them like customers, it increases employment commitment and reduces turnover intentions. A multivariate hierarchical regression analysis and structural equation modelling (SEM) incorporating demographic, personal, organizational and external variables were used to identify the unique contribution of internal marketing to turnover intentions. The findings showed a negative correlation between internal marketing and turnover intention that contributed significantly to the explained variance beyond the effects of other independent variables. These results are discussed in the light of their theoretical and practical implications and in particular that IT organizations should consider adopting internal-marketing practices to reduce turnover intention and hence voluntary turnover.

Psychological factors and subjective cognitive complaints after stroke: Beyond depression and anxiety

ABSTRACTSubjective Cognitive Complaints (SCC) are common after stroke and adversely affect quality of life. In the present study, we determined the associations of depression, anxiety, perceived stress and fatigue with post-stroke SCC, and whether these associations were independent of objective cognitive functioning, stroke characteristics and individual differences in personality traits and coping styles. Using a cross-sectional design, SCC and psychological measures were obtained in 208 patients (mean 3.3 ± 0.5 months after stroke; 65.9% men; mean age 64.9 ± 12.4 years). SCC were assessed using the Checklist for Cognitive and Emotional consequences following stroke (CLCE) inventory. Validated questionnaires were used to measure depression and anxiety (Hospital Anxiety and Depression Scale), perceived stress (Perceived Stress Scale), fatigue (Fatigue Assessment Scale), personality traits (Eysenck Personality Questionnaire Revised Short Scale) and coping style (Utrecht Coping List). Multivariate hierarchical linear regression analyses were used to adjust for covariates. Depression (β = 0.35), anxiety (β = 0.38), perceived stress (β = 0.39), and fatigue (β = 0.39) were associated with CLCE scores, independent of demographic, cognitive performance and stroke-related covariates. After including personality traits and coping styles in the model, independent associations with CLCE scores were found for fatigue (β = 0.26, p = .003) and neuroticism (β = 0.21, p = .05). Interventions aimed at improving psychological resilience and increasing energy levels might be a worthwhile addition to stroke rehabilitation programmes by reducing SCC and improving quality of life.

The mediation effect of PTSD, perceived job stress and resilience on the relationship between trauma exposure and the development of depression and alcohol use problems in Korean firefighters: A cross-sectional study

BackgroundFirefighters constitute a high-risk group for depression and alcohol use disorders (AUDs) due to frequent exposure to trauma. Perceived job stress and resilience are powerful factors affecting the occurrence of depression and AUDs; however, research on this subject is scarce. MethodsWe investigated the relationship of perceived job stress and resilience with depression or AUDs in firefighters. A total of 7151 Korean firefighters were included for analysis. Participants completed self-report scales, including a self-reported number of exposure to incident stressors, the Korean Occupational Stress Scale – Short Form, the Post-traumatic Stress Disorder (PTSD) Symptoms Checklist – Civilian version, the Patient Health Questionnaire 9, the Brief Resilience Scale, and the Alcohol Use Disorders Identification Test. Hierarchical multivariable linear regression analyses were performed to identify the relationship of perceived job stress and resilience with depression or AUDs. Path analyses were applied to investigate the mediation effects of PTSD, perceived job stress and resilience between trauma exposure and depression or AUDs. ResultsThere were significant associations of perceived job stress and resilience with depression and AUDs, respectively, even after adjusting for demographic factors, number of traumatic events, and PTSD symptoms. The relationship between trauma exposure and depression/AUDs was mediated by PTSD symptoms, which had both direct and indirect effects on depression and AUDs; indirect effect was mediated by job stress and resilience. ConclusionsThe findings in this study demonstrated that PTSD, perceived job stress and resilience can mediate the development of depression or AUDs following trauma exposure in firefighters. Efforts to prevent PTSD, reduce job stress and increase individual resilience could help prevent depression and AUDs. LimitationsThe cross-sectional study design and self-report nature of the assessment tools limit the current findings.

Addressing the quality and cost of cholecystectomy at a safety net hospital

BackgroundThe aim of this study was to evaluate the effects of safety-net burden on outcomes of a common, urgent operation like cholecystectomy. MethodsWe identified all cholecystectomies performed from 2005 to 2011 in the California State Inpatient Database and separated them into three cohorts based on the performing hospital's safety-net burden. Hierarchical multivariable regression analyses were performed with outcomes including laparoscopy, advanced disease, morbidity, length of hospitalization, and cost. ResultsSafety-net hospitals had similar rates of laparoscopy, overall advanced disease, and post-operative morbidity. Yet, they were able to maintain lower overall costs (cost difference −5592, 95% CI -8928, −2256, p < 0.01), despite having similar lengths of stay. ConclusionSafety-net hospitals performed cholecystectomy with similar rates of laparoscopy and morbidity, while achieving lower costs. Safety-net hospitals may be well equipped to perform common, urgent operations like cholecystectomy.

Effect of Nonalcoholic Fatty Liver Disease on In-Hospital and Long-Term Outcomes in Patients With ST–Segment Elevation Myocardial Infarction

Nonalcoholic fatty liver disease (NAFLD) is a risk factor for coronary artery disease. We investigated the effect of NAFLD grade on in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The study group consisted of 360 patients with STEMI. The patients were classified according to the grade of the NAFLD using ultrasonography. Based on this classification, all patients were divided into 4 subgroups as grade 0 (no fatty liver disease), grade 1, grade 2, and grade 3. Hierarchical logistic regression and Cox proportional regression analysis were used to establish the relation between NAFLD grade and outcomes. In-hospital mortality for grade 0, 1, 2, and 3 NAFLDs were 4.7%, 8.3%, 11.3%, and 33.9%, respectively. Three-year mortality for grade 0, 1, 2, and 3 NAFLDs were 5.6%, 7.8%, 9.5%, and 33.3%, respectively. In the multivariable hierarchical logistic regression analysis, in-hospital mortality risks were higher for patients with grade 3 NAFLD (odds ratio 4.2). In a multivariable Cox proportional regression analysis, the mortality risk was higher for patients with grade 3 NAFLD (hazard ratio 4.0). In conclusion, in patients with STEMI, the presence of NAFLD is associated with unfavorable clinical outcomes. Among these patients, grade 3 NAFLD had the highest mortality rates. The present study supports NAFLD screening in patients with STEMI.

The influence of unmet supportive care needs on anxiety and depression during cancer treatment and beyond: a longitudinal study of survivors of haematological cancers.

This paper aims to examine the cross-sectional and longitudinal associations between patient-reported unmet needs and anxiety and depression for survivors of diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM). In a longitudinal study design, self-reported data were collected through telephone interviews at two time points approximately 7 (T1) and 15 (T2) months post-diagnosis. The sample was recruited through the population-based Victorian Cancer Registry. At T1 and T2, the study outcomes, anxiety and depression, were assessed using the Hospital Anxiety and Depression Scale (HADS) and unmet needs were measured using the Supportive Care Needs Survey (SCNS-SF34). Questions related to social/family problems, relationship problems and financial problems were also asked. A three-step multivariable hierarchical logistic regression analysis examined the relative role of T1 anxiety and depression, T1 and T2 unmet needs and other psychosocial factors with T2 anxiety and depression. Both cross-sectional and longitudinal associations were observed between unmet needs and psychological distress. T2 anxiety was associated with T1 anxiety (OR 4.75, 95% CI 1.86-11.09), T2 psychological needs (OR 1.68, 95% CI 1.34-2.11) and with T1 social problems (OR 2.33, 95% CI 1.03-5.05) in multivariate analysis. T2 depression was associated with both T1 (OR 1.28, 95% CI 1.06-1.57) and T2 psychological needs (OR 1.35, 95% CI 1.06-1.70), T2 physical needs (OR 1.89, 95% CI 1.27-2.81) and T1 depression (OR 4.52, 95% CI 1.88-10.86). Unmet needs that manifest following diagnosis and treatment may persist into early survivorship and contribute to psychological distress. Addressing these needs during treatment may diminish the risk of current and future anxiety and depression.

Non-Suicidal Self-Injury and Suicidal Behavior in a Diverse Sample: The Moderating Role of Social Problem-Solving Ability

Non-suicidal self-injury and suicidal behavior are prevalent in young adults, and often constitute a continuum of self-destructiveness. Not all those who self-injure, however, engage in suicidal behaviors with intent to die, perhaps due to protective intrapersonal characteristics. We examined the role of one such potential buffer, social problem-solving ability, as a moderator of the association between non-suicidal self-injury and suicidal thoughts and attempts, hypothesizing that individuals with greater social problem-solving ability would report fewer suicidal behaviors in relation to self-harm. An ethnically diverse sample was recruited from a large, Northeastern urban university, and completed self-report questionnaires assessing non-suicidal self-injury, suicidal behaviors, and social problem-solving ability. Multivariate hierarchical regression analyses were conducted. For the entire sample, individuals with higher social problem-solving abilities reported fewer suicidal behaviors associated with non-suicidal self-injury. In ethnically stratified analyses, social problem-solving significantly moderated the relationship between self-injury and suicidal behaviors for Whites and Hispanics only. Promotion of problem-solving skills may weaken the linkage between self-injury and potential for future suicidal behaviors for some individuals; however, culture-specific differences in this effect may exist.

Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence.

The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.

Self-reported psychosis-like experiences in patients with mood disorders

BackgroundSelf-reported psychosis-like experiences (PEs) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania, anxiety, borderline (BPD) and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders. MethodsThe Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n=282) from specialized care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis was conducted to examine factors influencing the frequency of self-reported PE. ResultsPEs are common in patients with mood disorders. The “frequency of positive symptoms” score of CAPE-42 correlated strongly with total score of SPQ-B (rho=0.63; P<0.001) and moderately with total scores of BDI, MDQ, OASIS and MSI (rho varied from 0.37 to 0.56; P<0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ, SPQ-B and MSI (rφ varied from 0.2 to 0.5; P<0.001). Symptoms of anxiety, mania or hypomania and BPD were significant predictors of the “frequency of positive symptoms” score of CAPE-42. ConclusionsSeveral, state- and trait-related factors may underlie self-reported PEs among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive biases related to depressive or manic symptoms.

Interaction between personality traits and cerebrospinal fluid biomarkers of Alzheimer\u2019s disease pathology modulates cognitive performance

BackgroundDuring adulthood, personality characteristics may contribute to the individual capacity to compensate the impact of developing cerebral Alzheimer’s disease (AD) pathology on cognitive impairment in later life. In this study we aimed to investigate whether and how premorbid personality traits interact with cerebrospinal fluid (CSF) markers of AD pathology to predict cognitive performance in subjects with mild cognitive impairment or mild AD dementia and in participants with normal cognition.MethodsOne hundred and ten subjects, of whom 66 were patients with mild cognitive impairment or mild AD dementia and 44 were healthy controls, had a comprehensive medical and neuropsychological examination as well as lumbar puncture to measure CSF biomarkers of AD pathology (amyloid beta1–42, phosphorylated tau and total-tau). Participants’ proxies completed the Revised NEO Personality Inventory, Form R to retrospectively assess subjects’ premorbid personality.ResultsIn hierarchical multivariate regression analyses, including age, gender, education, APOEε4 status and cognitive level, premorbid neuroticism, conscientiousness and agreeableness modulated the effect of CSF biomarkers on cognitive performance. Low premorbid openness independently predicted lower levels of cognitive functioning after controlling for biomarker concentrations.ConclusionOur findings suggest that specific premorbid personality traits are associated with cerebral AD pathology and modulate its impact on cognitive performance. Considering personality characteristics may help to appraise a person’s cognitive reserve and the risk of cognitive decline in later life.

P210 The associations of optimism, social support, and coping strategies with health-related quality of life in a cohort of patients after proctocolectomy with ileal Pouch-anal anastomosis

Background: Inflammatory bowel diseases (IBD) are associated with reduced health-related quality of life (HRQoL). We aimed to identify factors that influence patients HRQoL by exploring the role of optimism, social support and coping strategies in contributing to patients' HRQoL. We focused on patients with ulcerative colitis (UC) after pouch surgery representing a distinct population which is followed up in a dedicated referral clinic. Methods: Patients were recruited at the Comprehensive Pouch Clinic and completed six questionnaires: demographics, HRQoL (IBDQ), dispositional optimism (revised Life Orientation Test, LOT-R), social support inventory (ENRICHD), Coping strategies (brief COPE), and illness acceptance (DDAQ). Pouch behavior was determined clinically and defined as normal pouch (NP) or pouchitis. Results: A total of 151 pouch patients were recruited: 75 (50%) females, average age 47.91±15.51 years, average age of UC diagnosis 27.11±13.53 years, mean time since pouch surgery 10.03±8.09 years. At the time of recruitment 48 (32%) had NP. Women had lower HRQoL than man (p=0.04), education level was correlated with HRQoL (r=0.27, p=0.001), age at diagnosis was negatively correlated to HRQoL (r=−0.19, p=0.02). Optimism was associated with higher HRQoL (R=0.40. p<0.001). Pessimism was associated to older age at diagnosis (r=0.23, p=0.01) and to lower education level (r=−0.20, p=0.02). Optimists and pessimists differed in the manner they cope with disease – optimists used more positive reframing and tended to find alternative meaningful activities, while pessimists tended to use self-blame, behavioral and mental disengagement. Furthermore, optimists reported better social support (r=0.29, p=0.00). Social support was also associated with higher HRQoL (R=0.40. p<0.001). Patients with pouchitis had lower HRQoL and social support (all p<0.01 compared to NP) but did not differ in the level of optimism. Predictors of HRQoL in the multivariate Hierarchical Regression analysis were gender (β=−0.12; p<0.05), educational level (β=0.22; p<0.001), social support (β=0.12; p<0.05) and coping strategies: behavioral disengagement (β=−0.19; p=0.05), mental disengagement (β=−0.22; p<0.001), activities engagement (β=0.29; p<0.001), and symptom tolerance (β=0.19; p=0.05). Conclusions: Factors affecting HRQoL levels in UC pouch patients are Gender, education level, age at disease diagnosis and pouch behavior. Dispositional optimism, social support and coping strategies play significant role in patients HRQoL.

Self-esteem moderates the associations between body-related self-conscious emotions and depressive symptoms.

The objectives of this study were to describe the cross-sectional associations between body-related self-conscious emotions and depressive symptoms in young adults and examine self-esteem as a moderator of these associations. Data from a population-based sample of 811 young adults were analyzed using hierarchical multivariate linear regression analysis. Body-related shame ( β = .26) and guilt ( β = .25) were positively related to frequency of depressive symptoms. Self-esteem was negatively related to frequency of depressive symptoms ( β = -.46). Self-esteem moderated the association between body-related guilt and frequency of depressive symptoms. These findings suggest promoting self-esteem may help to reduce the negative effects of body-related guilt on depressive symptoms.

Better Usability and Technical Stability Could Lead to Better Work-Related Well-Being among Physicians.

Background and Objective Finnish physicians have been increasingly dissatisfied with poor usability of the electronic patient record (EPR) systems, which they have identified as an overload factor in their work. Our aim is to specify which factors in EPRs are associated with work-related well-being of physicians. Methods A web-based questionnaire was sent to Finnish physicians younger than 65 years; the responses (n = 3,781) represent one-fourth of these. This was a repetition of a survey in 2010, where this questionnaire was used for the first time. In addition to statements assessing usability, there were questions measuring time pressure and job control. The relation between usability and work well-being was investigated with hierarchical multivariate regression analyses: With time pressure and job control as dependent variables, EPR usability assessments and physicians' background information were used as independent variables. Results In the multivariate analyses, technical problems that are often experienced in the EPR were related to higher time pressure and lower job control. Active participation in the development of the EPR system was related to stronger time pressure and stronger job control. In addition, use of several systems daily and the experience of time-consuming documentation of patient information for statistical purposes (billing, national registries, and reporting) were related to higher time pressure, while those with longer experience with the EPR system and those experiencing easy-to-read nursing records reported higher job control. Conclusion To relieve time pressure and increase sense of job control experienced by physicians, usability, integrations, and stability of the EPR systems should be improved: fewer login procedures, easier readability of nursing records, and decreased need for separate documentation for statistical purposes. Physician participation in the EPR development would increase the feeling of job control, but would add the time pressure. Hence, time for developmental work should be arranged.

The role of objective cognitive dysfunction in subjective cognitive complaints after stroke.

Objective cognitive performance (OCP) is often impaired in patients post-stroke but the consequences of OCP for patient-reported subjective cognitive complaints (SCC) are poorly understood. We performed a detailed analysis on the association between post-stroke OCP and SCC. Assessments of OCP and SCC were obtained in 208 patients 3 months after stroke. OCP was evaluated using conventional and ecologically valid neuropsychological tests. Levels of SCC were measured using the CheckList for Cognitive and Emotional (CLCE) consequences following stroke inventory. Multivariate hierarchical regression analyses were used to evaluate the association of OCP with CLCE scores adjusting for age, sex and intelligence quotient. Analyses were performed to examine the global extent of OCP dysfunction (based on the total number of impaired neuropsychological tests, i.e. objective cognitive impairment index) and for each OCP test separately using the raw neuropsychological (sub)test scores. The objective cognitive impairment index for global OCP was positively correlated with the CLCE score (Spearman's rho = 0.22, P = 0.003), which remained significant in multivariate adjusted models (β = 0.25, P = 0.01). Results for the separate neuropsychological tests indicated that only one task (the ecologically valid Rivermead Behavioural Memory Test) was independently associated with the CLCE in multivariate adjusted models (β = -0.34, P < 0.001). Objective neuropsychological test performance, as measured by the global dysfunction index or an ecologically valid memory task, was associated with SCC. These data suggest that cumulative deficits in multiple cognitive domains contribute to subjectively experienced poor cognitive abilities in daily life in patients post-stroke.

A Comparison of Risk and Protective Factors Related to Depressive Symptoms among American Indian and Caucasian Older Adults.

Despite efforts to reduce health disparities, many American Indian and Alaska Native (AI/AN) populations, including older adults, experience elevated levels of depression and associated suicide. Although adverse childhood experiences (ACEs) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults. The purpose of this study was to examine factors related to depression among a sample of AI older adults in the Midwest. Data were collected using a self-administered survey completed by 479 AI and Caucasian respondents over the age of 50. The survey included standardized measures such as the Geriatric Depression Scale-Short Form, ACE Questionnaire, and Multidimensional Scale of Perceived Social Support. Hierarchical multivariate regression analyses were conducted to evaluate the main hypotheses of the study. Results indicate that two dimensions of ACEs (childhood neglect and household dysfunction) were positively associated with depressive symptoms; social support was negatively associated with depressive symptoms. Perceived health and living alone were also significant predictors of depressive symptoms. ACEs may play a significant role in depression among AI/AN populations across the life course and into old age. Social support offers a promising mechanism to bolster resilience among AI/AN older adults.

Home-to-work spillover and employability among university employees

Purpose The purpose of this paper is to investigate the relationship between positive and negative home-to-work spillover, i.e., home-to-work facilitation (HWF) and home-to-work conflict (HWC) with employability. Moreover, this study also examined whether the relationship between home-to-work spillover and employability varied between academic and support staff employees. Design/methodology/approach An on-line self-report questionnaire was distributed among academic (n=139) and support staff employees (n=215) working at a Dutch university for distance-learning education. Thoroughly validated measures of home-to-work spillover and employability were used. The employability measure consisted of five dimensions: occupational expertise, anticipation and optimization, personal flexibility, corporate sense, and balance. Hypotheses were tested using hierarchical multivariate regression analyses including interaction effects. Findings HWF was positively related to anticipation and optimization only, while HWC appeared to be negatively associated with all employability dimensions. As expected, the relationships between HWF and HWC on the one hand and the specific employability dimensions on the other hand were stronger for support staff employees than for academic staff employees. Originality/value This study has extended research on employability, by focusing on the home context of employees as a possible antecedent. So far, studies have largely ignored the home context of employees, when investigating employability outcomes. Another contribution was the focus on both positive (facilitation) and negative (conflict) spillover from home-to-work, whereas previous studies mainly focused on one type of spillover only. Finally, the authors had the unique opportunity to compare support staff and academic staff employees in one and the same study.

Long-term effects of the implementation of state-wide exit exams: a multilevel regression analysis of mediation effects of teaching practices on students’ motivational orientations

This study extends previous research investigating the effects of state-wide exit exams by studying the change from a class-based to a state-wide exit exam system over 5 years, using multilevel analyses and examining mediating effects of teachers’ practices on students’ motivational orientations. In this multi-cohort study, we analyzed in particular the effects on students’ interest, scholastic self-efficacy, and persistence in advanced level English courses (N = 1835) and mathematics courses (N = 1336) in two states in Germany (28 schools). Descriptive analyses, multivariate hierarchical regression analyses, and differences-in-differences analyses were carried out. The results revealed long-term effects of the implementation of state-wide exit exams particularly in the advanced level English courses. Here, a close relationship between the change in all analyzed motivational orientations and teacher support perceived by the students can be identified. These results show the ambivalent effects of state-wide exit exams: Due to the increased teacher competence support, students’ interest is enhanced in the long term. However, scholastic self-efficacy and persistence might have been negatively affected by state-wide exams, if teacher competence support had not increased over time. In the advanced level mathematics courses, the results are mixed. Implications for further research are discussed.

Weight self-stigma and its association with quality of life and psychological distress among overweight and obese women.

There are limiting studies evaluating the weight self-stigma and its association with eating disorders and health concerns. However, no study is available evaluating weight self-stigma and its determinants among reproductive age women in Iran. The aim of this study was to evaluate weight self-stigma and its association with quality of life and psychological distress among overweight and obese Iranian women. The current cross-sectional study was performed among 170 women aged 17-45years referring to health centers of Tabriz-Iran. Anthropometric assessments were performed. Weight self-stigma was assessed by weight self-stigma questionnaire (WSSQ). Evaluation of quality of life and psychological distress was performed using SF-12 and general health questionnaires (GHQ-12), respectively. Analysis of data was performed by multivariate hierarchical regression analysis using SPSS 18 software. In this study, the multivariate hierarchical regression analysis revealed that being married and having low total weight self-stigma and fear of enacted stigma (FES) scores were associated with better physical component summary scores (p<0.05). Whereas, younger ages and lower total weight self-stigma scores were associated with better mental component summary scores. In addition, lower weight self-stigma total scores and lower self-devaluation scores were predictors of lower psychological distress. Our results indicated the negative impacts of weight self-stigma on quality of life and psychological distress among overweight and obese women. Since weight stigma might be a potent barrier of obese individuals to engage in health promoting behaviors, therefore, the results of the current study further warrants the need for developing interventional strategies to reduce the adverse impacts of weight stigma on quality of life via including the reduction of weight self-stigma as a key therapeutic goal in obesity treatment programs.