National Sample Research Articles

How and why do community stakeholders participate in the national stroke audit in England? Findings from a mixed-method online survey.

National audit programmes are a recognised means of assessing quality of healthcare by collecting and reporting data in relation to evidence-based standards. The Sentinel Stroke National Audit Programme is a prospective audit of processes and outcomes for all stroke patients in England, Wales and Northern Ireland which has historically focused on hospital-based care. Evidence suggests it has been successful in driving quality improvement. What has yet to be explored is the influence of such a national audit programme on community-based healthcare. The aims of this study were to understand how community stakeholders perceive and participate in the audit. The study used a realist approach, being theory driven and informed by collaborators including stroke clinicians and experts in realist and audit methodology. Contextual determinants and mechanisms were identified from the literature as having the potential to influence quality improvement. These were operationalised into 18 survey items, using a combination of 5-point scales and yes / no responses. Free text options offered the opportunity to expand upon responses. The online survey was distributed using social media, clinical networks and professional bodies. Representation was sought from community stroke stakeholders across England and from roles throughout the audit process including administrative, clinical, management and commissioning. The survey achieved a national sample from a broad range of stakeholders (n=206). Participants reported being engaged in the audit, committing significant resources to participation. National audit feedback was described as being used to support a range of improvement activities, including funding for additional staff and service reorganisation. A number of factors influenced the ability of teams to participate in audit and utilise feedback for quality improvement. These included the online platform, the accuracy of data submitted and leadership support. Findings highlight the work needed in terms of the data captured, organisational audit support and engagement with feedback if the potential of the audit as a tool for quality improvement in community rehabilitation (as highlighted in acute stroke care) is to be realised.

Explaining key stakeholders' preferences for potential policies governing psychiatric electroceutical intervention use.

In recent years, legislators in many states have proposed laws governing the use of psychiatric electroceutical interventions (PEIs), which use electrical or magnetic stimulation to treat mental disorders. To examine how the PEI views of relevant stakeholder groups (e.g., psychiatrists, patients, caregivers, and general public) relate to preferences for proposed policies governing PEI use, we analyze data from a survey on using one of four PEIs to treat major depressive disorder administered to national samples of the stakeholder groups above. We find that the three non-clinician groups' similar PEI policy preferences differ significantly from those of psychiatrists-with the greatest divide on policies governing the use of electroconvulsive therapy. This divide between psychiatrists' and non-clinicians' PEI policy preferences was greater with access-reducing than with access-expanding policies. We advise policymakers to consider such variation in the preferred availability of PEIs across modalities and stakeholder groups when crafting legislation on these interventions.

Perceived social support and symptoms of depression and anxiety in emerging adulthood: A Swedish prospective cohort study.

The transition from adolescence to young adulthood, often referred to as 'emerging adulthood', is a challenging period in life, and mental health problems are common. Although a large number of studies have shown that social support is linked with fewer mental health problems, few longitudinal studies have examined these associations during this life phase. The aim of the current study was to examine the associations between perceived social support from different sources - family, friends and significant other - at age 17-18 and symptoms of depression and anxiety at age 20-21. Data were obtained from the cohort study Futura01 based on a Swedish national sample of adolescents attending grade 9 in 2016/2017. We used survey information from 2019 (age 17-18) and 2022 (age 20-21) and linked registry information (N=2722). Symptoms of depression and anxiety were measured by the Patient Health Questionnaire-4 (PHQ-4) at age 20-21. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) at age 17-18. Control variables included sociodemographic characteristics and indicators of mental health problems at age 17-18. Binary logistic regressions were performed. When mutually adjusting for all sources of perceived social support, family support at age 17-18 had inverse associations with symptoms of both depression and anxiety at age 20-21. Perceived support from friends was associated with subsequent symptoms of anxiety only. Perceived social support can be a protective factor against mental health problems in emerging adulthood. The family serves a particularly important source of social support.

Quantity of delta-9-tetrahydrocannabinol consumption and cannabis use disorder among daily cannabis consumers.

Amid escalating cannabis legalization and daily consumption in the United States (US), determining the risk of cannabis use disorder (CUD) and relevant consequences among daily consumers has become a public health priority. Understanding these risks requires valid assessment of the daily quantity of delta-9-tetrahydrocannabinol (THC) consumed and its relation to consequences. This study characterized daily cannabis consumption using a new method for estimating milligrams of THC (mgTHC), and examined the relationship between daily mgTHC and CUD severity in a large national sample of daily consumers. US adult (aged 18+ years) daily cannabis consumers (n = 4134) completed a comprehensive online survey of cannabis consumption patterns (e.g. frequency, quantity, product types, potencies, administration methods) and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) CUD criteria. The primary exposure was past-week daily mgTHC consumption, calculated from survey responses to queries about product type, amount and potency consumed and including adjustments for puff size and loss of THC from specific methods of administration. The primary outcomes were (1) number of CUD criteria (range = 0-11) and (2) CUD severity categories: none, mild, moderate, severe. Median daily consumption was ~130 mgTHC, with substantial variability (25% ≤ 50 mg and 25% ≥ 290 mg). On average, participants endorsed 2.5 CUD criteria, and 65% met criteria for CUD (39% mild, 18% moderate, 8% severe). Greater daily mgTHC predicted higher CUD criteria count [betalog(mgTHC) = 0.50, 95% confidence interval (CI) = 0.267-0.734] and higher odds of mild [log odds ratio (logOR) = 0.238, 95% CI = 0.184-0.292], moderate (logOR = 0.303, 95% CI = 0.232-0.374) or severe (logOR = 0.335, 95% CI = 0.236-0.435) CUD. Among daily consumers of cannabis, there appears to be a positive relationship between the daily quantity of cannabis consumed (measured in milligrams of delta-9-tetrahydrocannabinol) and both the risk and severity of cannabis use disorder.

Psychometric evaluation and measurement invariance of the problematic smartphone use scale among college students: A national survey of 130 145 participants.

Given the insufficient validation of previously imported smartphone addiction scales in China, this study revised and evaluated the Problematic Smartphone Use Scale among Chinese college students (PSUS-C). We based our research on a national sample comprising 1324 higher education institutions and 130 145 participants. Using cross-sectional data, comprehensive methods were employed to examine validity, reliability and measurement invariance. The final scale consists of 20 items across four dimensions: withdrawal and loss of control, negative impact, salience behaviors and excessive use. All Heterotrait-Monotrait (HTMT) values were below 0.85, and the lower 90% and upper 95% confidence intervals were also below 0.85, except for factors 1 and 3. The amount of variance (AVE) values were greater than 0.5, composite reliability (ω) values exceeded 0.89 and all factor loadings were above 0.5. The criterion validity was supported as expected: problematic smartphone usage positively correlated with depression (r = 0.451), loneliness (8 items, r = 0.455), loneliness (6 items, r = 0.504), social media use (r = 0.614) and phone usage duration (r = 0.148); and negatively correlated with life satisfaction (r = -0.218) and self-esteem (r = -0.416). Across sex, type of university and place of residence, the measurement invariance performed well, with most changes in root mean square error of approximation (ΔRMSEA), comparative fit index (ΔCFI) and Tucker-Lewis index (ΔTLI) values being less than 0.005, and no indicator showing a difference greater than 0.010. The Problematic Smartphone Use Scale for College Students (PSUS-C) demonstrated good factor structure, internal consistency, construct validity, discriminant validity and criterion validity. Strict and structural invariance were demonstrated across sex, type of university and place of residence. The PSUS-C has the potential to assess smartphone addiction among Chinese university students.

Adverse childhood experiences and ICD-11 complex posttraumatic stress disorder in Poland: a population-based study

ABSTRACT Background: Research on the prevalence of ICD-11-based complex posttraumatic stress disorder (CPTSD) in nationally representative samples is lacking, with no such studies conducted considering national Polish samples until now. Objectives: The primary aim of this study was to explore profiles of study participants in terms of either PTSD or CPTSD symptoms regarding to ICD-11 diagnosis with the aid of latent profile analysis. We also investigated the relationship between the types and cumulative number of adverse childhood experiences (ACEs) with the probability of CPTSD rate in a national sample of Poles. Methods: A representative sample of Polish adults (n = 3,557) participated in this study. ACEs were assessed using the Adverse Childhood Experiences Questionnaire, while the core features of PTSD and CPTSD were measured using the International Trauma Questionnaire. Results: The findings showed a 11% prevalence rate of probable CPTSD in the studied sample of Poles. Sexual abuse, emotional neglect, physical neglect and having the experience of a mentally ill household member were the most significant predictors of potential diagnosis. Furthermore, significant differences concerning lifestyle data were observed in the group of participants with CPTSD. Conclusions: The current rate of probable CPTSD in Poland is substantially higher than the respective data reported for other countries. We also noted that the ICD-11 diagnosis of CPTSD may not apply to all cultural environments. Finally, it was observed that the ACEs – CPTSD association may depend both on the ACEs types as well as on their overall cumulative character.

Changes in Adolescent Heterosexual Behaviors from the 1980s to the Present in Various Western Countries: A Systematic Review

Adolescence is a stage of significant intrapersonal and interpersonal changes, influenced by cultural and historical shifts. This study aims to analyze the changes in heterosexual behaviors among adolescents in Western countries over the past 50 years approximately. For this purpose, we conducted a systematic review following the PRISMA model, utilizing the online databases EBSCO, WoS, and Scopus, covering the period from 1980 to 2024, across ten European countries. The review focused on studies published in scientific journals with regional or national samples. In addition to the 30 selected studies, three more were included due to their relevance as cited in the selected articles. Despite the considerable methodological heterogeneity, the results showed a relative stabilization of the differences in sexual behaviors of boys and girls throughout time. Those differences were more evident in Southern European countries. Some changes were also noted, such as the delay in the initiation of the first sexual intercourse, a trend observed over the last decade. The findings are discussed in terms of the sexual script theory, highlighting the importance of these mental frameworks in the heteronormative sexual socialization of boys and girls. Future research should emphasize the diversity of heterosexual behaviors, their significance, and the emotional experiences that accompany them.

“That’s not how abortions happen”: a qualitative study exploring how young adults navigate abortion misinformation in the post-Roe era

BackgroundMisinformation about abortion is widespread and was exacerbated by the overturn of Roe v Wade. Young adults are among those facing the most direct impacts of new abortion restrictions and...

The role of supportive relationships in academic performance and personal wellbeing: Results from a U.S. national sample of early adolescents

This study examined the associations of supportive relationships with academic performance and personal wellbeing in a national sample of early adolescents (N = 6,469). Six latent classes captured variation in youth-reported relational support from adults and peers in school, family, and community contexts. We report four main findings from models testing the associations of latent class with the outcomes. First, the three classes with emotional and informational support from school friends performed at or above the mean on academic performance. Second, the three classes with parental emotional and informational support performed at or above the mean on personal wellbeing. Third, the two classes with emotional, informational, and academic support from peers and adults had the highest outcomes. Lastly, the low/no support class had the lowest outcomes. Findings motivate the need to bolster programs and practices across settings to cultivate relational support during this critical time of early adolescence.

Antenatal pyelonephritis hospitalisation trends, risk factors and associated adverse outcomes: A retrospective cohort study.

To analyse trends, risk factors and adverse outcomes associated with antenatal pyelonephritis hospitalisations. Retrospective cohort. A national sample of US delivery hospitalisations with associated antenatal hospitalisations. US delivery hospitalisations in the Nationwide Readmissions Database from 2010 to 2020. Antenatal hospitalisations with a pyelonephritis diagnosis within the 9 months before delivery hospitalisation were analysed. Clinical, demographic and hospital risk factors associated with antenatal pyelonephritis hospitalisations were analysed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios as measures of effect. Temporal trends in antenatal pyelonephritis hospitalisations were analysed with Joinpoint regression to determine the relative measure of average annual percent change (AAPC). Risk for severe maternal morbidity and sepsis during antenatal pyelonephritis hospitalisations was similarly analysed with Joinpoint regression. Of an estimated 10.2 million delivery hospitalisations, 49 140 (0.48%) had an associated antenatal pyelonephritis hospitalisation. The proportion of deliveries with a preceding antenatal pyelonephritis hospitalisation decreased by 29% from 0.56% in 2010 to 0.40% in 2020 (AAPC -2.9%, 95% CI -4.0% to -1.9%). Antenatal pyelonephritis decreased, but risk for sepsis diagnoses increased during these hospitalisations from 3.7% in 2010 to 18.0% in 2020 (AAPC 17.2%, 95% CI 14.2%-21.1%). Similarly, risk for severe morbidity increased from 2.6% in 2010 to 4.4% in 2020 (AAPC 5.5%, 95% CI 0.8%-10.7%). Antenatal pyelonephritis admissions appear to be decreasing in the USA. However, these hospitalisations are associated with a rising risk for sepsis and severe maternal morbidity.

Initial validation of a short version of the PERMA profiler in a national sample of rural veterans

Initial validation of a short version of the PERMA profiler in a national sample of rural veterans

Adverse childhood experiences and diet quality in the national sample of Poles: The mediating role of emotion regulation

Adverse childhood experiences and diet quality in the national sample of Poles: The mediating role of emotion regulation

Generational Differences in Sexual Health Education Experiences Among LGBTQ+ Adolescents and Adults: Findings from a U.S. National Probability Sample

ABSTRACT Few U.S. states require school-based sex education to be representative or inclusive of LGBTQ+ people. Data suggests that adolescents’ receipt of necessary topics in sex education has declined in the past 25 years, yet the literature on LGBTQ+ people’s sex education experiences in the United States is largely limited to non-probability samples. Data were from a national probability sample of adolescents and adults in the United States. Individuals identifying as LGBTQ+ (N = 818) were asked an open-ended item about the type of sex education they would have liked to have received. Participants were classified into four generational cohorts: Boomer+, Generation X, Millennials, and Generation Z. Inductive content analyses and chi-square tests of independence were used. Having sex education that normalized LGBTQ+ identities was the most reported topic, with Boomer+ being more likely to report this and Generation X being least likely. About one-quarter of respondents indicated they would have liked any type of sex education. Millennials were more likely to report wanting more information on sexual orientation and gender identity and safe sexual practices compared to other cohorts. Nearly one-fourth of respondents indicated their sex education did not need improvement/was unnecessary. Older generations wished their sex education normalized their identities, while Generation Z and Millennials reported wanting more information on safe sex and/or sexual violence prevention. Findings from this study can inform the development of tailored sexual health education programs for LGBTQ+ individuals, particularly considering that current programming may not be different compared to the sex education received by earlier generations.

The perceptions of brand coappearance in product placement: cooperation, competition or coopetition?

Purpose Brands increasingly coappear in television programs while research in product placement has primarily focused on the placements of a single brand. Building on research related to product placement and cobranding, this study aims to systematically examine the roles of product competitiveness and brand competitiveness on the effectiveness of brand coappearance on television programs. Design/methodology/approach Extensive pretesting and four experimental studies were conducted. Real stimuli that had been digitally manipulated with fictitious brands were used in Study 1 (laboratory experiment involved student samples) and Study 2 (online experiment with a national sample) to examine the short- and long-term impacts of product competitiveness on brand coappearance. Real stimuli incorporated actual brands were used in Study 3 (involved advertisers’ key demographic) and Study 4 (alterative television program with a national sample) to examine the impacts of brand competitiveness and its interaction effect with product competitiveness. Findings The study found that coappearing with a product of high competitiveness significantly enhanced attitudes and purchase intention toward the coappearing products both in the short and long term. Product competitiveness further interacts with brand competitiveness to influence attitudes and purchase intention toward the coappearing brands suggesting a coopetition pattern for brand coappearances. The effect of brand coappearances did not vary substantially for low or high involvement products with or without character interaction. Research limitations/implications The study develops a useful framework for explaining and understanding the potential spillover effects in brand coappearances. It contributes to the existing literature on product placement and cobranding, while also paving the way for future research opportunities. Practical implications When introducing new brands, marketers are advised to consider coappearance deals with more competitive brands in highly competitive product categories. Conversely, coappearance deals with less competitive brands in less competitive product categories should be adopted to promote well-known brands. Advertisers may also consider product or brand exclusivity arrangements with broadcasters to enhance the effectiveness of the product placement. Originality/value Although brand coappearance in media content is likely to continue to proliferate, little is known about the phenomenon and its effects. To the best of the authors’ knowledge, this research is the first to systematically examine the perceptions toward brands coappeared in television programs.

Telomere Length and Biological Aging: The Role of Strength Training in 4814 US Men and Women

Telomere length is an index of cellular aging. Healthy lifestyles are associated with reduced oxidative stress and longer telomeres, whereas unhealthy behaviors are related to shorter telomeres and greater biological aging. This investigation was designed to determine if strength training accounted for differences in telomere length in a random sample of 4814 US adults. Data from the National Health and Nutrition Examination Survey (NHANES) were employed to answer the research questions using a cross-sectional design. Time spent strength training was calculated by multiplying days of strength training per week by minutes per session. Participation in other forms of physical activity was also calculated based on reported involvement in 47 other activities. Weighted multiple regression and partial correlation were used to calculate the mean differences in telomere length across levels of strength training, adjusting for differences in potential confounders. With the demographic covariates controlled, strength training and telomere length were linearly related (F = 14.7, p = 0.0006). Likewise, after adjusting for all the covariates, the linear association remained strong and significant (F = 14.7, p = 0.0006). In this national sample, 90 min per week of strength training was associated with 3.9 years less biological aging, on average. Regular strength training was strongly related to longer telomeres and less biological aging in 4814 US adults.

The relationship between LGBT older adults’ social network structure and function

Social prejudice, family nonacceptance, and lack of marriage or adoption rights often restrict the formation of conventional social ties among LGBT older adults. As a result, they often rely on families of choice constituted by other LGBT/age peers for support. Using a series of regression analyses with a national sample of LGBT older Americans, this study investigated how characteristics of social network structure (size and composition - LGBT vs. non-LGBT identity and age ≥50 vs. < 50) were related to LGBT older adults’ social network function (perceived social support). Larger social networks, especially those composed of LGBT members and older adults, were associated with more perceived social support. In subgroup analyses, larger social networks composed of more LGBT members and older adults were associated with more perceived social support among lesbian and gay respondents. For bisexual + older adults, larger social network size was associated with more perceived social support, but social network composition was not related to more perceived social support. For transgender older adults, neither social network size nor network composition were significantly associated with perceived social support. This study demonstrated that having more people with similar characteristics in their social networks cues LGBT older adults about the availability of social support. Findings may inform strategies for tailoring programs intended to maintain and strengthen LGBT older adults’ social support networks.

Incidence and risk factors of pain following breast cancer surgery: a retrospective national inpatient sample database study

BackgroundPostoperative pain (PP) is a dynamic process that reflects the complex interplay between symptoms, treatment, and patient experiences, and its intensity is reportedly primarily related to the severity of surgical trauma. However, no large-scale national database-based study has hitherto been conducted to assess the occurrence and features related to PP following breast cancer (BC) surgery.MethodsIn this retrospective analysis, we screened BC surgery cases between 2015 and 2019 within the National Inpatient Sample (NIS) Database, utilizing the International Classification of Diseases (ICD) 10th edition clinical modification codes. The researchers identified patients who developed PP and compared them to those who did not. Factors associated with PP were then screened: patient demographics (age and race), hospital characteristics (type of insurance, bed size, teaching status, type of admission, location, and hospital area), length of stay (LOS), total cost during hospitalization, inpatient mortality, comorbidities, and perioperative complications. Data were analyzed using descriptive statistics. Multivariate logistic regression analysis was used to determine the independent risk factors for postoperative pain in BC surgery.Results39,870 BC surgery cases were identified over a five-year period from 2015 to 2019. The overall occurrence of PP following breast cancer surgery was 6.15% (2,387 cases), with a slight upward trend every year. Significant racial disparities were observed, Whites associated with a higher incidence of PP (P < 0.001). In addition, the incidence of elective admission was 11.96% lower (67.491% vs. 79.451%) than that of patients without PP following breast cancer surgery (P < 0.001). Besides, PP was related to prolonged hospitalization duration (3 vs. 2 days; P < 0.001), and higher total cost ($68,283 vs. $60,036; P < 0.001). Multivariate logistic regression identified breast cancer surgery-independent risk factors for PP, including younger age, non-elective hospital admission, rural hospitals, depression, drug abuse, metastatic cancer, psychoses, weight loss, and chronic pulmonary disease. In addition, postoperative pain for BC was associated with urinary retention, gastrointestinal complications, continuous invasive ventilation, deep vein thrombosis, urinary tract infection, blood transfusion, arrhythmia, and chest pain.ConclusionDespite the low incidence of postoperative pain in BC surgery cases, it is essential to investigate factors predisposing to PP to allow optimal care management and improve the outcomes of this patient population.

Limited Congruence: Citizens’ Attitudes and Party Rhetoric About Referendums and Deliberative Practices

Both citizens and political parties refer to novel participatory practices in the contemporary crisis of representative democracy. Survey data indicate a growing demand for such practices within the electorate, while political parties have also begun discussing them more frequently. However, previous studies on citizens’ attitudes and parties’ discourse on democratic innovations rarely speak to each other. It remains unclear whether citizens’ attitudes and parties’ discourse are congruent. This article seeks to address this gap in the literature and analyses the extent to which political parties reflect citizens’ attitudes towards referendums and citizens’ deliberation in their manifestos. We cover 15 political parties in Germany and the UK. Our analysis uses party manifesto data between 2010 and 2024, and data from surveys conducted on national representative samples. Our findings reveal that political parties and citizens rarely have congruent approaches towards referendums and deliberative practices. People’s enthusiasm about referendums is hardly reflected in parties’ rhetoric, but the latter reacts gradually to the public appetite for deliberation. There are visible differences between opposition parties and those in government.

The development of attitudes toward science and technology: a longitudinal analysis of Generation X

Abstract Research on public attitudes toward science and technology policy has relied on surveys taken at single points in time. These surveys fail to indicate how these attitudes develop or change. In this study, we use data from the Longitudinal Study of American Life that has followed a national sample of Generation X for 33 years—from middle school to midlife. We demonstrate that the critical period for the formation of attitudes toward science and technology is the 15–18 years after high school—college, work, family, and career. The attitudes formed in this period remain stable for most individuals during midlife. This work provides an important perspective for scientists, engineers, and the leadership of the scientific community in their efforts to foster positive attitudes toward science and technology and to understand the roots of concerns and reservations about science.

State Full Practice Authority Regulations and Nurse Practitioner Practice Autonomy: Evidence From the 2018 National Sample Survey of Registered Nurses.

State full practice authority (FPA) laws are designed to permit NPs to practice autonomously from physicians. Little is known regarding how FPA laws affect NPs' practice autonomy in daily practice. This study used nationwide survey data from 20,830 NPs to estimate how NPs' practice autonomy differs between NPs in FPA and non-FPA states. NPs in states with FPA laws were more than twice as likely as NPs in non-FPA states to practice in clinic settings with no onsite physicians and were twice as likely to not have a physician collaborator. Associations between FPA laws and four other indicators of practice autonomy were positive but smaller in magnitude. States with FPA laws more than 10 years experienced larger changes in nurse practitioner (NP) autonomy compared with states with FPA laws in effect less than 10 years. FPA laws may promote the development of autonomous NP practice sites, thereby expanding access in underserved populations.