Random Intercept Model Research Articles

Evaluating the impacts of vehicle-mounted Variable Message Signs on passing vehicles: implications for protecting roadside incident and service personnel

This study aims to evaluate the Variable Message Signs (VMS) mounted over the cab of emergency vehicles as a safety countermeasure to protect roadside incident and service personnel. The research team collaborated with the Alabama Department of Transportation’s Safety Service Patrol (SSP) program, specifically the Alabama Service Assistance Patrol (ASAP) in the West Central Alabama region, to collect video data from their service vehicles. Deep learning techniques were employed to detect vehicles in the recorded videos. A total of 11,338 passing vehicles were detected in 135,946 frames of video footage, and their trajectories were extracted for analysis. The study focused on examining the behaviors and movements of passing vehicles, including their speed and lane change behaviors, and developed statistical models to systematically investigate the impact of VMS on these behaviors. Random intercept models were utilized to account for unobserved factors associated with different stop locations. The modeling results revealed significant relationships between the use of VMS and the behaviors of passing motorists. When the VMS was active, drivers were more likely to change lanes and reduce their speed compared to situations where the VMS was not active. The odds of a vehicle changing lanes were found to be 95% higher when the VMS was in use. These findings suggest that the utilization of VMS can have a positive impact on traffic, particularly for passenger vehicles. The study outcomes imply that the use of VMS could be an effective countermeasure in protecting roadside incidents and ensuring the safety of service personnel.

A diary study on location autonomy and employee mental distress: the mediating role of task-environment fit

PurposeThis study aims to examine the role of location autonomy (i.e. autonomy over where to work) in shaping employee mental distress during their working days.Design/methodology/approachA total of 316 employees from 6 organizations in the UK provided data for 4,082 half-day sessions, over 10 working days. Random intercept modeling is used to analyze half-day data nested within individuals.FindingsResults show that location autonomy, beyond decision-making autonomy and work-method autonomy, is positively associated with the perception of task-environment (TE) fit which, in turn, contributes to lower mental distress during each half-day session. Results of supplementary analysis also show that location autonomy can contribute to higher absorption, task proficiency and job satisfaction via TE fit during each half-day session.Originality/valueThis study reveals the importance and uniqueness of location autonomy in shaping employees' outcomes, offering implications for how organizations can use this in the work–life flexibility policies to support employee mental health.

Do student differences in reading enjoyment relate to achievement when using the random-intercept cross-lagged panel model across primary and secondary school?

Recent longitudinal research using the random-intercept cross-lagged panel model (RI-CLPM), which disentangles the within and between variances, has afforded greater insights than previously possible. Moreover, the impact of reading enjoyment and reading for fun on subsequent school achievement, and vice versa, has only recently been scrutinized through this lens. This study's longitudinal data (grades 3, 5, 7, and 9) comprised 2,716 Australian students aged 8 to 16 years, with school reading achievement measured by the National Assessment Program: Literacy and Numeracy (NAPLAN). The RI-CLPMs' within-person effects were not trivial, accounting for approximately two-thirds and one-third of the variance in enjoyment/fun and achievement, respectively, with between-person effects accounting for the balance. Here, we highlight a reversing direction of reading achievement's cross-lagged effect on subsequent reading enjoyment but note that the evidence for this over a reciprocal directionality was marginal. In mid-primary school, achievement at grade 3 predicted enjoyment at grade 5 more than the converse (i.e. enjoyment at grade 3 to achievement at grade 5). By secondary school, however, the directionality had flipped: enjoyment at grade 7 predicted achievement at grade 9 more so than the reverse. We termed this pattern the skill-leisure-skill directionality (S-L-S), as it concurred with the only two former studies that modelled equivalent instruments with the RI-CLPM. This model's cross-lagged estimates represent deviations relative to a student's average (i.e., within-person effect). In other words, students who enjoyed reading more (or less) in grade 7 achieved reading scores that were higher (or lower) than their average in grade 9. The implications for reading pedagogy are further discussed.

Impact of organizational justice and manager's mental health on staff nurses’ affective commitment: A multilevel analysis of the work environment of hospital nurses in Japan-Part II (WENS-J-II)

BackgroundNursing shortage is a global and priority issue. Affective commitment has been identified as a key to retention in the workplace. Exploring the way to promote the nurse's affective commitment is necessary to maintain the nursing workforce and care quality. The staff nurse's organizational justice (procedural and interactional justice) and the manager's condition of mental health have the potential to be related to the staff nurse's affective commitment. ObjectiveTo explore the impact on the nurse's affective commitment from procedural and interactional justices at individual and unit levels and the manager's mental health. DesignA multi-site longitudinal design. Setting(s)Nine Japanese hospitals with more than 200 beds and located in an area with more than 150,000 people. Participants385 staff nurses and their 42 nurse managers who completed both surveys in 2016 and 2017. MethodsWe analyzed the data from a two-year national survey of the Work Environment for hospital Nurses in Japan part II. Nurse staff and their managers completed the surveys. This multilevel analysis performed four random intercept models on affective commitment and entered the variables of procedural and interactional justices and manager mental health into the models. ResultsThe staff nurse's affective commitment was positively associated with procedural justice climate (unit level), interactional justice climate (unit-level), and the perception of interactional justice (individual justice). The manager's mental health (psychological distress) had a negative relationship with affective commitment. ConclusionsThe climates of procedural and interactional justice, the individual perception of interactional justice, and the manager's mental health impacted the nurses’ affective commitment as a predictor of retention. Moreover, the perception of interactional justice and the organizational contexts (organizational justice climates and managers’ psychological distress) were mediated by affective commitment. Thus, support to maintain the manager's mental health is required to promote staff's affective commitment related to retention. RegistrationNone. Tweetable abstractNurse staff's affective commitment was stimulated by interactional justice, two types of organizational justice climate, and the manager's mental health.

A review of using multilevel modeling in e-learning research

Improving e-learning involves various levels of supports. Accordingly, researchers usually adopt complex research designs with a multilevel structure or repeated measurements to capture a heuristic view of learners’ perceptions, comprehension, and behavior in e-learning settings. A total of 76 studies with Hierarchical Linear Modeling (HLM) as a multilevel modeling technique in 13 major e-learning journals from January 2000 to September 2022, published in the Web of Science, were reviewed. We assessed the applications of the following key criteria: reasons for using HLM, data characteristics, sample characteristics, model characteristics, variables used in the research, software use, and main technology used in the research. The results revealed that two-level models and random-intercept models are mostly used in multilevel model building. Moreover, most e-learning studies included two-level random intercept models with “students” as sampling units of analysis in Level 1, and “cognitive learning” (i.e., examination score, learning achievement) as the dependent variable in Level 1. Based on our review results, we provide suggestions and potential applications of using multilevel modeling in e-learning studies.

Do regional labor market conditions matter for temporary work disability duration? A multilevel analysis of workers' compensation claims in five Canadian provinces.

Research has shown how regionally varying labor market conditions are associated with differences in work disability duration. However, the majority of these studies have not used multilevel models to appropriately account for the hierarchical clustering of individuals nested within contextual units (e.g., regions). Studies that have used multilevel models have focused on privately insured workers or on disability not specifically caused by work-related injury or illness. Using claims data from five Canadian provincial workers' compensation systems, linear random-intercept models were used to estimate how much variance in temporary work disability duration ('work disability duration' for brevity) for work-related injuries and musculoskeletal disorders was due to differences between economic regions, what economic region-level labor market characteristics were associated with work disability duration, and what characteristics best explained economic region differences in work disability duration. Economic region characteristics, such as the unemployment rate and proportion of goods-producing employment, were independently associated with individual-level work disability duration. However, economic region variation only accounted for 1.5%-2% of total variation in work disability duration. The majority (71%) of economic region-level variation was explained by the provincial jurisdiction where the worker livedand was injured. Regional variation tended to be greater for female workers than males. The findings suggest that while regional labor market conditions matter for work disability duration, system-level differences in workers' compensation and health care are more important factors influencing work disability duration. Furthermore, while this study includes both temporary and permanent disability claims, the work disability duration measure only captures temporary disability.

Cross-sector Collaboration Between Public Health, Healthcare and Social Services Improves Retention: Findings from a Nurse Home Visiting Program.

The study aimed to examine the association between cross-sector collaboration in Nurse-Family Partnership (NFP), a model home visiting program, and participant retention. We used the 2018 NFP Collaboration Survey that measured agency-level collaboration, operationalized as relational coordination and structural integration, among nine community provider types (including obstetrics care, substance use treatment, child welfare). This dataset was linked to 2014-2018 NFP program implementation data (n = 36,900). We used random-intercept models with nurse-level random effects to examine the associations between provider-specific collaborations and participant retention adjusting for client, nurse, and agency characteristics. The adjusted models suggest that stronger relational coordination between nurses and substance use treatment providers (OR:1.177, 95% CI: 1.09-1.26) and greater structural integration with child welfare (OR: 1.062, CI: 1.04-1.09) were positively associated with participant retention at birth. Stronger structural integration between other home visiting programs and supplemental nutrition for women, infants, and children was negatively associated with participant retention at birth (OR: 0.985, CI: 0.97-0.99). Structural integration with child welfare remained significantly associated with participant retention at 12-month postpartum (OR: 1.032, CI: 1.01-1.05). In terms of client-level characteristics, clients who were unmarried, African-American, or visited by nurses who ceased NFP employment prior to their infant's birth were more likely to drop out of the NFP program. Older clients and high school graduates were more likely to remain in NFP. Visits by a nurse with a master's degree, agency rurality, and healthcare systems that implement the program were associated with participant retention. Cross-sector collaboration in a home visiting setting that bridges healthcare and addresses social determinants of health has potential to improve participant retention. This study sets the groundwork for future research to explore the implications of collaborative activities between preventive services and community providers.

Longitudinal Stability and Interrelations of Tonic and Phasic Irritability in Adolescent Girls.

Irritability is a transdiagnostic feature and a common mental health problem in adolescence. Prior studies indicate that irritability is composed of two correlated but separable dimensions, tonic irritability (i.e., irritable mood) and phasic irritability (i.e., temper outbursts), which are respectively associated with internalizing and externalizing outcomes. However, little is known about the stability and interrelations of tonic and phasic irritability. The current study examined the longitudinal interplay between tonic and phasic irritability during adolescence. A community sample of 544 girls (age 13.5-15.5 years) was assessed at 5 waves (over 3 years, in 9-month intervals). A random-intercept cross-lagged panel model was used to examine the within-person stability and longitudinal interrelations of tonic and phasic irritability. Pseudo-indicator models were used to help analyze all available data. Results suggest that tonic and phasic irritability had distinct patterns of development and co-development. Between individuals, tonic and phasic irritability showed moderate rank-order stability and high concurrent correlations. Within individuals, phasic irritability was found to positively predict both tonic and phasic irritability at the subsequent wave, whereas tonic irritability did not predict later phasic irritability and showed weaker within-person stability. These results suggest that increased or decreased phasic irritability in adolescent girls may signify continued increase or decrease in both tonic and phasic irritability. The study was among the first to demonstrate the discriminant validity of tonic and phasic irritability from a developmental perspective.

Examining bi-directional change in sleep and depression symptoms in individuals receiving routine psychological treatment

BackgroundSleep disturbance is a common symptom of depression. There is conflicting evidence whether improvements in sleep might impact depressive symptoms, or whether treating the core depressive symptoms might improve sleep disturbance. This study explored the bi-directional impact of sleep and depressive symptom change among individuals receiving psychological treatment. MethodsSession-by-session change in sleep disturbance and depressive symptom severity scores were explored in patients receiving psychological therapy for depression from Improving Access to Psychological Therapies services in England. Bi-directional change in sleep disturbance and depressive symptoms was modelled using random-intercept cross-lagged panel models with items from the PHQ-9. ResultsThe sample included 17,732 adults that had received three or more treatment sessions. Both depressive symptoms and sleep disturbance scores decreased. Between initial timepoints, higher sleep disturbance was associated with lower depression scores, but after this point positive cross-lagged effects were observed for both the impact of sleep disturbance on later depressive symptoms, and depressive symptoms on later sleep disturbance scores. The magnitude of effects suggested depressive symptoms may have more impact on sleep than the reverse, and this effect was larger in sensitivity analyses. ConclusionsFindings provide evidence that psychological therapy for depression results in improvements in core depressive symptoms and sleep disturbance. There was some evidence that depressive symptoms may have more impact on sleep disturbance scores at the next therapy session, than sleep disturbance does on later depressive symptoms. Targeting the core symptoms of depression initially may optimise outcomes, but further research is needed to elucidate these relationships.

No Evidence for Transactional Effects Between Religiosity and Self-Esteem in a Secular Country

This research tests the unique predictions of three different theoretical perspectives on the self-esteem benefits of religiosity: the religiosity-as-a-personal-relationship-with-a-higher-power perspective, the religiosity-as-a-resource perspective, and the religiosity-as-social-value perspective. To do so, we used random-intercept cross-lagged panel models and examined the between- and within-person associations between three indicators of religiosity (belief in God, service attendance, and prayer frequency) and self-esteem across 11 annual assessments in a nationally representative sample of Dutch individuals (N = 12,915). The results reveal largely nonsignificant associations between all three religiosity indicators and self-esteem at the between- and the within-person levels. This finding supports the religiosity-as-a-social-value perspective, suggesting that the self-esteem benefits of religiosity are restricted to religious cultures only. This research extends previous research by showing that the results hold across different measures of religiosity and by providing some initial evidence that the power of the religiosity-as-a-social-value perspective might be larger than formerly assumed.

Diversity of network communication mode and interpersonal interactions: Relationship with social support and well-being

Social interactions today expand beyond in-person interactions. Therefore, it is important to recognize that social interactions can occur with social network members across multiple communication modes (in-person, phone, and online). The current study explored the role that social support plays in the relationship between mode frequency (in-person, phone, and online), network communication mode diversity (breadth and evenness of communicating with network members via different communication modes), and well-being (positive affect, stress, and loneliness) from the 3-year UCNET (UC Berkley Social Networks Study, N = 1159) dataset. The study contained samples for two age groups (cohorts) – 21–31 year-olds and 50–70 year-olds, which also allowed for an exploration of age differences in these relationships. Longitudinal random-intercept cross-lagged panel models (RI-CLPM) showed a high degree of stability over the 3 years for all variables. Cross-sectional structural equation mediation models showed that social support mediated the relationships of mode frequency (in-person, phone, and online) and network communication mode diversity with well-being (more positive affect and less loneliness and stress). Age differences were found in the relationship between frequency of communication modes and social support, in that the frequency of communication mode was positively related to social support for younger adults, but not for middle-aged/older adults. Current findings provided future research directions geared toward further understanding of the mode frequency and network communication mode diversity constructs and how they relate to various psychosocial outcomes.

Cleaning the dose falloff with low modulation in SBRT lung plans

Purpose. This dosimetric study is intended to lower the modulation factor in lung SBRT plans generated in the Eclipse TPS that could replace highly modulated plans that are prone to the interplay effect. Materials and methods. Twenty clinical lung SBRT plans with high modulation factors (≥4) were replanned in Varian Eclipse TPS version 15.5 utilizing 2 mm craniocaudal and 1 mm axial block margins followed by light optimization in order to reduce modulation. A unique plan optimization methodology, which utilizes a novel shell structure (OptiForR50) for R50% optimization in addition to five consecutive concentric 5 mm shells, was utilized to control dose falloff according to RTOG 0813 and 0915 recommendations. The prescription varied from 34–54 Gy in 1–4 fractions, and the dose objectives were PTV D95% = Rx, PTV Dmax < 140% of Rx, and minimizing the modulation factor. Plan evaluation metrics included modulation factor, CIRTOG, homogeneity index (HI), R50%, D2cm, V105%, and lung V8–12.8Gy (Timmerman Constraint). A random-intercept linear mixed effects model was used with a p ≤ 0.05 threshold to test for statistical significance. Results. The retrospectively generated plans had significantly lower modulation factors (3.65 ± 0.35 versus 4.59 ± 0.54; p < 0.001), lower CIRTOG (0.97 ± 0.02 versus 1.02 ± 0.06; p = 0.001), higher HI (1.35 ± 0.06 versus 1.14 ± 0.04; p < 0.001), lower R50% (4.09 ± 0.45 versus 4.56 ± 0.56; p < 0.001), and lower lungs V8–12.8Gy (Timmerman) (4.61% ± 3.18% versus 4.92% ± 3.37%; p < 0.001). The high dose spillage V105% was borderline significantly lower (0.44% ± 0.49% versus 1.10% ± 1.64%; p = 0.051). The D2cm was not statistically different (46.06% ± 4.01% versus 46.19% ± 2.80%; p = 0.835). Conclusion. Lung SBRT plans with significantly lower modulation factors can be generated that meet the RTOG constraints, using our planning strategy.

Physician Compliance With a Computerized Clinical Decision Support System for Anemia Management of Patients With End-stage Kidney Disease on Hemodialysis: Retrospective Electronic Health Record Observational Study.

Previous studies on clinical decision support systems (CDSSs) for the management of renal anemia in patients with end-stage kidney disease undergoing hemodialysis have previously focused solely on the effects of the CDSS. However, the role of physician compliance in the efficacy of the CDSS remains ill-defined. We aimed to investigate whether physician compliance was an intermediate variable between the CDSS and the management outcomes of renal anemia. We extracted the electronic health records of patients with end-stage kidney disease on hemodialysis at the Far Eastern Memorial Hospital Hemodialysis Center (FEMHHC) from 2016 to 2020. FEMHHC implemented a rule-based CDSS for the management of renal anemia in 2019. We compared the clinical outcomes of renal anemia between the pre- and post-CDSS periods using random intercept models. Hemoglobin levels of 10 to 12 g/dL were defined as the on-target range. Physician compliance was defined as the concordance of adjustments of the erythropoietin-stimulating agent (ESA) between the CDSS recommendations and the actual physician prescriptions. We included 717 eligible patients on hemodialysis (mean age 62.9, SD 11.6 years; male n=430, 59.9%) with a total of 36,091 hemoglobin measurements (average hemoglobin and on-target rate were 11.1, SD 1.4, g/dL and 59.9%, respectively). The on-target rate decreased from 61.3% (pre-CDSS) to 56.2% (post-CDSS) owing to a high hemoglobin percentage of >12 g/dL (pre: 21.5%; post: 29%). The failure rate (hemoglobin <10 g/dL) decreased from 17.2% (pre-CDSS) to 14.8% (post-CDSS). The average weekly ESA use of 5848 (SD 4211) units per week did not differ between phases. The overall concordance between CDSS recommendations and physician prescriptions was 62.3%. The CDSS concordance increased from 56.2% to 78.6%. In the adjusted random intercept model, the post-CDSS phase showed increased hemoglobin by 0.17 (95% CI 0.14-0.21) g/dL, weekly ESA by 264 (95% CI 158-371) units per week, and 3.4-fold (95% CI 3.1-3.6) increased concordance rate. However, the on-target rate (29%; odds ratio 0.71, 95% CI 0.66-0.75) and failure rate (16%; odds ratio 0.84, 95% CI 0.76-0.92) were reduced. After additional adjustments for concordance in the full models, increased hemoglobin and decreased on-target rate tended toward attenuation (from 0.17 to 0.13 g/dL and 0.71 to 0.73 g/dL, respectively). Increased ESA and decreased failure rate were completely mediated by physician compliance (from 264 to 50 units and 0.84 to 0.97, respectively). Our results confirmed that physician compliance was a complete intermediate factor accounting for the efficacy of the CDSS. The CDSS reduced failure rates of anemia management through physician compliance. Our study highlights the importance of optimizing physician compliance in the design and implementation of CDSSs to improve patient outcomes.

The bidirectional effects of antisocial behavior, anxiety, and trauma exposure: Implications for our understanding of the development of callous–unemotional traits.

The association of anxiety and trauma with antisocial behavior in children and adolescents has long been the focus of research, and more recently this area of research has become critical to theories of the development of callous-unemotional (CU) traits. Research suggests those with elevated CU traits and anxiety (i.e., secondary CU variant) seem to show more severe externalizing behaviors and are more likely to show histories of trauma, compared to those with elevated CU and low anxiety (i.e., primary CU variant). These findings have typically been interpreted as being indicative of distinct etiological pathways to the development of CU traits. We test an alternative explanation that the higher rates of anxiety and trauma exposure in some youth with elevated CU traits are largely a consequence of their higher levels of antisocial behavior. The current study recruited a sample of 1,216 justice-involved adolescents (Mage = 15.28, SD = 1.28) from three distinct regions of the United States, who were assessed at 6, 12, 18, 24, 30, 36, 48, and 60 months following their first arrest. Using random-intercept cross-lagged models, both antisocial behavior and CU traits predicted changes in future anxiety and CU traits predicted increases in future victimization. Further, using longitudinal parallel mediation models, antisocial and aggressive behavior largely accounted for the predictive association between CU traits and anxiety and CU traits and victimization. These results support a model in which anxiety and trauma histories may be a marker of the severity of antisocial behavior displayed by youth with elevated CU traits. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Bring the outcome expectations back in: Chinese adolescent perceived value of effort and academic achievement

AbstractThe existing literature mainly examines the impact of academic self‐efficacy on academic achievement in educational psychology. Much less is known about the relationship between outcome expectations and adolescent academic achievement. This article applies the random intercept model to investigate the association between Chinese adolescent perceived value of effort as outcome expectations and academic achievement and employs the Karlson, Holm, and Breen (KHB) method to examine the underlying mechanisms. Additionally, this paper uses the random coefficient model to explore the heterogeneous association between the perceived value of effort and adolescent academic achievement across families and schools. Based on the Programme for International Students Assessment 2018 (N = 11751; 48.07% females), we found that the adolescent perceived value of effort was significantly and positively correlated with academic achievement. Adolescent educational expectations and academic engagement partially mediated the relationship between the perceived value of effort and academic achievement. Adolescents from disadvantaged families and schools benefited more from the perceived value of effort. These findings enhance existing literature by revealing how the adolescent outcome expectations contribute to academic achievement and provide a scientific basis for bridging the gap in academic achievement between families and schools to promote equity in education.

Penerapan model regresi multilevel untuk data ketepatan waktu lulus mahasiswa

Multilevel logistic regression is one of the alternatives to solving a problem that has a nested data structure like the student data in Alauddin in 2016. The data indicates that students are nested in each different study program. This condition allows the students in the same study program tend to have similar characteristics. The study aims to gain a student graduating model of punctuality using multilevel regression analysis and recognize factors that have a significant impact on student graduating time. Based on our research, we find the best model that fits the data to be the random intercepts model with a random slope of gender variable. The variables that have significant effects are gender, cumulative achievement index, educational background, and accredited program.&#x0D; Keywords: logistic regression, nested, multilevel logistic regression, graduation of studentMSC2020: 62J05

Reducing Officer-Involved Deaths of Civilians in Urban Areas: Forecasting the Effects of Departmental Policies

Recent police-involved deaths of Black civilians have sparked public outcry and demand for police reforms. However, many departmental policies intended to reduce the lethal use-of-force by police officers lack empirical support for their effectiveness. To address this shortcoming, a Bayesian random intercept model is used to forecast the effects of eight departmental policies on the number of police-involved civilian deaths across 66 police departments. Results suggest that although several policies are associated with a reduction in officer-involved deaths of civilians in some police departments, they are unlikely to eliminate officer-involved deaths completely. Specifically, we observed that introducing additional departmental policies would only reduce the number of officer-involved deaths by approximately 5 to 10. Moreover, variation in the baseline number of officer-involved deaths and the effectiveness of these policies existed between the 66 police departments. The results suggest that de-escalation training, ban on chokeholds, comprehensive reporting, restrictions on foot pursuit, restrictions on vehicle pursuit, community surveys, and problem-oriented policies could reduce the number of officer-involved civilian deaths. Nevertheless, variation in the number of police-involved deaths of civilians and differential effects of policies across agencies suggests a more tailored solution, and additional research is needed to address this crisis.

Longitudinal associations of parental psychological control and friend support with autonomy during early adolescence.

Although theories suggest transactional associations between adolescents' autonomy and relationships with parents and friends, few studies have examined these within-person effects. This longitudinal study examined the within-person co-development of adolescents' autonomy and relationships with parents and friends. Adolescents (N = 244 Mage = 11.54, SD = 0.43 at T1; 50% boys) participated in a four-wave study across 2 years in the Netherlands. In random-intercept cross-lagged panel models, within-person results showed that higher levels of autonomy predicted less parental psychological control but not vice versa. However, no lagged-effects between friend support and autonomy were found. This study suggests that adolescents' autonomy steers changes in parental psychological control.

Bidirectional associations between mental health problems and language ability across 8 years of childhood

Research examining the development of behavior, emotions and language, and their intertwining is limited as only few studies had a longitudinal design, mostly with a short follow-up period. Moreover, most studies did not evaluate whether internalizing symptoms and externalizing symptoms are independently associated with language ability. This study examines bidirectional associations between internalizing symptoms, externalizing symptoms and language ability in childhood in a large, population-based cohort. Longitudinal data from the Millennium Cohort Study, a cohort of children in the United Kingdom followed from birth to 11 years (n = 10,878; 50.7% boys), were analyzed. Internalizing and externalizing symptoms were based on parent reports. Language ability (higher scores reflecting poorer ability) was assessed by trained interviewers at ages 3, 5, 7 and 11 years. Structural Equation Models (SEM) were performed, including random-intercept cross-lagged panel models (RI-CLPM) and cross-lagged panel models (CLPM). Internalizing symptoms, externalizing symptoms and language ability were stable over time and co-occur with each other from early life onwards. Over time, externalizing symptoms in early childhood were associated with less growth in language skills and with increases in internalizing symptoms. In late childhood, language ability was negatively associated with later internalizing and externalizing symptoms. The early start, co-occurrence and persistent nature of internalizing symptoms, externalizing symptoms and (poorer) language ability highlights the importance of comprehensive assessments in young children who present problems in one of these domains. Specifically, among children in the early grades of elementary school, those with language difficulties may benefit from careful monitoring as they are more likely to develop difficulties in behavior and emotions.

Compliance with hand hygiene practices and its appropriateness among healthcare workers during COVID-19 pandemic in public health facilities of Tamil Nadu, India

BackgroundCompliance with appropriate hand hygiene practises is the most efficient and cost-effective intervention that can be implemented in the healthcare setting. Given its importance, we tried to capture the compliance with hand hygiene practises and their appropriateness among healthcare workers during the COVID-19 pandemic in public health facilities in Tamil Nadu. MethodsThis cross-sectional study involved doctors, nurses, and allied healthcare professionals from various departments in 18 public healthcare facilities spanning six districts in Tamil Nadu. A random-intercept model was employed for the multivariable logistic regression analysis to evaluate the factors influencing hand hygiene compliance and its adequacy. The effect size was presented as an adjusted odds ratio (aOR) accompanied by a 95% confidence interval (CI). ResultsIn total, 2733 hand hygiene observations were made. Only during 19.4% (95%CI: 17.9%–20.9%) of these observations, hand washing was done. Only during 37.9% (95%CI: 33.9%–42.1%) of these observations, hand washing was done appropriately by following all the essential steps of hand hygiene. Nurses (aOR = 2.49; 95%CI: 1.90–3.26), healthcare workers in General Surgery (aOR = 2.18; 95%CI: 1.53–3.10) and Obstetrics & Gynaecology departments (aOR = 1.75; 95%CI: 1.26–2.43), working in inpatient departments (aOR = 2.64; 95%CI: 1.38–5.04) had significantly higher compliance to hand hygiene practices. Nurses (aOR = 2.58; 95%CI: 1.33–5.01) and General Medicine department healthcare workers (aOR = 1.98; 95%CI: 1.09–3.61) had significantly higher compliance to appropriate hand hygiene practices. ConclusionOur study shows that only during one-fifth of the observations did healthcare workers do hand washing, and less than 10% did it appropriately by following all the essential steps of hand hygiene.