Stratified Regression Analyses Research Articles

Objective ranges of soil-to-dust transfer coefficients for lead-impacted sites

Residential yard soil and indoor dust datasets from eight communities near historical mining, smelting, and refining operations were used to quantify soil track-in, an important factor in evaluating indoor exposures to soil metals and to set residential soil cleanup levels. Regression analyses were used to derive slopes that represent mass soil-to-dust transfer coefficients or MSDs. Lead concentration data were available for all datasets. Arsenic data were available for six of the eight datasets. Cadmium and zinc data were available for one dataset, allowing limited comparison of MSDs for lead with other metals. Covariates that could indicate potential indoor sources of metals, such as house age and indoor heating source, were examined by multivariate regression analysis when available (three datasets). Covariates that could affect soil track-in, such as the amount of bare soil in the yard or having pets, were examined by stratified linear regression analysis when available (two datasets). Most of the R-squared values for lead, cadmium and zinc indicate a good to moderate fit (≥0.25), but for arsenic most indicate a poor fit (<0.25). Significant MSDs for models with a good to moderate fit range from 0.14 to 0.47 for lead, and 0.12 to 0.43 for the other metals (arsenic, cadmium, and zinc). The treatment of outliers was a significant methodological factor affecting the slope of the regressions. Substantial variability is expected among soils at residences due to both physical characteristics of each property and the ways in which residents interact with their home. Survey data providing information on various factors affecting soil track-in help to refine MSD estimates. For three of the datasets, covariate data were available that improved model fit by multivariate or stratified regression analysis for lead. When multivariate or stratified regression analyses were performed, the estimated MSD varied as little as <1% to as great as 200% depending on the dataset, but all estimates were below 0.4. Notably, the MSDs were lowest for the three datasets with the highest soil lead concentrations, i.e., those with average soil lead concentrations greater than 300 mg/kg after outlier removal. For five of the six datasets that had both arsenic and lead sampled, arsenic MSDs were much less than the lead MSDs; however, only two of the sites’ arsenic models had significant MSDs and adequate fit. Cadmium and zinc were only included in one dataset, limiting our ability to draw any conclusions from comparison to those MSDs. The results of our study are consistent with prior studies suggesting that MSDs for metals without internal sources are 0.3–0.4, and application of MSDs in that range will provide more reliable exposure estimates than the 0.7 default value used by the United States Environmental Protection Agency in the Integrated Exposure Uptake Biokinetic (IEUBK) Model.

Prediabetes and structural brain abnormalities: Evidence from observational studies.

SummaryType 2 diabetes mellitus has been linked to structural brain abnormalities, but evidence of the association among prediabetes and structural brain abnormalities has not been systematically evaluated. Comprehensive searching strategies and relevant studies were systematically retrieved from PubMed, Embase, Medline and web of science. Twelve articles were included overall. Stratified analyses and regression analyses were performed. A total of 104 468 individuals were included. The risk of infarct was associated with continuous glycosylated haemoglobin (HbA1c) [adjusted odds ratio (OR) 1.19 (95% confidence interval [CI]: 1.05‐1.34)], or prediabetes [adjusted OR 1.13 (95% CI: 1.00‐1.27)]. The corresponding ORs associated with white matter hyperintensities were 1.08 (95%CI: 1.04‐1.13) for prediabetes, and 1.10 (95%CI: 1.08‐1.12) for HbA1c. The association was significant between the decreased risk of brain volume with continuous HbA1c (the combined OR 0.92, 95% CI: 0.87‐0.98). Grey matter volume and white matter volume were inversely associated with prediabetes [weighted mean deviation (WMD), −9.65 (95%CI: −15.25 to −4.04) vs WMD, −9.25 (95%CI: −15.03 to −3.47)]. There were no significant association among cerebral microbleeds, hippocampal volume, continuous total brain volume, and prediabetes. Our findings demonstrated that (a) both prediabetes and continuous HbA1c were significantly associated with increasing risk of infarct or white matter hyperintensities; (b) continuous HbA1c was associated with a decreased risk of brain volume; (c) prediabetes was inversely associated with grey matter volume and white matter volume. To confirm these findings, further studies on early diabetes onset and structural brain abnormalities are needed.

Laser photobiomodulation for cartilage defect in animal models of knee osteoarthritis: a systematic review and meta-analysis.

To review and assess the efficacy of laser photobiomodulation for cartilage defect in animal models of knee osteoarthritis (KOA). Medline, Web of Science, and EMBASE were searched. Studies were considered if the global quality score of cartilage were parallelly reported between laser and untreated control groups. The methodological quality of each study was assessed using a modified 10-item checklist. The effect size was estimated by standardized mean difference (SMD) and pooled based on the random-effects model. Stratified analysis and regression analysis were conducted to partition potential heterogeneity. An adjusted significant level of 0.01 was acceptable. Five hundred eight initial search recordings were identified, of which 14 studies (including 274 animals) were included for quantitative analysis. The global quality scores mostly weighted by the structural integrity and chondrocyte distribution were measured by different four scales including Histologic Histochemical Grading System (HHGS), Osteoarthritis Research Society International (OARSI), Pineda, and Huang. There were considerable variances on laser parameters and irradiation time among those included studies. Overall, a moderate level of methodological qualities was determined. The synthesis results indicated that the SMD effect size was significantly larger in HHGS (z = 2.61, P = 0.01) and Huang (z = 4.90, P < 0.01) groups. Stratified by irradiance, SMD of low (< 1W/cm2) but not high (≥ 1W/cm2) level estimated significant difference (z = 5.62, P < 0.01). Meta-regression identified a significant association for SMDs and irradiation time (P < 0.01). Yet, Egger's test detected small study effect (P < 0.01). No individual study with significant variance was found in homogeneity tests. The results demonstrated the positive effect of laser photobiomodulation for cartilage defect in animal models of KOA under proper irradiance and adequate irradiation time.

The role of serum oxytocin levels in the second trimester in regulating prenatal anxiety and depression: A sample from Shanghai Maternal-Child Pairs Cohort study

BackgroundRecent research suggested that oxytocin might be associated with prenatal anxiety or depression. Also, our previous study indicated that resilience could buffer the effect of stress on prenatal anxiety and depression, which is a kind of psychological adjustment ability to stress in life. The effects of oxytocin and resilience are supposed to be similar but no study was carried out to find the association between them. Current evidence on the effect of oxytocin on prenatal mental health were with small sample size and equivocal results, especially with a lack of studies in Chinese pregnant women. AimsTo investigate the relationship between oxytocin and resilience, and its role in regulating prenatal anxiety and depression among Chinese women. MethodsThe study was based on a sub-sample of the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) by stratified random sampling. A total of 632 participants completed blood collection for serum oxytocin measurement and questionnaires pertaining to early pregnancy stress and resilience in the second trimester, which were assessed by the Life Event Scale for Pregnancy Women (LESPW) and the revised Resilience Scale for Adults (RSA), respectively. Prenatal anxiety and depression were assessed by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively, at the third trimester. Correlation analysis and stratified linear regression analyses were conducted to understand the role of oxytocin in regulating prenatal anxiety and depression. ResultsThe concentration of serum oxytocin in the second trimester ranged from 98.14 pg⋅ml−1 to 197.28 pg⋅ml−1, and there was no significant difference between different gestational age (r = 0.024, P = 0.579). The association between stress and prenatal anxiety was stronger in high oxytocin group than that in low oxytocin group, with B value of 3.338 and 2.638, respectively, after adjusting for residence, educational level, family income and parity. The same effect was found in the association between stress and prenatal depression, with B value of 2.360 and 2.060, respectively. However, it was not significantly associated with early pregnancy stress (Z = 1.933, P = 0.630), prenatal anxiety (Z = 1.387, P = 0.165), prenatal depression (Z = −0.027, P = 0.978), nor resilience (F = 1.282, P = 0.280). LimitationsThe existence of recall bias and restricted residential areas of the participants may limit the extrapolation of the study. Also, unsynchronized sampling timing of the oxytocin and psychological resilience measures is another limitation. ConclusionsSerum oxytocin levels in the second trimester had an effect of modification between early pregnancy stress and prenatal anxiety and depression. Pregnant women with high oxytocin in the second trimester should receive more attention and further study is needed on the mechanism of oxytocin for the mental health of pregnant women.

PREDICTORS OF DEMENTIA IN OLDER ADULTS: VARIATION BY NATIVITY STATUS AND RACE-ETHNICITY

Among many possible factors that are associated with increased risk for dementia, one important topic is the role of race and ethnicity. However, previous studies did not examine rates separately by racial/ethnic groups and by nativity status, and little of this research comes from nationally representative data. The current study investigated different predictors of dementia by race/ethnicity and nativity status using Round 1 of the National Health and Aging Trends Study (NHATS, N=7,473). Our stratified log-binominal regression analyses by race/ethnicity (Non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other) show that the relationship of nativity status to dementia (Probable dementia vs Possible and no dementia) is likely determined by multiple factors (e.g., education, # of cardiovascular conditions/risk factors, # in household) that may vary across race and ethnicity. The relative risks of Probable dementia were higher among immigrants in the Hispanic, and other groups, but lower among immigrants in NHBs, although the relative risk of dementia among NHBs was marginally significant. Gender was not a significant factor of Probable dementia across the four groups after adjustment for other variables including nativity status. Older age was significantly associated with the higher prevalence of Probable dementia across the four groups. However, other risk factors for dementia varied considerably between the four racial/ethnic groups after controlling for nativity status. Healthcare providers systems must be prepared to deliver culturally competent supports and services to diverse groups of older Americans and their family members.

Correlation between coaching leadership and psychological capital of nursing managers

Objective To investigate the current condition and correlation of coaching leadership ability and psychological capital of nursing managers. Methods A cross-sectional study was conducted at the National Nursing Conference on Efficient Nursing Management and Clinical Practice in the Context of Great Health in June 2018. Totally 217 nursing managers from 107 hospitals and 38 regions were selected by convenience sampling and investigated by the General Information Questionnaire, Coaching Leadership Perception Assessment Scale (CLPAS) , and Psychological Capital Questionnaire (PCQ) . Rank-based non-parametric statistical method was used to compare the scores of coaching leadership of nursing managers with different general information. Spearman correlation analysis was used to analyze the correlation between coaching leadership and psychological capital, and stratified regression analysis was used to analyze the influencing factors of coaching leadership. A total of 222 questionnaires were distributed with 217 valid ones retrieved, yielding an effective recovery rate of 98%. Results The 217 nursing managers achieved a total score of (64.15±6.19) points from CLPAS, (90.00±9.31) points from PCQ, there was positive correlation among each dimensions in CLPAS and PCQ (P<0.01) ; there was good effect of the psychological capital in predicting the coaching leadership ability (P<0.01) . Conclusions The coaching leadership ability of nursing managers needs to be improved. The psychological capital of nursing managers will affect their coaching leadership ability and should be paid attention to; effective measures should be taken to improve the psychological capital of nursing managers so that it can play a greater role in the nursing team and improve the efficiency of nursing management. Key words: Nurse administrators; Coaching leadership; Psychological capital; Correlation

Study on the influencing factors of perinatal depression and its alleviating effect

Objective The influencing factors of perinatal depression and the study of social support and anti-stress ability. Methods A total of 712 women were enrolled in the Obstetrics and Gynecology Department of Rizhao City Maternal and Child Health Hospital from January 2014 to January 2016. From the second trimester (after 12 weeks of pregnancy)-pregnant women within 1 month after delivery, each pregnancy was recorded. The maternal population was scored at the first visit, and the depression score was scored at each visit. Stress resistance scores and social support scores, stratified binary Logistic regression analysis of variables, stress resistance, social support on depression and mitigation effects. Results Of the 712 maternal women, 615 were included in the standard. The enrollment rate was 86.3% (615/712). The average score of 615 maternal uncomfortable symptoms was 2.2±0.8, and the average score of the compressive capacity scale was 115.3 ±32.1, the average score of the social support scale was: 48.2 ± 9.4. The degree of education, monthly income, and physical discomfort scores significantly affected the perinatal depression score (b=-0.023, -0.013, 0.625, P<0.05). Self-compression ability can alleviate the impact of physical discomfort on perinatal depression, and social support can not be significantly relieved. Conclusions Education level and monthly income level are independent factors of perinatal depression, self-resistance can relieve depression. Key words: Perinatal depression; Stress resistance; Social support

Community food environment moderates association between health care provider advice to lose weight and eating behaviors.

Patients who receive weight loss advice from a health care provider (HCP) are more likely to eat healthy. The food environment affects eating behaviors. This study explored how the community food environment may moderate the relationship between HCP advice to lose weight and eating behaviors. Data were obtained from a household telephone survey in 4 New Jersey cities from two cross-sectional panels (2009–10 and 2014). Analyses were limited to 1427 overweight and obese participants. Self-reports assessed frequency of consumption of fruits, vegetables, sugar sweetened beverages, and fast food. Community food data were purchased from InfoUSA and Nielsen and classified according to previously established protocol. Stratified gamma regression analysis determined the differences in the association between receiving weight loss advice and eating behaviors stratified by community food environment. Stratified analyses revealed that receiving advice to lose weight from a HCP was associated with lower reported consumption of total sugar-sweetened beverages, soda, and sweetened fruit drinks when participants lived near a small grocery store, or far from a supermarket, limited service restaurant, or convenience store. There were no associations between receiving weight loss advice and sugar sweetened beverage consumption when participants lived near supermarkets, limited service restaurants, or convenience stores. There were no associations with fruit, vegetable, salad or fast-food consumption, regardless of the community food environment. Food environment may play a critical role in moderating the association between HCP advice and eating behaviors. Interventions that enhance the community food environment may help convert HCP advice into improved eating behaviors.

Percentage of Time in Range 70 to 139 mg/dL Is Associated With Reduced Mortality Among Critically Ill Patients Receiving IV Insulin Infusion

In addition to hyperglycemia, hypoglycemia, and glycemic variability, reduced time in targeted blood glucose range (TIR) is associated with increased risk of death in critically ill patients. This relation between TIR and mortality may be confounded by diabetic status and antecedent glycemic control. This study retrospectively analyzed critically ill patients managed with the same IV insulin protocol at multiple centers. The percentage of TIR between 70 and 139mg/dL was calculated. Patients with diabetic ketoacidosis, patients who had< 10 blood glucose readings, and patients with repeat admissions were excluded. The highest recorded glycosylated hemoglobin value in the preceding 3months or up to 1month following admission were used as a surrogate for the patient's preexisting glucose control. Stratified regression analyses were performed for 30-day mortality, with covariates of age, sex, TIR ≥ 80%, Acute Physiology Score, and Charlson Comorbidity Index. A total of 9,028 patients, 53.2%of whom had diabetes, were studied. Median TIR was 84.1%for nondiabetic patients and 64.5%for patients with diabetes. Mortality was lower in those with TIR> 80%compared with those with TIR≤ 80%(12.4%vs19.2%; P< .001). TIR> 80%was independently associated with reduced mortality in nondiabetic patients (OR, 0.52; P< .001), patients with diabetes (OR, 0.69; P= .001), and patients with well-controlled disease (OR, 0.50; P< .001) but not in patients with poorly controlled disease (OR, 0.86; P= .40). TIR was independently associated with mortality in critically ill patients, particularly those with good antecedent glucose control.

Unhealthy weight control behaviors and substance use among adolescent girls: The harms of weight stigma

RationaleUnhealthy weight control behaviors (UWCBs) often predict future substance use, resulting in a comorbidity that predicts later health consequences. ObjectiveThe current study aimed to examine whether weight stigma and its associated harms magnify or attenuate the effect of UWCBs at baseline on substance use at 10-year follow-up among girls and to elucidate factors related to the perceived harms of weight stigma. MethodsData from 1147 adolescent girls from Project EAT (Eating and Activity in Teens and Young Adults) were analyzed at baseline and 10-year follow-up. Participants were split into three groups at baseline: no weight stigma; weight stigma only (being teased by peers or parents); and weight stigma with perceived harms (e.g., being bothered by teasing). Moderation and stratified regression analyses examined the role of weight stigma and its perceived harms on the relationship between UWCBs and substance use. ANOVA models aimed to elucidate factors related to the perceived harms of weight stigma. ResultsModeration analyses revealed marginally significant effects of group membership on the effect of UWCB on substance use (p = .08). Stratified regression results indicated that UWCBs at baseline predicted substance use at 10-year follow-up among girls in the weight stigma with perceived harms group (p = .005), but not in the no weight stigma or weight stigma only groups. Girls in the weight stigma with perceived harms group reported higher weight concern, depressive symptoms and BMIs than girls who report no weight stigma or weight stigma only. ConclusionsHealth initiatives should seek to reduce weight stigma and its associated harms to prevent substance use in girls and women. Clinicians working with adolescent girls with UWCB should inquire about experiences with weight stigma with its harms to assess substance use risk. Due to the marginally significant moderation, results should be interpreted with caution. ConclusionsHealth initiatives should seek to reduce weight stigma and its associated harms to prevent substance use in girls and women. Clinicians working with adolescent girls with UWCB should inquire about experiences with weight stigma with its harms to assess substance use risk. Due to the marginally significant moderation, results should be interpreted with caution.

Racial and Ethnic Differences in Diagnostic Imaging Utilization During Adult Emergency Department Visits in the United States, 2005 to 2014

ObjectiveTo compare the use of medical imaging (x-ray [XR], CT, ultrasound, and MRI) in the emergency department (ED) for adult patients of different racial and ethnic groups in the United States from 2005 to 2014. MethodsWe performed a multilevel stratified regression analysis of the National Hospital Ambulatory Medical Care Survey ED Subfile, a nationally representative database of hospital-based ED visits. We examined race (white, black, Asian, other) and ethnicity (Hispanic versus non-Hispanic) as the primary exposures for the outcomes of ED medical imaging use (XR, CT, ultrasound, MRI, and any imaging). We controlled for other potential patient-level and facility-level determinants of ED imaging use. ResultsApproximately half (48.8%) of the 225,037 adult patient ED visits underwent imaging; 36.1% underwent XR, 16.4% CT, 4.1% ultrasound, and 0.8% MRI. White patients received imaging during 51.3% of their encounters, black patients received imaging during 43.6% of their encounters, Asians received imaging during 50.8% of their encounters, and other races received imaging during 46% of their encounters. As compared with white patients, black patients had decreased adjusted odds of receiving imaging in the ED (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.84-0.89). Comparatively, black patients had a lower odds of CT scan (OR = 0.80, 95% CI: 0.77-0.83) or MRI (OR = 0.74, 95% CI: 0.65-0.85). Hispanic patients and Asian patients had a higher odds of receiving ultrasound (OR = 1.36, 95% CI: 1.27-1.44 and OR = 1.25, 95% CI: 1.10-1.42), respectively. ImplicationsWe observed significant racial and ethnic differences in medical imaging use in the ED even after controlling for patient- and facility-level factors.

Association between working hours, work engagement, and work productivity in employees: A cross-sectional study of the Japanese Study of Health, Occupation, and Psychosocial Factors Relates Equity.

ObjectivesThe aims of the study were to investigate the association between working hours, work engagement, and work productivity, and to examine if work engagement moderates the influence of working hours on work productivity.MethodsWe used cross‐sectional data from the Japanese occupational cohort survey, which involved 2093 employees in a manufacturing industry. Working hours were self‐reported by the study participants. Work productivity was assessed with absolute presenteeism based on the scale of the validated Japanese version of World Health Organization Health and Work Performance Questionnaire (WHO‐HPQ). Work engagement was assessed with the Nine‐item Utrecht work Engagement Scale (UWES‐9). Univariate and multivariable regression analyses were conducted to examine the association of working hours and work engagement with work productivity. We also carried out stratified multivariable regression analysis separately for those with high‐work engagement and those with low‐work engagement.ResultsWorking >40 to 50 hours per week and >50 hours per week were significantly positively associated with work productivity in univariate analysis. However, the significant association no longer held after adjusting for work engagement. Work engagement was positively associated with work productivity even after controlling for potential confounders. Working hours were not significantly associated with work productivity among those with high‐work engagement or among those with low‐work engagement.ConclusionsWorking hours did not have any significant associations with work productivity when taking work engagement into account. Work engagement did not moderate the influence of working hours on work productivity, though it attenuated the relationship between working hours and work productivity.

Nitromethane Exposure from Tobacco Smoke and Diet in the U.S. Population: NHANES, 2007-2012.

Nitromethane is a known toxicant and suspected human carcinogen. Exposure to nitromethane in a representative sample of the civilian, noninstitutionalized population in the United States ≥12 years old was assessed using 2007-2012 National Health and Nutritional Examination Survey (NHANES) data. Nitromethane was detected in all 8000 human blood samples collected, of which 6730 were used for analyses reported here. Sample-weighted median blood nitromethane was higher among exclusive combusted tobacco users (exclusive smokers; 774 ng/L) than nonusers of tobacco products (625 ng/L). In stratified sample-weighted regression analysis, smoking 0.5 pack of cigarettes per day was associated with a statistically significant increase in blood nitromethane by 150 ng/L, and secondhand smoke exposure (serum cotinine >0.05 ng/mL and <10 ng/mL) was statistically significant with a 31.1 ng/L increase in blood nitromethane. Certain dietary sources were associated with small but statistically significant increases in blood nitromethane. At median consumption levels, blood nitromethane was associated with an increase of 7.55 ng/L (meat/poultry), 9.32 ng/L (grain products), and 14.5 ng/L (vegetables). This is the first assessment of the magnitude and relative source apportionment of nitromethane exposure in the U.S. population.

Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome

BackgroundThe lung ultrasound score has been regarded as a decent semiquantitative score to measure the lung aeration loss. The score has been proven to be valuable in diagnosing and monitoring lung pathology, but no studies have demonstrated its relationship to the outcome. We aimed to investigate the relationship between the lung ultrasound score and outcome in shock patients in the Intensive Care Unit.MethodsThe data were extracted from the SHOCK-ICU study, a 14-month prospective study of shock patients in the Medical Intensive Care Unit in West China Hospital. A bivariate logistic regression model was established to identify the correlation between the lung ultrasound score on admission and the 28-day mortality. For subsequent analyses, we divided patients into lung ultrasound score quartiles, and survival analysis was performed using Cox stratified survival analysis and regression analysis with the Breslow method of ties.ResultsA total of 175 cases with a completed lung ultrasound exam were included. The mean APACHE II score was 23.7 ± 8.8, and the 28-day mortality was 46.3% (81/175). The multivariate analysis demonstrated that the lung ultrasound score was an independent risk factor for 28-day mortality, as well as the APACHE II score and lactate level. When divided into lung ultrasound score quartiles, after correcting for the APACHE II score, vasoactive use, PaO2/FiO2, and lactate level, the COX analysis reveals that a higher lung ultrasound score was related to a lower survival rate. Quartile 1 and quartile 2 had a significantly lower hazard ratio versus quartile 4 (OR 0.442[0.215–0.911]; 0.484[0.251–0.934], respectively).ConclusionsThe lung ultrasound score is independently related to the 28-day mortality, as well as the APACHE II score and lactate level, in Intensive Care Unit shock patients. A higher elevated lung ultrasound score on admission is associated with a worse outcome.Trial registrationThe study is registered on Clinical Trials. Trial registration: NCT03082326; retrospectively registered on 3 March 2017.

Urine NGAL as an early biomarker for diabetic kidney disease: accumulated evidence from observational studies

Objectives: Urine neutrophil gelatinase-associated lipocalin (NGAL) was found to increase in diabetic kidney disease (DKD). However, the clinical value of urine NGAL as diagnostic indicators in DKD remains to be clarified.Methods: Relevant studies were systematically retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. Stratified analyses and regression analyses were performed.Results: Fourteen studies with 1561 individuals were included in our analysis, including 1204 cross-sectional participants and 357 cohort participants. For the cross-sectional studies, the pooled sensitivity and specificity of NGAL in the diagnosis of DKD were 0.82 (95% confidence interval (CI): 0.75–0.87) and 0.81 (95% CI: 0.68–0.90), respectively. The pooled diagnostic odds ratio was 19 (95% CI: 11–33), and the overall area under the curve was 0.88 (95% CI: 0.84–0.90). For the cohort studies, the pooled sensitivity and specificity of NGAL in the diagnosis of DKD were 0.96 (95% CI: 0.91–0.98) and 0.89 (95% CI: 0.84–0.92), respectively. The overall area under the curve was 0.98, indicating good discriminative ability of NGAL as biomarkers for DKD.Conclusions: Urine NGAL, as the early diagnostic marker of DKD, might have the high diagnostic value, especially in cohort studies.

Do functional impairments promote or hinder mental health treatment seeking: Differential results for women and men

Although symptom severity is a known predictor of treatment seeking, the role of functional impairment in this association is unclear. The purpose of this study was to examine the contribution of relationship and work impairment to service use among women and men with posttraumatic stress disorder (PTSD) and depression symptoms. Data from mailed surveys of 363 military veterans were examined longitudinally. Stratified regression analyses were applied to evaluate moderating and mediating effects of functional impairment in association between symptoms and mental health service use, with significant effects observed for relationship but not work impairment. For men, relationship impairment moderated the association between mental health and service use, such that the impact of depression symptoms on treatment seeking was reduced when accompanied by high impairment. For women, subsequently assessed relationship impairment acted as a mediator of the positive association between PTSD symptom severity and service use. The finding that relationship impairment interfered with treatment seeking for men but facilitated treatment seeking for women may help explain widely demonstrated sex differences in treatment seeking. Results underscore the importance of attending to the role of relationship impairment in veterans’ treatment seeking and highlight the value of implementing sex-informed approaches to treatment promotion efforts.

Dementia Prevalence in Older Adults: Variation by Race/Ethnicity and Immigrant Status

ObjectiveTo examine differences in prevalence and risk factors of dementia by race/ethnicity and immigrant status using a nationally representative sample of Medicare beneficiaries. MethodsThis was a cross-sectional study performed in the United States among non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and other Medicare beneficiaries from round 1 of the National Health and Aging Trends Study (N = 7,609). The authors used log-binomial regression analyses to investigate risk factors and interactions between race/ethnicity and immigrant status and dementia. Stratified log-binomial regression analyses by race/ethnicity were used to interpret the results of interaction effects of immigrant status found in these surveys. Analyses were conducted in three forms: probable dementia versus possible and no dementia, probable and possible dementia versus no dementia; and probable dementia versus no dementia. ResultsConsistent with previous studies, U.S.-born NHBs have a higher prevalence of dementia than U.S.-born whites, Hispanics, and others. Immigrant status moderated the relationship between race/ethnicity and dementia. NHWs, Hispanics, and other immigrants had a higher prevalence of dementia compared with their U.S.-born counterparts. However, U.S.-born NHBs had a higher prevalence of dementia compared with NHB immigrants. Results were consistent across the three forms of analysis. Greater age predicted higher dementia across the four racial/ethnic groups. ConclusionImmigrant status may have complex effects on dementia risk. Selection factors affecting immigration—varied health and educational systems in diverse countries of origin, acculturative stress, and validity of dementia assessment across diverse groups—deserve further attention.

The influence of professional identity of clinical nursing teachers on competence

Objective To explore the current status of competence and professional identity of clinical nursing teachers and analyze the influence of professional identity of clinical nursing teachers on competence. Methods A questionnaire survey was conducted among 420 clinical nursing teachers in the hospital with the competency scale and professional identity scale. Results The scores of clinical nursing teachers' competency and professional identification were respectively(160.89±19.28)points and(103.97.83±18.12)points.The results of Pearson correlation analysis showed that there was a positive correlation between clinical nursing teachers' competence and professional identity, and the difference was statistically significant(P<0.05). Stratified regression analysis showed that after controlling for demographic variables, occupational cognitive evaluation, occupational social support, occupational social skills, occupational frustration coping, and occupational self-reflection could jointly explain 89.50% of the variation, which was a positive predictive indicator of clinical nursing teachers' competence. Conclusion Clinical nursing teachers' professional identity are related to the level of competence and can positively predict the competence level, nursing managers should pay attention to cultivate clinical nursing teachers' professional identity, so as to improve clinical nursing teachers' competence, to ensure the quality of clinical nursing teaching, and to cultivate the social needs to nursing talents to provide powerful guarantee. Key words: Clinical nursing teacher; Professional identification; Competence

Correlation between metacognitive ability and professional values among undergraduate nursing students

Objective To investigatethe current condition and correlation of metacognitive abilities and professional values in undergraduate nursing students, and analyze the influence of metacognitive ability on professional values. Methods Totally 310 undergraduate nursing students from a medical university during October to December 2017 were selected by convenience sampling method. All the students were investigated with general information questionnaire, Metacognitive Ability Scale and College Students' Occupational Values Scale. Pearson correlation analysis was used to analyze the correlation between metacognitive ability and professional values of undergraduate nursing students, and stratified regression analysis was used to analyze the influencing factors of professional values of undergraduate nursing students. A total of 310 questionnaires were distributed and 300 valid questionnaires were collected. Results The total score of metacognitive ability in undergraduate nursing students was (74.97±10.20), and the total score of professional values in undergraduate nursing students was (123.32±14.51). Undergraduate nursing students' metacognitive ability dimensions were positively correlated with professional values (P<0.01). The metacognitive ability of undergraduate nursing students has a significant predictive effect on their occupational values (P<0.01). Conclusions The metacognitive ability and professional values of undergraduate nursing students need to be improved, and their metacognitive ability can significantly affect their professional values. Nursing educators can promote the improvement of their professional values through cultivating the metacognitive ability of undergraduate nursing students. Key words: Students, nursing; Education, medical, undergraduate; Metacognitive; Professional values

INCIDENCE OF DEMENTIA IN ADULTS WITH CEREBRAL PALSY: A UK COHORT STUDY

Researchers have previously hypothesised that ageing with cerebral palsy (CP) may be associated with an increased risk of developing dementia. However no study has yet formally investigated this proposition while accounting for important morbidities such as intellectual disabilities (ID) or epilepsy. We used a United Kingdom primary care database as our data source (CPRD Gold). Data for 1,705 adults with CP (age range 18–89) and 5,115 age, sex and general practice matched controls without CP was extracted from the database. Dementia was defined by read codes. We used stratified Cox Proportional Hazards Regression analyses to determine incidence of dementia. In total there were 51 cases of incident dementia over follow-up. There was no significant difference in the risk of developing dementia between people with CP and those without CP (HR 1.40, 95% CI 0.58–3.40). We then repeated our analysis comparing those with CP and either ID or epilepsy with adults without CP. Those with ID co-morbidity had a higher risk of developing dementia than people with no CP (HR 7.11, 95% CI 1.38–36.75) as did those with CP and epilepsy (HR 12.0, 95% CI 1.34–107.36). Results suggest that only those people with CP and ID or epilepsy are more likely to develop dementia. This suggests that the previously speculated link between CP and dementia may be due to other neurologic or intellectual co-morbidities rather than as a direct effect of CP; however, more work is needed to confirm this link and the mechanisms underlying it.