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Clinical prediction models are widely used in modern clinical practice. Such models are often developed using individual patient data (IPD) from a single study, but often there are IPD available from multiple studies. This allows using meta-analytical methods for developing prediction models, increasing power and precision. Different studies, however, often measure different sets of predictors, which may result to systematically missing predictors, i.e. when not all studies collect all predictors of interest. This situation poses challenges in model development. We hereby describe various approaches that can be used to develop prediction models for continuous outcomes in such situations. We compare four approaches: a "restrict predictors" approach, where the model is developed using only predictors measured in all studies; a multiple imputation approach that ignores study-level clustering; a multiple imputation approach that accounts for study-level clustering; and a new approach that develops a prediction model in each study separately using all predictors reported, and then synthesizes all predictions in a multi-study ensemble. We explore in simulations the performance of all approaches under various scenarios. We find that imputation methods and our new method outperform the restrict predictors approach. In several scenarios, our method outperformed imputation methods, especially for few studies, when predictor effects were small, and in case of large heterogeneity. We use a real dataset of 12 trials in psychotherapies for depression to illustrate all methods in practice, and we provide code in R. This article is protected by copyright. All rights reserved.

The COVID-19 crisis brought numerous challenges to work life. One of the most notable may be the acceleration of digital transformation, accompanied by an intensification of e-mail usage and related demands such as high e-mail workload. While research quickly started to examine the implications of these changes for employees, another important group of stakeholders has been overlooked: leaders. We focus on leaders during the COVID-19 crisis and examine how COVID-19 related work intensification links to leaders? e-mail overload appraisal and finally exhaustion and transformational leadership, a leader behavior especially needed in times of crisis. In a five-day diary study in September 2020, 84 leaders responded to daily surveys on 343 days. Results of multilevel analysis showed that perceived COVID-19 related work intensification was positively linked to worktime spent dealing with e-mail and appraised e-mail overload. E-mail overload appraisal was positively related to leaders? exhaustion, but unrelated to their transformational behavior. Day-specific time spent dealing with e-mail, however, was negatively related to transformational leadership. E-mail overload appraisal mediated the relationship between COVID-19 related work intensification and exhaustion. Turning the focus on leaders during the COVID-19 crisis, our study has important implications for the design of work of leaders in times of crisis and beyond.

There are limited data to provide better understanding of the knowledge/awareness of general population towards liver health in Asia. We sought to identify the knowledge gaps and attitudes towards liver health and liver diseases as well as evaluate associated individual-level and macro-level factors based on contextual analysis. An online survey assessing knowledge, awareness and attitudes towards liver health and disease was conducted among 7500 respondents across 11 countries/territories in Asia. A liver index was created to measure the respondents' knowledge level and the degree of awareness and attitudes. Multilevel logistic regression was performed to identify individual factors and contextual effects that were associated with liver index. The overall liver index (0-100-point scale) was 62.4 with 6 countries/territories' liver indices greater than this. In the multilevel model, the inclusion of geographical information could explain for 9.6% of the variation. Residing in a country/territory with higher HBV prevalence (80% IOR: 1.20-2.79) or higher HCV death rate (80% IOR: 1.35-3.13) increased the individual probability of obtaining a high overall liver index. Individual factors like age, gender, education, household income, disease history and health screening behaviour were also associated with liver index (all p-values0.001). The overall liver index was positively associated with the two macro-level factors viz. HBV prevalence and HCV death rate. There is a need to formulate policies especially in regions of lower HBV prevalence and HCV death rate to further improve the knowledge, awareness and attitudes of the general public towards liver diseases.

Psychosocial safety climate (PSC) is a facet-specific climate for psychological health and safety which constitutes an important organizational resource for creating a conducive work environment. The process to regain/restore energy expended at work, known as "recovery," also plays a pivotal role for individuals; however, this process, together with PSC, remains largely underexplored. The main purpose of this study is to investigate the role of PSC in enhancing the moderating role of individuals' psychological detachment and relaxation during weekends on the relationship between daily job demands in Week 1 and daily emotional exhaustion in Week 2. Data from a shortitudinal study of 178 teachers (in total, 534 diaries) in Terengganu, Malaysia, over two consecutive weeks, were operationalized at the individual level and daily level using Hierarchical Linear Modeling (HLM) software. The analysis showed that the daily experience of job demands in the prior week led to an increment of emotional exhaustion in the following week. Interestingly, the interaction role of PSC*psychological detachment and PSC*relaxation moderated the relationship between daily job demands and daily emotional exhaustion. Overall, this study highlights the importance of individual off-job recovery time and that building good PSC at work is fundamental in compensating for the adverse relationships between job demands and its consequences.

The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUD-only treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.

OBJECTIVE The aims of this study are to investigate (1) how family response to acculturation (e.g., accusations of assimilation) is related to anxiety and depressive symptomatology for Latinx emerging adults. This study's goal is also to analyze (2) the extent to which ethnic identity components and gender moderate the respective associations. METHOD Cross-sectional survey was completed by 200 Latinx emerging adults. Inclusion criteria involved reading English, ages 18-25, currently reside in Maricopa or Miami-Dade Counties and self-identify as Latinx. Analysis used hierarchical multiple regression and moderation analyses. RESULTS Findings indicate that higher familial accusations of assimilation were associated with higher symptoms of depression and anxiety. Moderation analyses indicate that gender had a statistically significant interaction with accusations of assimilation in relation to symptoms of both depression and anxiety. A significant three-way interaction between ethnic identity exploration, gender, and intracultural accusations of assimilation in relation to symptoms of depression interaction among men was found. CONCLUSION Findings from the study add to literature on the effect of intragroup marginalization on Latinx mental health and highlight gender differences. The ethnic identity component of exploration is found to be a protective factor for men which wanes over increasing levels of accusation of assimilation.

BACKGROUND Social context has been found to influence pain intensity and tolerance. The aims of this study were to determine the impact of one type of social context on the painful experiences of adolescents with and without chronic pain by examining interactions within and across friendship dyads during experimental pain. METHODS Each adolescent in 61 same-sex friendship dyads (30 dyads with a chronic pain member) across three sites participated in the cold pressor task and acted as the observer during their friend's participation. They also completed a battery of measures to capture friendship features and pain outcomes. Pain intensity was measured using an 11-point numeric scale. Pain tolerance was measured by the length of time in the cold pressor device. Videotapes of their interactions were coded for verbal and non-verbal behaviours. A series of Actor Partner Independence Modelling, Hierarchical Multiple Regression and Multivariate Analysis of Covariance was used to analyse the data. RESULTS Friendship features were not associated with pain intensity or tolerance. Both members of dyads with a chronic pain member used fewer non-attending behaviours when they were observing their friend resulting in participants in those dyads having lower pain tolerance. Moreover, within dyads, one's friend's behaviours when experiencing pain influenced pain tolerance but only for those dyads with a chronic pain member. CONCLUSIONS Strategies aimed at improving social interactions for adolescents with chronic pain while they are experiencing pain are discussed. Research is needed to understand how different peer relationships influence pain tolerance in adolescents with chronic pain. SIGNIFICANCE OF THE RESEARCH During pain, patterns of interactions differ within and between adolescent friendship dyads when one has chronic pain (CP) versus controls. Dyads with a CP member use fewer non-attending behaviours despite non-attending behaviours rated as more helpful. Pain intensity was solely related to the participant's behaviour. Amongst dyads with a CP member, pain tolerance was also influenced by their friend's behaviours. Friends of adolescents with pain engage in more unhelpful behaviours perhaps decreasing the ability of CP adolescents to engage in social activities.

A sizeable portion of parents say they lack time with children-an important social problem given that time strains link to parental well-being. Extending perspectives on the demands and rewards of parenting beyond the individual level, we provide a contextual-level window onto mothers' and fathers' time strains. Based on data from the European Quality of Life Survey 2016/17 (n = 5,898), we analyze whether parents feel they spend enough time caring for their children using multilevel models. We first observe that country context matters in that perceptions of time only moderately or weakly relate to hours with children across countries, especially for fathers, suggesting varying social expectations across Europe. Second, in multivariate analyses examining micro- and macro-level factors, we show that at the individual level, feeling too little time with children is more frequent among fathers and those who work more hours, even when controlling for estimated weekly hours spent caring for children. At the country level, parents' time strain is higher in countries where employees have less time and place flexibility, typically in Central and Eastern as well as Southern Europe. Gender norms matter as well. Extending contextual perspectives, we argue that how gender-work-family regimes color felt time strain is a promising future research direction.

This study draws on institutional theory to investigate why and how staffing effectiveness varies across countries. Utilising data from multiple sources (Cranfield Network on Comparative Human Resource Management [CRANET], Global Leadership and Organisational Behaviour Effectiveness [GLOBE], World Economic Forum [WEF], Transparency International, Tightness-Looseness Index), it covers 2,918 organisations in 11 countries. Extending earlier research on comparative staffing that focuses on cultural or regulatory differences separately, our findings show that companies in different countries implement staffing practices in line with their normative (i.e., cultural), regulatory, and cognitive institutions. A second key finding shows that institutionally embedded staffing practices are associated with organisational turnover, thus challenging dominant universalist perspectives on staffing effectiveness. Finally, we shed light on a central yet understudied boundary condition of contextual perspectives on staffing by identifying the strength of institutional pressures (i.e., societal tightness-looseness) as a moderator of the relationships between national institutions, staffing, and turnover., NA

The COVID‐19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020–December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross‐level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.

The primary purported change process in emotion-focused couples therapy (EFT-C) occurs as therapists assist one partner to access and reveal vulnerable emotions and needs and promotes a subsequent compassionate responding from the other partner. This study aimed to examine the association between therapists' views regarding their interventions during a given session and the degree to which partners reported the session as helpful in resolving their unfinished business. Data from 22 couples who took part in the York Emotional Injury Project and received 10-12 EFT-C sessions were analyzed using multilevel models. The primary findings revealed that when therapists reported using interventions that promoted acceptance of feelings and needs in a given session, both partners reported higher resolution levels in relation to their partner. Our results suggest that interventions that facilitate responsiveness between partners are particularly important in EFT-C, and perhaps in couples therapy in general.

Random effects in longitudinal multilevel models represent individuals' deviations from population means and are indicators of individual differences. Researchers are often interested in examining how these random effects predict outcome variables that vary across individuals. This can be done via a two-step approach in which empirical Bayes (EB) estimates of the random effects are extracted and then treated as observed predictor variables in follow-up regression analyses. This approach ignores the unreliability of EB estimates, leading to underestimation of regression coefficients. As such, previous studies have recommended a multilevel structural equation modeling (ML-SEM) approach that treats random effects as latent variables. The current study uses simulation and empirical data to show that a bias-variance tradeoff exists when selecting between the two approaches. ML-SEM produces generally unbiased regression coefficient estimates but also larger standard errors, which can lead to lower power than the two-step approach. Implications of the results for model selection and alternative solutions are discussed.

Couple interventions are limited in their effectiveness for reducing marital distress and dissolution. One explanation for this may be the narrow focus on conflict management and a limited understanding of how other domains in marriage influence one another over time. We present the first test of the relational domain spillover model (RDSM) to understand the extent to which poor functioning in either positive or negative areas of the relationship spill over into other aspects of relationship functioning across time. Husbands and wives reported annually on the quality of five relationship domains (emotional intimacy, sex, support, power/control, and conflict) over the first seven years of marriage. Longitudinal dyadic multilevel modeling techniques were used to examine how domains change over time and how earlier declines in positive areas of couple functioning predict later problems in negative areas of couple functioning and vice versa. We found support for both directions of the RDSM model. Earlier declines in sexuality and support predicted later declines in conflict, and, for wives, earlier declines in couple sexuality were linked to later control issues. Earlier declines in conflict communication and control predicted later problems with emotional intimacy. For men, longitudinal associations between sexuality and conflict, and control, were bidirectional. These findings point to the need to move toward a multi-dimensional, dynamic conceptualization of relationship functioning across time and the importance of focusing on different relational domains as targets for couple interventions.

Spending on active labour market policies (ALMPs) has increased across Europe following the 2007 flexicurity strategy which emphasised smooth and rapid transitions from unemployment to work. Despite broad scholarly coverage of the activation turn, the connection between labour market policies and changes in non-standard employment remains unclear. Applying random effects within-between regression analysis, this paper finds that coercive, 'hard' ALMP instruments incentivising rapid re-employment with the threat of withdrawing unemployment benefits are associated with higher likelihood of involuntary part-time employment, whereas supportive, 'soft' ALMP strategies with a focus on upskilling and public sector occupation are associated with higher voluntary but lower involuntary part-time employment. The results from 25 countries over two decades shed light on the heterogeneous results of past ALMP research which has not adopted a consistent line on the supportive-coercive dichotomy. With European employment policy increasingly applying hard activation instruments to achieve full employment, an unintended consequence might be the expansion of precarious employment.

Teams can benefit markedly when formal supervisors stimulate their individual members’ emergence as informal leaders. Combining insights from informal leadership research and social learning theory, we cast supervisors’ role modeling of initiating structure and consideration behaviors as seemingly straightforward means of achieving this—but we suggest that the success of such role modeling critically hinges on supervisors’ as well as members’ status in the team. Results from a study of 220 nurses across 48 teams showed, accordingly, that a supervisor’s initiating structure promoted individual members’ informal leader emergence by increasing members’ respective behavior. This indirect relationship only materialized, however, among relatively high-status supervisors and relatively low-status members. Moreover, although supervisors’ and members’ consideration were positively related (among relatively high-status supervisors, and largely irrespective of a member’s status), such behavior did not influence members’ emergence as informal leaders. Together, these findings offer novel insights into how, when, and why formal supervisors may aid their team members’ attainment of informal leader roles. They shed new light on the complexity of formal–informal leadership linkages, with both supervisors’ and members’ standing in the team representing crucial, yet heretofore largely unexamined boundary conditions for formal supervisors’ respective influence.

Background: The study was conducted to examine the effect of attachment orientation and empathy on the relationship quality of infertile couples and assess the interdependency model of these factors.Method: In this study, 168 infertile couples (336 individuals) were enrolled and asked to finish he following questionnaires: the revised Adult Attachment Scales, the Interpersonal Response Index questionnaire, and the Relationship Quality subscale of the Fertility Quality of Life (FertiQol).Results: The attachment orientation of infertile couples can influence their relationship quality, and empathetic wives and husbands have actor and partner effects on the infertile couples’ relationship quality.Conclusion: Empathetic infertile couples are conducive to the harmony of the relationship. In order to provide better psychological services for patients, the clinical personnel should consider the infertile couple as a team both experiencing the stress of infertility together, and then should evaluate their ability for empathy systematically.

BACKGROUND Alcohol expectancies (AE; beliefs about the likelihood of outcomes) and valuations (beliefs about the desirability of outcomes) may help explain alcohol use by young adults. However, it remains unclear how variability in AE and valuations over time are related to alcohol-related outcomes, and whether these associations are moderated by sex. The current study addressed these gaps in knowledge by examining within-person variability among positive and negative AEs, valuations, and alcohol-related outcomes over a 12-month period. METHODS Data were collected from 433 college students (Mage = 20.06; 59.81% women) who completed surveys at 4 timepoints: at baseline and 3-month, 6-month, and 12-month follow-up. RESULTS We found substantial within-person variability in both AE and valuations (intraclass correlation coefficients ranged from 50% to 66%), and differences in variability by sex, with women showing more variability than men. Multilevel models revealed that weekly drinking was significantly higher at timepoints in which participants held relatively greater AE for sociability, sexuality, and risk/aggression, but lower when participants expected greater effects on self-perception. Weekly drinking was also higher when participants reported more favorable valuation of risk/aggression. Participants experienced significantly more negative consequences at timepoints in which they held relatively greater AE for sexuality and self-perception. No AEs were associated with a reduced likelihood of negative consequences. Participants experienced more negative consequences at timepoints in which they reported more favorable valuation of self-perception No valuations were associated with fewer consequences. Several between- and within-person associations were moderated by sex. CONCLUSIONS These findings suggest that AE and valuations are dynamic, that young adults' beliefs about the effects of alcohol varied over time, and that both negative and positive AE and valuations may be important correlates of alcohol use and consequences. These findings have implications for interventions designed to challenge expectancies and valuations with the goal of reducing alcohol use and associated consequences.

Aims The study aimed to investigate the relationship among physical symptom distress, sleep quality, depression and spiritual well-being of patients with chronic renal failure (CRF) and analyse the predictors of the spiritual well-being. Design A cross-sectional study. Methods A total of 188 patients were selected. The collection tools were the Physical Symptom Distress Scale, the Chinese version of PSQI, the Geriatric Depression Scale and the Spiritual Well-Being Scale. Hierarchical regression analysis was conducted using SPSS 20.0. Results Patients with different treatments exhibited significantly different physical symptom distress. Furthermore, spiritual well-being was significantly negatively correlated with physical symptom distress, poor sleep disturbances and depression. After controlling for the variables, sleep quality and haemodialysis treatment were the key predictors of spiritual well-being. Conclusion To achieve holistic caregiving for patients' physiological, psychological and spiritual health, Nurses should evaluate patients' symptom distress and depression when providing care for these patients to enhance their spiritual well-being.

Adolescents who share information with their parents tend to have more positive parent-adolescent relationships. This brief report examined daily variability in adolescents' disclosure to mothers and mother-adolescent responsiveness. Using a 7-day intensive longitudinal design with 109 mother-adolescent (14-18 years) pairs, multilevel models revealed the amount of information adolescents disclosed to mothers varied day-to-day, according to both adolescent and mother reports. On days when adolescents perceived mothers to be more responsive than usual, adolescents were more likely to disclose. On days when mothers perceived adolescents to be more responsive than usual, mothers perceived more adolescent disclosure. Lastly, more responsive adolescents disclosed more on average across the week according to both adolescent and mother reports of disclosure compared to less responsive adolescents.

AIM AND OBJECTIVES The study aimed to investigate whether the patients' education level affected the mediation effect of self-efficacy on the relationship between the autonomy-supportive healthcare climate and health behaviour among patients with cardiovascular risk factors. BACKGROUND Autonomy and self-efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self-efficacy and if patients' education level affects the association. DESIGN A cross-sectional study. METHODS A convenience sample of 207 individuals with one or more cardiovascular diseases completed self-administered surveys including the healthcare climate questionnaire, self-efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines. RESULTS The influence of autonomy support from healthcare providers on self-efficacy differed by individuals' education level. Self-efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy-supportive climate. Additionally, the autonomy-supportive healthcare climate affected health behaviour through self-efficacy only in less educated individuals. CONCLUSION The relationship between autonomy support from healthcare providers and self-efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self-efficacy and health behaviour differed by patient education level, and the mediating role of self-efficacy on the relationship between autonomy-supportive climate and health behaviour was found only in those less educated. RELEVANCE TO CLINICAL PRACTICE Healthcare providers should recognise the importance of supporting patients' need for autonomy to improve self-efficacy and healthy behaviour, particularly in less educated patients. Additionally, healthcare providers' support tailored to patients' needs and educational status should be highlighted.

AIM To explore the status of quality of life and psychological capital and analyse the different effects of psychological capital on the quality of life of cancer patients with different preferences for nurse spiritual therapeutics. DESIGN A cross-sectional survey was used. METHODS Two hundred and eight cancer patients were recruited using convenience sampling from a tertiary Chinese hospital, between March and July 2019. Data on preferences for nurse spiritual therapeutics (PNST), psychological capital (PsyCap) and quality of life (QoL) were collected using paper questionnaires. Hierarchical multiple regression was employed to investigate the different influences of PsyCap on QoL of cancer patients with various levels of PNST. RESULTS Compared with patients having high PNST, patients with mild-moderate PNST experienced lower self-efficacy, hope, optimism, PsyCap and social/family well-being. PsyCap significantly explained the variance on QoL of patients with various levels of PNST. Age, gender, presence of caregiver were significant factors influencing physical, social/family and emotional well-being of patients with high PNST. CONCLUSION The present study demonstrates disparities in PsyCap and QoL between cancer patients with mild-moderate and high PNST. It is essential to be aware of the positive influences of PsyCap on QoL and develop effective interventions for patients to improve their QoL, especially for those with mild-moderate PNST. IMPACT It is necessary to realize the benefits of PsyCap on QoL of cancer patients with various levels of PNST. Appropriate training for nurses needs to be developed to promote their spiritual care competencies. Moreover, supportive interventions should be developed for cancer patients to improve their PsyCap and QoL.

BACKGROUND: With the outbreak of the COVID-19 pandemic, pediatric experts called attention to the potential adverse effects of living restrictions (e.g., lockdown) on child well-being, but at the same time- acknowledged their possible benefits. To date, only few data-driven reports have been published on child sleep during COVID-19, and all have been based on parent- or self-reports. This study used auto-videosomnography to capture the effects of COVID-19 stay-at-home orders imposed in the USA on objectively measured infant sleep. METHODS: Auto-videosomnography metrics of infants assessed nightly between January and May 2020 were compared with metrics of an equivalent infant cohort, assessed in the corresponding 2019 period. A total of 610 infants (50.7% girls) aged 6-18 months (M = 11.8, SD = 3.6) were included, with 71,472 analyzed nights. Multilevel models were applied to assess differences between 2019 and 2020 infant sleep pre- and during-lockdown. RESULTS: Whereas infant cohorts were equivalent in demographic and January-March/April sleep characteristics, during the 2020 lockdown infants had longer nighttime sleep durations (Mdifference = 11.0 min, p = .01), later morning rise times (Mdifference = 9.5 min, p = .008), and later out-of-crib times (Mdifference = 12.3 min, p

© 2021 The Authors. Regional Science Policy & Practice published by John Wiley & Sons Ltd on behalf of Regional Science Association International.This paper provides a comprehensive overview of intergenerational income mobility in Sweden. Intergenerational income mobility is considered in both relative and absolute terms, and the analysis is carried out at the individual and municipality level. We use multilevel models to explore the correlation between upward mobility and social, economic and demographic characteristics of cities. We account for a wider set of local characteristics, such as the spatial distribution of income inequality within city and housing affordability that have not been considered by previous studies analysing social mobility in the United States or other European countries. The analyses are carried out on three subpopulations: offspring who live in a different municipality than their parents (spatial mobile population); offspring who live in the municipality where they grew up (spatial immobile population); offspring belonging to visible minority groups. Our results show substantial differences across municipalities, meaning that the particular combination of municipality attributes contributes to shaping the chance of status attainment among young generations. Highly mobile municipalities have more significant human capital, more residential segregation by income, more local levels of income inequality, and greater accessibility to jobs. The results indicate that dependence on parents’ support and network for upward mobility is of less importance, and that spatial mobility (regardless of background) especially to larger urban areas is associated with upward mobility for the children.

Emotionally Focused Couple Therapy, an experiential modality, views emotion central to therapeutic change. In this exploratory study, we examined therapists' repetition of somatically focused interventions (therapist verbalizing somatic cues, such as facial expressions) and their impact on clients' emotional experiencing in-session. We also assessed difference for withdrawing versus pursuing partners. The sample included 13 EFT therapists who worked with one couple each for a single session. From transcripts we coded therapists' repetition of somatically focused interventions and clients' depth of experiencing pre-and post-intervention. Multilevel modeling demonstrated that a higher number of repetitions of somatically focused interventions predicted greater increase in depth of experiencing, unlike length of time spent repeating interventions. Somatically focused interventions resulted in greater increase in depth of experiencing for withdrawing as compared to pursuing partners. The results of this exploratory study suggest that such interventions may be a specific technique of EFT therapists that enhances emotional experiencing especially among withdrawing partners. peerReviewed

Drawing on an ecological approach with multiple informants, this study investigated the mediating role of youth–caregiver relationship quality in associations between different features of residential care settings' organizational social context and youth's psychopathology. Participants were 378 youth aged between 12 and 25 years old, and 54 caregivers aged between 24 and 57 years old, from 29 generalist residential youth care settings in Portugal. Given the hierarchical structure of data, analyses were performed using multilevel modeling. Results revealed that organizational social contexts characterized by higher levels of engagement, stress, and centralization, as perceived by the caregivers, were associated with lower levels of youth's externalizing problems (e.g., aggressive behavior and delinquency), reported by the caregivers, via better youth–caregiver relationship quality, perceived by the youth in care. These findings highlight the relevance of creating an organizational social context in residential care settings that supports caregivers in establishing high-quality relationships with the youth in care, thereby promoting their mental health. This study contributes to the clarification of conflicting findings in previous studies of this field, by offering further empirical investigation of these issues. info:eu-repo/semantics/acceptedVersion

OBJECTIVES This study explores population-level variation in different types of health insurance coverage in India. We aimed to estimate the extent to which contextual factors at community, district, and state levels may contribute to place-based inequalities in coverage after accounting for household-level socioeconomic factors. METHODS We used data from the 2015-2016 National Family Health Survey in India, which provides the most recent and comprehensive information available on reports of different types of household health insurance coverage. We used multilevel regression models to estimate the relative contribution of different population levels to variation in coverage by national, state, and private health insurance schemes. RESULTS Among 601,509 households in India, 29% reported having coverage in 2015-2016. Variation in each type of coverage existed between population levels before and after adjusting for differences in the distribution of household socioeconomic and demographic factors. For example, the state level accounted for 36% of variation in national scheme coverage and 41% of variation in state scheme coverage after adjusting for household characteristics. In contrast, the community level was the largest contextual source of variation in private insurance coverage (accounting for 24%). Each type of coverage was associated with higher socioeconomic status and urban location. CONCLUSIONS Contextual factors at community, district, and state levels contribute to variation in household health insurance coverage even after accounting for socioeconomic and demographic factors. Opportunities exist to reduce disparities in coverage by focusing on drivers of place-based differences at multiple population levels. Future research should assess whether new insurance schemes exacerbate or reduce place-based disparities in coverage.

To address the recent call for investigations of job insecurity as a collective construct-namely, job insecurity climate-this study developed and tested a multilevel model of consequences of job insecurity climate. Specifically, we examined the association of job insecurity climate with employees' perceived organizational obstruction, which, in turn, relates to their work engagement and job satisfaction. In the current study, cross-sectional data were collected from a sample of 357 full-time Taiwanese employees in 42 work units. Using multilevel structural equation modeling analyses to test our hypotheses, we found that job insecurity climate was positively related to employees' perceived organizational obstruction. We also found that job insecurity climate had a negative indirect association with employees' work engagement and job satisfaction through the perceived organizational obstruction. Our results shed light on the relationship between job insecurity climate and employee outcomes beyond individual job insecurity and the psychological mechanism through which job insecurity climate relates to employee work engagement and job satisfaction. Theoretical and practical implications are discussed.

Control of the arboviral disease vector Aedes aegypti has shown variable levels of efficacy around the globe. We evaluated an Autocidal Gravid Ovitrap (AGO) intervention as a stand‐alone control tool for population suppression of A. aegypti in US communities bordering Mexico.We conducted a cluster randomized crossover trial with weekly mosquito surveillance of sentinel households from July 2017 to December 2018. The intervention took place from August to December of both years. Multilevel models (generalized linear and additive mixed models) were used to analyse the changes in population abundance of female A. aegypti.We observed that female populations were being suppressed 77% (2018) and four times lower outdoor female abundance when AGO coverage (number of intervention AGO traps that surrounded a sentinel home) was high (2.7 AGOs/house). However, we also observed that areas with low intervention AGO coverage resulted in no difference (2017) or slightly higher abundance compared to the control. These results suggest that coverage rate might play a critical role on how populations of female A. aegypti are being modulated in the field. The lack of larval source habitat reduction and the short duration of the intervention period might have limited the A. aegypti population suppression observed in this study. Synthesis and applications. The mosquito, A. aegypti, is a public health concern in most tropical and subtropical regions. With the rise of insecticide resistance, the evaluation of non‐chemical tools has become pivotal in the fight against arboviral disease transmission. Our study shows that the AGO intervention, as a stand‐alone control tool, is limited by its coverage in human settlements. Vector control programmes should consider, that if the target coverage rate is not achieved, measures will be ineffective unless coupled with other control approaches. Although our multilevel modelling was focused on A. aegypti and the AGO, the approach can be applied to other mosquito vector species., The mosquito, A. aegypti, is a public health concern in most tropical and subtropical regions. With the rise of insecticide resistance, the evaluation of non‐chemical tools has become pivotal in the fight against arboviral disease transmission. Our study shows that the AGO intervention, as a stand‐alone control tool, is limited by its coverage in human settlements. Vector control programmes should consider, that if the target coverage rate is not achieved, measures will be ineffective unless coupled with other control approaches. Although our multilevel modelling was focused on A. aegypti and the AGO, the approach can be applied to other mosquito vector species.

This study examined how existential fears are related to COVID‐19 vaccination anxiety and followed the Terror Management Theory (TMT) by examining the contribution of two existential concerns, subjective nearness‐to‐death (SNtD) and death anxiety, to COVID‐19 vaccination anxiety during the first month of COVID‐19 vaccinations. Data were collected during January 2021, when Israel was in lockdown, from a convenience sample of 381 Jewish Israelis (M = 55.39, SD = 17.17). Participants completed questionnaires examining demographics, SNtD, death anxiety and COVID‐19 vaccination anxiety. A hierarchical regression analysis examined the connections between these variables and COVID‐19 vaccination anxiety while controlling for demographics and for receiving COVID‐19 vaccinations. In line with the hypotheses, SNtD and death anxiety were each positively associated with COVID‐19 vaccination anxiety, and death anxiety levels moderated the positive connection between SNtD and COVID‐19 vaccination anxiety, as this association was not significant for individuals with low death anxiety. The findings of this study provide preliminary evidence concerning the role of death anxiety in moderating the effect that SNtD has on COVID‐19 vaccination anxiety. These findings are in line with the TMT and justify further investigation and may be utilized in future research in order to address COVID‐19 vaccination anxiety more effectively.

Meta-analysis is the synthesis of findings from research projects, which enables an estimate of the average or pooled effect across various studies. This study presents findings from the intention to treat analysis for a series of educational evaluations in England using a two stage meta-analysis with standardised outcome data and Individual Participant Data (IPD) meta-analyses. The research estimates the overall impact of educational trials on pupils eligible for Free School Meals (FSM) and the attainment gap in literacy and mathematics performance between FSM and non-FSM pupils based on analysis of 88 trials and data from over half a million pupils. For the meta-analyses, frequentist and Bayesian multilevel models were used to estimate the individual and pooled effect size across categories of explanatory variables such as age groups (key stages in England) and aspects of the type of interventions (one-to-one, small group, and whole class). Results indicated that the overall impact of interventions on the literacy outcomes of FSM pupils was positive with a pooled effect size of 0.06 (0.03, 0.08). However, for mathematics, no overall effect on FSM pupils was observed. Analysis of the attainment gap indicated that literacy outcomes for FSM pupils were improved by interventions marginally more than for non-FSM pupils (pooled attainment gap 0.01(-0.01, 0.04)). The risk of bias assessment showed that estimates were consistent across different methodological approaches. Overall, evidence from this study can be used to identify, test and scale educational interventions in schools to improve educational outcomes for disadvantaged pupils.

Objectives The study aims to develop a continuing bonds scale, investigate the relationship between continuing bonds and adjustment after loss, and test the moderating role of meaning reconstruction in this relationship. Methods Data were collected from two different samples of 306 (Study 1) and 271 (Study 2) bereaved adults. Results The four factors structure of the Multidimensional Continuing Bonds Scale (MCBS) was explored and confirmed. Hierarchical regression analysis revealed that continuing bonds showed a significant relationship with prolonged grief symptoms after controlling the risk factors such as gender, age of the deceased, time since loss, and cause of death. Meaning reconstruction moderated the relationship between continuing bonds and prolonged grief symptoms. Conclusion The results revealed that the MCBS can be used as a valid and reliable scale to assess the continuing bonds construct. The relationship between continuing bonds and prolonged grief symptoms varies according to the levels of meaning reconstruction.

The present study examines the associations between multiple measures of social trust and two outcomes of psychological wellbeing (happiness and depression) among South Korean adults (n = 1549) living in residential communities, that is, administrative districts (n = 77) in and around the capital city of Seoul. Based on multilevel modeling, we find that familial trust positively predicts happiness at both individual and contextual levels; and it negatively predicts depression at the individual level only. In comparison, peer trust is negatively related only to depression at the individual level, albeit marginally. Lastly, general trust significantly predicts both outcomes at the community, but not individual, level. These mixed findings suggest that the trust-wellbeing relationship depends critically on issues of definition (how the variables are conceptualized) and measurement (how they are operationalized according to different units of analysis). Our study offers implications for the literature on social determinants of mental health broadly and, more specifically, on the role of social trust.

Background There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6-month follow-up period in psychiatric populations. Building upon these results, we set out to expand the follow-up period and to investigate various implicit methods. Methods Seventy-nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self-harm-Me/Others; Self-Harm-Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts. Results In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow-up period. Conclusion Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long-term prediction of suicide plans or attempts using implicit measures seems limited.

Contains fulltext : 241716.pdf (Publisher’s version ) (Closed access) The present longitudinal study examined how and why classroom-level victimization moderates the prospective association between peer victimization and depressive symptoms with 2,643 third- and fourth-graders (Mage = 10.01 years) in China. Multilevel modeling revealed that peer victimization was more strongly associated with increasing depressive symptoms in classrooms with lower classroom-level victimization. Moreover, two mechanisms were identified to explain the moderating effect of classroom-level victimization. First, low classroom-level victimization reduced victimized children's received friendship nominations from peers, thereby leading to increases in depressive affect. Second, low classroom-level victimization affected victimized children’s depressive symptoms through damage to their social self-concept. These findings provide support for the "healthy context paradox" in the Chinese culture, and highlight the mechanisms of this phenomenon. 19 p.

Purpose To explore the association of genomic knowledge, self-epistemic authority (SEA; i.e., subjective perception of knowledge expertise), perceived importance of genomics in nursing, and the integration of genomic skills into nursing practice. Design A cross-sectional study of nurses working in pediatric, obstetric, and internal wards of two medical centers in Israel between February and October 2018. Methods Participants completed anonymous questionnaires about genomic knowledge, SEA, perceived importance of genomics, and the performance of genomic skills in nursing practice. Associations between variables were analyzed using Pearson correlations, and a hierarchical regression model was used to determine which variables explained the performance of genomic practices among participants. Findings Altogether 423 nurses participated in the study. The mean genomic knowledge was low (55.05 ± 14.82%). Nurses reported a low integration of genomic skills in their practice (M = 1.90, SD = 0.71), although their overall perceived importance of genomics was positive (M = 2.88, SD = 0.68). Positive correlations were found between SEA and the integration of genomic skills in nursing practice. Obstetric nurses had more genomic knowledge, more positive perceptions about genomics, and performed more genomic skills in their nursing practice. Conclusions Although nurses realized the importance of genomics to their practice, and genomics is part of the Israeli nursing core curriculum, we found disappointingly low levels of knowledge and performance of genomic skills in nursing practice. Clinical relevance The results call for action to establish ongoing education programs in genomics for nurses, which would lead to the inclusion of genomic skills into routine nursing practice, and prepare nurses for providing personalized medicine.

AIMS AND OBJECTIVES To investigate the relationships of sociodemographic factors, self-stigma, glycaemic control (measured by glycated haemoglobin (A1C)) and self-care behaviours in young adults with type 2 diabetes. BACKGROUND Young adults aged 25-44 years are in their most productive period. Once diagnosed with diabetes, this population tends to experience poor glycaemic control and perform poorly in self-care activities. Such patterns may raise perceptions of self-stigma and further decrease motivations to engage in self-care behaviours in patients with diabetes. DESIGN A cross-sectional, correlational research design. METHODS The STROBE guidelines for cross-sectional studies were followed. A convenience sample of 115 participants was recruited from a medical centre in southern Taiwan. Instruments included the Self-Stigma Scale-Chinese version and the Diabetes Self-Care Behaviours Scale. Data were analysed using a three-step hierarchical regression analysis and the Sobel test. RESULTS The average age of the participants was 36.7 years. Marital status, employment status, self-stigma and A1C were significantly associated with self-care behaviours, and these four variables explained 43.6% of the variance in self-care behaviours. However, A1C (β = -.58, p

The present study examined whether certain Veterans Health Administration (VHA) therapists have more success than others in keeping patients engaged in evidence-based psychotherapies for posttraumatic stress disorder (PTSD). Our objective was to use multilevel modeling to quantify the variability between therapists in two indicators of patient engagement: early dropout (i.e., < 3 sessions) and adequate dose (i.e., ≥ 8 sessions). The phenomenon of systematic variability between therapists in patients' treatment experience and outcomes is referred to as "therapist effects." The sample included the 2,709 therapists who provided individual cognitive processing therapy (CPT) or prolonged exposure (PE) to 18,461 veterans with PTSD across 140 facilities in 2017. Data were extracted from administrative databases. For CPT, therapist effects accounted for 10.9% of the variance in early dropout and 8.9% of the variance in adequate dose. For PE, therapist effects accounted for 6.0% and 8.8% of the variance in early dropout and adequate dose, respectively. Facility only accounted for an additional 1.1%-3.1% of the variance in early dropout and adequate dose. For CPT, patients' odds of receiving an adequate dose almost doubled, OR = 1.41/0.72 = 1.96, if they were seen by a therapist in the highest compared with the lowest retention decile. For PE, the odds of a patient receiving an adequate dose were 84% higher, OR = 1.38/0.75 = 1.84, when treated by a therapist in the highest compared with the lowest retention decile. Therapist skills and work environment may contribute to variability across therapists in early dropout and adequate dose.

Many individuals may face traumatic events throughout their lives. For intimate relationship partners, early traumatic experiences can have a specific effect on their interpersonal communication. This study examined the moderating effect of traumatic experiences at early ages between perceived conflict and communication behavior among individuals in an intimate relationship. A total of 186 college students in intimate relationships reported their perceived conflict and communication behaviors with their partners three times a day for 14 days using ambulatory assessment. Findings from the multilevel model showed that a higher level of perceived conflict significantly positively associated with negative communication and negatively correlated with positive communication at the within-person level. Traumatic experiences at the between-person level moderated the within-person level associations between the dynamic perceived conflict and negative and positive communication behavior. However, the moderating effect of traumatic experiences on the association between perceived conflict and positive communication was contrary to the hypothesis. Daily perceived conflict was associated with daily communication behavior. For those with early traumatic experiences, the relationship between negative communication and conflict was stronger than for those who had not experienced such trauma.

Objectives Duration, frequency, and intensity of nature exposure link to different physical and psychological benefits. The present study aimed to determine how time outdoors affected military veterans' posttraumatic stress disorder (PTSD) symptomology during PTSD treatment. Method Hypotheses regarding time outdoors and the effect of program duration on PTSD symptoms were examined using multilevel models. The authors hypothesized that hours outdoors, both within- and between-persons, would predict reduced PTSD symptomology, program duration would predict reduced PTSD symptomology, and that hours outdoors and program duration would be significant when accounting for the other. Results The present study found that time outdoors correlated with participants' decreased PTSD symptomology: the more time participants spent outdoors, the greater the reduction in their PTSD symptoms. Conclusion The effect of time outdoors was significant within-person, not between persons, suggesting that nature exposure may be used as an adjunct to traditional mental health treatment where exposure or dosage should be person-specific.