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Aims Chronic heart failure (CHF) has an increasing burden of comorbidities, which affect clinical outcomes. Few studies have focused on the clustering and hierarchical management of patients with CHF based on comorbidity. This study aimed to explore the cluster model of CHF patients based on comorbidities and to verify their relationship with clinical outcomes. Methods and results Electronic health records of patients hospitalized with CHF from January 2014 to April 2019 were collected, and 12 common comorbidities were included in the latent class analysis. The Fruchterman–Reingold layout was used to draw the comorbidity network, and analysis of variance was used to compare the weighted degrees among them. The incidence of clinical outcomes among different clusters was presented on Kaplan–Meier curves and compared using the log‐rank test, and the hazard ratio was calculated using the Cox proportional risk model. Sensitivity analysis was performed according to the left ventricular ejection fraction. Four different clinical clusters from 4063 total patients were identified: metabolic, ischaemic, high comorbidity burden, and elderly‐atrial fibrillation. Compared with the metabolic cluster, patients in the high comorbidity burden cluster had the highest adjusted risk of combined outcome and all‐cause mortality {1.67 [95% confidence interval (CI), 1.40–1.99] and 2.87 [95% CI, 2.17–3.81], respectively}, followed by the elderly‐atrial fibrillation and ischaemic clusters. The adjusted readmission risk of patients with ischaemic, high comorbidity burden, and elderly‐atrial fibrillation clusters were 1.35 (95% CI, 1.08–1.68), 1.39 (95% CI, 1.13–1.72), and 1.42 (95% CI, 1.14–1.77), respectively. The comorbidity network analysis found that patients in the high comorbidity burden cluster had more and higher comorbidity correlations than those in other clusters. Sensitivity analysis revealed that patients in the high comorbidity burden cluster had the highest risk of combined outcome and all‐cause mortality (P

Introduction The heterogeneity of street-involved youth was examined using a person-centered approach. Youth were classified based on patterns of street involvement and the identified profiles compared to identify theoretically coherent and practically significant differences. Methods Participants were 111 street-involved youth aged 9 to 18 (M age = 14.15 years; 81.1% male, 91.1% non-white) from three Brazilian cities. Youth completed a life history interview and structured assessment. Latent class analysis was used to identify three profiles of youth based on reasons for going to the street and connections to major developmental contexts (street, family, institutions). Profile comparisons on psychosocial variables (e.g., age, life events) and adjustment indicators (e.g., drug use, life satisfaction) were conducted using multinomial logistic regression. Results The largest profile (48.6%) included youth drawn to the street by drug use or trafficking, who had moderate connections to street and family. Another group (40.5%) went to the street to escape family dysfunction, and the street represented their primary developmental context. These groups differed on some psychosocial indicators but had similar patterns of adjustment. The third group of youth (10.8%) had families with a history of street involvement and maintained strong ties to all three developmental contexts. These youth had generally better adjustment than their peers (e.g., less drug use, higher life satisfaction) but had higher levels of sexual risk related to the overrepresentation of girls. Conclusions Street involvement is a multidetermined phenomenon that may expose young people to distinct conditions of vulnerability. Findings have implications for research, practice, and policy.

Aims The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches. Design The study followed a multisite cross-sectional design. Methods A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. Results Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. Conclusion Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. Impact This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Latent class analysis is an intuitive tool to characterize disease phenotype heterogeneity. With data more frequently collected on multiple phenotypes in chronic disease studies, it is of rising interest to investigate how the latent classes embedded in one phenotype are related to another phenotype. Motivated by a cohort with mild cognitive impairment (MCI) from the Uniform Data Set (UDS), we propose and study a time-dependent structural model to evaluate the association between latent classes and competing risk outcomes that are subject to missing failure types. We develop a two-step estimation procedure which circumvents latent class membership assignment and is rigorously justified in terms of accounting for the uncertainty in classifying latent classes. The new method also properly addresses the realistic complications for competing risks outcomes, including random censoring and missing failure types. The asymptotic properties of the resulting estimator are established. Given that the standard bootstrapping inference is not feasible in the current problem setting, we develop analytical inference procedures, which are easy to implement. Our simulation studies demonstrate the advantages of the proposed method over benchmark approaches. We present an application to the MCI data from UDS, which uncovers a detailed picture of the neuropathological relevance of the baseline MCI subgroups. This article is protected by copyright. All rights reserved.

This study investigated patterns of universal health and education service use from birth through Kindergarten (age 4 years) and estimated associations between cumulative risk and service use patterns, and between service use patterns and children's developmental vulnerability in the Preparatory Year (age 5 years). The study used population-wide linkage of health and education administrative data records for 5168 children who had a 2018 AEDC instrument collected in Tasmania and were born in Tasmania (2011–2013). Latent class analysis (LCA) identified three service use patterns: Regular (72.2 per cent of children; reference group), Low (15.6 per cent of children) and High service use (12.2 per cent of children). The patterns of Regular, Low and High service use were consistent across health and education services used at different ages and stages of child development. Membership of the Low and High service use groups was associated with higher cumulative risk and increased odds of developmental vulnerability, relative to the Regular service use group. This population-wide view of universal service use can be used by the health and education sectors to explore ways in which their specialist expertise, resources and referral processes can be further integrated within and across services to meet the developmental needs of children and families.

INTRODUCTION Substance use is increasingly prevalent among women. Little research examines subgroups of women with substance use issues to identify their characteristics and thus enable treatment recommendations. The present study used latent class analysis to identify subgroups of substance use among women in substance-use treatment based on use in the 30 days prior to intake and examined changes in mental health and treatment outcomes following 60 days of treatment. METHODS Participants were women (N = 493) attending specialist non-government substance use treatment services in New South Wales, Australia. RESULTS Four distinct classes of substance users were identified: (i) Amphetamine Type Stimulants (ATS) Polysubstance (40.6%, n = 200); (ii) Alcohol Only (33.1%, n = 163); (iii) Cannabis and Alcohol (17.0%, n = 84) and (iv) Other Polysubstance (9.3%, n = 46). Women in the ATS Polysubstance class were the youngest and those in the Alcohol Only class were the oldest. DISCUSSION AND CONCLUSIONS Findings show that classes with high polysubstance use (ATS Polysubstance) differed from the single-substance use class (Alcohol Only). The ATS Polysubstance class had significantly greater improvements in health outcomes after 60 days compared to the Alcohol Only class. These findings suggest that although women with polysubstance use can benefit from substance use treatment, younger women (ATS Polysubstance) may benefit even more than older women (Alcohol Only). Future research should utilise a longitudinal design and examine additional psychosocial characteristics to extend on current findings.

Objective Substance use rates have increased in adults 50 years and older, and substance use in this population is associated with significant consequences. Given that little is known about their underlying substance use patterns, the objective was to identify latent classes of adults 50 years and older by past-year substance use, past-month substance use, and past-year substance use disorder (SUD) diagnosis. Methods The National Survey on Drug Use and Health is an annual nationwide cross-sectional U.S. survey. Participants were 35,229 civilian, non-institutionalized U.S. residents, 50 years and older. Past-year and past-month alcohol, tobacco, marijuana, heroin, cocaine, methamphetamine use, and opioid, stimulant, and tranquilizer/sedative prescription drug misuse (PDM) were captured, as was past-year DSM-IV SUD from these substances. Correlates included mental health, physical health, and healthcare utilization variables. Results Latent class analysis indicated four past-year or past-month substance use subgroups (Alcohol-Only, Alcohol-Tobacco-Marijuana, Cocaine-Polydrug, PDM-Polydrug), with SUD prevalence rising from 3.2% to 17.3%, 68.8%, and 78.5% by past-year subgroup; similarly, rates of past-year suicidal ideation increased from 2.1%, to 4.8%, 12.0%, and 20.4% by past-year subgroup. For SUD, there were three subgroups (Low Nicotine Dependence [ND], High Alcohol Use Disorder, Multiple SUDs). Over 90% of adults were in a low-risk subgroup (i.e., Alcohol-Only and Low ND), but members of Cocaine-Polydrug, PDM-Polydrug, or Multiple SUDs latent classes had high rates of mental and physical health concerns. Conclusions Most adults 50 and older have lower risk profiles, but those engaged in PDM or cocaine use are heavily substance-involved and need screening and likely multi-disciplinary intervention.

Researchers and practitioners have a need for valid and generalizable typologies of juvenile homicide offenders (JHOs) to better understand the heterogeneous nature of JHOs, and use this knowledge to inform prevention efforts. Prior studies of JHOs have typically utilized a clinical approach, which is rich in data but based on small nonrepresentative samples, or relied on larger aggregate datasets which are more reliable but have few measures available. This study aimed to address these limitations by examining the latent heterogeneity (i.e. unapparent differences) in JHOs, their victims, and incident characteristics among more than 40,000 male JHOs arrested in the United States between 1976 and 2016 using latent class analysis, to allow for the objective identification of latent taxonomies. Six distinct subtypes of male JHOs are found in the analysis, which contributes to the theoretical and substantive knowledge base regarding JHOs, and may be used to develop and implement more effective interventions and violence prevention programs for these young offenders.

Background Despite abundant evidence that emotional distress is frequent in cancer patients and associated with adverse health outcomes, distress screening rates and adequate referrals to psychological support programs among those in need are insufficient in many cancer centers. We therefore aimed to analyze patient- and treatment-related barriers to distress screening and referrals to psychological support as a mandatory component of best-practice cancer care. Method In the present explorative study, latent class analysis was used to identify homogeneous subgroups among 4837 patients diagnosed with cancer between 2011 and 2019. Results Four subgroups were identified. Patients with a mental disorder and psychopharmacology were least probable to be screened for distress. Together with patients aged 65 or older and male patients, they were also less likely to receive psychological support. Patients hospitalized for 28 days or longer were most likely to be both screened and to receive psychological support. Conclusions Clinicians and researchers are recommended not neglect patients with mental disorders and psychopharmacological treatment as well as male and elderly patients when screening for distress and providing access to psychological support.

Background and purpose: This study was undertaken to identify clinically meaningful comorbidity patterns and their associations with the demographic/clinical characteristics of people with multiple sclerosis (MS). Methods: We conducted latent class analysis to identify clinically distinct comorbidity patterns in MS using the 15 most common comorbidities among 1518 Australian Multiple Sclerosis Longitudinal Study participants. The associations between demographic/clinical characteristics and comorbidity patterns were examined using log-binomial and multinomial logistic regression. Results: Five distinct comorbidity patterns were identified: "minimally diseased class" (30.8%), consisting of participants with no or one comorbidity; "metabolic class" (22.7%); "mental health-allergy class" (21.7%); "nonmetabolic class" (7.6%); and "severely diseased class" (7.0%), consisting of participants with higher prevalence of these comorbidities. The relative probabilities of being assigned to comorbidity classes compared to the minimally diseased class were significantly increased for participants who were older (metabolic: relative risk ratio [RRR] = 1.09, 95% confidence interval [CI] = 1.06-1.11; nonmetabolic: RRR = 1.07, 95% CI = 1.04-1.11; severely diseased: RRR = 1.04, 95% CI = 1.01-1.08), female (nonmetabolic: RRR = 5.35, 95% CI = 1.98-14.42; severely diseased: RRR = 2.21, 95% CI = 1.02-4.77), and obese (metabolic: RRR = 4.06, 95% CI = 2.45-6.72; mental health-allergy: RRR = 1.57, 95% CI = 1.00-2.46; severely diseased: RRR = 4.53, 95% CI = 2.21-9.29) and who had moderate disability (mental health-allergy: RRR = 2.32, 95% CI = 1.47-3.64; severely diseased: RRR = 2.65, 95% CI = 1.16-6.04). Conclusions: Comorbidity patterns exist in MS. Women, people who were older, people who were obese, and people who had higher disability levels were more likely to be in classes with higher levels of comorbidity. These findings may offer opportunities for designing more personalised approaches to comorbidity prevention and treatment.

OBJECTIVE Cancer is associated with an increased risk for completed suicide. We explored subtypes of thoughts of death, death wishes, suicidal ideation and behavior and their association with mental disorders and demographic and disease-related characteristics. METHODS We studied 2,141 cancer patients with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O). Assessment included 4-weeks-prevalences of thoughts of death, wish to die, suicidal ideation, suicide plans, and lifetime suicide attempts. We further assessed 4-weeks-prevalences of mood, anxiety, adjustment, somatoform, substance use, and disorders due to general medical condition. We conducted latent class analyses (LCA). RESULTS The LCA identified three classes with distinct patterns of suicidality. Class 1 (89.0% of the sample) showed no suicidality. Class 2 (6.9%) was characterized by thoughts of death without suicidal ideation. Class 3 (4.1%) was characterized by thoughts of death, suicidal ideation, and suicide plans. Death wishes occurred in both classes 2 and 3. Classes 2 and 3 were associated with a significantly higher risk for any mental disorder (OR from 4.22, adjustment disorder, to 10.20, mood disorders, p

The study of perceived economic differences in everyday life is relevant to deepen the knowledge of how inequality shapes psychological processes. In the current research, Spanish undergraduates (N=547) were asked what their friends with the most and least money could do with their resources. Using a qualitative and quantitative approach, we performed a content analysis of the 1,085 open-ended responses given, ran latent class analyses with the coded material to identify groups of participants, and explored whether class membership was associated with their awareness of inequality and support for redistribution. Participants perceived inequality among their friends through daily indicators such as consumption, opportunities, leisure, and mental health; some participants used compensatory strategies to mitigate perceived inequality. Latent class analyses suggested that participants differed mostly in the attention paid to consumption and in the use of compensatory strategies. Exploratory analyses suggested that perceiving inequality in everyday life in terms of consumption, negative attributes towards the wealthy, or positive attributes towards low socioeconomic groups was related to acknowledging economic differences among individuals and support for redistribution. The study of perceived economic inequality in everyday life continues a new line of research with the potential to obtain results more consistent with people's experiences. OAICE-006-2017 UCR::Sedes Regionales::Sede de Occidente

Objective: To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. Method: From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). Results: Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. Discussion: Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches. © 2021 Wiley Periodicals LLC.

Aims This study sought to determine whether clinical clusters exist in takotsubo cardiomyopathy. Takotsubo cardiomyopathy (TCM) is a heterogeneous disorder with a complex, poorly understood pathogenesis. To better understand the heterogeneity of TCM, we identified different clinical phenotypes in a large sample of TCM patients by using latent class analysis (LCA). Methods and results Using the National Inpatient Sample (NIS) database, we identified 3139 patients admitted to hospitals in 2016–2017 with a primary diagnosis of TCM. We performed LCA based on several patient demographics and comorbidities: age, sex, hypertension, hyperlipidaemia, diabetes mellitus, obesity, current smoking, asthma, chronic obstructive pulmonary disease (COPD), and anxiety and depressive disorders. We then repeated LCA separately with the NIS 2016 and 2017 data sets and performed a robust test to validate our results. We also compared in‐hospital outcomes among the different clusters identified by LCA. Four patient clusters were identified. C1 (n = 1228, 39.4%) had the highest prevalence of hyperlipidaemia (93.4%), hypertension (61.6%), and diabetes (34.3%). In C2 (n = 440, 14.0%), all patients had COPD, and many were smokers (45.8%). C3 (n = 376, 11.8%) largely comprised patients with anxiety disorders (98.4%) and depressive disorders (80.1%). C4 (n = 1097, 34.8%) comprised patients with isolated TCM and few comorbidities. Among all clusters, C1 had the lowest in‐hospital mortality (1.0%) and the shortest length of stay (3.2 ± 3.1 days), whereas C2 had the highest in‐hospital mortality (3.4%). Conclusions Using LCA, we identified four clinical phenotypes of TCM. These may reflect different pathophysiological processes in TCM. Our findings may help identify treatment targets and select patients for future clinical trials.

This research note identifies patterns of stressor exposure among Canadian workers, their stratification by occupational and socio-demographic factors, and their relationship to high self-reported work stress. Using latent class analysis and data from the Canadian Community Health Survey we examine the intersection of six stressors, identifying five distinct patterns (Few stressors, Multiple stressors, Physical, Monotonous, and Chaotic patterns of stressor exposure). Results show that the patterns of stressor exposure are stratified by gender, education, income, age group, and occupation; as well as give insight on how particular patterns of stressor exposure relate to individual perceptions of high self-reported work stress. The project also provides a research example of using quantitative data to examine qualitative differences in patterns of experience that provide more nuanced insight into complex social phenomena.Cette note de recherche identifie les modèles d'exposition aux facteurs de stress chez les travailleurs canadiens, leur stratification en fonction de facteurs professionnels et sociodémographiques et leur relation avec un stress au travail autodéclaré élevé. À l'aide d'une analyse des classes latentes et des données de l'Enquête sur la santé dans les collectivités canadiennes, nous examinons l'intersection de six facteurs de stress, identifiant cinq modèles distincts (peu de facteurs de stress, plusieurs facteurs de stress, physiques, monotones et chaotiques d'exposition aux facteurs de stress). Les résultats montrent que les modèles d'exposition aux facteurs de stress sont stratifiés selon le sexe, le niveau de scolarité, le revenu, le groupe d'âge et la profession. Les résultats donnent également un aperçu de la manière dont certains schémas d'exposition sont liés aux perceptions individuelles du stress au travail. Le projet fournit également un exemple de recherche sur l'utilisation de données quantitatives pour examiner les différences qualitatives dans l'expérience, afin de fournir un aperçu plus nuancé de phénomènes sociaux complexes.

BACKGROUND AND AIMS In recent decades, alcohol drinking in the European Union has been characterized by increasing homogenization of levels of drinking coupled with an overall decrease. This study examined whether we can still distinguish distinct practices of drinking by addressing two research questions: (1) are drinking practices still characterized by the choice of a certain alcoholic beverage; and (2) how do drinking practices vary across countries? DESIGN Cross-sectional study: latent-class analyses of drinking variables and fractional response regression analyses of individual characteristics for individual-level class endorsement probabilities, respectively. SETTING Nineteen European countries and one autonomous community. PARTICIPANTS A total of 27 170 past-year drinkers aged 18-65 years in 2015. MEASUREMENTS Data were collected through the Standardized European Alcohol Survey included frequency of past-year drinking, pure alcohol intake per drink day, occurrence of monthly risky single-occasion drinking and preferred beverage, together with socio-demographic data. FINDINGS Three latent classes were identified: (1) light to moderate drinking without risky single-occasion drinking [prevalence: 68.0%, 95% confidence interval (CI) = 66.7-69.3], (2) infrequent heavy drinking (prevalence: 12.6%, 95% CI = 11.5-13.7) and (3) regular drinking with at least monthly risky single-occasion drinking (prevalence: 19.4%, 95% CI = 18.1-20.9). Drinking classes differed considerably in beverage preference, with women reporting a generally higher share of wine and men of beer drinking. Light to moderate drinking without risky single-occasion drinking was the predominant drinking practice in all locations except for Lithuania, where infrequent heavy drinking (class 2) was equally popular. Socio-demographic factors and individual alcohol harm experiences (rapid alcohol on-line screen) explained up to 20.5% of the variability in class endorsement. CONCLUSIONS Beverage preference appears to remain a decisive indicator for distinguishing Europeans' drinking practices. In most European countries, multiple drinking practices appear to be present.

Guided by the Stages of Change (SOC) model, we explored relationship-repair behaviors among those thinking about divorce, employing a recent national longitudinal survey of married individuals (N = 745). Person-centered analyses explored whether there were distinct typologies of relationship-repair behaviors. We found four distinct classes: Intense Seekers (6%), who engaged at high levels of all kinds of repair behaviors, including professional services; Moderate-fading Seekers (14%), who engaged in moderate levels of various repair behaviors, including professional services, but did not sustain that behavior over a year; and Minimal-private Seekers (42%) and Private-sustained Seekers (38%), who eschewed professional services and engaged in low-to-moderate personal and private repair behaviors. We discuss possible applications of the SOC model to the divorce decision-making process and conclude with implications for practice, including the need to allocate greater attention to personal and self-help interventions that match the way most people try to repair their relationships.

peer-reviewed The full text of this article will not be available in ULIR until the embargo expires on the 2021/12/16 Background While pain is very common in older adults, the associated impact on daily life, including usage of medication and healthcare, varies considerably and often pain remains inadequately treated. It is not clear what is associated with this variation. Methods Latent class analysis (LCA) is a model‐based approach to identifying underlying subgroups in a population. In this study LCA was used to examine biopsychosocial risk classes of adults aged 50 years and older, who were often troubled by pain, from The Irish Longitudinal Study on Ageing (TILDA), (n = 2,896), and the associations with future medication and healthcare use. Results Four biopsychosocial risk classes (Low Biopsychosocial Risk, Physical Health Risk, Mental Health Risk, High Biopsychosocial Risk) were identified, with the 'High Biopsychosocial Risk' class accounting for 24% of older adults with pain. This class were much more likely to use medication and healthcare services when followed up across three waves of the TILDA study. In contrast, the Physical Health Risk and the Mental Health Risk classes reported lower usage of medication and healthcare at waves 2 and 3. Amongst the higher risk classes of older adults who are troubled by pain, there is considerable consumption of medication and healthcare services evident. Conclusion Given our ageing population and significant number of adults in this high risk class, there is a need to optimize current pain management approaches among older adults. Intensive non‐pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring. Significance While pain is very common in older adults, the usage of medication and healthcare varies considerably and often pain remains inadequately treated. Given our ageing population and the significant number of older adults reporting high biopsychosocial risk (24%), there is a need to optimize current pain management approaches. Intensive non‐pharmacological approaches to pain management in older adults, tailored to individual biopsychosocial risk indicators for each individual class, may be worth exploring.

Background/objectives Frequent geriatric users of emergency departments (EDs) represent a complex and heterogeneous population. Identifying their specific subgroups would allow the development of interventions better customized to their needs and characteristics. Thus, this study aimed to develop profiles of frequent geriatric ED users using the individual characteristics of patients. Design This was a retrospective cohort study. Setting Databases from the Regie de l'assurance maladie du Quebec (RAMQ) were utilized. PARTICIPANTSThis study included individuals aged 65 years or older living in the community in the Province of Quebec (Canada), who consulted in an ED at least four times in the year after an ED index date (an ED visit, chosen randomly, during an index period of January 1, 2012 to December 31, 2013) and who had received a diagnosis of ambulatory care-sensitive conditions (ACSCs) in the 2 years preceding the index date. Measurements A latent class analysis was used to identify subgroups of frequent geriatric ED users according to their individual characteristics, including ACSC type, dementia, mental health disorders, cancer diagnosis, and comorbidity index. Results The study cohort consisted of 21,393 frequent geriatric ED users. Four groups of frequent geriatric ED users were identified: people with low comorbidity (39.0%), comprising the individuals with the lowest number of physical and mental health conditions; people with cancer (32.7%); people with pulmonaryand cardiac diseases (18.1%); and people with dementia or mental health disorders (10.2%), composed of individuals with the highest proportion of common and severe mental health disease, as well as dementia. This group accounts for the highest use of overall healthcare services. Conclusion These profiles will be useful in developing customized interventions addressing the needs of each subgroup of frequent geriatric ED users. More research is needed to bridge the remaining gaps, especially regarding the healthiest frequent geriatric users of EDs.

OBJECTIVE AND BACKGROUND: The current study examines the types of childhood experiences with mothers (i.e., maternal abuse, affection, discipline) among caregivers of aging mothers, and investigates whether membership in specific latent classes, particularly maternal maltreatment, is associated with psychological functioning among caregivers. METHOD: Using data from the Midlife in the United States (MIDUS), we used the Bolck, Croon, and Hagenaars (BCH) approach of latent class analysis (LCA) to predict distal outcomes. RESULTS: We identified four latent classes (prevalence rate noted): “Affectionate and authoritative” (65%), “affectionate and permissive” (11%), “emotionally abusive and neglectful” (8%), and “emotionally/physically abusive and authoritative” (16%). Caregivers in the “emotionally/physically abusive and authoritative” class endorsed high probabilities of both maternal affection and abuse and were most negatively affected across the three psychological functioning outcomes (i.e., self-rated mental health, psychological distress, and psychological well-being). CONCLUSION AND IMPLICATIONS: In support of the life course perspective, our findings emphasized the importance of examining adult children caregivers’ early life experiences with aging mothers and how those experiences can impact the psychological effects of caregiving. This study suggests specific practice implications; for example, assessment tools for evaluating caregiver burden should consider life course factors such as caregivers’ childhood experiences with aging parents.

The debate around the construct validity of complex posttraumatic stress disorder (CPTSD) has begun to examine whether CPTSD diverges from posttraumatic stress disorder (PTSD) when it co-occurs with the diagnosis of borderline personality disorder (BPD). The present study (a) examined the construct validity of CPTSD through a latent class analysis of a non–treatment-seeking sample of young trauma-exposed adults and (b) characterized each class in terms of trauma characteristics, social emotions (e.g., shame, guilt, blame), and interpersonal functioning. A total of 23 dichotomized survey items were chosen to represent the symptoms of PTSD, CPTSD, and BPD and administered to 197 trauma-exposed participants. Fit statistics compared models with 2–4 latent classes. The four-class model showed the best fit statistics and clinical interpretability. Classes included a “high PTSD+CPTSD+BPD” class, characterized by high-level endorsement of all symptoms for the three diagnoses; a “moderate PTSD+CPTSD+BPD” class, characterized by endorsement of some symptoms across all three diagnoses; a “PTSD” class, characterized by endorsement of the ICD-11 PTSD criteria; and a “healthy” class, characterized by low symptom endorsement overall. Pairwise comparisons showed individuals in the high PTSD+CPTSD+BPD class to have the highest levels of psychological distress, traumatic event history, adverse childhood experiences, and PTSD symptoms. Shame was the only social emotion to significantly differ between the classes, p = .002, η(2) = .16. The findings diverge from the literature, indicating an overlap of PTSD, CPTSD, and BPD symptoms in a non–treatment-seeking community sample. Further, shame may be a central emotion that differentiates between presentation severities following trauma exposure.

Objectives To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes. Methods Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed. Results Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes. Conclusions Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.

BACKGROUND: Breast cancer mortality is higher for black and younger women. This study evaluated two possible contributors to disparities -- time to treatment and treatment duration -- by race and age. METHODS: Among 2,841 participants with stage I-III disease in the Carolina Breast Cancer Study, we identified groups of women with similar patterns of socioeconomic status (SES), access to care, and tumor characteristics using latent class analysis. We then evaluated latent classes in association with treatment delay (initiation >60 days after diagnosis) and treatment duration (in quartiles by treatment modality). RESULTS: Thirty-two percent of younger black women were in the highest quartile of treatment duration (versus 22% of younger whites). Black women experienced a higher frequency of delayed treatment [adjusted relative frequency difference (RFD) = 5.5%; 95% confidence interval (CI): 3.2%, 7.8%)] and prolonged treatment duration (RFD = 8.8%; 95% CI: 5.7%, 12.0%). Low SES was significantly associated with treatment delay among white women (RFD 3.5%; 95% CI: 1.1, 5.9), but treatment delay was high at all levels of SES in black women (e.g. 11.7% in high SES black women compared to 10.6% and 6.7% among low and high SES whites, respectively). Neither SES nor access to care classes were significantly associated with delayed initiation among black women, but both low SES and more barriers were associated with treatment duration across both races. CONCLUSIONS: Factors that influence treatment timeliness persist throughout the care continuum, with prolonged treatment duration being a sensitive indicator of differences by race, SES, and care barriers.

Latent class analysis and multigroup mediation were used with 8,860 families in Chile to identify risk groups varying in socioeconomic status, family structure, and maternal depression, to determine whether profiles differed in children's development of externalizing problems (EP) from 35 to 61 months, and maternal parenting that predicted EP. Four groups were identified: one no-risk profile and three risk profiles, impoverished and undereducated, depressed and impoverished, and father-absent and impoverished. All classes differed in EP. Maternal emotional support and harsh parenting were differentially associated with the development of EP across the three risk groups, relative to the low-risk group. Thus, specific constellations of adversities differentially predicted children's EP and socialization processes mediating links between risk and EP. Implications are discussed.

To examine whether nurses' location of employment, demographics, or training influences their perceptions of what constitutes optimal care for dying patients in hospital.Questionnaire-based, cross-sectional study.Between December 2016-June 2018, 582 registered or enrolled nurses from Australia (N = 153), South Korea (N = 241), and Hong Kong (N = 188) employed in a variety of hospital care units rated the extent to which they agreed with 29 indicators of optimal end-of-life care across four domains: patient, family, healthcare team, and healthcare system. Latent class analysis identified classes of respondents with similar responses.Top five indicators rated by participants included: 'physical symptoms managed well'; 'private rooms and unlimited visiting hours'; 'spend as much time with the patient as families wish'; 'end-of-life care documents stored well and easily accessed' and 'families know and follow patient's wishes'. Four latent classes were generated: 'Whole system/holistic' (Class 1); 'Patient/provider-dominated' (Class 2); 'Family-dominated' (Class 3) and 'System-dominated' (Class 4). Class 1 had the highest proportion of nurses responding positively for all indicators. Location was an important correlate of perceptions, even after controlling for individual characteristics.Nurses' perceptions of optimal end-of-life care are associated with location, but perhaps not in the direction that stereotypes would suggest. Findings highlight the importance of developing and implementing location-specific approaches to optimize end-of-life care in hospitals.The findings may be useful to guide education and policy initiatives in Asian and Western countries that stress that end-of-life care is more than symptom management. Indicators can be used to collect data that help quantify differences between optimal care and the care actually being delivered, thereby determining where improvements might be made.目标: 研究护士的工作地、人口统计或培训是否影响其对医院临终病人理想关怀的看法。 设计: 基于问卷调查的横断面分析研究。 方法: 2016年12月至 2018年6月,582名来自澳大利亚(N = 153)、韩国(N = 241)和香港(N = 188)各医院科室定额的登记或注册护士,他们对29个理想临终关怀指标表示认同,涵盖患者、家庭、医疗团队和医疗系统四大领域。潜在类别分析将给出相似回答的受访者归为一类。 结果: 受访者评分最高的五个指标包括:“身体症状管理良好”,“私人病房和不限探视时间”,“家属尽情陪护患者”,“临终关怀文件保存良好且易于获取”,“家属了解并遵循患者意愿”。生成的四个潜在类别是:“全系统/整体”(1类)、“患者/提供者主导”(2类)、“家庭主导”(3类)和“系统主导”(4类)。第1类对所有指标给出积极回答的护士比例最高。即使在控制了个体特征之后,其工作地也是感知的重要关联。 结论: 护士对理想临终关怀的看法与所在地有关,但可能与刻板印象暗示的方向无关。研究发现强调制定和实施特定工作地方法以优化医院临终关怀的重要性。 影响: 研究发现可能有助于指导亚洲和西方国家的教育和政策举措,这些国家强调临终关怀不仅仅是症状管理。指标可用于收集数据,帮助量化理想关怀与实际提供的关怀之间的差异,从而确定可改进的方面。.

This is a cross-sectional study whose objective was to identify clustering of lifestyle behaviors among undergraduate nursing students to inform health promotion efforts and improve health outcomes later in life. All 353 undergraduate nursing students from the School of Nursing in a public university, Bahia, Brazil were invited to participate. The inclusion and exclusion criteria were according to the major project. Participants must be enrolled and attending the 1st to 10th semester, with a minimum age of 18 years. Participants were excluded if they had any physical disabilities that limited the collection of anthropometric measures or were completing an internship off-campus. A total of 286 undergraduate nursing students met the criteria and completed the survey. The questionnaires included standardized measures for demographic, academic, and lifestyle behaviors (e.g., tobacco use, alcohol use, physical activity level, sedentary behavior, and fruits and vegetables consumed). Latent class analysis was performed to identify any clustering of lifestyle behaviors. Descriptive analyses indicated that 3.1% of the students were smokers, 23.1% consumed alcohol, 34.3% were inactive, 85.0% were sedentary, and 80.8% did not consume recommended amounts of fruits and vegetables. Latent class analysis produced four distinct subtypes of health risk: (a) low-health risk (33.57%); (b) moderate-health risk (27.97%); (c) high-health risk (19.58%); and (d) very high-health risk (18.88%). Approximately 38.5% of students were in the very high or high-risk classes. The proportion of students with very high and high-health risks emphasizes the importance of health promotion programs for university nursing students.

The purpose of this study was to identify subgroups of adolescents with distinct perceptions of parental messages supporting fighting and nonviolence. Latent class analysis identified four subgroups among 2,619 urban middle school students (90% African American; 52% female): messages supporting fighting (32%), messages supporting nonviolence (29%), mixed messages (23%), and no messages (16%). We found significant differences across subgroups in their frequency of physical aggression and peer victimization and beliefs about the use of aggressive and nonviolent responses to peer provocation. Beliefs significantly mediated the relation between parental messages subgroups and both aggression and victimization. Findings illustrate the heterogeneity in the messages urban adolescents perceive from their parents, as well as relations with adolescents' beliefs and behavior.

Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse.

Background This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well-being at ages 10-11 years. Methods Data were from the first six waves of the Longitudinal Study of Australian Children - Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver-reported, teacher-reported and child-completed tasks were used to index child well-being outcomes at ages 10-11 years including emotional/behavioural functioning (internalizing and externalizing symptoms; self-control), health-related quality of life, cognitive skills and academic achievement. Results Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life, although effects were smaller than the other sleep trajectories. Conclusions The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being.

Background Opioid use has increased to epidemic levels over the past decade within the United States, particularly among vulnerable populations. This retrospective study aimed to evaluate rates of prolonged opioid use in the Veteran population after thoracic surgery and identify specific risk clusters. Methods Veterans Administration data on patients who underwent thoracic surgery between January 1, 2006 and September 30, 2015 included preoperative opioid use information for stratification of patients to preoperative chronic opioid use (PCOU; nPCOU = 16,612) versus patients without preoperative chronic opioid use (WPCOU; nWPCOU = 2,328). A Poisson regression model and prior literature were used to identify variables for use in a Latent Class Analysis (LCA) model for each stratum. Three-cluster models were selected, and identified as 'low-', 'intermediate-' and 'high-' risk groups. Results Cluster interpretations included: (a) Low risk: no psychiatric diagnoses, preoperative medication use, or preoperative chronic pain, (b) Intermediate risk: no psychiatric diagnoses, but had preoperative medication use and some preoperative chronic pain and (c) High risk: psychiatric diagnoses, preoperative medication use and preoperative chronic pain. For the PCOU stratum, rates of prolonged opioid use 1 year after surgery were as follows: 46.3%, 61.9% and 66.0%. For the WPCOU stratum, the observed rates were 4.7%, 8.3% and 9.2%. Conclusions Prolonged opioid use trajectories obviously differ by PCOU status, as well as preoperative psychosocial diagnoses, medication use and chronic pain. This is a first step in population-level research to curb the rate of prolonged opioid use in Veterans following thoracic surgery. Significance This article presents population-level chronic opioid use trajectories after thoracic surgery, using latent class structures. Demographics, preoperative psychological diagnoses, medication usage and chronic pain variables were utilized to identify population-level clusters. The cluster identified as highest risk had preoperative chronic opioid use, psychological diagnoses, other medication prescriptions and chronic pain.

Using an experimental methodology based on investment games, we examine whether smallholder rice farmers from Nueva Ecija, Philippines have heterogeneous preferences for improvements in 10 rice varietal traits. We use a latent class cluster approach to identify different segments of rice producing households and their distinct preferences for trait improvements. These clusters were characterised post hoc using household, farm, and marketing characteristics. On average, farmers invested the most in rice varietal trait improvements that offered opportunities to reduce losses caused by lodging, insects and diseases. We found four classes of farmers with distinct preferences for improvements in variety traits. The clusters were significantly different in terms of household and farm characteristics. These findings can guide breeding research in the development of varieties that have the traits farmers identified for improvement, and that will address the unique needs of distinct farmer segments.

Consumers prefer beef to be bright, cherry red in color. As beef becomes discolored, consumers may perceive it to be unwholesome, reducing their willingness‐to‐pay (WTP). This study uses a choice experiment in an online survey to measure how discoloration affects consumer WTP for beef steak and ground beef. A cheap talk script combined with a trap question designed to simultaneously reduce hypothetical bias as well as measurement error caused by inattentive respondents is included in the survey. Results indicate even slightly discolored beef may require at least a 50% discount before the average consumer will purchase it. However, through latent class analysis, consumer preferences for discolored steak and ground beef are found to be heterogeneous with several latent classes identified. Thus, if the quantity of discolored meat to be sold is low, retailers can sell discolored meat at smaller discounts to consumers in one of the subgroups with less discriminating discoloration preferences [EconLit Citations: D10, D12, Q18].

The link between financial attitudes and consumer financial market behaviour is well documented. However, little is known about the role of financial knowledge and skills—the main components of the financial literacy construct—in shaping debt attitudes. This link is especially absent from the gender perspective. This study focuses on consumer debt literacy and debt attitudes. A representative sample of adult Poles (N = 1,004) was participated in a computer‐assisted telephone interview. Latent class analysis was employed to reveal their debt attitudes, and subsequently, links between debt literacy and debt attitudes were studied with multinomial regression models. The results show that respondents in Poland can be grouped into five classes exhibiting different attitude profiles. The structure of debt attitudes is complex and differs from a simple unidimensional pro‐debt/ anti‐debt construct. Although this study did not find significant gender differences either in the conceptualization of debt attitudes or in their drivers, the results showed that in all but one class, consumer attitudes are strongly linked to either debt knowledge or debt skills or to both. Debt skills were revealed to be a particularly strong predictor of consumer debt attitudes.

We adopt an empirical approach to analyse, measure and decompose inequality of opportunity (IOp) in health, based on a latent class model. This addresses some of the limitations that affect earlier work in this literature concerning the definition of types, such as partial observability, the ad hoc selection of circumstances, the curse of dimensionality and unobserved type-specific heterogeneity that may lead to biased estimates of IOp. We apply our latent class approach to measure IOp in allostatic load, a composite measure of biomarker data. Using data from Understanding Society: The UK Household Longitudinal Study (UKHLS), we find that a latent class model with three latent types best fits the data, with the corresponding types characterised in terms of differences in their observed circumstances. Decomposition analysis shows that about two thirds of the total inequalities in allostatic load can be attributed to the direct and indirect contribution of circumstances and that the direct contribution of effort is small. Further analysis conditional on age-sex groups reveals that the relative (percentage) contribution of circumstances to the total inequalities remains mostly unaffected and the direct contribution of effort remains small.

Objective International research suggests that many women do not return to their previous work after breast cancer. This study aimed to identify workforce participation patterns for Australian women with breast cancer and compare these to healthy aged matched women. Methods Using the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health, the work status of women was compared three years before and three years after their first reported breast cancer diagnosis. Latent class analysis was used to identify workforce participation patterns of women with breast cancer and healthy aged matched women. Multinomial logistic regression examined associations between work patterns and other risk factors. Results Pre and post breast cancer diagnosis work status data were available for 448 women with breast cancer between 1998 and 2010. Three years after diagnosis, 48% of full-time workers returned to full-time work but 52% returned to part time work or were not in paid work. Latent class analysis identified five classes. Women with breast cancer were more likely to be in the 'mostly full-time work' and 'mostly not in paid work' classes compared to healthy women. Odds ratios showed that women in remote areas, partnered, with less education or with chronic health condition were more likely to be 'not in paid work'. Conclusion Breast cancer has a negative impact on the workforce participation of Australian women. Women with breast cancer need support to return to work.