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Forecasting extremely rare events is a pressing problem, but efforts to model such outcomes are often limited by the presence of multiple causes within classes of events, insufficient observations of the outcome to assess fit, and biased estimates due to insufficient observations of the outcome. We introduce a novel approach for analyzing rare event data that addresses these challenges by turning attention to the conditions under which rare outcomes do not occur. We detail how configurational methods can be used to identify conditions or sets of conditions that would preclude the occurrence of a rare outcome. Results from Monte Carlo experiments show that our approach can be used to systematically preclude up to 78.6% of observations, and application to ground-truth data coupled with a bootstrap inferential test illustrates how our approach can also yield novel substantive insights that are obscured by standard statistical analyses. [ABSTRACT FROM AUTHOR]

Fertility in Ghana has declined steadily since 1980, however, a slight increase was observed between 2008 and 2014. While several factors may account for this pattern, research on the contribution of type of union is limited. This study examined differentials in the fertility of women in different types of union. Secondary data from 6,285 (weighted) ever-married women aged 15–49 years were analysed using compare means, t-test, analysis of variance, Poisson and binary logistic regression analyses. The findings indicate that, independent of other factors, fertility among remarried women is higher compared to first-time married women but this does not hold true when other factors are controlled for. Additionally, there was no significant difference in the fertility of remarried women who were in union and women who were in union in a first-time marriage. However, compared to remarried women who were currently in a union, fertility was significantly lower among remarried women who were not currently in union (β = -0.121, p<0.01) and women who have been married only once but were not currently in union (β = -0.212, p<0.001). Further analysis revealed that remarried women were significantly more likely to desire more children and less likely to use any method of contraception compared to first-time married women. There is the need for further research to better understand the fertility needs of remarried women. [ABSTRACT FROM AUTHOR]

The practice of early marriage, although acknowledged as a human rights violation, continues to occur in many countries. Different studies have identified the associated factors in many developing countries. However, these factors often assume no geographical variation in these factors within countries. Again, cultural practices and beliefs which strongly influence the acceptance and practices of early marriage vary geographically. In addition, geographic clusters of high rates of early marriage and union formation are also unknown. Thus, area specific correlates of early child marriage are required for the development of location specific policies to aid the eradication of early child marriage. Using data from the 2010 Ghana Population and Housing Census, this study examines the extent of geospatial clustering in early marriage amongst girls and their spatially-varying associated factors at the district level. The findings reveal strong clustering of high early marriage amongst districts in the Upper West, Northern and Volta regions. Nationally, 6.96% (CI = 6.83, 7.08) of girls are married or in union before their 18th birthday. The estimates range from 2.7% in the Jaman North district in Brong Ahafo region to 19.0% in the Gushiegu district in Northern region. Economic factors were observed as important spatially-varying associated factors. The findings suggest that targeted interventions are required in the effort to eradicate the practice in Ghana. [ABSTRACT FROM AUTHOR]

We analyse and compare NBA and Euroleague basketball through box-score statistics in the period from 2000 to 2017. Overall, the quantitative differences between the NBA and Euroleague have decreased and are still decreasing. Differences are even smaller after we adjust for game length and when playoff NBA basketball is considered instead of regular season basketball. The differences in factors that contribute to success are also very small—(Oliver’s) four factors derived from box-score statistics explain most of the variability in team success even if the coefficients are determined for both competitions simultaneously instead of each competition separately. The largest difference is game pace—in the NBA there are more possessions per game. The number of blocks, the defensive rebounding rate and the number of free throws per foul committed are also higher in the NBA, while the number of fouls committed is lower. Most of the differences that persist can be reasonably explained by the contrasts between the better athleticism of NBA players and more emphasis on tactical aspects of basketball in the Euroleague. [ABSTRACT FROM AUTHOR]

Background: Previous studies have documented that disordered eating is associated with a wide range of impaired physical and mental health conditions among children and adolescents. The relationship between disordered eating and health-related quality of life (HRQOL) has been predominantly examined in children and adolescents who are overweight or obese or suffer from chronic illnesses. In the last decade, several studies have been conducted to investigate the relationship between disordered eating and HRQOL among school and community children and adolescents. No systematic review or meta-analysis has synthesized the findings from these population-based studies. The purpose of this systematic review and meta-analysis was to synthesize the relationship between disordered eating and HRQOL among the general population of children and adolescents. Methods: We performed a computer search for the English language literature using the databases PUBMED, EMBASE and PSYCINFO to retrieve eligible studies published between 1946 and August 9, 2018. We also searched the relevant articles using PubMed related article search features and manually examined the reference lists of the retrieved full text articles selected from the database search. The association between disordered eating and HRQOL was synthesized using both a qualitative method and a meta-analysis. The review was conducted adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: We identified eight studies that met the inclusion criteria and were included in the final synthesis. The studies included six cross-sectional studies and two longitudinal studies. The systematic review found that disordered eating attitudes and behaviors were associated with lower HRQOL among children and adolescents. Children and adolescents with bulimia nervosa (BN), binge eating disorder (BED), purging disorder (PD) and other eating disorder symptoms had poorer HRQOL than their healthy peers without the eating disorder conditions. The meta-analysis using four out of the eight studies showed that disordered eating was significantly associated with poor psychosocial health and lower overall HRQOL among children and adolescents. Conclusion: The present review reveals that disordered eating behaviors and eating disorders are associated with decreased HRQOL in children and adolescents. More prospective studies are needed to ascertain the directions in the relationship between disordered eating and HRQOL among children and adolescents. The findings of this review suggest that health programs for promoting healthy eating and reducing disordered eating behaviors among school children and adolescents may help to enhance the HRQOL and overall health status of these individuals. [ABSTRACT FROM AUTHOR]

In order to support decision making on how to most effectively improve broiler welfare an innovative expert survey was conducted based on principles derived from semantic modelling. Twenty-seven experts, mainly broiler welfare scientists (n = 20; and 7 veterinarians), responded (response rate 38%) by giving welfare scores (GWS, scale 0–10) to 14 benchmarking housing systems (HSs), and explaining these overall scores by selecting, weighing and scoring main welfare parameters, including both input and output measures. Data exploration followed by REML (Linear Mixed Model) and ALM (Automatic Linear Modelling) analyses revealed 6 clusters of HSs, sorted from high to low welfare, i.e. mean GWS (with superscripts indicating significant differences): 1. (semi-natural backyard) Flock (8.8a); 2. Nature (7.7ab), Label Rouge II (7.4ab), Free range EU (7.2ab), Better Life (7.2ab); 3. Organic EU (7.0bc), Freedom Food (6.2bc); 4. Organic US (5.8bcd), Concepts NL (5.6abcdef), GAP 2 (4.9bcd); 5. Conventional EU (3.7de), Conventional US (2.9ef), Modern cage (2.9abcdef); 6. Battery cage (1.3f). Mean weighting factors (WF, scale 0–10) of frequently (n> = 15) scored parameters were: Lameness (8.8), Health status (8.6), Litter (8.3), Density (8.2), Air quality (8.1), Breed (8.0), Enrichment (7.0) and Outdoor (6.6). These did not differ significantly, and did not have much added value in explaining GWS. Effects of Role (Scientist/Vet), Gender (M/F) and Region (EU/non-EU) did not significantly affect GWS or WF, except that women provided higher WF than men (7.2 vs 6.4, p<0.001). The contribution of welfare components to overall welfare has been quantified in two ways: a) using the beta-coefficients of statistical regression (ALM) analyses, and b) using a semantic-modelling type (weighted average) calculation of overall scores (CalcWS) from parameter level scores (PLS) and WF. GWS and CalcWS were highly correlated (R = ~0.85). CalcWS identified Lameness, Health status, Density, Breed, Air quality and Litter as main parameters contributing to welfare. ALM showed that the main parameters which significantly explained the variance in GWS based on all PLS, were the output parameter Health status (with a beta-coefficient of 0.38), and the input parameters (stocking) Density (0.42), Litter (0.14) and Enrichment (0.27). The beta-coefficients indicated how much GWS would improve from 1 unit improvement in PLS for each parameter, thus the potential impact on GWS ranged from 1.4 welfare points for Litter to 4.2 points for Density. When all parameters were included, 81% of the variance in GWS was explained (77% for inputs alone; 39% for outputs alone). From this, it appears that experts use both input and output parameters to explain overall welfare, and that both are important. The major conventional systems and modern cages for broilers received low welfare scores (2.9–3.7), well below scores that may be considered acceptable (5.5). Also, several alternatives like GAP 2 (4.9), Concepts NL (5.6), Organic US (5.8) and Freedom Food (6.2) are unacceptable, or at risk of being unacceptable due to individual variation between experts and farms. Thus, this expert survey provides a preliminary semi-quantified decision-support tool to help determine how to most effectively improve broiler welfare in a wide range of HSs. [ABSTRACT FROM AUTHOR]

Human neonates spontaneously associate changes in magnitude across the dimensions of number, length, and duration. Do these particular associations generalize to other pairs of magnitudes in the same way at birth, or do they reflect an early predisposition to expect specific relations between spatial, temporal, and numerical representations? To begin to answer this question, we investigated how strongly newborns associated auditory sequences changing in number/duration with visual objects changing in levels of brightness. We tested forty-eight newborn infants in one of three, bimodal stimulus conditions in which auditory numbers/durations increased or decreased from a familiarization trial to the two test trials. Auditory numbers/durations were paired with visual objects in familiarization that remained the same on one test trial but changed in luminance/contrast or shape on the other. On average, results indicated that newborns looked longer when changes in brightness accompanied the number/duration change as compared to no change, a preference that was most consistent when the brightness change was congruent with the number/duration change. For incongruent changes, this preference depended on trial order. Critically, infants showed no preference for a shape change over no shape change, indicating that infants likely treated brightness differently than a generic feature. Though this performance pattern is somewhat similar to previously documented associations, these findings suggest that cross-magnitude associations among number, length, and duration may be more specialized at birth, rather than emerge gradually from postnatal experience or maturation. [ABSTRACT FROM AUTHOR]

Background: Multi-substance use is accompanied by increased morbidity and mortality and responsible for a large number of emergency department (ED) consultations. To improve the treatment for this vulnerable group of patients, it is important to quantify and break down in detail the ED resources used during the ED treatment of multi-substance users. Methods: This retrospective single centre case-control study included all ED consultations of multi-substance users over a three-year study period at a university hospital in Switzerland. Resource consumption of these patients was compared to an age-matched control group of non-multi-substance users. Results: The analysis includes 867 ED consultations of multi-substance users compared to 4,335 age-matched controls (5:1). Multi-substance users needed more total resources (median tax points [medical currency] (IQR): 762 (459–1226) vs. 462 (196–833), p<0.001), especially physician, radiology, and laboratory resources. This difference persisted in multivariable analysis (geometric mean ratio (GMR) 1.2, 95% CI: 1.1–1.3, p = 0.001) adjusted for sociodemographic parameters, consultation characteristics, and patient comorbidity; the GMR was highest in ED laboratory and radiology resource consumption. Among multi-substance user, indirect and non-drug-related consultations had higher ED resource consumption compared to drug-related consultations. Furthermore, leading discipline as well as urgency were predictors of ED resource consumption. Moreover, multi-substance users had more revisits (55.2% vs. 24.9%, p<0.001) as well as longer ED and in-hospital stays (both: GMR 1.2, 95% CI: 1.1–1.3, p<0.001). Conclusion: ED consultations of multi-substance users are expensive and resource intensive. Multi-substance users visited the ED more often and stayed longer at the ED and in-hospital. The findings of our study underline the importance of this patient group. Additional efforts should be made to improve their ED care. Special interventions should target this patient group in order to decrease the high frequency and costs of emergency consultations caused by multi-substance users. [ABSTRACT FROM AUTHOR]

Few studies have examined the sustainability of family planning program outcomes in the post-program period. This article presents the results of a natural experiment where the Nigerian Urban Reproductive Health Initiative Phase I programming ended in early 2015 and Phase II activities continued in a subset of cities. Using data collected in 2015 and 2017, we compare contraceptive ideation and modern family planning use in two cities: Ilorin where program activities concluded in 2015 and Kaduna where program activities continued. The results demonstrate that exposure to program activities decreased in Ilorin but for those individuals reporting continuing exposure, the effect size of exposure on modern family planning use remained the same and was not significantly different from Kaduna. Modern family planning use continued to increase in both cites but at a lower rate than during Phase I. The results are useful for designing family planning programs that sustain beyond the life of the program. [ABSTRACT FROM AUTHOR]

This study examines the relationship between female representation in different organisational positions and performance using a sample of Spanish secondary schools. These organizations have been usually depicted as ‘feminised environments’ although women in managerial positions are still underrepresented. Based on different theoretical approaches, we separately investigate the relationship between a greater female presence and school performance in three positions: a) as principal; b) on the management team; and c) as teachers. We also investigate if having a female leader exerts a significant mediator role on the relationship between greater female representation on the management team and teachers, respectively, and school performance. Our results reveal a positive and significant relationship between having a woman principal or a greater proportion of women teachers and school performance. However, the relationship between a high proportion of women on the management team and school performance is negative. We also find that a female principal does not play a significant role as mediator in the relationship between having a greater proportion of women on the management team and as teachers and school performance. [ABSTRACT FROM AUTHOR]

The Best Possible Self (BPS) exercise promotes a positive view of oneself in the best possible future, after working hard towards it. Since the first work that attempted to examine the benefits of this intervention in 2001, studies on the BPS have grown exponentially and, currently, this is one of the most widely used Positive Psychology Interventions. However, little is yet known about its overall effectiveness in increasing wellbeing outcomes. Thus, the aim of this meta-analysis is to shed light on this question. A systematic literature search was conducted, and 29 studies (in 26 articles) met the inclusion criteria of empirically testing the intervention and comparing it to a control condition. In addition, BPS was compared to gratitude interventions in some of the included studies. A total of 2,909 participants were involved in the analyses. The outcome measures were wellbeing, optimism, depressive symptoms, and positive and negative affect. Results showed that the BPS is an effective intervention to improve wellbeing (d+ = .325), optimism (d+ = .334) and positive affect (d+ = .511) comparing to controls. Small effect sizes were obtained for negative affect and depressive symptoms. Moderator analyses did not show statistically significant results for wellbeing, except for a trend towards significance in the age of the participants (years) and the magnitude of the intervention (total minutes of practice). In addition, the BPS was found to be more beneficial for positive and negative affect than gratitude interventions (d+ = .326 and d+ = .485, respectively). These results indicate that the BPS can be considered a valuable Positive Psychology Intervention to improve clients’ wellbeing, and it seems that it might be more effective for older participants and with shorter practices (measured as total minutes of practice). [ABSTRACT FROM AUTHOR]

Previous studies suggest theory of mind (ToM) ability declines with age. However, prior tasks not only required ToM competence but also imposed high executive function (EF) demands, so decline in ToM ability could be caused by deterioration in ToM competence, EF, or both. It was predicted that if the elderly have intact ToM competence but compromised EF, then they should perform similarly to younger adults when using ToM tasks that lower executive demands, such as spontaneous-response tasks. Results showed that on tasks with reduced demands, older adults tracked belief to the same extent as younger adults, despite their declining EF. The findings support a model in which age-related decline in ToM ability is primarily caused by compromised EF, not ToM competence, suggesting that underlying ToM mechanisms are still intact in the elderly. We discuss implications of this work for competence-performance issues in ToM processing and the underlying sources of age-related deterioration of ToM. [ABSTRACT FROM AUTHOR]

Background and aim: Prevalence and motives for nipple shield use are not well studied in preterm infants and recommendations of nipple shield use in preterm infants are inconsistent. The aim of this study was to determine the prevalence of nipple shield use, explore the motives for nipple shield use and elucidate the association with exclusive breastfeeding in preterm infants. Methods: The study was part of a prospective survey of a Danish national cohort of preterm infants based on questionnaires answered by the 1221 mothers of 1488 preterm infants with gestational age of 24–36 weeks. Data on nipple shield use was available for 1407 infants. Results: Nipple shields were used by 54% of the mother-infant dyads for many different motives and was more often related to breastfeeding problems associated with the infant than with the mother. The most common motive for nipple shield use was “infant slipped the nipple” (52%). The lower the gestational age, the more frequently nipple shields were used for motives related to the infant. For those using a nipple shield, only the motive “infant fell asleep at the breast” was associated with a higher risk of not breastfeeding exclusively at discharge (OR 1.90 (95% CI 1.15; 3.13), p = 0.012), and “breast too engorged” with a lower risk of not breastfeeding exclusively (OR 0.32 (0.16; 0.63), p = 0.001), but overall nipple shield use was associated with failure of exclusive breastfeeding. Conclusion: The present study does not give justifiable motives for nipple shield use, except for “breast too engorged”. Nipple shields should not be recommended for infants falling asleep at the breast, instead, staff and mothers should be patient, allowing the dyad time skin-to-skin. The results indicate that the use of a nipple shield does not promote exclusive breastfeeding in preterm infants. [ABSTRACT FROM AUTHOR]

Research in the field of work and organizational psychology more and more highlights the importance of employees’ experience of meaningful work. Adding to this area of research, the present study among teachers examined the relationship between meaningful work and resilience and tested whether this proposed relationship is mediated by teachers’ work engagement and job crafting behaviour. Data for this study was collected among a group of Dutch teachers working in a school for primary education (N = 174). To test the hypothesized relationships, we conducted a bootstrapping analysis. The outcomes revealed that work engagement and job crafting fully mediated the relationship between meaningful work and teacher’s resilience. The insights provided in this study may be useful for the deliberate cultivation of teachers’ resilience and may help them to stay enthusiastic in their meaningful but demanding profession. Theoretical contributions, limitations, suggestions for future research and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) requires multidisciplinary management. We evaluated differences in healthcare resource utilization and costs between Federico II and Vanvitelli MS Centres of Naples (Italy), representative of centralised (i.e., MS Care Unit) and local service-based models of multidisciplinary care, respectively. Methods: We included MS patients continuously seen at the same local healthcare services and MS Centre (Federico II = 187; Vanvitelli = 90) from 2015 to 2017. Healthcare resources for MS treatment and management were collected and costs were calculated. Adherence was estimated as the rate of medication possession ratio (MPR) during 3-years of follow-up. Mixed-effect linear regression models were used to estimate differences in all outcomes between Federico II and Vanvitelli. Results: Patients at Federico II had more consultations within the MS centre (p<0.001), blood tests (p<0.001), and psychological/cognitive evaluations (p = 0.040). Patients at Vanvitelli had more consultations at local services (p<0.001). Adherence was not-significantly lower at Vanvitelli (p = 0.060), compared with Federico II. Costs for MS treatment and management were 10.6% lower at Vanvitelli (12417.08±8448.32EUR) (95%CI = -19.0/-2.7%;p = 0.007), compared with Federico II (15318.57±10919.59EUR). Discussion: Healthcare services were more complete (and expensive) at the Federico II centralised MS Care Unit, compared with the Vanvitelli local service-based organizational model. Future research should evaluate whether better integration between MS Centres and local services can lead to improved MS management and lower costs. [ABSTRACT FROM AUTHOR]

Purpose: Self-regulation is the capacity to regulate attention, emotion, and behaviour to pursue long-term goals. The current study examined the associations between role model presence and self-regulation during early adolescence, controlling for hopefulness, using a large population-based data set from the Tokyo Teen Cohort study. Methods: Adolescents, aged 12 years, identified a role model using a single item on a paper questionnaire: ‘Who is the person you most look up to?’ Level of hopefulness was also assessed using a single question: ‘To what extent do you feel hopeful about the future of your life?’ Trained investigators evaluated self-regulation. Results: Of 2550 adolescents, 2279 (89.4%) identified a role model. After adjusting for level of hopefulness, identifying a role model was associated with higher levels of self-regulation in comparison to indications of no role model. Hopeful future expectations were also associated with higher self-regulation; however, the beta coefficient was smaller than role model presence in the multivariate linear regression analysis. Conclusions: Role model presence was significantly associated with higher self-regulation among early adolescents. Educational environments should focus on support for adolescents with no role models. [ABSTRACT FROM AUTHOR]

Objectives: Patients with mental health disorders often have to endure the burdens of the condition itself and the stigma that follows. Since no study has been conducted in Lebanon on this topic, our objective was to assess the knowledge, attitude and behaviors towards public stigma of mental health diseases, among a sample of the Lebanese population. Methods: A cross-sectional study, conducted between November 2017 and May 2018, enrolled 2289 participants. The Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward Mental Illness (CAMI) and the Reported and Intended Behavior Scale (RIBS) were used to assess knowledge, attitude and behaviors toward mental illness respectively. The 25th, 50th and 75th percentile of the MAKS, CAMI and RIBS scales scores were considered as cutoff points for low, medium and high scores respectively. Results: A high knowledge score was found in 33.0% of the participants, whereas a high attitude score and a higher behavior score were found in 32.2% and 26.9% of the participants respectively. Living in North Lebanon (Beta = 1.331) and being familiar with a non-close person with mental illness (Beta = 0.811) were associated with higher knowledge of mental illness (higher MAKS score), whereas living in Bekaa (Beta = -8.693) and being 70 years old and above (Beta = -5.060) were associated with lower knowledge toward mental illness (lower MAKS score). Higher knowledge of mental illness (higher MAKS score) (Beta = 0.670), having a high level of education (university (Beta = 8.785), secondary (Beta = 6.084) and technical (Beta = 5.677)) were associated with less stigmatizing attitudes (higher CAMI scale). Being familiar with close people with mental illness (Beta = 0.577), less stigmatizing attitudes (higher CAMI scale) (Beta = 0.077) and higher knowledge of mental illness (higher MAKS score) (Beta = 0.115) were associated with higher favorable behaviors (higher RIBS score), whereas knowing a non-close person who have a mental illness (Beta = -0.720) was associated with lower favorable behaviors (lower RIBS score). Conclusion: A mass media awareness campaigns that could transmit health messages to a wide public audience in the country to fight stigma toward mental illness, seems warranted. [ABSTRACT FROM AUTHOR]

Background: Speaking up behavior is a manifestation the culture of safety in an organization; however, withholding voice is commonly observed. Within one academic teaching hospital, it was the aim to assess students’ speaking up behaviors and perceived culture in order to stimulation of the academic development in terms of patient safety. Methods: Survey amongst medical students using a validated questionnaire. Data were analysed using descriptive statistics. Results: 326 individuals completed the questionnaire (response rate 24%). 37% of responders were in their 5th- 6th clinical term, 32% were in their 7th-8th term and 31% were in the 9th-12th term. 69% of students had a specific safety concern in the past four weeks, 48% had observed an error and 68% noticed the violation of a patient safety rule. Though students perceived specific patient safety concerns, 56% did not speak up in a critical situation. All predefined barriers seemed to play an important role in inhibiting students’ voicing concerns. The scores on the psychological safety scale were overall moderately favourable. Students felt little encouraged by colleagues and, in particular, by supervisors to speak up. Conclusion: Speaking up behaviour of students was assessed for the first time in an Austrian academic teaching hospital. The higher the term the more frequent students reported perceived patient safety concerns or rule violations and withholding voice. These results suggest the need to adapt the curriculum concept of the faculty in order to address patient safety as a relevant topic. [ABSTRACT FROM AUTHOR]

Objectives: To examine the morbidities associated with workplace injury and to explore how clinical variables modify the risk of injury recurrence. Methods: A case-control study was designed using Florida’s statewide inpatient, outpatient, and emergency visits data obtained from the Healthcare Cost and Utilization Project. We included adults who were admitted for a workplace injury (WPI) or injury at other places (IOP), and a matched population of random controls without WPI/IOP. The associations between WPI and clinical morbidities were assessed by univariate and multivariable regression, ranking predictors by information gain, area under the receiver operating characteristic (AUROC), and odds ratios. We analyzed WPI recurrence using survival methods (Kaplan-Meier, Cox regression, survival decision trees) and developed prediction models via regularized logistic regression, random forest, and AdTree. Performance was assessed by 10-fold cross-validation comparing AUROC, sensitivity, specificity, and Harrell’s c-index. Results: A total of 80,712 WPI, 161,424 IOP, and 161,424 control patients were included; 485 distinct clinical diagnostic and 160 procedure codes were analyzed after filtering. Acute bronchitis and bronchiolitis, sprains and strains of shoulder and upper arm, ankle and foot, or other and unspecified parts of back, accidents caused by cutting and piercing instruments or objects, and overexertion and strenuous movements were identified as important consequences of WPI. The prediction models of injury recurrence identified several key factors, such as insurance type and prior injury events, although none of the models exhibited high predictive performance (best AUROC = 0.60, best c-index = 0.62). Conclusions: WPI is associated to diverse serious physical comorbidity burden. There are demographic, social and clinical comorbidity components associated to the risk of WPI recurrence, although their predictive value is moderate, which warrants future investigation in other information source domains, e.g. deepening into the environmental and societal sphere. [ABSTRACT FROM AUTHOR]

Background: While drink driving continues to be significantly more common among male drivers, there is evidence from many countries that shows a growing trend of women engaging in this risky behaviour. The aims of the current study were threefold: (i) determine to what extent a sample of women drivers reported engaging in drink driving behaviour by expanding the construct into a range of definitions, (ii) determine if there were significant differences in self-reported engagement in drink driving behaviours in accordance with hazardous drinking behaviour, and (iii) identify which situational or personal factors would increase women drivers’ likelihood to engage in drink driving through presenting a range of scenarios. Method: Data were collected using an on-line, purpose-designed survey and promoted to reach women aged 17 years and older, living in Queensland, Australia. In addition to questions relating to demographic characteristics, participants completed items relating to engagement in seven drink driving related behaviours in the previous 12-month period, hazardous drinking as measured by the Alcohol Use Disorders Identification Test, and likelihood of driving when unsure if over the legal limit for licence type across a range of scenarios manipulating different situational factors. A total of 644 valid responses were received in the two-week period the study was advertised. Results: The results demonstrate women’s self-reported engagement in drink driving behaviour ranged from 12.6% (driving when they believed they were over the legal limit) to over 50.0% (driving when unsure if over the legal limit the morning after drinking alcohol) and was significantly more likely among those who reported hazardous levels of alcohol use. Circumstances in which women reported they would drive when unsure if over the legal BAC limit were when they were a few blocks from home, if they subjectively felt they were not too intoxicated, or if they needed their car to get somewhere the next morning. Conclusion: Examining drink driving behaviour by way of responses to nuanced definitions provided valuable insight into self-reported engagement in the behaviour and highlights the usefulness of multi-measure dependent variables in order to illuminate a more accurate acknowledgement into both the type (and extent) of drink driving behaviours. [ABSTRACT FROM AUTHOR]

This scoping review presents an overview of cognitive and social congruence in peer assisted learning (PAL), as the positive effects of PAL have been shown to rely on these critical factors. The scoping review followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Databases were systematically searched for articles that focus on PAL and cognitive and social congruence. Participants of the studies included were medical, health science, polytechnic, law and paramedic students. Studies that assessed cognitive and social congruence by questionnaires with a 5-point Likert scale were regarded for meta-analytic pooling. Sixteen of 786 identified articles were included in the review, whereof 9 studies were considered for meta-analytic pooling. The meta-analytic pooling showed that tutees tend to see their student tutors as cognitively (Mweighted = 3.84; range of Mweighted = 2.69–4.56) and socially congruent (Mweighted = 3.95; range of Mweighted = 2.33–4.57). Further, characteristics of student tutors are summarized. This scoping review presents an overview and operationalization of cognitive and social congruence in PAL. Based on the presented meta-analytic pooling, cognitive and social congruence were found to represent relevant key factors in the PAL context. Thus, this theoretical background should be acknowledged as a core concept for tutorials within the medical curriculum. [ABSTRACT FROM AUTHOR]

Objective: Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population. Method: Secondary data analysis performed using cross-sectional data from the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued. Results: Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87). Conclusions: The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population. [ABSTRACT FROM AUTHOR]

Purpose: The Edinburgh Postnatal Depression Scale (EPDS) aims at detecting postpartum depression. It has been hypothesized that a subscale (items 3, 4, 5) may detect anxiety. The aim of this study is to assess whether this EPDS anxiety subscale is present in a community-based dataset, and if so, to assess its validity and stability during the first six months postpartum. Methods: We obtained EPDS data of a community sample of 1612 women at 1 month, with follow-up at 3 and 6 months, postpartum (Post-Up study). We performed an exploratory factor analysis on the EPDS forcing two- and three-factor solutions. We assessed the correlations of the extracted factor subscales and the total EPDS with the short-form of the STAI (STAI-6). We examined the stability of the identified factors by means of a confirmatory factor analysis (CFA), using the EPDS data collected at 3 and 6 months postpartum. Results: Both the two- and three-factor solutions contained a hypothesized anxiety subscale of items 3,4,5,10, and fitted well with the 3- and 6-months EPDS data, with CFI and TLI values >.99 and RMSEA and SRMR values < .035 and < .45. The subscale’s Pearson correlations with the STAI-6 were moderate: .516, compared to .643 for the total EPDS. Conclusions: The factor structure of the EPDS is stable across the first six months postpartum, and includes the subscale assumed to represent anxiety. However, this subscale as well as the total EPDS correlate only moderately with anxiety criteria. Using the EPDS thus does not imply adequate screening for anxiety. [ABSTRACT FROM AUTHOR]

Personal control relies on the expectation that events are contingent upon one’s own behavior. A common ‘inconsistency compensation approach’ posits that a violation of expectancies in social interaction triggers aversive arousal and compensatory effort. Following this approach, we tested the hypothesis that interventions affecting participants' decisions violate the expected personal control. In a modified version of the established cyberball paradigm, participants were not excluded, but consistently included. However, their decisions regarding the recipient of a ball throw in the virtual game were occasionally overruled (expectancy violation). We hypothesized that this intervention will trigger a P3 response in event-related brain potentials (ERP). Since this component is related to subjective expectancies, its amplitude was assumed to depend on the frequency of interventions (independent factor: loss of control). Further, we manipulated the vertical position of the participants’ avatar on the computer screen (independent factor: verticality). Building on research showing that verticality is related to the self-assigned power and influences the expected level of control, we hypothesized that the ERP effects of intervention should be more pronounced for participants with avatars in superior position. As predicted, both experimental factors interactively affected the expression of the ERP response: In case of low intervention frequency, P3 amplitudes were significantly pronounced if the participants’ avatar was positioned above as compared to below co-players (high > low self-assigned power). The effect of verticality could be traced back to a lack of adaptation of P3 amplitudes to recurring aversive events. By demonstrating that loss of control triggers ERP effects corresponding to those triggered by social exclusion, this study provides further evidence for a common cognitive mechanism in reactions to aversive events based on an inconsistency in expectancy states. [ABSTRACT FROM AUTHOR]

To balance the supply and demand in China's beef market, beef consumption must be scientifically and effectively forecasted. Beef consumption is affected by many factors and is characterized by gray uncertainty. Therefore, gray theory can be used to forecast the beef consumption, In this paper, the structural defects and unreasonable parameter design of the traditional gray model are analyzed. Then, a new gray model termed, EGM(1,1,r), is built, and the modeling conditions and error checking methods of EGM(1,1,r) are studied. Then, EGM(1,1,r) is used to simulate and forecast China’s beef consumption. The results show that both the simulation and prediction precisions of the new model are better than those of other gray models. Finally, the new model is used to forecast China’s beef consumption for the period from 2019–2025. The findings will serve as an important reference for the Chinese government in formulating policies to ensure the balance between the supply and demand for Chinese beef. [ABSTRACT FROM AUTHOR]

This paper examines whether tobacco expenditure leads to the crowding out or crowding in of different expenditure items in South Africa. We apply genetic matching to expenditure quartiles of the 2010/2011 South African Income and Expenditure Survey. Genetic matching is a more appealing approach for dealing with the endogeneity of tobacco expenditure that often plagues studies using systems of demand equations. Further, genetic matching provides transparent measures of covariate balance giving the analyst objective means of assessing match success. We find that the poorest tobacco consuming households in South Africa consistently allocate smaller budget shares towards food items than non-smoking households. Specifically, we find that dairy, fruits, nuts and oils are displaced in favour of tobacco expenditure in the two poorest quartiles. Unsurprisingly, food items are never displaced for households in the top two quartiles, given these households’ greater access to resources. Like other studies in the literature, we find that tobacco expenditure consistently crowds-in alcohol across all quartiles confirming the strong complementarities between the two. [ABSTRACT FROM AUTHOR]

Background: Patients and clinicians endorse the importance of compassionate healthcare but patients report gaps between its perceived importance and its demonstration. Empathy and compassion have been associated with quality of life and significant health outcomes but these characteristics are not optimally measured or used for performance and organizational improvement. Objective: To address these gaps, we conducted a study with the objective of evaluating the properties of the 12-item Schwartz Center Compassionate Care Scale® using psychometric analysis and cognitive debriefing. Methods: Non-hospitalized patients with multiple chronic conditions were sampled using an on-line platform. Classical test theory and Rasch measurement theory were used to evaluate psychometric properties of the scale. Structured questions elicited cognitive responses regarding clarity of each item. Results: Classical test theory analysis confirmed that the 12-item Schwartz Center Compassionate Care Scale is a unidimensional scale with excellent internal consistency and test-retest reliability. Patients’ ratings of compassionate behaviors using the Schwartz Center Compassionate Care Scale correlated significantly with a related instrument designed to measure empathy, demonstrating convergent validity. Rasch measurement theory showed that reducing the number of response options on 3 items in the scale would improve respondents’ discrimination between responses on these items. Although person-item threshold distribution analysis showed that patients may wish to rate compassionate care at levels both higher and lower than the scale permits, items could be ordered on an interval scale from low to high levels of compassionate care. Conclusions: The current 12-item Schwartz Center Compassionate Care Scale demonstrates excellent psychometric properties by Classical Test Theory and Rasch measurement theory. The 12-item Schwartz Center Compassionate Care Scale adds questions related to understanding and discussing emotional, contextual issues and the needs of the patient and family. Easily completed on-line, it could be used for work-place based assessment and feedback to clinicians and performance or quality improvement. [ABSTRACT FROM AUTHOR]

Objectives: Stigma toward people with mental health problems (MHP) in primary health care (PHC) settings is an important public health challenge. Research on stigma toward MHP is relatively scarce in Chile and Latin America, as are instruments to measure stigma that are validated for use there. The present study aims to validate the Opening Minds Scale for Health Care Professionals (OMS-HC) among staff and providers in public Chilean PHC clinics, and examine differences in stigma by sociodemographic characteristics. Methods: 803 participants from 34 PHC clinics answered a self-administered questionnaire. Confirmatory factor analysis was completed. Average 15-item OMS-HC scores were calculated, and means were compared via t-test or ANOVA to identify group differences. Correlations of OMS-HC scores with other commonly used stigma scores were calculated to evaluate construct validity. Results: The 3-factor OMS-HC structure was confirmed in this population. The average OMS-HC (α = 0.69) score was 34.55 (theoretical range 15–75). Significantly lower (less stigmatizing) mean OMS-HC scores were found in those with additional training and/or personal experience with MHP. Conclusion: The validated, Spanish version of OMS-HC can be of use to further research stigma toward MHP in Chile and Latin America, advancing awareness and inspiring interventions to reduce stigma in the future. [ABSTRACT FROM AUTHOR]

Similarity between targets and distracters is a key factor in generating distractibility, and exerts a large detrimental effect on aging. The present EEG study tested the role of a new stimulus dimension in generating distractibility in visual Working Memory (vWM), namely numerical similarity. In a change detection paradigm a varying number of relevant and irrelevant stimuli were presented simultaneously in opposite hemifields. Behavioral results indicated that young participants outperformed older individuals; however, in both groups numerical similarity per se did not modulate performance. At the electrophysiological level, in young participants the Contralateral Delay Activity (CDA, a proxy for item maintenance in vWM) was modulated by the numerosity of the relevant items regardless of numerical similarity. In older participants, the CDA was modulated by target numerosity only in the same numerical condition, where the total number of (relevant and irrelevant) items increased with increasing target numerosities. No effect was present in the dissimilar numerical condition, where the total number of items did not vary substantially across target numerosity. This pattern was suggestive of an age-related effect of the total number of (relevant and irrelevant) items on vWM. The additional analyses on alpha-band lateralization measures support this interpretation by revealing that older adults lacked selective deployment of attentional and vWM resources towards the relevant hemifield. Overall, the results indicate that, while numerical similarity does not modulate distractibility, there is an age-related redistribution of vWM resources across the two visual fields, ultimately leading to a general decrease in task performance of older adults. [ABSTRACT FROM AUTHOR]

Background: Although trachoma causes more cases of preventable blindness than any other infectious disease, a combination of strategies is reducing its global prevalence. As a district moves toward eliminating trachoma as a public health problem, national programs conduct trachoma impact surveys (TIS) to assess whether to stop preventative interventions and trachoma surveillance surveys (TSS) to determine whether the prevalence of active trachoma has rebounded after interventions have halted. In some contexts, programs also conduct trachomatous trichiasis (TT)-only surveys. A few costing studies of trachoma prevalence surveys exist, but none examine TIS, TSS, or TT-only surveys. Methodology/Principal findings: We assessed the incremental financial cost to the national program of TIS, TSS, and TT-only surveys, which are standardized cluster-sampled prevalence surveys. We conducted a retrospective review of expenditures and grant disbursements for TIS and TSS in 322 evaluation units in 11 countries between 2011 and 2018. We also assessed the costs of three pilot and five standard TT-only surveys in four countries between 2017 and 2018. The median cost of TIS and TSS was $8,298 per evaluation unit [interquartile range (IQR): $6,532–$10,111, 2017 USD]. Based on a linear regression with bootstrapped confidence intervals, after controlling for country, costs per survey did not change significantly over time but did decline by $83 per survey implemented in a single round (95% CI: -$108 –-$63). Of total costs, 80% went to survey fieldwork; of that, 58% went towards per diems and 38% towards travel. TT-only surveys cost a median of $9,707 (IQR: $8,537–$11,635); within a given country, they cost slightly more (106% [IQR: 94%–136%]) than TIS and TSS. Conclusions/Significance: The World Health Organization requires trachoma prevalence estimates for validating the elimination of trachoma as a public health problem. This study will help programs improve their planning as they assemble resources for that effort. [ABSTRACT FROM AUTHOR]

Introduction: Eating breakfast has been proved to positively influence human health. However, evidence for the association between breakfast consumption and depressive symptoms is lacking, especially among young adults. The aim of this study was to determine whether breakfast consumption is associated with depressive symptoms among Chinese university students. Methods: A cross-sectional study involving 10,174 undergraduate students (6,287 males and 3,887 females) was conducted in 2015. Breakfast consumption was assessed using a self-reported questionnaire. Depressive symptoms were assessed using the Zung self-rating depression scale (SDS) score. Three cut-off values of the SDS score (40, 45, and 50) were used to assess the severity of the depressive symptoms. Logistic regression models were used to analyze the association between the frequency of breakfast consumption and depressive symptoms. Results: The mean SDS score was 37.1±8.0 in present study. In crude model, a higher frequency of breakfast consumption was primarily associated with a lower prevalence of depressive symptoms in all three SDS groups (p = 0.001, < 0.001, = 0.009 for SDS cut-off value 40, 45, and 50 points, respectively). These associations remained significant after adjustment for confounding factors. Conclusions: A higher frequency of breakfast consumption was strongly associated with a lower prevalence of depressive symptoms among Chinese university students. These results corroborate the evidence that the habit of eating breakfast may be beneficial to mental health. [ABSTRACT FROM AUTHOR]

Background: Several clinical trials reported that clopidogrel was superior to aspirin in secondary stroke prevention by reducing the risk of major adverse cardiovascular events (MACE). We aimed to compare the efficacy of clopidogrel with aspirin in reducing one-year risk of MACE based on real-world evidence from Taiwan Health Insurance Database. Methods: We identified ischemic stroke patients between 2000 and 2012 who took aspirin or clopidogrel within 7 days of stroke onset for 1-year follow-up. The primary outcome was one-year MACE including recurrent stroke, acute myocardial infarction, and death. Propensity score matching and conditional Cox proportional hazards regression were conducted to control the confounding factors. Results: From 9,089 ischemic stroke patients, we found 654 patients on aspirin and 465 patients on clopidogrel who met the selective inclusion criteria. After propensity score matching, 379 patients were selected from each group. The clopidogrel group had a 1.78-fold MACE risk compared with the aspirin group at one-year follow-up (95% CI = 1.41–2.26, p<0.01). The MACE-free rate in the aspirin group was 15.74% higher than in the clopidogrel group at one-year follow-up. Sub-analysis of the three components of MACE showed that clopidogrel conferred higher risk of recurrent stroke (OR 1.43, 95% CI = 1.06–1.92, p 0.02) and acute myocardial infarction (OR 3.72, 95% CI = 1.04–13.3, p 0.04), but no different risk of death than that of aspirin. Conclusions: Among first-ever ischemic stroke patients, secondary stroke prevention using clopidogrel was associated with higher rates of MACE than aspirin. Aspirin might have better efficacy in secondary stroke prevention and was associated with lower risk of MACE. The real-world evidence raises the need to re-assess the current therapeutic options in secondary stroke prevention applying aspirin vs. clopidogrel. [ABSTRACT FROM AUTHOR]

Recent research has shown Major League Baseball (MLB) players that bat left-handed and throw right-handed, otherwise known as sinister right-handers, are more likely to have a career batting average (BA) of .299 or higher compared to players with other combinations of batting and throwing handedness. Moreover, possibly owing to early exposure to hockey, Canadian-born MLB players have an increased propensity to be sinister right-handers, however, it has yet to be determined whether this provides a relative offensive performance advantage compared to players born in other countries. Using the largest archival dataset of MLB statistics available, the present study examined the independent influence of batting (i.e., left, right, switch) and throwing (i.e., left, right) handedness combinations and country/region of origin (i.e., Canada, USA, Latin America, Asia, Other) on several indices of offensive performance including BA, slugging percentage (SLG), on-base plus slugging (OPS), on-base plus slugging plus (OPS+), home runs (HR), runs batted in (RBI), strikeouts (SO) and wins above replacement (WAR). Mediation models were also computed to examine whether birthplace influences offensive performance through handedness. Examination of all recorded MLB batters revealed that batting left, regardless of throwing handedness, confers an offensive performance advantage. Since the inception of the MLB, the relative proportion of Canadian-born sinister right-handers is at least two times greater than players from other regions, although being Canadian-born does not provide a direct offensive advantage. Rather, results showed evidence of a significant indirect effect in that being Canadian-born increases the odds of being a sinister right-hander and in turn leads to greater performance across each offensive performance statistic. Collectively, findings provide further support for the hockey influence on batting hypothesis and suggest this effect extends to offensive performance. [ABSTRACT FROM AUTHOR]

A growing body of evidence has shown that active learning has a considerable advantage over traditional lecture for student learning in undergraduate STEM classes, but there have been few large-scale studies to identify the specific types of activities that have the greatest impact on learning. We therefore undertook a large-scale, curriculum-wide study to investigate the effects of time spent on a variety of classroom activities on learning gains. We quantified classroom practices and related these to student learning, assessed using diagnostic tests written by over 3700 students, across 31 undergraduate biology classes at a research-intensive university in the Pacific Northwest. The most significant positive predictor of learning gains was the use of group work, supporting the findings of previous studies. Strikingly, we found that the addition of worksheets as an active learning tool for in-class group activities had the strongest impact on diagnostic test scores. This particular low-tech activity promotes student collaboration, develops problem solving skills, and can be used to inform the instructor about what students are struggling with, thus providing opportunities for valuable and timely feedback. Overall, our results indicate that group activities with low barriers to entry, such as worksheets, can result in significant learning gains in undergraduate science. [ABSTRACT FROM AUTHOR]

In this study, we assumed that correct functional movements for weightlifting can be learned with the help of a music-based biofeedback system. We compared musical feedback with verbal feedback from experienced trainers using two independent groups. The focus was on one specific movement called deadlift. Physical parameters under considerations were the spine (i.e. loss of midline stability resulting in flexion) and the forward displacement of the barbell during the repetitions relative to the mid-foot. We recruited 31 recreational weight lifters (21-42 years of age). Results revealed that both feedback types are effective in improving the movements for deadlift. No significant differences were found across the two feedback types, neither in terms of movement, nor in terms of clarity and motivation. The results suggest that the proposed feedback system is a valid tool for technology-aided training and self-training practices. [ABSTRACT FROM AUTHOR]

Background: Risky sexual behaviours are not uncommon among young adults particularly those in the higher levels of education. It is known that higher self-efficacy could contribute to better sexual and reproductive health outcomes including the use of condoms. However, there is limited research on the role of socio-demographic, behavioural and parental factors as predictors of condom-use self-efficacy. As a result, this exploratory study was designed to assess the predictors of self-efficacy for condom use among university students in Nigeria Methods: A cross-sectional survey was conducted with 755 university students in Nigeria from February to April 2018. Self-efficacy for condom use was assessed by combining responses to 11-items measures of condom self-efficacy drawn from the work of Barkley and colleagues. We fitted a structural equation model to identify the pathways through which socio-demographic, behavioural and parental factors predict two constructs of condom-use self-efficacy (self-efficacy for condom purchase and use and partner communication self-efficacy) in the sample. Results: Demographic factors such as age (β = -0.29, p<0.05) and sex (β = 0.42, p<0.05), as well as ratings on religious importance (β = -0.08, p<0.05) were directly associated with self-efficacy for condom purchase and use. These factors showed significantly mediated effects through sexual experience which also had a direct positive relationship (β = 0.73, p<0.05) with self-efficacy for condom purchase and use. The receipt of parental support, on the other hand, was directly associated with higher partner communication efficacy for condom use (β = 0.07, p<0.05). We found no evidence that the level of partner communication efficacy was directly associated with any of the behavioural, demographic or parental factors. Conclusion: The findings of this study affirm that sex, or age or having higher ratings on religious importance alone does not increases self-efficacy but also exposure to sexual activity through which these factors affect self-efficacy for condom purchase and use. These findings also highlight the need to address and strengthen condom use self-efficacy among young adults, particularly the sexually inexperienced, highly religious and young adults with limited support from their parent. [ABSTRACT FROM AUTHOR]

Introduction: School victimization by peers is an important social problem with serious short- and long-term consequences poorly studied at preschool ages, which can lead to school bullying without timely intervention. Longitudinal data was used to determine the prevalence of warning signs of preschool peer victimization and its individual and family risk factors. Methods: Data was obtained from 577 community preschoolers. School victimization was measured using the Strengths and Difficulties Questionnaire (SDQ) administered to parents and teachers of children at ages 4 and 5. Risk factors for the child (demographics, conduct and emotional problems, aggressiveness) and the family (maternal problems during pregnancy and early development, parenting styles, adaptive functioning and parents’ problems) were previously recorded at 3 years old. Results: Combined information from parents and teachers showed that 4.2% of preschoolers presented warning signs of victimization at ages 4 and 5. Low socioeconomic status, poor emotional control, early problems making friends and low level of parenting education in social norms at age 3 predicted later victimization at ages 4 and 5 (AUC = .78). Conclusion: Peer victimization affects a considerable percentage of preschoolers. Early detection may help to reduce the risk of escalation. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorders (ASD) are a set of neurodevelopmental disorders characterised by behavioural, communication and social impairments. The prevalence of sleep disturbances in children with ASD is 40–80%, with significant effects on quality of life for the children and carers. This systematic review aimed to synthesise evidence of the effects of behavioural interventions to improve sleep among children with ASD. Methods: Databases (MEDLINE, PsycINFO, CINAHL, ScienceDirect, Autism Data, CENTRAL, ClinicalTrials.gov and Current Controlled Trials) were searched for published, unpublished and ongoing randomised controlled trials evaluating the effect of non-pharmacological interventions for insomnia in children with autism spectrum conditions. Results: Three studies met the inclusion criteria, one provided actigraphy data, one Children’s Sleep Habits Questionnaire (CSHQ) data, and one both actigraphy and CSHQ data for use in meta-analyses. There were significant differences between the behavioural intervention and comparison groups (actigraphy data) for total sleep time (24.41 minutes, 95% CI 5.71, 43.11, P = 0.01), sleep latency (-18.31 minutes, 95% CI -30.84, -5.77, P = 0.004) and sleep efficiency (5.59%, 95% CI 0.87, 10.31, P = 0.02). There was also a favourable intervention effect evident for the subjective CSHQ data (-4.71, 95% CI -6.70, -2.73, P<0.00001). Risk of bias was low across several key domains (randomisation, allocation concealment and reporting), with some studies being unclear due to poor reporting. Conclusions: There are very few high quality randomised controlled trials in this area. Here we provide initial synthesised quantitative evidence of the effectiveness of behavioural interventions for treating sleep problems in children with ASD. Trial registration: Protocol was registered () on the International Prospective Register of Systematic Reviews (). [ABSTRACT FROM AUTHOR]

Parenting behavior is a key factor in children’s socio-emotional development. However, little is known about similarities and differences in maternal and paternal parenting behavior, as most studies have focused on mothers. The present study investigated similarities and differences in mothers’ and fathers’ parenting behavior during observed free play with their preschool children, in a Danish well-resourced sample. We examined differences in mean scores and associations between mothers’ and fathers’ sensitivity, intrusiveness and limit-setting assessed with the Coding Interactive Behavior instrument. Additionally, we conducted confirmatory factor analysis to test the model-fit between the measurement model and parental data. Exploratory factor analysis was conducted to investigate if maternal and paternal factor structures replicated the three parenting constructs, and to explore if certain parenting behaviors seemed specifically related to either mothering or fathering. Participants included 52 mothers, 41 fathers and their 5-year old children. Similar mean scores were found for mothers and fathers on all parenting constructs. Maternal and paternal parenting behavior were not correlated. Confirmatory factor analysis revealed a poor model-fit. For both mothers and fathers, latent factors related to sensitivity, intrusiveness and limit-setting emerged, which indicated that the Coding Interactive Behavior instrument was suitable for assessment of both maternal and paternal sensitivity, intrusiveness and limit-setting. However, item loadings suggested that the instrument assessed maternal sensitivity more accurately than paternal sensitivity in our sample. Two additional factors were retrieved for fathers, i.e. paternal performance and challenging behavior, and paternal teaching behavior. This finding may suggest that additional parenting constructs need to be developed for researchers to be able to thoroughly investigate similarities and differences in mothers’ and fathers’ parenting behavior. Despite difference in factor structure, we did not identify behaviors solely related to mothering or to fathering. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decades, obesity stigma has become a substantial public health issue as studies have highlighted its negative consequences for mental and physical health. However, comparative studies are scarce. In this cross-national study, we focus on the following research questions: (1) Are there differences in the magnitude of public obesity stigma between Germany and the United States (US), and (2) are there differences in the associations of sociodemographic as well as experience (i.e. former obesity experience) and contact-related (i.e. contact to a person with obesity) factors with public obesity stigma between these two countries? Material and methods: National telephone surveys in Germany and the United States were conducted (total sample = 2,802) by using vignettes for the description of a person with obesity. Fat Phobia Scale, negative reactions, and desire for social distance were assessed as components of public obesity stigma. All three stigma components were examined with multilevel linear regression analyses. Results: Overall, results show that public obesity stigma is significantly more pronounced in the US than in Germany. Relationships between obesity stigma and sociodemographic as well as experience and contact-related factors remain rather inconclusive, though, in general, stronger associations are shown in the US. Conclusions: Contrary to the normalization hypothesis, findings indicate that a comparatively high prevalence of obesity like in the US is associated with a higher level of obesity stigma. [ABSTRACT FROM AUTHOR]

Introduction: Demographic and Health Surveys, widely used for estimation of fertility and reproductive health indicators in developing countries, remain underutilized for the study of pregnancy termination. This is partly due to most surveys not reporting the type of pregnancy termination, whether spontaneous or induced. Reproductive calendar data makes it possible to examine termination patterns according to contraceptive use at the time of pregnancy. Contraceptive failure is expected to increase the likelihood of induced abortion helping in the interpretation of reported termination patterns. Materials and methods: We use individual-level calendar data regarding 623,966 pregnancies to analyze levels and differentials in reported patterns of pregnancy termination by age, union status, and contraceptive use in 107 DHS surveys from 50 countries. From the estimates of the probability of pregnancy termination, we compute derived reproductive health indicators providing an assessment of what is driving the differences by comparison to the few surveys reporting the type of pregnancy termination. Results: From our estimates, 10.9% of pregnancies do not end in live-birth and 63.7% of them are spontaneous terminations. Reported pregnancy termination is higher among women using contraceptives, consistent with expectations. Very low levels of reported PT in some countries, particularly in sub-Saharan Africa, suggests possible underreporting. Differential patterns emerging from cluster analysis and regional rates indicate high rates of pregnancy termination driven by induced abortion in countries from the Former Soviet Union and Asian countries with liberal laws. Most countries with restrictive abortion laws have low levels of reported termination. While the probabilities of pregnancy termination are higher at older ages, termination rates generally peak at younger ages due to higher conception rates. Discussion: This is the first large comparative study of the patterns of reported pregnancy termination in DHS surveys. While we have explored the extent to which differences arise from spontaneous terminations or induced abortion, more research is needed regarding the determinants of reported pregnancy termination. [ABSTRACT FROM AUTHOR]

Background: Active living approaches seek to promote physical activity and reduce sedentary time across different domains, including through active travel. However, there is little information on how movement behaviours in different domains relate to each other. We used compositional data analysis to explore associations between active commuting and patterns of movement behaviour during discretionary time. Methods and findings: We analysed cross-sectional and longitudinal data from the UK Biobank study. At baseline (2006–2010) and follow up (2009–2013) participants reported their mode of travel to work, dichotomised as active (walking, cycling or public transport) or inactive (car). Participants also reported activities performed during discretionary time, categorised as (i) screen time; (ii) walking for pleasure; and (iii) sport and do-it-yourself (DIY) activities, summed to produce a total. We applied compositional data analysis to test for associations between active commuting and the composition and total amount of discretionary time, using linear regression models adjusted for covariates. Adverse events were not investigated in this observational analysis. The survey response rate was 5.5%. In the cross-sectional analysis (n = 182,406; mean age = 52 years; 51% female), active commuters engaged in relatively less screen time than those who used inactive modes (coefficient -0.12, 95% confidence interval [CI] -0.13 to -0.11), equating to approximately 60 minutes less screen time per week. Similarly, in the longitudinal analysis (n = 4,323; mean age = 51 years; 49% female) there were relative reductions in screen time in those who used active modes at both time points compared with those who used inactive modes at both time points (coefficient -0.15, 95% confidence interval [CI] -0.24 to -0.06), equating to a difference between these commute groups of approximately 30 minutes per week at follow up. However, as exposures and outcomes were measured concurrently, reverse causation is possible. Conclusions: Active commuting was associated with a more favourable pattern of movement behaviour during discretionary time. Active commuters accumulated 30–60 minutes less screen time per week than those using inactive modes. Though modest, this could have a cumulative effect on health over time. [ABSTRACT FROM AUTHOR]

In this study, we assessed the factor structure and construct validity of the parent-reported Inventory of Callous-Unemotional Traits (ICU) among school-aged children and adolescents, aged 6 to 15 years, in a community setting in Japan (n = 10,936). We investigated 15 models that have been reported in previous studies and used confirmatory factor analyses to determine a model that might actually be the best-fit among these. We then examined the correlations between the score of ICU and the Strengths and Difficulties Questionnaire (SDQ) in the best fit model and the three-factor bifactor (3FBF) model with the original ICU through cross-sectional and longitudinal analysis to determine the concurrent and predictive validity of the ICU. The results showed that the best-fit model was the two-factor bifactor (2FBF) model with a revised version of the ICU with 12 items, excluding all but one item of unemotional factors. The cross-sectional and longitudinal analysis showed that higher general callous-unemotional factor scores, callousness and uncaring specific factor scores were significantly associated with a higher level of conduct problems and a lower level of prosocial behaviors in the SDQ. These tendencies were shown both in the 2FBF model with the revised version of the ICU and the 3FBF model with the original ICU. We conclude that the 2FBF model was useful for school-aged community samples, as it predicts increases in conduct problems and decreases in prosocial behavior with fewer items than the 3FBF model. [ABSTRACT FROM AUTHOR]

Background: Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses. Methods: Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses’ cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale. Results: The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach’s α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70. Conclusions: The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion. [ABSTRACT FROM AUTHOR]

Background: Older individuals receiving home assistance are at high risk for emergency visits and unplanned hospitalization. Anticipating their health difficulties could prevent these events. This study investigated the effectiveness of an at-home monitoring method using social workers’ observations to predict risk for 7- and 14-day emergency department (ED) visits. Methods: This was a prospective cohort study of persons ≥75 years, living at home and receiving assistance from home care aides (HCA) at 6 French facilities. After each home visit, HCAs reported on participants’ functional status using a smartphone application that recorded 27 functional items about each participant (e.g., ability to stand, move, eat, mood, loneliness). We recorded ED visits. Finally, we used machine learning techniques (i.e., leveraging random forest predictors) to develop a 7- and 14-day predictive algorithm for the risk of ED visit. Results: The study included 301 participants, and the HCA made 9,987 observations. Over the mean 10-month follow-up, 97 participants (32%) had at least one ED visit. Modeling techniques identified 9 contributory factors from the longitudinal records of the HCA and developed a predictive algorithm for the risk of ED visit. The predictive performance (i.e., the area under the ROC curve) was 0.70 at 7 days and 0.67 at 14 days. Interpretation: For frail elders receiving in-home care, information on functional status collected by HCA helps predict the risk of ED visits 7 to 14 days in advance. A survey system for real-time identification of risks could be developed using this exploratory work. [ABSTRACT FROM AUTHOR]

Picture fuzzy sets (PFSs) are comparatively a new extension of fuzzy sets which describe the human opinions that has more answers like acceptance, rejection, neutral and desist, which cannot be correctly presented in fuzzy sets (FSs) and intuitionistic fuzzy sets (IFSs). The PFSs are categorized by three objects, the degree of belonging, the degree of neutral belonging and the degree of non- belonging such that the total of these three degrees must not be more than one. So far, there is no such work presented in the literature which deals with unknown weights of criteria based on PFSs. In the present work, we have developed a linear programming (LP) model to find the exact weights from the given constraints of weights for the criteria and construct a modified distance based on similarity measure between picture fuzzy sets. Then we have utilized this similarity measure to achieve the best option in the multiple criteria decision making (MCDM) problem. Lastly, two practical examples for the selection of alternatives are presented to compare the obtained results with the existing similarity measures. [ABSTRACT FROM AUTHOR]

Study objective: The aim of the study was to investigate factors that best predict patient’s satisfaction with their ED visit, as well as examine whether patients and their families perceived the factors related to satisfaction similarly. Methods: This is a retrospective study where secondary data analysis was done on patient satisfaction data collected over three quarters for quality improvement purposes. Exploratory factor analysis (EFA) was conducted on the data from the first quarter to identify the factor structure, followed by confirmatory factor analysis (CFA) on the rest of the data to confirm the EFA factor structure. A structural equation model (SEM) was fitted where the factors predicted overall satisfaction with the ED visit. Finally, measurement invariance was conducted to examine if patients and families perceived the factors related to ED services alike. Results: Two factors were found to be predictive of satisfaction: clinical team and system processes. The SEM showed that system process was a statistically significant predictor of overall satisfaction, while clinical team predicted overall satisfaction to a smaller extent. Multi-group CFA showed that the factor structure fitted neither family nor patient groups adequately. The instrument did not exhibit partial invariance. Conclusion: This study found that system process was the best predictor of overall satisfaction. Furthermore, this study showed that the same instrument might not reliably compare the perceptions of patients and families. [ABSTRACT FROM AUTHOR]

Migration is a social phenomenon that has an impact both on the lives of the people who migrate, and on the societies who receive them; with psychological well-being being one of the most affected variables. The objective of this research is to analyze the possible mediating role of rooting in the host location on the negative effect that acculturation stress has on the level of well-being. Data for this study were collected using 699 Colombian and Peruvian immigrants who have been permanently residing in Chile for more than six months. Participants were assessed by using Riff’s Psychological Well-being Scale, rooting of Torrente et al., and Ruiz et al. scales of stress. The results demonstrated the mediating role of settling down within the host country in relation to stress and psychological well-being, except for the sub-dimension of autonomy. It is concluded that the need for rooting in the host country is a protective factor against the negative effects of stress on perceived well-being. [ABSTRACT FROM AUTHOR]

Background: People with disability (PWD) often rely on others, both for direct support and for the creation of enabling environments to meet their needs. This need makes it crucial for professionals to be willing to work with PWD, and for people to pursue careers that focus on supporting PWD. Objectives: To explore self-other overlap as a unique predictor of willingness to work with PWD as part of one’s career, using three studies. Methods: Studies 1 and 2 used cross-sectional surveys of college undergraduates to explore: 1. whether an association between self-other overlap and willingness to work with PWD exists, and 2. whether self-other overlap is a unique predictor, controlling for attitudes and empathy. Study 3 investigated whether self-other overlap is associated with the groups with whom the students indicated they want (and do not want) to work as part of their career. Results: Across the three studies, self-other overlap was uniquely associated with students’ willingness to work with PWD as part of one’s profession, even when controlling for attitudes and empathy. Conclusions: Self-other overlap may be an important additional factor to take into consideration when developing interventions targeted toward promoting working with PWD. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 14 million unintended pregnancies are recorded annually in sub-Saharan Africa (SSA). We sought to investigate the prevalence and determinants of unintended pregnancies among women in sub-Saharan Africa. Materials and methods: The study pooled data from current Demographic and Health Surveys (DHS) conducted from January 1, 2010 to December 31, 2016 from 29 countries in SSA. Logistic regression analysis was used to examine the factors that influence unintended pregnancies in SSA. Results were presented using odds ratios (OR). Results: We found overall unintended pregnancy prevalence rate of 29%, ranging from 10.8% in Nigeria to 54.5% in Namibia. As compared to women aged 15–19 years, women of all other age categories had higher odds of unintended pregnancies. Married women were 6 times more probable to report unintended pregnancy as compared to women who had never married (OR = 6.29, CI = 5.65–7.01). The phenomenon had higher odds among rural residents as compared to urban residents (OR = 1.08, CI = 1.01–1.16). Women with primary (OR = 0.74, CI = 0.69–0.80) and secondary (OR = 0.71, CI = 0.65–0.77) levels of education had less chances of unintended pregnancies, compared to those with no education. Again, women in all other wealth categories had less probability of unintended pregnancy, as compared to women with poorest wealth status. Conclusion: Our study contributes substantially towards the discourse of maternal wellbeing by unveiling the prevalence and determinants of unintended pregnancy across the SSA region. There is the need for SSA countries with high prevalence of unintended pregnancies to consider past and present successful interventions of other countries within the region such as health education, counselling, skills-building, comprehensive sex education and access to contraception. Much of these efforts rest with the governments of SSA countries. [ABSTRACT FROM AUTHOR]