Reading comprehension and working memory: structural equation modeling approach

We examined the relationship among intelligence, working memory, and reading comprehension using structural equation modeling (SEM). Ninety-six participants were instructed to perform two reading comprehension tests and six cognitive tasks: two verbal intelligence subtests, two spatial intelligence subtests, and two reading span tasks. Three latent variables that were called verbal ability, spatial ability, and working memory were derived from the six cognitive tasks. SEM demonstrated that the latent variables of working memory and verbal ability contribute to reading comprehension, suggesting that central executive functioning related to attention control was mediated among these cognitive abilities.     

Executive function in older adults: a structural equation modeling approach

Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to study the organization of executive functions in older adults. The four primary goals were to examine (a) whether executive functions were supported by one versus multiple underlying factors, (b) which underlying skill(s) predicted performance on complex executive function tasks, (c) whether performance on analogous verbal and nonverbal tasks was supported by separable underlying skills, and (d) how patterns of performance generally compared with those of young adults. A sample of 100 older adults completed 10 tasks, each designed to engage one of three control processes: mental set shifting (Shifting), information updating or monitoring (Updating), and inhibition of prepotent responses (Inhibition). CFA identified robust Shifting and Updating factors, but the Inhibition factor failed to emerge, and there was no evidence for verbal and nonverbal factors. SEM showed that Updating was the best predictor of performance on each of the complex tasks the authors assessed (the Tower of Hanoi and the Wisconsin Card Sort). Results are discussed in terms of insight for theories of cognitive aging and executive function.     

Determinants and patient-reported long-term outcomes of physician empathy in oncology: A structural equation modelling approach

ObjectiveThe aim of the present cross-sectional study was to explore patient- and physician-specific determinants of physician empathy (PE) and to analyse the influence of PE on patient-reported long-term outcomes in German cancer patients.MethodsA postal survey was administered to 710 cancer patients, who had been inpatients at the University Hospital Cologne (response rate 49.5%). PE was measured with the German translation of the consultation and relational empathy (CARE) measure, and patient-reported long-term outcomes were assessed using the major (ICD-10) depression inventory (MDI) and the EORTC quality of life (Qol) questionnaire QLQ-C30. Hypotheses were tested by structural equation modelling.ResultsPE had (a) a moderate indirect effect on “depression” and a smaller indirect effect on “socio-emotional-cognitive Qol” by affecting “desire for more information from the physician regarding findings and treatment options” and (b) a moderate indirect effect on “socio-emotional-cognitive Qol” and a smaller effect on “depression” via “desire for more information about health promotion”. The determinant with the greatest importance was “patient-perceived general busyness of hospital staff”: it had a strong negative influence on PE, indirectly influencing “desire for more information from the physician regarding findings and treatment options” and also patients’ “depression”.ConclusionPE seems to be an important pre-requisite for information giving by physicians and through this pathway having a preventive effect on depression and improving Qol. Conversely, physicians’ stress negatively influences these relationships.Practice implicationsThe research findings suggest that reducing physicians’ stress at the organizational and individual may be required to enhance patient–physician communication. Empathy, as an outcome-relevant professional competence needs to be assessed and developed more intensively in medical students and physicians.     

Australian community pharmacists' practice in complementary medicines: a structural equation modeling approach

Objective

This survey tested a model of factors influencing pharmacists’ practice in relation to complementary medicines (CMs).

Methods

Self-administered questionnaires were used to collect data from 212 community pharmacists in New South Wales. Structural equation modeling with AMOS version 6.0, was used to model two practices in relation to CMs: an evaluation of appropriateness of CM use and the decision to sell.

Results

Pharmacists’ perceptions of their responsibilities in ensuring the safe use of CMs predicted the comprehensiveness of an evaluation for appropriateness of CM use (P = 0.002). When level of comprehensiveness of evaluation increased, pharmacists were less likely to sell CMs in situations where the use of the products was not considered appropriate (P = 0.021). Pharmacists’ confidence in their CM knowledge, attitudes towards CMs, concern about pharmacy income and pharmacists’ characteristics did not significantly affect their practice.

Conclusion

Pharmacists’ acceptance of their counseling responsibility with respect to CMs was the strongest predictor of both comprehensiveness of an evaluation and the decision to sell a CM.

Practice implications

Pharmacists must be encouraged to recognise and accept their responsibility in ensuring the safe and effective use of CMs.     

Relation between body mass index and depression: a structural equation modeling approach

Background  

Obesity and depression are two major diseases which are associated with many other health problems such as hypertension, dyslipidemia, diabetes mellitus, coronary heart disease, stroke, myocardial infarction, heart failure in patients with systolic hypertension, low bone mineral density and increased mortality. Both diseases share common health complications but there are inconsistent findings concerning the relationship between obesity and depression. In this work we used the structural equation modeling (SEM) technique to examine the relation between body mass index (BMI), as a proxy for obesity, and depression using the Canadian Community Health Survey, Cycle 1.2.     

Mobile computing acceptance factors in the healthcare industry: a structural equation model

OBJECTIVE: This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals. METHOD: Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model. RESULTS: The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS self-efficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported. CONCLUSION: This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research.     

Demographic determinants of work deviant behaviors of rural community-based primary school teachers: A structural equation modeling approach

Schools across the globe and especially in Nigeria have witnessed situations in which teachers work outside their work ethics. This situation breeds exhibition of work deviant behaviors among the teachers at different levels of education as evidenced in the literature. However, literature is scarce on the influence of teachers' demographic characteristics on their work deviant behaviors in primary schools. Thus, this study was necessitated to explore the determinants of work deviant behaviors of rural community-based primary school teachers in Enugu State, Nigeria. This study was anchored on the affective events theory propounded by Weiss and Cropanzano. Basing the study on the quantitative research approach, a correlational survey research design was adopted using a sample of 254 rural community-based primary school teachers. Necessary information for the study were collected using researchers' adapted questionnaire on work deviant behaviors with 28 items. The questionnaire items had an internal consistency reliability index of 0.87. Data collected were analyzed using hierarchical multiple regression analysis and the structural equation modeling approach. It was revealed that among the demographic characteristics (age, working status, qualification, marital status, gender, years of teaching experience, and location) of the teachers, only age and qualification were found to be significantly (p < 0.05) related to work deviant behaviors. The implication of this study, therefore, is that the age and qualification of rural community-based primary school teachers determine the nature of their work deviant behaviors. Thus, it was recommended that the age and qualification of teachers should be considered very paramount in the employment of teachers.     

A structural equation modeling approach to the concepts of adherence and readiness in antiretroviral treatment

OBJECTIVE: The objective of this secondary analysis of data from a cross-sectional, nation-wide survey, was to test a hypothesized model with two latent concepts (readiness and adherence), based on the theory of trigger events. A secondary objective was to compare this model with two simpler models, without the concept of readiness. METHODS: Data consisted of a consecutive sample of 828 HIV patients > or = 18 years on antiretroviral treatment at 30 out of 32 HIV Clinics in Sweden (response rate 97.5%). Structural equation modeling (SEM) was used to test the models against the empirical data. Chi2 test was used to compare fit between models. RESULTS: The hypothesized model, with two latent concepts (readiness and adherence), fitted the data best (chi(2)=223.508, d.f.=129, p-value<0.0001, GFI=0.970, CFI=0.913, RMSEA=0.030), and significantly better than the models with adherence as the only latent concept. CONCLUSION: Although the SEM technique could not rule out that other models might also fit the data equally well, the hypothesized model, where readiness and adherence were two separate latent concepts, fitted data the best. This supports readiness as a distinct factor that influences adherence and hence treatment outcome. Increased attention should therefore be attached to interventions that focus on the individual' readiness for behavioural change, i.e. factors amendable to change and that can be addressed by the patients themselves. PRACTICE IMPLICATIONS: Based on these results it seems necessary to shift focus from adherence to readiness, especially in conditions where treatment can be postponed such as antiretroviral treatment.     

Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach

Although fatigue is one of the most common and disabling symptoms in patients with multiple sclerosis (MS), its pathogenesis is still poorly understood and it is difficult to treat. The aim of the current study was to test the assumptions of a cognitive-behavioral model that explains fatigue and physical disability in MS patients, by comparing this approach with a more traditional biomedical approach. Structural equation modeling was applied to a sample of 262 MS patients. Neither the cognitive-behavioral, nor the biomedical model showed an adequate fit of our data. The modification indices supported an integration of both models, which showed a better fit than those of the separate models. This final model, is notable for at least three features: (1) fatigue is associated with depression and physical disability, (2) physical disability is associated with disease severity and fatigue-related fear and avoidance behavior, and (3) catastrophic interpretations about fatigue, fueled by depression, mediated the relationship between fatigue and fatigue-related fear and avoidance behavior. Our results suggest that an integrated approach, including the modification of catastrophic thoughts about fatigue, would be beneficial in the treatment of fatigue in MS patients.     

Predictors of youth diabetes care behaviors and metabolic control: a structural equation modeling approach

OBJECTIVE: To empirically test a biopsychosocial model of predictors of youth diabetes care behaviors and metabolic control. METHODS: A cross-sectional multisite study of youths (N = 222) with T1D (mean age = 12.6) used structural equation modeling to examine interrelations among predictors, with follow-up analyses of covariance (ANCOVAs). RESULTS: Youths' memory skills related to diabetes knowledge which, along with self-efficacy and age, was associated with greater youth responsibility that in turn predicted poorer self-care behaviors. Less frequent/briefer exercise and less frequent blood glucose monitoring/eating were found; the latter directly related to poorer metabolic control. Behavior problems also were associated directly with poorer metabolic control. A parsimonious model found memory directly related to blood glucose testing. CONCLUSIONS: Continued parental supervision of adolescents, along with monitoring diabetes knowledge and efficacy, may help optimize transfer of diabetes care from parents to youths. Behavior problems warrant immediate attention because of their direct and adverse relation to metabolic control.     

A framework for power analysis using a structural equation modelling procedure

Background  

This paper demonstrates how structural equation modelling (SEM) can be used as a tool to aid in carrying out power analyses. For many complex multivariate designs that are increasingly being employed, power analyses can be difficult to carry out, because the software available lacks sufficient flexibility.     

Gender differences in the psychosocial and cognitive correlates of physical activity among taiwanese adolescents: A structural equation modeling approach

This study examined gender differences in the factors related to physical activity in 832 Taiwanese adolescents. Differences in psychosocial and cognitive correlates were noted by gender group. Taiwanese adolescent girls reported lower physical activity self-efficacy and less perceived benefits and more perceived barriers to being active than boys. Girls compared to boys reported significantly more positive social support, modeling, and norms from parents to be active but significantly less social support and norms from their peers. Structural equation modeling was used to test the direct and indirect paths of a model of proposed correlates and physical activity. The results indicated that peer influences had both direct and indirect paths to physical activity for both genders. Among all examined variables, perceived self-efficacy was the strongest correlate of physical activity for these adolescents. The findings of this study provide information relevant to designing physical activity interventions targeted to Taiwanese adolescents.     

Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach

OBJECTIVE: The aim of the present cross-sectional study was to explore patient- and physician-specific determinants of physician empathy (PE) and to analyse the influence of PE on patient-reported long-term outcomes in German cancer patients. METHODS: A postal survey was administered to 710 cancer patients, who had been inpatients at the University Hospital Cologne (response rate 49.5%). PE was measured with the German translation of the consultation and relational empathy (CARE) measure, and patient-reported long-term outcomes were assessed using the major (ICD-10) depression inventory (MDI) and the EORTC quality of life (Qol) questionnaire QLQ-C30. Hypotheses were tested by structural equation modelling. RESULTS: PE had (a) a moderate indirect effect on "depression" and a smaller indirect effect on "socio-emotional-cognitive Qol" by affecting "desire for more information from the physician regarding findings and treatment options" and (b) a moderate indirect effect on "socio-emotional-cognitive Qol" and a smaller effect on "depression" via "desire for more information about health promotion". The determinant with the greatest importance was "patient-perceived general busyness of hospital staff": it had a strong negative influence on PE, indirectly influencing "desire for more information from the physician regarding findings and treatment options" and also patients' "depression". CONCLUSION: PE seems to be an important pre-requisite for information giving by physicians and through this pathway having a preventive effect on depression and improving Qol. Conversely, physicians' stress negatively influences these relationships. PRACTICE IMPLICATIONS: The research findings suggest that reducing physicians' stress at the organizational and individual may be required to enhance patient-physician communication. Empathy, as an outcome-relevant professional competence needs to be assessed and developed more intensively in medical students and physicians.     

A non-linear approach to the Kuhn-Mark-Houwink-Sakurada equation

Intrinsic viscosities and molecular weights were evaluated to obtain Kuhn-Mark-Houwink-Sakurada (KMHS) relationships for some selected polymers by means of a non-linear regression analysis. The proposed method yields unbiased values of the KMHS parameters a and K, improves the fitting and shows that KMHS relationship must be considered as a simple correlation with two interdependent parameters, a and K.     

Risk factors for adenomyosis

In order to analyse risk factors for adenomyosis, 707 consecutive women who underwent hysterectomy between January 1993 and June 1994 at the Clinica Luigi Mangiagalli, Milan, Italy, were interviewed before surgery by trained physicians. Information on the presence of adenomyosis was obtained from pathologic records. Out of the 707 women, adenomyosis was identified in 150 subjects (21.2%). Women who smoked tended to be at decreased risk of the condition: in comparison with women who had never smoked, the risk for current smokers was 0.7 (0.3- 1.3) and the risk decreased with number of cigarettes smoked per day, the odds ratios being 0.8 and 0.6 respectively in women reporting fewer than 10 and more than 10 cigarette smoked per day (chi2 trend 3.57, P = 0.06). The frequency of adenomyosis was higher in parous women: in comparison with nulliparae, the odds ratio of the disease were 1.8 [95% confidence interval (CI) 0.9-3.4] and 3.1 (95% CI 1.7-5.5) respectively in women reporting one and two or more births (chi2 trend 20.71, P < 0.01). Likewise, women reporting one or more spontaneous abortions had an odds ratio of 1.7 (95% CI 1.1-2.6) for adenomyosis, in comparison with those reporting no spontaneous abortion.