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DesignThis is a retrospective cohort study. Setting: The study was conducted at the Instituto de Neurociencias de la Junta de Beneficencia de Guayaquil, a primary neuroscience institute in Ecuador.ParticipantsThe study evaluated 425 participants diagnosed with Mild Cognitive Impairment (MCI) or dementia, out of which 272 individuals (mean age = 75 years; 164 female) presenting specific medical conditions were selected for analysis.MeasurementsData were collected on demographics, medical history, and neuropsychological assessment using the Neuropsi scale. Conditions such as Type 2 Diabetes Mellitus, hypertension, obesity, and history of traumatic brain injury were specifically noted.ResultsLatent Class Analysis identified three distinct classes of patients: Unspecified Cognitive Deterioration, Dementia, and MCI. The three-class model provided the best fit, revealing varied morbidity patterns and highlighting the influence of vascular and metabolic conditions on cognitive decline. Notably, similarities in hypertension and diabetes prevalence between Dementia and MCI classes suggested shared risk factors. The study also found no significant age differences between the classes, indicating that age alone might not be the primary determinant in the progression of cognitive decline.ConclusionsThe study underscores the complexity of dementia and MCI in an ageing Ecuadorian population, with vascular health playing a crucial role in cognitive impairment. These findings advocate for a holistic approach in managing dementia and MCI, emphasising the importance of addressing cardiovascular and metabolic health alongside neurocognitive care. The distinct morbidity patterns identified offer insights into tailored intervention strategies, highlighting the need for comprehensive, multidisciplinary care in dementia management.

Background: The COVID-19 pandemic has caused psychological problems among nurses worldwide. However, their willingness to seek professional help is relatively low, due to perceived barriers that have remained unknown. Aims: This study analysed the potential barriers and influencing factors of psychological help-seeking among nurses participating in community COVID-19 epidemic prevention work. Methods: Five variables – depression, anxiety, post-traumatic stress syndrome, social support and mental health literacy – were measured from a sample of 667 nurses. Latent class analysis identified homogeneous classes about psychological help-seeking barriers and multinomial logistic regression identified factors associated with potential grouping outcomes. Results: Three categories were identified: major barriers (N = 17, 2.5%), stigma and accessibility barriers (N = 132, 21.2%) and low barriers (N = 518, 76.4%). Mental health literacy was significantly correlated with the 'low barriers' class (OR = 0.953, B = −0.047, p = 0.03), whereas depression (OR = 1.091, B = 0.085, p = 0.011) had a slightly positive effect on being in the 'stigma and accessibility barriers' class. Conclusions: During pandemics or other social health crises, nurses may experience psychological barriers to help seeking. Communities and hospitals should consider increasing the resources available for psychological counselling services, improving mental health awareness and literacy that may help reduce depression levels and promote mental health. [ABSTRACT FROM AUTHOR]

While interest pursuits are widely recognized as being inherently contextual, what this contextuality entails for different interests has not been explored systematically. In this study, 410 adolescents reported on the temporal, epistemic, material, geographical, social, institutional, and cultural dimensions of 820 interest pursuits. Latent class analyses identified four interest pursuit configurations, revealing quantitative (overall high/low structure) and qualitative (expertise- and social-oriented) differences. We observed similar interests being pursued in the same configuration, but also identified individual differences, reflecting the social–historical meaning and object characteristics of interests, as well as adolescents' preferences and structural opportunities. The findings show that interest entails more than a preference for an object, but also a preference for a wider configuration, which should be considered when designing (educational) contexts to stimulate adolescents' interest. [ABSTRACT FROM AUTHOR]

The concept of resilience encompasses various elements such as spirituality, cultural heritage, adverse life events, and family lineage. Due to this diversity, examining the items measuring resilience, which is one of the concepts evaluated within the scope of positive psychology, differential item function (DIF), is considered important in terms of revealing the structure. As well as determining DIF, there is a need to reveal the reasons for its sources. At this point, the variable intolerance of uncertainty, which is highly related to resilience, is addressed. In this context, the general purpose of this research is to examine whether the resilience scale items show DIF before and after the latent classes have been created within the scope of intolerance of uncertainty. The research, in which the Brief Resilience and Intolerance of Uncertainty scales were used, was conducted with 718 university students. In the first stage of data analyses, likelihood ratio, one of the DIF determination methods, was used. In the second stage, the latent class analysis was carried out to create latent classes within the scope of intolerance of uncertainty. According to the results of this research, all items within the scope of gender for the Brief Resilience scale show a middle level of DIF. Within the scope of Latent Class analysis, it was determined that the fourclass model was compatible with the data. After the groups were formed, DIF was examined in terms of gender for the Brief Resilience scale within each group. DIF was not determined in any of the items in class 1 and class 4. However, in class 3, all items showed moderate DIF. It was determined that the DIF results changed after the created latent classes. All these results show that intolerance of uncertainty may be the source of DIF determined in resilience scale items. Therefore, it is recommended to study the interrelated variables together when studying DIF. [ABSTRACT FROM AUTHOR]

Abstract Background Patterns of utilization of numerous smoking cessation methods among pregnant women amidst the increasing popularity of vaping (use of e-cigarettes) remains unknown. Methods This study included 3,154 mothers who self-reported smoking around the time of conception and delivered live births in 2016–2018 in seven US states. Latent class analysis was used to identify subgroups of smoking women based on their utilization of 10 surveyed quitting methods and vaping during pregnancy. Results We identified four subgroups of smoking mothers with different utilization patterns of quitting methods during pregnancy: 22.0% reported “not trying to quit”; 61.4% tried to “quit on my own” without any behavioral or pharmacological assistance; 3.7% belonged to the “vaping” subgroup; and 12.9% utilized “wide-ranging methods” with higher use rate of multiple approaches, such as quit line and nicotine patch. Compared to mothers “not trying to quit,” the subgroup trying to “quit on my own” were more likely to be abstinent (adjusted OR 4.95, 95% CI 2.82–8.35) or to reduce the number of cigarettes smoked daily (adjusted OR 2.46, 95% CI 1.31–4.60) in late pregnancy, and these improvements lasted into early postpartum. We did not observe a measurable reduction in smoking among the “vaping” subgroup or women trying to quit with “wide-ranging methods”. Conclusions We identified four subgroups of smoking mothers with different utilization patterns of eleven quitting methods during pregnancy. Pre-pregnancy smokers who tried to “quit on my own” were most likely to be abstinent or to reduce smoking amount.

Objectives: This study aimed to identify the behavioural pattern of psychological distress (PD) in the population of 18 to 65 years old people in Mashhad, Iran, using latent class regression and evaluate the related factors. PD is a unique emotional state with suffering in response to a stressor or specific need that leads to temporary or permanent impacts. Due to its negative effects on several features of life like the quality of life, health, performance and productivity of individuals, PD and its consequences are considered a public health priority. Methods: A crosssectional study was performed on 425,286 individuals aged 18 to 65, who were referred to health centres in Mashhad, northeastern Iran in the first half of 2018. The information required for this study, including a checklist of demographic information and the six-item Kessler Psychological Distress Scale (K-6), was obtained from the Sina System. Results: Latent class regression identified three latent patterns of PD in answering the questions of the K-6 questionnaire, including severe PD (14%), low PD distress (40%) and no PD (46%). Statistical variables of this study due to the results are considered as the following: women, illiterate people, unemployed and divorced people, individuals aged between 50 and 59 years and people with low weight were more likely to be in the severe PD class than in the no PD class. Conclusion: Although a small percentage of people were classified as severely disturbed, the findings showed a high rate of symptoms of distress and sadness even in the no PD class. [ABSTRACT FROM AUTHOR]

Background: Patterns of utilization of numerous smoking cessation methods among pregnant women amidst the increasing popularity of vaping (use of e-cigarettes) remains unknown. Methods: This study included 3,154 mothers who self-reported smoking around the time of conception and delivered live births in 2016–2018 in seven US states. Latent class analysis was used to identify subgroups of smoking women based on their utilization of 10 surveyed quitting methods and vaping during pregnancy. Results: We identified four subgroups of smoking mothers with different utilization patterns of quitting methods during pregnancy: 22.0% reported "not trying to quit"; 61.4% tried to "quit on my own" without any behavioral or pharmacological assistance; 3.7% belonged to the "vaping" subgroup; and 12.9% utilized "wide-ranging methods" with higher use rate of multiple approaches, such as quit line and nicotine patch. Compared to mothers "not trying to quit," the subgroup trying to "quit on my own" were more likely to be abstinent (adjusted OR 4.95, 95% CI 2.82–8.35) or to reduce the number of cigarettes smoked daily (adjusted OR 2.46, 95% CI 1.31–4.60) in late pregnancy, and these improvements lasted into early postpartum. We did not observe a measurable reduction in smoking among the "vaping" subgroup or women trying to quit with "wide-ranging methods". Conclusions: We identified four subgroups of smoking mothers with different utilization patterns of eleven quitting methods during pregnancy. Pre-pregnancy smokers who tried to "quit on my own" were most likely to be abstinent or to reduce smoking amount. [ABSTRACT FROM AUTHOR]

People exposed to potentially traumatic events (PTEs) may develop distinct symptom patterns, which may require different therapeutic approaches. We aimed to identify classes of people exposed to PTEs based on the presence of posttraumatic stress disorder (PTSD) clusters, anxiety, and depression and to explore which cognitive factors (rumination, worry, and negative cognitions) are associated with class membership. Latent class analyses were conducted to identify subgroups of 258 PTE-exposed Spanish adults. A three-class solution emerged: a resilient class with low odds of all symptoms (n = 188); a partial PTSD class, characterized by partial PTSD clusters, moderate anxiety, and low depression (n = 36); and a high symptom class, characterized by high PTSD, moderate anxiety, and low depression (n = 34). These classes related meaningfully to rumination, worry, and negative cognitions. Distinct symptom patterns of PTSD clusters, anxiety, and depression can be distinguished in people exposed to PTEs and relate to cognitive risk factors of psychopathology. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to investigate student subgroups' responses to the coercive digitalisation of teaching and learning processes during the pandemic. Respective variance is discussed in terms of digital inequality and is interpreted as a need to individualise teaching and learning and quality assurance practices. Design/methodology/approach: This study uses data from surveys (N = 955) on student perceptions of the introduction of emergency digitalisation – an important aspect of higher education. The authors perform latent class analyses to identify student subgroups. The students were asked to rate digital learning processes and their overall learning experiences. Findings: The identified student subgroups are proponents, pragmatics and sceptics of digitalised teaching and learning processes. These subgroups have different preferences with regard to teaching and learning modes of delivery, which implies the relevance of individualised educational services and respective quality assurance practices to reflections on improvement needs. Research limitations/implications: The data are from a single, typical German university; therefore, the scope of the results may be limited. However, this study enriches future research on the traits of student subgroups and students' coping strategies in an ever-changing learning environment. Practical implications: The findings may help individualise universities' counselling services to enhance overall teaching performance and quality assurance practices in a digitalised environment. Originality/value: The findings provide insights into students' responses to the COVID-19 pandemic and its impact on teaching and learning. This paper enriches the research on student heterogeneity and relates this to development needs of quality assurance practice. [ABSTRACT FROM AUTHOR]

Background: Heart diseases are one of the leading causes of health-related deaths among children. Concurrent hospice care offers hospice and nonhospice healthcare services simultaneously, but the use of these services by children with cardiac disease has been rarely investigated. Objective: The aims of this study were to identify patterns of nonhospice healthcare services used in concurrent hospice care and describe the profile of children with cardiac disease in these clusters. Methods: This study was a retrospective cohort analysis of Medicaid claims data collected between 2011 and 2013 from 1635 pediatric cardiac patients. The analysis included descriptive statistics and latent class analysis. Results: Children in the sample used more than 314 000 nonhospice healthcare services. The most common services were inpatient hospital procedures, durable medical equipment, and home health. Latent class analysis clustered children into "moderate intensity" (60.0%) and "high intensity" classes (40.0%). Children in "moderate intensity" had dysrhythmias (31.7%), comorbidities (85.0%), mental/behavioral health conditions (55%), and technology dependence (71%). They commonly resided in urban areas (60.1%) in the Northeast (44.4%). The health profile of children in the "high intensity" class included dysrhythmias (39.4%), comorbidities (97.6%), mental/behavioral health conditions (71.5%), and technology dependence (85.8%). These children resided in rural communities (50.7%) in the South (53.1%). Conclusions: Two patterns of use of nonhospice healthcare services were identified in this study. This information may be used by nurses and other healthcare professionals working in concurrent hospice care to assess the healthcare service needs of children with cardiac conditions at the end of life. [ABSTRACT FROM AUTHOR]

Abstract Background Review studies increasingly emphasize the importance of the role of parenting in interventions for preventing overweight in children. The aim of this study was to examine typologies regarding how consistently parents apply energy-balance related behavior rules, and the association between these typologies and socio-demographic characteristics, energy balance-related behaviors among school age children, and the prevalence of being overweight. Methods For this cross-sectional study, we had access to a database managed by a Municipal Health Service Department in the Netherlands. In total, 4,865 parents with children 4–12 years of age participated in this survey and completed a standardized questionnaire. Parents classified their consistency of applying rules as “strict”, “indulgent”, or “no rules”. Typologies were identified using latent class analyses. We used regression analyses to examine how the typologies differed with respect to the covariates socio-demographic characteristics, children’s energy balance-related behaviors, and weight status. Results We identified four stable, distinct parental typologies with respect to applying dietary and sedentary behavior rules. Overall, we found that parents who apply “overall strict EBRB rules” had the highest level of education and that their children practiced healthier behaviors compared to the children of parents in the other three classes. In addition, we found that parents who apply “indulgent dietary rules and no sedentary rules” had the lowest level of education and the highest percentage of non-Caucasians; in addition, their children 8–12 years of age had the highest likelihood of being overweight compared to children of parents with “no dietary rules”. Conclusions Parents’ consistency in applying rules regarding dietary and sedentary behaviors was associated with parents’ level of education and ethnic background, as well as with children’s dietary and sedentary behaviors and their likelihood of becoming overweight. Our results may contribute to helping make healthcare professionals aware that children of parents who do not apply sedentary behavior rules are more likely to become overweight, as well as the importance of encouraging parents to apply strict dietary and sedentary behavior rules. These results can serve as a starting point for developing effective strategies to prevent overweight among children.

Two recent articles (Grunow et al. in J Marriage Fam 80(1):42–60, 2018; Knight and Brinton in Am J Sociol 122(5):1485–1532) suggest that gender ideology is multidimensional. Such a finding is of utmost importance because, if robust, it can be used in future comparative (multilevel) research. However, these two articles present different results on which gender ideology profiles are dominant in Europe. Using the European Value Study, we replicate and extend these Latent Class analyses and address the question of generalizability and content- and criterion-related validity. We come to a five-cluster solution that not only synthesizes theoretically and empirically the results of the two articles, but also contributes to the literature by clarifying the place of these five gender ideology types in a multidimensional space. We suggest that in Europe five 'worlds of norms' exist that are mutually influenced by the general institutional context of welfare states. [ABSTRACT FROM AUTHOR]

Design: This is a retrospective cohort study. Setting: The study was conducted at the Instituto de Neurociencias de la Junta de Beneficencia de Guayaquil, a primary neuroscience institute in Ecuador., Participants: The study evaluated 425 participants diagnosed with Mild Cognitive Impairment (MCI) or dementia, out of which 272 individuals (mean age = 75 years; 164 female) presenting specific medical conditions were selected for analysis., Measurements: Data were collected on demographics, medical history, and neuropsychological assessment using the Neuropsi scale. Conditions such as Type 2 Diabetes Mellitus, hypertension, obesity, and history of traumatic brain injury were specifically noted., Results: Latent Class Analysis identified three distinct classes of patients: Unspecified Cognitive Deterioration, Dementia, and MCI. The three-class model provided the best fit, revealing varied morbidity patterns and highlighting the influence of vascular and metabolic conditions on cognitive decline. Notably, similarities in hypertension and diabetes prevalence between Dementia and MCI classes suggested shared risk factors. The study also found no significant age differences between the classes, indicating that age alone might not be the primary determinant in the progression of cognitive decline., Conclusions: The study underscores the complexity of dementia and MCI in an ageing Ecuadorian population, with vascular health playing a crucial role in cognitive impairment. These findings advocate for a holistic approach in managing dementia and MCI, emphasising the importance of addressing cardiovascular and metabolic health alongside neurocognitive care. The distinct morbidity patterns identified offer insights into tailored intervention strategies, highlighting the need for comprehensive, multidisciplinary care in dementia management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Valdevila Figueira, Valdevila Santiesteban, Carvajal Parra, Benenaula Vargas, Ramírez, Leon-Rojas and Rodas.)

The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play. • Identifies four latent classes of needs based on substance use among Black women • High comorbidity latent class predicted use of mutual support groups, but not SUD treatment • Religious well-being was a predictor of mutual support group use • Non-CLS-involved women were less likely to use mutual support groups & SUD treatment [ABSTRACT FROM AUTHOR]

Background: Review studies increasingly emphasize the importance of the role of parenting in interventions for preventing overweight in children. The aim of this study was to examine typologies regarding how consistently parents apply energy-balance related behavior rules, and the association between these typologies and socio-demographic characteristics, energy balance-related behaviors among school age children, and the prevalence of being overweight.Methods: For this cross-sectional study, we had access to a database managed by a Municipal Health Service Department in the Netherlands. In total, 4,865 parents with children 4-12 years of age participated in this survey and completed a standardized questionnaire. Parents classified their consistency of applying rules as "strict", "indulgent", or "no rules". Typologies were identified using latent class analyses. We used regression analyses to examine how the typologies differed with respect to the covariates socio-demographic characteristics, children's energy balance-related behaviors, and weight status.Results: We identified four stable, distinct parental typologies with respect to applying dietary and sedentary behavior rules. Overall, we found that parents who apply "overall strict EBRB rules" had the highest level of education and that their children practiced healthier behaviors compared to the children of parents in the other three classes. In addition, we found that parents who apply "indulgent dietary rules and no sedentary rules" had the lowest level of education and the highest percentage of non-Caucasians; in addition, their children 8-12 years of age had the highest likelihood of being overweight compared to children of parents with "no dietary rules".Conclusions: Parents' consistency in applying rules regarding dietary and sedentary behaviors was associated with parents' level of education and ethnic background, as well as with children's dietary and sedentary behaviors and their likelihood of becoming overweight. Our results may contribute to helping make healthcare professionals aware that children of parents who do not apply sedentary behavior rules are more likely to become overweight, as well as the importance of encouraging parents to apply strict dietary and sedentary behavior rules. These results can serve as a starting point for developing effective strategies to prevent overweight among children. [ABSTRACT FROM AUTHOR]

To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation. People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3). Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity. Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity. Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation. In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation. A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue. [ABSTRACT FROM AUTHOR]

Abstract Objective Bullying victimization among adolescents has been well-recognized as a behavior associated with adverse psychological and mental health outcomes. Most studies on bullying victimization have focused on adolescents, but research is sparse regarding school victimization among preadolescents before they transition to adolescence. This study sought to identify latent classes of different types of co-occurring bullying victimization, based on a sample of 3829 school students in grades 5–8, ages 9–14 in the year of 2011 from the Saskatoon Health Region, Saskatchewan, Canada. Results Using a latent class analysis approach, the results uncovered three groups of victimized students, including those who were aggressively victimized (7.2%), moderately victimized (34.6%) and non-victimized (58.2%). Younger age and being overweight was associated with a higher likelihood of bullying victimization. Moderately and aggressively victimized students had greater probabilities of feeling like an outsider, experiencing anxiety, depressed moods, engaging in suicidal ideation and drinking when compared to non-victimized students. Peer and parent supports had significant protective effects against being victimized. Given the negative consequences of recurrent victimization among the preadolescents, it is imperative to address bullying incidents as they occur to prevent repeated transgressions, especially for those who suffer from multiple types of victimization.

This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes. This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity). Physical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities. Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation. Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes. The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice. [ABSTRACT FROM AUTHOR]

One of the greatest challenges in the application of finite mixture models is model comparison. A variety of statistical fit indices exist, including information criteria, approximate likelihood ratio tests, and resampling techniques; however, none of these indices describe the amount of improvement in model fit when a latent class is added to the model. We review these model fit statistics and propose a novel approach, the likelihood increment percentage per parameter (LIPpp), targeting the relative improvement in model fit when a class is added to the model. Simulation work based on two previous simulation studies highlighted the potential for the LIPpp to identify the correct number of classes, and provide context for the magnitude of improvement in model fit. We conclude with recommendations and future research directions.

Introduction: Few studies have assessed patterns of substance use among Canadian adolescents. This cross-sectional study examined substance use classes among Canadian secondary school students and associations with anxiety and depression. Methods: This study used data from Year 6 (2017/18) of the COMPASS study. Students (n = 51 767) reported their substance use (alcohol, cannabis, cigarette and e-cigarette use) and anxiety and depression symptoms. We employed latent class analysis to identify substance use classes and multinomial logistic regression to examine how anxiety and depression were associated with class membership. Results: Overall, 40% of students indicated having anxiety and/or depression (50% in females; 29% in males) and 60% of students reported substance use (60% in females; 61% in males). We identified three substance use classes: poly-use, dual use, and nonuse. Females with both anxiety and depression had the highest odds of being in the poly-use class compared to the non-use class (odds ratio [OR] = 4.09; 95% confidence interval [CI]: 3.59-4.65) followed by females with depression only (OR = 2.65; 95% CI: 2.31-3.04) and males with both anxiety and depression (OR = 2.48; 95% CI: 2.19-2.80). Symptomatology was also associated with belonging to the dual use class except among males with anxiety only (OR = 1.13; 95% CI: 0.94-1.37). Conclusion: Canadian secondary school students are engaging in dual and poly-substance use, and anxiety and depression were associated with such use. Females had a higher prevalence of anxiety and depression and should be a priority population for mental health programming. [ABSTRACT FROM AUTHOR]

Migraine is heritable and formally diagnosed by structured criteria that require presence of some but not all possible migraine symptoms which include aura, several distinct manifestations of pain, nausea/vomiting, and sensitivity to light or sound. The most recent genome-wide genetic association study (GWAS) for migraine identified 38 loci. We investigated whether 46 single-nucleotide polymorphisms (SNPs), i.e., genetic variants, at these loci may have especially pronounced, i.e., selective, association with migraine presenting with individual symptoms compared to absence of migraine. Selective genetic associations of SNPs were evaluated through a likelihood framework in the Women's Genome Health Study (WGHS), a population-based cohort of middle-aged women including 3,003 experiencing migraine and 18,108 not experiencing migraine, all with genetic information. SNPs at 12 loci displayed significant selective association for migraine subclassified by specific symptoms, among which six selective associations are novel. Symptoms showing selective association include aura, nausea/vomiting, photophobia, and phonophobia. The selective associations were consistent whether the women met all formal criteria for diagnostic for migraine or lacked one of the diagnostic criteria, formally termed probable migraine. Subsequently, we performed latent class analysis of migraine diagnostic symptoms among 69,861 women experiencing migraine from the WGHS recruitment sample to assess whether there were clusters of specific symptoms that might also have a genetic basis. However, no globally robust latent migraine substructures of diagnostic symptoms were observed nor were there selective genetic associations with specific combinations of symptoms revealed among weakly supported latent classes. The findings extend previously reported selective genetic associations with migraine diagnostic symptoms while supporting models for shared genetic susceptibility across all qualifying migraine at many loci.

Introduction: Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person–centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable–centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes.Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes.Results: A four–class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76–85 years–old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White.Conclusion: The use of a person–centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.

Abstract Aims: to identify and describe the clustering of characteristics related to running amongst Brazilian runners using latent class analysis and to verify if there is a profile associated with better performance. Material and Methods: a sample of 1149 Brazilian runners answered an online questionnaire, that provided information about biological (sex, age, height, weight), training (running pace, frequency and volume/week, motivation), and socioeconomic factors, as well as a multidimensional questionnaire of fear of failure. Latent Class Analysis was used to identify subgroups of Brazilian runners, based on BMI, training volume and frequency/week, motivation, socioeconomic factors, and the fear of failure. Further, a χ2 test was computed to verify statistical differences in the frequency of the descriptive variables between classes. Finally, binary logistic regression analysis estimated factors associated with running performance, with running pace as the dependent variable. Results: It was possible to identify two different classes among Brazilian runners, which were called “amateur runners” and “recreational runners”. Variables that highlighted classes’ differences were: volume and frequency training/week, motivation for the practice, and BMI. Regarding the running performance, logistic regression analysis showed that men (OR=5.39; 95%CI=4.00-7.25), young runners (OR=0.38; 95%CI=0.28-0.51), and “amateur runners” (OR=4.19; 95%CI=2.95-5.94) were more prone to have higher performance. Conclusion: Two distinct classes were found among Brazilian runners that were linked to their performance, highlighting that even among non-professional runners, differences can be observed regarding their classification. Hence, future studies should consider using these classes to properly stratify or identify non-professional runners.

Migraine is heritable and formally diagnosed by structured criteria that require presence of some but not all possible migraine symptoms which include aura, several distinct manifestations of pain, nausea/vomiting, and sensitivity to light or sound. The most recent genome-wide genetic association study (GWAS) for migraine identified 38 loci. We investigated whether 46 single-nucleotide polymorphisms (SNPs), i.e., genetic variants, at these loci may have especially pronounced, i.e., selective, association with migraine presenting with individual symptoms compared to absence of migraine. Selective genetic associations of SNPs were evaluated through a likelihood framework in the Women's Genome Health Study (WGHS), a population-based cohort of middle-aged women including 3,003 experiencing migraine and 18,108 not experiencing migraine, all with genetic information. SNPs at 12 loci displayed significant selective association for migraine subclassified by specific symptoms, among which six selective associations are novel. Symptoms showing selective association include aura, nausea/vomiting, photophobia, and phonophobia. The selective associations were consistent whether the women met all formal criteria for diagnostic for migraine or lacked one of the diagnostic criteria, formally termed probable migraine. Subsequently, we performed latent class analysis of migraine diagnostic symptoms among 69,861 women experiencing migraine from the WGHS recruitment sample to assess whether there were clusters of specific symptoms that might also have a genetic basis. However, no globally robust latent migraine substructures of diagnostic symptoms were observed nor were there selective genetic associations with specific combinations of symptoms revealed among weakly supported latent classes. The findings extend previously reported selective genetic associations with migraine diagnostic symptoms while supporting models for shared genetic susceptibility across all qualifying migraine at many loci. [ABSTRACT FROM AUTHOR]

Background and Objectives: Most individuals experience multiple potentially traumatizing events (PTEs); hence, it is important to consider count and types of PTEs (polytraumatization) in relation to post-trauma health. Notably, no research has examined polytraumatization typologies in relation to positive memory count and phenomenology. We examined (1) latent subgroupings of individuals based on PTE endorsements; and (2) relation of the optimal latent class solution to positive memory count and phenomenology. Design: Participants were 203 trauma-exposed adults (Mage  = 35.40; 61.10% females); we used PTEs endorsed on the Life Events Checklist for DSM-5 as indicators for analyses. Results: Latent class analyses indicated a three-class solution differing in quantity and quality of PTE types: Low Experience, Predominant Interpersonal PTEs, and Predominant Non-Interpersonal PTEs. Further, more positive memories predicted membership in the Low Experience vs. other classes; greater sensory details of a positive memory predicted membership in the Low Experience vs. the Predominant Interpersonal PTEs Classes; and greater accessibility of a positive memory predicted membership in the Predominant Interpersonal PTEs vs. the Predominant Non-Interpersonal PTEs Classes. Conclusions: Results indicated three meaningful subgroups endorsing differing levels/types of PTEs; count, sensory details, and accessibility of positive memories, pending further investigation, may differentiate these subgroups. [ABSTRACT FROM AUTHOR]

Purpose: Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to (1) use latent class analysis to identify distinct classes of social context and social networks and (2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL. Methods: We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017–2018), via community-based sampling methods, and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor sas a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions. Results: For our first objective, there were three classes each of county-level contexts (1, highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2, mostly rural, moderately disadvantaged, and underserved; 3, mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1, no caregivers; 2, only spousal caregivers with whom they communicated daily; 3, multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL. Conclusions: Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL. [ABSTRACT FROM AUTHOR]

Objective: Bullying victimization among adolescents has been well-recognized as a behavior associated with adverse psychological and mental health outcomes. Most studies on bullying victimization have focused on adolescents, but research is sparse regarding school victimization among preadolescents before they transition to adolescence. This study sought to identify latent classes of different types of co-occurring bullying victimization, based on a sample of 3829 school students in grades 5–8, ages 9–14 in the year of 2011 from the Saskatoon Health Region, Saskatchewan, Canada. Results: Using a latent class analysis approach, the results uncovered three groups of victimized students, including those who were aggressively victimized (7.2%), moderately victimized (34.6%) and non-victimized (58.2%). Younger age and being overweight was associated with a higher likelihood of bullying victimization. Moderately and aggressively victimized students had greater probabilities of feeling like an outsider, experiencing anxiety, depressed moods, engaging in suicidal ideation and drinking when compared to non-victimized students. Peer and parent supports had significant protective effects against being victimized. Given the negative consequences of recurrent victimization among the preadolescents, it is imperative to address bullying incidents as they occur to prevent repeated transgressions, especially for those who suffer from multiple types of victimization. [ABSTRACT FROM AUTHOR]

Research on activities overlooks the possibility that older adults engage in different activities contemporaneously. To address this gap, we used latent class analyses to identify activity patterns and then examined demographic and health correlates of these patterns among a nationally representative sample of older adults in Singapore. We identified four classes of activities: the family-focused instrumental activity (FIA) class, the social leisure activity (SLA) class, the multidynamic activity (MDA) class, and the passive activity (PA) class. Furthermore, the MDA members showed higher scores in their mental health. Worse physical functioning and higher depression scores also increased the likelihood of being in the FIA and PA groups. Significant demographics such as gender, ethnicity, marital status, education, employment, house type, and income were related to heterogeneity in older adults' activity patterns. Service providers might consider the impact of certain significant demographic and health-related correlates when planning programs to ensure greater reach and access. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationships between the physical work environment and sleep using a person-centered approach. Methods: A total of 542 Australian employees aged 18 to 60 years completed a survey assessing exposure to physical work environment stressors (eg, noise, poor air quality, and hazardous manual tasks), sleep timing and sleep quality, and relevant covariates. Results: Latent class analysis (LCA) revealed three physical work environment classes: Infrequent exposure (51%); Occasional Exposure (31%); and Regular Exposure (18%). LCA also identified four sleep classes: Larks (24%); Typical sleep (43%); Insufficient sleep (20%); and Owls (13%). The Regular Exposure class was significantly associated with the Insufficient Sleep (odds ratio [OR] = 3.15, [1.29, 7.66]) and Owls (OR = 3.47 [1.24, 9.71]) classes. Conclusions: The person-centered approach provides important insights into how unique physical work environment experiences are linked with sleep. [ABSTRACT FROM AUTHOR]

This longitudinal study explored the existence of, and the transition between, latent classes based on risk/need domains of the Structured Assessment of Violence Risk in Youth (SAVRY). The study included 4,267 male and 661 female justice-involved juveniles who had at least one SAVRY assessment completed between 2006 and 2011. A three-step approach was used for the latent class analyses (LCA): (1) A standard LCA estimated the classes; (2) the class-membership was determined; and (3) latent transition analyses estimated the likelihood of transition between the subgroups. For male adolescents, five latent classes were identified: (a) low risk/needs (36%); (b) low-moderate risk/needs (26%); (c) moderate risk/needs (11%); (d) moderate-high risk/needs (19%); and (e) high risk/needs (8%). For female adolescents, three subgroups were identified: (a) low risk/needs (30%); (b) moderate risk/needs (51%); and (c) high risk/needs (19%). Recidivism rates differentiated the subgroups, and the likelihood of transition within a 12-months timeframe was low. [ABSTRACT FROM AUTHOR]

Objective: Studies have shown that antidepressants are no better than placebo in treating depression in dementia. The authors examined antidepressant efficacy in subgroups of depression in dementia with different depressive symptom profiles.Methods: This study focuses on exploratory secondary analyses on the randomized, parallel-group, double-blind, placebo-controlled Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia (HTA-SADD) trial. The setting included old-age psychiatry services in nine centers in England. The participants included 326 patients meeting National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association probable/possible Alzheimer disease criteria, and Cornell Scale for Depression in Dementia (CSDD) scores of 8 or more. Intervention was placebo (n = 111), sertraline (n = 107), or mirtazapine (n = 108). Latent class analyses (LCA) on baseline CSDD items clustered participants into symptom-based subgroups. Mixed-model analysis evaluated CSDD improvement at 13 and 39 weeks by randomization in each subgroup.Results: LCA yielded 4 subgroups: severe (n = 34), psychological (n = 86), affective (n = 129), and somatic (n = 77). Mirtazapine, but not sertraline, outperformed placebo in the psychological subgroup at week 13 (adjusted estimate: -2.77 [standard error (SE) 1.16; 95% confidence interval: -5.09 to -0.46]), which remained, but lost statistical significance at week 39 (adjusted estimate: -2.97 [SE 1.59; 95% confidence interval: -6.15 to 0.20]). Neither sertraline nor mirtazapine outperformed placebo in the other subgroups.Conclusion: Because of the exploratory nature of the analyses and the small sample sizes for subgroup analysis there is the need for caution in interpreting these data. Replication of the potential effects of mirtazapine in the subgroup of those with depression in dementia with "psychological" symptoms would be valuable. These data should not change clinical practice, but future trials should consider stratifying types of depression in dementia in secondary analyses. [ABSTRACT FROM AUTHOR]

Introduction: In order to prevent youth and young adult partner abuse, it is necessary to have a better understanding of dating relationship dynamics as the context for potential abusive interactions.Methods: Youth and young adults (ages 10-18 at baseline) were surveyed along with a matched parent/caregiver. Data, including parent and youth responses (n = 437 youth/parent dyads), are drawn from the nationally representative Survey on Teen Relationships and Intimate Violence (STRiV).Results: Applying latent class analytic techniques with seven different positive and problematic descriptors of dating relationships, this study found four classes of relationship dynamics representing healthy, unhealthy, intense, and disengaged relationships. The intense relationship dynamic class exhibits the strongest associations with reports of any youth and young adult partner abuse, as well as distinctly with the subtypes of psychological, physical, and sexual victimization and perpetration.Conclusions: Results demonstrate the importance of clinicians, parents and other responsible adults attending to an array of youth and young adult dating relationship dynamics rather than single indicators, to assess youth and young adult risk for involvement in abusive relationships. [ABSTRACT FROM AUTHOR]

Objective: Posttraumatic stress disorder (PTSD) often co-occurs with substance use (SU). Although there has been independent research on subgroups of participants based on their PTSD or SU responses, rarely are PTSD-SU typologies examined consistent with a precision medicine approach (and corresponding person-centered statistical approaches). The current study examined the nature and construct validity (covariates of depression, physical aggression, verbal aggression, anger, hostility, reckless and self-destructive behaviors [RSDB]) of the best-fitting latent class solution in categorizing participants based on PTSD (PTSD Checklist for DSM-5) and alcohol/drug use responses (Alcohol Use and Disorders Identification Test Alcohol Consumption Questions, Drug Abuse Screening Test). Methods: The sample included 375 trauma-exposed participants recruited from Amazon's Mechanical Turk online labor market. Results: Latent class analyses indicated an optimal three-class solution (low PTSD/SU, moderate PTSD/drug and high alcohol, and high PTSD/SU). Multinomial logistic regressions indicated that depression (OR = 1.22) and frequency of RSDBs (OR = 1.20) were significant predictors of the moderate PTSD/drug and high alcohol class versus the low PTSD/SU class. Depression (OR = 1.55) and frequency of RSDBs (OR = 1.19) were significant predictors of the high PTSD/SU class versus the low PTSD/SU class. Only depression (OR = 1.27) was a significant predictor of the high PTSD/SU class versus the moderate PTSD/drug and high alcohol class. Conclusions: Results provide construct validity support for three meaningful latent classes with unique relations with depression and RSDBs. These findings improve our understanding of heterogeneous PTSD-SU comorbidity patterns and highlight acknowledgment of such subtyping (subgrouping) in considering differential treatment options, treatment effectiveness, and resource allocation. [ABSTRACT FROM AUTHOR]

Little is known about how people use their smartphones, and whether usage patterns are related to psychopathology and problematic smartphone use. We sampled 296 college students, and administered self-report scales to assess frequency of using various smartphone features, and problematic smartphone use. We also assessed psychopathology constructs (ruminative thinking and emotion regulation deficits), and demographics (age and gender) as potential covariates of smartphone use patterns. Using latent class analysis, we identified two distinct classes of smartphone feature use, with one class representing especially heavy use (particularly that of social networking, audio and visual entertainment, and image- and video-taking), and the other class involving light use (particularly that of social networking, audio entertainment and image- and video-taking). Higher levels of rumination, and higher levels of cognitive reappraisal as an emotion regulation strategy, were related to the heavy use class. The heavy use class scored higher on all problematic smartphone use outcome variables. Results aid in understanding the nature and relation of smartphone usage patterns to psychopathology and problematic smartphone usage. [ABSTRACT FROM AUTHOR]

Using data from the National Longitudinal Study of Adolescent Health (Add Health), this study expands on previous research by (a) examining differences across race in patterns or "subgroups" of adolescents based on nine self-reported behaviors (e.g., delinquency, substance use, risky sexual practices) and (b) comparing the risk factors (e.g., peer association, parenting, neighborhood cohesion), both within and across the race-specific subgroups, related to membership into the identified latent classes. The data used in this study include respondents aged 13 to 17 who participated in Waves 1 and 2 of the Add Health in-home interview. Latent class analysis (LCA) identified key differences in the number and characteristics of the latent classes across the racial subgroups. In addition, both similarities and differences in the risk factors for membership into the latent classes were identified across and within the race-specific subgroups. Implications for understanding risky behavior in adolescence, as well as directions for future research, are discussed. [ABSTRACT FROM AUTHOR]

Objective: Bodily Distress Syndrome (BDS) represents a new research concept for adult patients with various functional somatic syndromes. We evaluated the utility of the BDS research concept and the associated BDS-25-checklist as a screening tool for diverse functional somatic symptoms (FSS) in adolescence by investigating: 1) the psychometric and factorial structures of the checklist, 2) symptom cluster patterns and 3) illness classification and associations with emotional psychopathology and sociodemographic factors.Methods: This cross-sectional study obtained data from the 16/17-year follow-up (N = 2542) of the general population Copenhagen Child Cohort 2000 (CCC2000). We used self-reported questionnaires to assess physical symptoms (the BDS-25 checklist), overall health (KidScreen), emotional psychopathology (Spence Children's Anxiety Scale; The Mood and Feelings Questionnaire), and illness worry (Whiteley-6 Index), and utilized data from Danish national registers to assess sociodemographic factors.Results: The BDS-25 checklist items displayed satisfactory psychometric data quality. Factor analyses revealed a similar four-factor model as reported in adults (factor loadings λ ≥0.5), representing distinct BDS symptom clusters: cardio-pulmonary, gastro-intestinal, musculoskeletal and general symptoms. Latent class analyses revealed a model with three latent classes, i.e. probable no to mild BDS, probable moderate, single-organ BDS and probable severe, multi-organ BDS, displaying acceptable class quality (Entropy = 0.904). Trend analyses revealed sociodemographic group differences across latent classes. Increased emotional psychopathology was associated with more pronounced BDS symptoms.Conclusion: Our findings support the BDS concept with four symptom clusters and three illness severity groups (no BDS, single- organ and multi-organ BDS) to screen for FSS in adolescence. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research was to identify distinct trajectories of recovery in older depressed patients in order to identify optimal samples and points for interventions.Methods: The sample was 368 patients ages 60 years and older diagnosed with major depression and enrolled in a naturalistic treatment study and followed for up to 3 years.Results: A model with four trajectory classes fit the data best: a quick recovery class (43%), a persistent moderate symptom class (27%), a persistent high symptom class (15%), and a slow recovery class (15%). Compared with patients in the quick recovery class, patients in the persistent moderate symptom class had more instrumental activities of daily living/mobility limitations and lower levels of subjective social support. Patients in the persistent high symptom class had higher levels of perceived stress and lower levels of social support compared with those with a quick recovery. Patients in the slow recovery class had a younger age of onset compared with those in the quick recovery group. In multinomial logistic regression, levels of perceived stress and social support at baseline significantly differed across classes controlling for demographic and health variables.Conclusions: Older patients diagnosed with major depression can have varying patterns of response to treatment. Interventions targeting those patients with higher levels of perceived stress and lower levels of subjective social support at the time of the index episode may lead to more favorable long-term trajectories. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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