The Role of Place Attachment in the Relationship between Attitudes toward Aging and Subjective Well-Being among Community-Dwelling Older Adults in Taiwan

Subjective well-being presents a societal challenge for vulnerable older adults. This study aims to investigate the mediating role of place attachment in the relationship between attitudes toward aging and subjective well-being among community-dwelling older adults in Taiwan. Two waves of investigations were conducted to examine the interplay between attitudes toward aging, subjective well-being, and place attachment among older adults. In Wave I, 1190 participants were enrolled, revealing predominantly younger cohorts with substantial educational levels. The subsequent Wave II involved 483 participants, maintaining continuity in characteristics. Subjective well-being remained moderate across waves, with prevalent positive attitudes toward aging. Place attachment scores indicated moderate to high associations. After controlling for demographics, structural equation modeling (SEM) in both waves revealed significant positive associations: attitudes toward aging influenced well-being, attitudes toward aging were positively associated with place attachment, and place attachment was positively related to well-being. Mediation testing confirmed the mediating role of place attachment in the relationship between attitudes toward aging and well-being. These findings underscore the important role of place attachment. It is evident that improving attitudes toward aging is an effective intervention which can lead to a better sense of well-being by enhancing place attachment to empower civil society.

Motivational drivers and Sense of Belonging: unpacking the persistence in Chinese Martial Arts practice among international practitioners

Background

Chinese Martial Arts (CMAs) have garnered a global following, with their rich historical and cultural heritage transcending geographical and cultural differences, sparking profound interest among an international community. As an increasing number of non-Chinese individuals persist in practicing CMAs, investigating the motivations behind their continued participation has emerged as a compelling question. This study aims to delve deeper into the factors driving international practitioners to sustain their practice of CMAs, thereby broadening our understanding of the global resonance of CMAs.

Methods

Employing Self-Determination Theory, 226 international CMAs practitioners completed the Physical Activity and Leisure Motivation Scale, Perceived Belonging Scale, and Persistence in Practicing CMAs Scale. SPSS 20.0 was utilized for conducting descriptive statistics, common method bias tests, and correlation analyses. Structural equation modeling was performed using AMOS 26.0.

Results

Motivation for Practicing CMAs, comprised of enjoyment, mastery, physical condition, psychological condition, and appearance, has a positive impact on Persistence in Practicing CMAs (β = 0.297, p < 0.01). Sense of Belonging also positively affects Persistence in Practicing CMAs (β = 0.268, p < 0.01). The aforementioned variables account for 22.1% of the variance in Persistence in Practicing CMAs. Furthermore, Affiliation, Competition/Ego, and Others' Expectations were found to have no significant correlation with Persistence in Practicing CMAs.

Conclusion

The formation of persistence in the practice of CMAs among international practitioners is propelled by their ongoing desire for skill mastery, enjoyment, enhanced physical and mental health, body shape improvement, and a Sense of Belonging. The study reveals that a stronger motivation and Sense of Belonging significantly enhance their commitment to CMAs. Recommendations include that international instructors should center their teaching strategies around the practitioners, helping them to find joy in their practice, achieve skill mastery, and foster the development of physical, mental, and aesthetic qualities, alongside virtues and etiquette. Additionally, building a supportive CMAs community and cultivating a sense of ritual are essential. Such strategies are intended to reinforce practitioners' self-affirmation and group identity, thus boosting their Sense of Belonging and encouraging their continued engagement in CMAs.

Day-to-day associations between mindfulness and perceived stress: insights from random intercept cross-lagged panel modeling

Objective

Mindfulness is frequently seen as a protective factor of stress, but self-report measures of mindfulness may overlap with other related constructs, such as mental health, and could thus not only be a predictor, but also an outcome of stress. This study thus aimed to examine the longitudinal bidirectional associations between the use and perceived helpfulness of the four mindfulness facets Observe, Describe, Nonjudge, and Nonreact with daily perceived stress.

Methods

Participants from a large (N = 1,276) mixed student and community group sample filled out a brief daily diary over the time span of 7 days. Bidirectional cross-lagged effects were investigated using the random-intercept cross-lagged panel model, an extension of the traditional cross-lagged panel model that allows to differentiate between stable between-unit differences and time-varying within-unit dynamics. In addition, we controlled for several baseline and sociodemographic confounders.

Results

At the within-subject level, the use of Actaware was associated with higher perceived stress on the next day (β = 0.03, p = 0.029). The use (β = -0.04, p = 0.025) and perceived helpfulness (β = -0.05, p = 0.014) of Nonreact were associated with lower perceived stress on the next day. In turn, perceived stress was associated with lower perceived helpfulness of Describe (β = -0.04, p = 0.037) and Nonreact (β = -0.03, p = 0.038) on the next day. In addition, there were several residual correlations between mindfulness facets and perceived stress within days. At the between-subject level, there was a positive association between the random intercept of Describe and daily stress (r = 0.15, p = 0.003). In addition, while baseline perceived stress was negatively associated with the random intercepts of the mindfulness facets, two baseline components of mindfulness were not associated with the random intercept of perceived stress.

Conclusion

On the currently investigated time scale, our results challenge prior results and assumptions regarding mindfulness as a buffering and protective factor against daily stress. With the exception of Nonreact, mindfulness was either positively associated with perceived stress, or in turn perceived stress appeared to interfere with the ability to stay mindful in daily life.

Towards a taxonomy of mechanisms of change? Findings from an expert survey on the association between common factors and specific techniques in psychotherapy

OBJECTIVE

In the present study, we used structural equation modeling (SEM) to investigate the complex relationship between common factors, i.e., mechanisms of change, and specific factors, i.e., therapeutic techniques.

METHOD

N = 256 psychotherapy experts were asked to rate the appropriateness of 14 techniques commonly used in psychotherapy to facilitate five different common factors - resource activation, motivational clarification, self-management & emotion regulation, social competence, and therapeutic relationship. Using SEM, we defined techniques as indicators and common factors as latent variables. Data were split randomly into two subsets. Indicators were selected if three a priori defined criteria were met based on training data (n = 128). Subsequently, the goodness of model fit was assessed in the test data (n = 128).

RESULTS

The proposed model revealed adequate fit. All factor loadings were theoretically sound and significant in magnitude. Findings suggest that psychotherapy experts discriminate between common factors by their various associations with therapeutic techniques.

CONCLUSION

Suggestions are made, how therapeutic techniques are to be used to facilitate desirable change in the patient. Our model is a step towards a taxonomy of mechanisms of change that may help to improve research-informed decision-making.

Dynamics of the soil microbial community associated with Morchella cultivation: diversity, assembly mechanism and yield prediction

Introduction

The artificial cultivation of morels has been a global research focus owing to production variability. Understanding the microbial ecology in cultivated soil is essential to increase morel yield and alleviate pathogen harm.

Methods

A total of nine Morchella cultivation experiments in four soil field types, forest, paddy, greenhouse, and orchard in Shanghai city were performed to determine the potential ecological relationship between Morchella growth and soil microbial ecology.

Results

Generally, significant variation was observed in the soil microbial diversity and composition between the different experimental field types. The niche width analysis indicated that the bacterial habitat niche breadth was significantly greater than the fungal community width, which was further confirmed by a null model that revealed that homogeneous selection could explain 46.26 and 53.64% of the variance in the bacterial and fungal assemblies, respectively. Moreover, the neutral community model revealed that stochastic processes dominate the bacterial community in forests and paddies and both the bacterial and fungal communities in orchard crops, whereas deterministic processes mostly govern the fungal community in forests and paddies and both the bacterial and the fungal communities in greenhouses. Furthermore, co-occurrence patterns were constructed, and the results demonstrated that the dynamics of the soil microbial community are related to fluctuations in soil physicochemical characteristics, especially soil potassium. Importantly, structural equation modeling further demonstrated that the experimental soil type significantly affects the potassium content of the soil, which can directly or indirectly promote Morchella yield by inhibiting soil fungal richness.

Discussion

This was the first study to predict morel yield through soil potassium fertilizer and soil fungal community richness, which provides new insights into deciphering the importance of microbial ecology in morel agroecosystems.

Academic self-efficacy, grit, and teacher support as predictors of psychological well-being of Chinese EFL students

Introduction

This study explores the determinants of psychological well-being among 968 Chinese English as a Foreign Language (EFL) students by employing structural equation modeling (SEM). Focusing on academic self-efficacy, grit, and teacher support, this research aims to illuminate their roles in shaping the psychological well-being of EFL students within the Chinese educational context.

Methods

Data from a robust sample of Chinese EFL students were analyzed using SEM techniques to investigate the relationships between academic self-efficacy, grit, teacher support, and psychological well-being. Validated instruments were utilized to measure these constructs, ensuring accuracy and reliability. The study employed meticulous data collection procedures over a three-month period, maintaining strict ethical standards and anonymity for participants.

Results

The SEM analysis revealed intricate connections among academic self-efficacy, grit, teacher support, and the psychological well-being of Chinese EFL students. Academic self-efficacy and grit emerged as direct predictors of psychological well-being, highlighting their significance in fostering students' overall well-being. Additionally, teacher support was identified to play a mediating role in this relationship, emphasizing its critical influence on enhancing academic self-efficacy and grit, thereby contributing to students' psychological well-being.

Discussion

These findings underscore the crucial importance of nurturing academic self-efficacy and grit to enhance the psychological well-being of Chinese EFL students. Furthermore, teacher support stands out as a pivotal factor in elevating students' academic self-efficacy and grit, emphasizing the need for educational interventions centered on fostering these attributes among Chinese EFL learners. The implications of these results extend to educational practices, emphasizing the indispensable role of teacher support and interventions aimed at cultivating academic self-efficacy and grit to promote the psychological well-being of EFL students within the learning environment.

Exploring the relationships among teacher-student dynamics, learning enjoyment, and burnout in EFL students: the role of emotional intelligence

Introduction

Within the realm of Chinese English as a Foreign Language (EFL) education, this research endeavors to explore the intricate interplay among teacher-student relationships, learning enjoyment, and burnout. It specifically aims to investigate the potential mediation role of emotional intelligence. The study delves into the experiences of 806 EFL students to comprehensively scrutinize these dynamics.

Methods

Employing Structural Equation Modeling (SEM), this study conducts a thorough analysis of the relationships between teacher-student dynamics, learning enjoyment, and burnout among EFL students. The primary objectives involve uncovering correlations among these factors and elucidating the potential mediating impact of emotional intelligence.

Results

The findings underscore robust associations between positive teacher-student relationships, heightened learning enjoyment, and reduced levels of burnout among EFL students. Noteworthy is the pivotal role of emotional intelligence, acting as a mediator, offering insights into the intricate ways in which teacher-student relationships and learning enjoyment influence burnout levels.

Discussion

These outcomes highlight the significance of nurturing students' emotional intelligence as a protective factor against burnout, advocating for tailored educational interventions. The research advocates for proactive measures to enhance emotional intelligence among EFL students, emphasizing its potential to mitigate burnout. Moreover, it suggests pedagogical strategies and institutional support prioritizing emotional intelligence to foster the well-being and academic success of Chinese EFL students.

Evaluating the impact of COVID-19 on traffic congestion and safety skills using structural equation modeling (SEM) and Auto-Regressive Integrated Moving Average (ARIMA)

The current work presented a comparative analysis of traffic demand and safety skills before and after control measures during the COVID-19 epidemic, acquired time-series change data curves, and constructed a prediction model after determining the trend of traffic demand over time. From a data analysis perspective, the paper draws some interesting conclusions about long span, coarse sampling studies. In terms of the study population, the paper did focus on the specificity of the global epidemic. Kuwait was selected as a case study. Traffic demand analysis was conducted using a Structural Equation Model (SEM), Auto-Regressive Integrated Moving Average (ARIMA), and safety skills questionnaire along with flow charts and demographic variables. These methods were utilized to study the impact of COVID-19 on traffic congestion and safety skills as well as to forecast the future traffic volumes. Results showed that traffic congestion had a significant reduction during COVID-19 as a result of the preventive safety measures taken to control the spread of the virus. Such reduced traffic volume was associated with a decrease in traffic violations and an increase in the safety skills and PM skills of drivers.

Exploring the Influence of Public Perception of Mass Media Usage and Attitudes towards Mass Media News on Altruistic Behavior

Based on the cultivation theory and the theory of planned behavior, this study determined how people's perceptions of mass media news and their attitudes towards it impact their altruistic behavior by examining the factors that influence perception. The study collected data from 435 individuals with access to mass media in Taiwan, which were analyzed using SEM. The results revealed that media exposure, credibility, and social influence were critical factors that influenced individuals' perceptions of mass media news, with media exposure having a more significant influence. Surprisingly, the findings demonstrated that perception was negatively related to attitudes, inconsistent with the proposed hypothesis. Thus, perceptions and attitudes were positively associated with altruistic behavior, and attitude was found to mediate the relationship between perceptions about mass media news and altruistic behavior. The study also provides important implications for theory and practice, especially in mass media entities, in developing and adopting practices that promote trust among the audience by encouraging altruistic behaviors through news coverage of various issues.

Associations between neighborhood environment and sense of community belonging in urban China: Examining mediation effects of neighborly interactions and community satisfaction

Introduction

Improving sense of community belonging (SCB) would help people live longer, happier lives. Although the importance of neighborhood environment on SCB is stressed in the literature, few studies have paid attention to perceived environment, as well as consider mediation effects such as neighborhood social interactions and place satisfaction.

Methods

Relied on a sample of 1051 respondents in Shanghai in 2018, this study investigates the associations between both objective and perceived neighborhood environment attributes and SCB in urban China, mediated by neighborly interactions and community satisfaction using structural equation modeling.

Results

The results suggest that the influence of perceived neighborhood environment on SCB is more prominent than that of objective neighborhood environment. In detail, perceived pedestrian facilities and perceived leisure facilities are vital to SCB, while among objective neighborhood environmental elements, the influence of land use entropy, park density and street greenery are significant. Then, neighborhood environmental attributes can influence SCB by affecting neighborly interactions and community satisfaction. We also identify gender differences in the effects of neighborhood environment upon SCB.

Discussion

Given increasing awareness of the connection, neighborhood environment may prove to be valuable assets to improve individuals' psychosocial constructs such as SCB.

Trait creativity, personality, and physical activity: a structural equation model

BACKGROUND

Previous studies have shown that personality affects creativity, and physical activity and is associated with cognitive function. However, the relationship among physical activity, creativity, and personality remains unclear. This study sought to examine the relationship among personality, physical activity, and creativity to identify relevant risk factors of trait creativity. Structural equation modeling (SEM) was used to assess the effect of personality (extraversion, agreeableness, conscientiousness, neuroticism, and openness) on physical activity, the effect of physical activity on creativity traits.

METHODS

A total of 296 university students were recruited for this study. The survey was administered by WeChat. The self-reported questionnaires included questions related to demographic information, creativity (from the Williams Creativity Assessment Packet), the Big Five personality traits, and physical activity. A correlation analysis was conducted and the structural equation models were constructed using SPSSAU.

RESULTS

The SEM analysis showed that openness in personality was positively correlated with physical activity. Physical activity was negatively correlated with curiosity, challenging, risk-taking, and imagination.

CONCLUSIONS

Among university students, openness may be a profound positive factor affecting physical activity. Moreover, physical activity was also associated with trait creativity. Consideration should be given to assessing personality traits and physical activity to ensure the selection of more creative students.

The Role of Economic Stress, Health Concerns, and Institutional Trust in Supporting Public Protests against COVID-19 Lockdown Measures in Denmark

During the current COVID-19 pandemic, most governments around the world have adopted strict COVID-19 lockdown measures. In Denmark, mainly from January to March 2021, an anonymous protest group called Men in Black organized demonstrations against the Danish COVID-19 lockdown measures in the three major cities in Denmark. Based on an online survey that we carried out in March 2021 in the Danish population aged 16 years and above (n = 2692), we analyze the individual-level factors behind supporting these demonstrations. Based on ordered logit regressions, the results show that being Muslim and being self-employed (business owner) was positively related to supporting the demonstrations, and that age and living in a city municipality was negatively related to supporting the demonstrations. Based on structural equation modeling (SEM), the results showed that the municipal COVID-19 incidence rate mediates the effect of living in a city municipality, that institutional trust mediates the effect of being Muslim, and that COVID-19 health concerns and institutional trust mediate the effect of age. Overall, economic stress among business owners, health concerns, and institutional trust were found to be the main predictors of supporting the demonstrations against the COVID-19 lockdown measures in Denmark.

Determinants of Quality of Life in Individuals With Spinal Cord Injury Using Structural Equation Modeling

OBJECTIVE

The objective of this study is to examine the interdependent associations between International Classification of Functioning, Disability and Health (ICF) domains and their relationship with environmental factors with regard to quality of life (QoL) in individuals with spinal cord injury (SCI).

DESIGN

Survey, cross-sectional study, and model testing using structural equation modeling.

SETTING

Two inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel.

PARTICIPANTS

Convenience sample of 156 individuals with SCI (N=156).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

QoL assessed by the World Health Organization Quality of Life Assessment-BREF. Neurological impairment after SCI reflected by lesion completeness and neurologic level of injury as measured by the International Standards for Neurological Classification of Spinal Cord Injury. The Spinal Cord Independence Measure to assess SCI-related task performance. ICF Brief Core Sets composition scores to assess impairment in body structure and function domains, limitations in activities, restriction in participation constructs, and the effect of environmental factors within the ICF model.

RESULTS

Level of spinal cord injury and ICF Brief Core Sets composite score relating to activities and participation construct demonstrated a direct significant association with QoL. Moreover, a significant indirect association with QoL was found between the composite scores in ICF body structure and function and environmental factors, level of spinal cord injury, time since injury onset, and sex. Because the Spinal Cord Independence Measure was not related to QoL, we inferred that the categories related to instrumental activities of daily living and participation exert the most significant influence on QoL.

CONCLUSIONS

In order to optimize improvements in quality of life, current rehabilitation programs should target limitations specifically related to instrumental activities of daily living and participation restrictions. It may serve as a focal point for further development of current therapeutic models and analytical methods that optimize rehabilitation planning and decision making among both health care professionals and patients.

The ABC-X's of Stress among U.S. Emerging Adults during the COVID-19 Pandemic: Relationship Quality, Financial Distress, and Mental Health

Many emerging adults have experienced increased financial distress and mental health problems during the COVID-19 pandemic, and isolation may have amplified the importance of close relationships (especially as parents' influence diminishes during this developmental stage). Using the ABC-X Model to frame our model, we tested whether financial distress (C) mediates the associations between COVID-19 impact (A) and anxiety and depressive symptoms (X), and whether or not romantic relationship quality (B) moderates these indirect associations. Our sample comprised of 1950 U.S. emerging adults in a romantic relationship. Mediation and first-stage moderated mediation were tested using structural equation modeling. Financial distress partially mediated the association between COVID-19 impact and anxiety symptoms and fully mediated the association between COVID-19 impact and depressive symptoms. Strong evidence of moderated mediation was found but in the opposite direction expected: the indirect associations of COVID-19 impact with anxiety and depressive symptoms (through financial distress) were stronger for those in high-quality romantic relationships. The findings may inform policy and practice aimed at optimizing the mental health of emerging adults, especially in light of the ongoing COVID-19 pandemic: specifically, alleviating financial distress may improve the mental health of emerging adults, while focusing on the quality of their romantic relationships may not.

Art education lecturers' intention to continue using the blackboard during and after the COVID-19 pandemic: An empirical investigation into the UTAUT and TAM model

The success of faculty in adopting technology in this digital era has a direct impact on the success of the students and, eventually, the educational institution. Many teachers, on the other hand, have yet to implement technological tools such as Canvas into their classes. As a result, this study looked at art universities lecturers' opinions of variables influencing actual blackboard use, as well as their desire to utilize the lesson plan in learning and teaching during the COVID-19 Pandemic. The TAM model and the unified theory of acceptance and use of technology (UTAUT) were used to analyze lecturers' satisfaction with the blackboard and their desire to continue using it, as well as the actual usage of blackboards. A survey of 159 professors using Canvas in art instruction at five Saudi Arabian public institutions yielded the research findings. In addition, structural equation modeling (SEM) was used to evaluate the study model as well as the mediating relationship between factors influencing the desire to implement the lesson in learning and teaching during the COVID-19 Pandemic. According to the study's findings, superior impact, performance expectation, effort expectations, enabling conditions, and reported enjoyment all had statistically significant effects on perceived usefulness (PU) and perceived ease of use. The current study discovered that PU and perception of use had statistically significant influence on behavior intent, actual blackboard usage, and lecturers' happiness with utilizing blackboard in learning and teaching during the COVID-19 Pandemic. Furthermore, the results demonstrate that lecturer's intention to continue utilizing chalkboard in learning and teaching during and after COVID-19 Pandemic was influenced by actual usage of blackboard and reported pleasure. The findings are useful for education based, regulators, and practitioners who seek to create and enhance effective methods to use e-learning systems during and after the COVID-19 Pandemic.

Family and Academic Stress and Their Impact on Students' Depression Level and Academic Performance

Current research examines the impact of academic and familial stress on students' depression levels and the subsequent impact on their academic performance based on Lazarus' cognitive appraisal theory of stress. The non-probability convenience sampling technique has been used to collect data from undergraduate and postgraduate students using a modified questionnaire with a five-point Likert scale. This study used the SEM method to examine the link between stress, depression, and academic performance. It was confirmed that academic and family stress leads to depression among students, negatively affecting their academic performance and learning outcomes. This research provides valuable information to parents, educators, and other stakeholders concerned about their childrens' education and performance.

Developing a Validated Instrument to Measure Students' Active Learning and Actual Use of Information and Communication Technologies for Learning in Saudi Arabia's Higher Education

Higher education authorities have supplied information and communication technologies (ICTs) to guarantee that students use ICT to improve their learning and research outputs. ICT, on the other hand, has been proven to be underused, particularly by students. Therefore, we aimed to develop a new model to measure students' active learning and actual use of ICT in higher education. To investigate this issue, the technology acceptance model and constructivism learning theory were verified and applied to evaluate university students' use of ICT for active learning purposes. The participants in the study were 317 postgraduate and undergraduate students from four faculties at King Faisal University who consented to take part. The research data were analyzed using structural equation modeling (AMOS-SEM). Three specific components were used: the technology adoption model, constructivism learning, and active learning using ICT. The findings revealed that: (a) using ICTs for students' interactivity, engagement, expected effort, subjective norm, and perceived ease of use has a direct positive impact on perceived enjoyment and usefulness; (b) perceived enjoyment and usefulness has a direct positive impact on active learning, attitude toward use, and behavioral intention to use ICTs; (c) active learning has a direct positive impact on attitude toward use, behavioral intention to use ICTs; and (d) active learning has a direct positive impact on attitude. Moreover, the results showed the mediator factors' values positively "R square," active learning (0.529), attitude toward use (0.572), behavioral intention to use (0.583), and actual ICT use (0.512) in higher education. Therefore, the results of the hypotheses developed a validated instrument to measure students' active learning and actual use of ICTs in higher education in Saudi Arabia.

How Accurate Is Your Correlation? Different Methods Derive Different Results and Different Interpretations

Assessing the association between conceptual constructs are at the heart of quantitative research in educational and psychological research. Researchers apply different methods to the data to obtain results about the correlation between a set of variables. However, the question remains, how accurate are the results of the correlation obtained from these methods? Although various considerations should be taken to ensure accurate results, we focus on the types of analysis researchers apply to the data and discuss three methods most researchers use to obtain results about correlation. Particularly, we show how correlation results in bivariate correlation, confirmatory factor analysis (CFA), and exploratory structural equation modeling (ESEM) differ substantially in size. We observe that methods that assume independence of the items often generate inflated factor correlations whereas methods that relax this assumption present uninflated, thus more accurate correlations. Because factor correlations are inflated in bivariate correlation and CFA, the discriminant validity of the constructs is often unattainable. In these methods, the size of the correlation can be very large and biased. We discuss the reasons for this variation and suggest the type of correlation that researchers should select and report.

The Effect of Healing Perception on the Visitors' Place Attachment and Their Loyalty toward a Metropolitan Park-Under the Aspect of Environmental Design

Healing perception is considered to increase visitors’ place attachment and loyalty. This research employed structural equation modeling (SEM) to examine the structural relationship between healing perception, place attachment, environmental design, and visitors’ loyalty to a place. The study investigated a metropolitan park in Gaoxiong, Taiwan, and collected 431 valid questionnaires on the site. The results showed that the environmental design affected the human perception of healing and place attachment, which substantially affected the visitors’ loyalty toward the place. The healing perception powerfully impacted loyalty (0.76), which contained an indirect effect through place attachment and enhanced the direct impact of healing perception. Moreover, the environmental design had a capable direct effect (0.62) on visitors’ loyalty through two full mediation paths: healing perception and place attachment. The study sheds light on designing a healing park that could enhance visitors’ place attachment and strongly affect their loyalty to the park.

Does Health Consciousness Matter to Adopt New Technology? An Integrated Model of UTAUT2 With SEM-fsQCA Approach

Every emerging technology has its pros and cons; health-conscious users pay more importance to healthy and environment-friendly technologies. Based on the UTAUT2 model, we proposed a comprehensive novel model to study the factors influencing consumers' decision-making to adopt the technology. Compared to prior studies that focused on linear models to investigate consumers' technology adoption intentions and use behavior. This study used a Structural Equation Modeling-fuzzy set qualitative comparative analysis (SEM-fsQCA) approach to account for the complexity of customers' decision-making processes in adopting new technology. We collected valid responses from 830 consumers, analyzed them, and evaluated them using a deep learning SEM-fsQCA technique to capture symmetric and asymmetric relations between variables. We have extensively incorporated a health-consciousness attitude as a predictor and mediator to understand better the decision-making toward technology adoption, specifically 5G technology. All the factors tested in our model are statistically significant except the economic factors. Health-consciousness attitude (HCA) and behavioral intention (BI) found significant predictors and valid mediators in the process of 5G technology adoption. FsQCA provided six configurations to achieve high 5G adoption. The findings have significant practical ramifications for telecom corporations, advertisers, government officials, and key policymakers. Additionally, the study added substantial theoretical literature to technology adoption, particularly the adoption of 5G technology.

Empathy, Emotion Recognition, and Paranoia in the General Population

Background

Paranoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition - a very early component of empathic processing - are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia.

Methods

Paranoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults (n = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition.

Results

Paranoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia (p < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear (p = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition (p = 0.002). All indirect paths through emotion recognition were non-significant.

Discussion

These results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations.

Understanding the continuous vaccination of the COVID-19 vaccine: an empirical study from China

Vaccination for the novel coronavirus disease 2019 (COVID-19) provides an effective approach for the general improvement of social safety and individual health. However, given that the current COVID-19 vaccine can only work for a period of time, the continuous vaccination of the vaccine will be particularly important. Using the Health Action Process Approach (HAPA) Model, Expectation Confirmation Model (ECM) and vaccine hesitancy (VH) theory, this research evaluates the continuous vaccination for COVID-19. This research selected Chinese survey platform to recruit respondents and conducted online surveys. A total of 768 Chinese individuals who were vaccinated participated in the survey, and 561 responses were effective after screening. Six valuable and novel findings are identified through this research. First, perceived efficacy has a positive significant impact on vaccination intention, but the positive effects of outcome expectancy and risk perception on vaccination intention are not significant. Second, social positive cues play a significant role in promoting vaccination intention. Third, VH has a negative significant influence on vaccination intention. Fourth, vaccination behavior produces a positive significant effect on perceived usefulness and satisfaction, respectively. Fifth, perceived usefulness exerted a positive significant impact on satisfaction and continuous vaccination, respectively. Sixth, satisfaction has no positive significant influence on continuous vaccination. Our theoretical model, which is the main contribution of this research, indicates that individual continuous vaccination is a process from motivation to intention, and from intention to behavior, and then from behavior to continuous vaccination.

Predictors of family violence through the COVID-19 pandemic: Structural equation modeling

There has been much talk, globally and locally, about family violence during the COVID-19 pandemic. Family violence has received increasing interest from the researchers in many different fields, while family violence during the COVID-19 pandemic outbreak still needs researchers' attention to investigate its predictors and detect the prevalence among family members through this health crisis. This study aimed to investigate the spread of family violence and detect the predictors of it with the applied advanced statistical procedure, structural equation modeling (SEM). The researchers prepared the family violence scale that consisted of 21 items, and applied it in a random sample that consisted of (312) individual. The finding indicated that there are high levels of family violence, violence between spouses, violence from parents to children, and sibling violence. As well as, the findings found that the years of marriage are statistically significant of violence between spouses, violence from parents to children, and sibling violence, and the total score of the family violence. As well as, sex is a statistically significant predictor of violence between spouses. While the educational level, age, and income level did not predict violence (total score or dimensions). Based on the results of the current study, counseling programs to reduce family violence and psychotherapy programs to reduce the negative effects of family violence on parents and children must be planned. Therefore, the role of traditional and online family counseling and psychotherapy must be activated in light of the outbreak of the COVID-19 pandemic.

Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

Structural Equation Modeling (SEM): Childhood Aggression and Irritable ADHD Associated with Parental Psychiatric Symptoms

Background: Children with attention deficit hyperactivity disorder (ADHD) co-occurring with Oppositional Defiant Disorder (ODD) further present aggressive behavior and may have a depressive parent. A child with co-occurring ADHD and ODD has differentially higher levels of behavioral and emotional difficulties. Little is known about how the irritable subtype of ADHD in children mediates the development of parental symptomatology. This study aims to elucidate the direct or indirect influence of childhood disruptive ADHD with aggressive behavior on their parental symptom using Structural Equation Modeling (SEM). Methods: A total of 231 ADHD children and their parents completed the Swanson, Nolan, and Pelham Version IV questionnaire for symptoms of ADHD, Oppositional Defiant Disorder (ODD) scale for irritable symptoms, Child Behavior Check List (CBCL) for aggression, and Symptom Checklist (SCL) for parental symptom. Results: The three-factor confirmatory factor analysis (CFA) model found symptoms of inattention, hyperactivity/impulsivity, irritable ODD, and aggression were inter-related. Mediational analyses demonstrated ODD mediates symptoms directly predicting the risk of increasing ADHD severity. Disruptive child symptoms (ADHD + ODD + aggression) may increase the risk of depression-related symptoms in the parent. When the child’s aggression increases by one standard deviation (SD), parental psychiatric symptoms increase by 0.235 SD (p < 0.001). Conclusions: By this SEM pathway analysis, there is the correlation between the disruptive, more aggressive subtype of ADHD in children/adolescents and the existence of psychopathological symptomatology of their parents. ADHD + ODD + aggression in children should be classified as an irritable subtype of ADHD, warranting early diagnosis and intensive treatment.

Fractional Anisotropy in Selected, Motor-Related White Matter Tracts and Its Cross-Sectional and Longitudinal Associations With Motor Function in Healthy Older Adults

Background

While it is well-known that deficits in motor performance and brain structural connectivity occur in the course of healthy aging, it is still unclear if and how these changes are related to each other. While some cross-sectional studies suggest that white matter (WM) microstructure is positively associated with motor function in healthy older adults, more evidence is needed. Moreover, longitudinal data is required to estimate whether similar associations can be found between trajectories of change in WM microstructure and motor function. The current study addresses this gap by investigating age-associations and longitudinal changes in WM microstructure and motor function, and the cross-sectional (level-level) and longitudinal (level-change, change-change) association between these two domains.

Method

We used multiple-occasion data (covering 4 years) from a large sample (N = 231) of healthy older adults from the Longitudinal Healthy Aging Brain (LHAB) database. To measure WM microstructure, we used diffusion-weighted imaging data to compute mean FA in three selected WM tracts [forceps minor (FMIN); superior longitudinal fasciculus (SLF); corticospinal tract (CST)]. Motor function was measured via two motor speed tests (grooved pegboard, finger tapping) and one motor strength test (grip force test), separately for the left and the right hand. The statistical analysis was conducted with longitudinal growth curve models in the structural equation modeling framework.

Results

The results revealed longitudinal decline and negative cross-sectional age-associations for mean WM FA in the FMIN and SLF, and for motor function in all tests, with a higher vulnerability for left than right hand motor performance. Regarding cross-domain associations, we found a significant positive level-level correlation among mean WM FA in the FMIN with motor speed. Mean FA in SLF and CST was not correlated with motor performance measures, and none of the level-change or change-change associations were significant. Overall, our results (a) provide important insights into aging-related changes of fine motor abilities and FA in selected white matter tracts associated with motor control, (b) support previous cross-sectional work showing that neural control of movement in older adults also involves brain structures outside the core motor system and (c) align with the idea that, in healthy aging, compensatory mechanisms may be in place and longer time delays may be needed to reveal level-change or change-change associations.

The Impact of Adolescent Internet Addiction on Sexual Online Victimization: The Mediating Effects of Sexting and Body Self-Esteem

Adolescents’ problematic use of the internet and the risk of sexual online victimization are an increasing concern among families, researchers, professionals and society. This study aimed to analyze the interplay between adolescents’ addiction to social networks and internet, body self-esteem and sexual–erotic risk behavior online: sexting, sextortion and grooming. While sexting refers to the voluntary engagement in texting sexual–erotic messages, sextortion and grooming are means of sexual–erotic victimization through the use of the internet. Participants were 1763 adolescents (51% girls), aged 12 to 16 years (M = 14.56; SD = 1.16), from public (n = 1068; 60.60%) and private (n = 695; 39.40%) high schools in the Basque Country (Spain). We carried out structural equation modeling (SEM) using Mplus to assess the mediating effects of body self-esteem in the relationship between addiction to social media and internet and sexual–erotic risk behavior. The results showed that internet addiction predicts online sexual victimization; specifically, the best predictors of sexting, sextortion and grooming victimization were symptoms of internet addiction and geek behavior. Body self-esteem and sexting mediated the relationship between internet addiction and sexual online victimization in adolescents. These results highlight the importance of attending to adolescents’ mental health regarding their online behavior, considering the risk and protective factors involved, due to its close association with online sexual victimization.

School Violence and Teacher Professional Engagement: A Cross-National Study

School violence research has mainly focused on the impact on students. Very few studies, even fewer from a cross-cultural perspective, have examined the relationships between school violence and teacher professional engagement, and the role played by teacher self-efficacy and school climate related factors. The present study utilizes a SEM research methodology to analyze the 2013 TALIS data. The purpose is to understand and compare the relationships in four different cultural contexts; the U.S., England, South Korea, and Mexico. Results indicate, on average, that the significant and negative impacts of school violence on teacher professional engagement are partly mediated by teacher self-efficacy. The negativity of school violence is significantly alleviated by enhancing participation among school stakeholders and improving teacher–student relationships. The relationships among the factors apply across all four cultural systems, though, the effects of factors and variables vary to a degree. The paper also discusses other relevant issues and differences as well as their implications.

Investigating into the critical factors supporting healthy independent longevity: A proposition of a conceptual model with measurements during and beyond COVID-19 pandemic

This study investigated the factors that support the elderly citizens' perceived healthy independent longevity during and beyond the COVID-19 pandemic. The Structural Equation Modeling was conducted with the 1607 dataset collected from Japan to validate a proposed model with six antecedent factors. It has been found that "Town vibrancy" and "Mobility and transportations" have the most significant impact, whereas "Health and welfare policies" and "Community bonding" have a relatively lower impact on their perceived healthy longevity. The study has provided a conceptual model with measurements for further discussions in the field of study.

Predicting mask-wearing behavior intention among international students during COVID-19 based on the theory of planned behavior

BACKGROUND

The global outbreak of the coronavirus disease 2019 (COVID-19) has emerged as a major public health threat. This study aimed to analyze the influencing factors of international students' intention to wear a mask based on the theory of planned behavior (TPB). The findings are important because they provide pertinent information in designing and implementing COVID-19 prevention programs.

METHODS

Self-designed questionnaires were distributed to 477 international students. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to identify and confirm the factor structure, and the structural equation model (SEM) was applied to determine the predictors of masks wearing.

RESULTS

The final structural model was well reflected by fit indices. The research model of international students' intention to wear a mask for protection against COVID-19 was acceptable. All of the hypotheses were supported. Attitude and perceived behavioral control (PBC) were positively related to behavior intention (BI), respectively. Subjective norm (SN) also had a direct effect on attitude, PBC, and BI.

CONCLUSIONS

Referring to TPB was useful in identifying determinants of mask-wearing. The strongest predictor was SN, which indicated it was deserving of increased attention. These findings are significant to strengthen international students' awareness regarding self-protection and enhance the effectiveness of COVID-19 prevention programs.

Understanding how e-health interventions meet psychosocial needs of breast cancer patients: The pathways of influence on quality of life and cancer concerns

OBJECTIVE

This investigation explores how using different e-health interventions facilitates positive psychosocial changes and how these changes reduce cancer concerns and improve quality of life in breast cancer patients over time.

METHODS

A total of 326 breast cancer patients were randomly assigned to one of three e-health interventions: (a) Internet only, (b) the Comprehensive Health Enhancement Support System information and support services (CHESS-IS), or (c) CHESS with mentor. Proximal health outcomes such as information overload, emotional functioning, and social support were measured alongside distal outcomes like cancer concerns and quality of life. Participants completed surveys at four time points: pretest as a baseline, 6 weeks, 3 months, and 6 months.

RESULTS

Both interventions were effective in improving patient health beyond Internet only but they differed in type of change mechanism and clinical benefit. The CHESS-IS enhanced proximal outcomes at 3 months through improved information competence. The CHESS with mentor intervention reduced breast cancer concerns at 6 months, mediated mainly by emotional-social competence and emotional functioning.

CONCLUSIONS

Using e-health interventions like CHESS can help patients improve cancer information management skills and emotional functioning, contributing to better short-term health outcomes. Adding a human mentor can enhance the benefits of CHESS use, extending the experience among breast cancer patients. Theoretical, practical, and clinical implications of the study results are discussed.

The Effect of Estimation Methods on SEM Fit Indices

We examined the effect of estimation methods, maximum likelihood (ML), unweighted least squares (ULS), and diagonally weighted least squares (DWLS), on three population SEM (structural equation modeling) fit indices: the root mean square error of approximation (RMSEA), the comparative fit index (CFI), and the standardized root mean square residual (SRMR). We considered different types and levels of misspecification in factor analysis models: misspecified dimensionality, omitting cross-loadings, and ignoring residual correlations. Estimation methods had substantial impacts on the RMSEA and CFI so that different cutoff values need to be employed for different estimators. In contrast, SRMR is robust to the method used to estimate the model parameters. The same criterion can be applied at the population level when using the SRMR to evaluate model fit, regardless of the choice of estimation method.

The influence of local market and household factors on aflatoxin presence in maize and symptoms of its exposure to children in Guatemala

Recent evidence supports the hypothesis that aflatoxin exposure from maize can influence malnutrition rates among children. Therefore, in Guatemala we investigated two questions; which maize sources exposed households to higher risk of aflatoxin exposure symptoms and what the risk factors were for each maize source, pre- and post-maize harvest. Survey data and household maize samples were collected in October 2016 (pre-harvest) and February 2017 (post-harvest) in San Vicente, Guatemala. Structural equation modeling (SEM) and odds ratios were used to assess the data. The results suggested that households which purchased maize from the market had 3.64 higher odds of high levels of aflatoxin. The models identified that good market purchase habits were significant for market-based maize sources while improved post-harvest practices and improved types of maize storage were significant for subsistence-based maize sources. Cumulative results suggest multiple interventions may be effective but are dependent on time of year and source of maize.

Determinants of soil organic carbon sequestration and its contribution to ecosystem carbon sinks of planted forests

The area of forest established through afforestation/reforestation has been increasing on a global scale, which is particularly important as these planted forests attenuate climate change by sequestering carbon. However, the determinants of soil organic carbon (SOC) sequestration and their contribution to the ecosystem carbon sink of planted forests remain uncertain. By using globally distributed data extracted from 154 peer-reviewed publications and a total of 355 sampling points, we investigated above-ground biomass carbon (ABC) sequestration and SOC sequestration across three different climatic zones (tropical, warm temperate, and cold temperate) through correlation analysis, regression models, and structural equation modeling (SEM). We found that the proportion of SOC sequestration in the ecosystem C sequestration averaged 14.1% globally, being the highest (27.0%) in the warm temperate and the lowest (10.7%) in the tropical climatic zones. The proportion was mainly affected by latitude. The sink rate of ABC (R_ABC ) in tropical climates (2.48 Mg C ha^-1  year^-1 ) and the sink rate of SOC (R_SOC ) in warm temperate climates (0.96 Mg C ha^-1  year^-1 ) were higher than other climatic zones. The main determinants of R_SOC were the number of frost-free days, latitude, mean annual precipitation (MAP), and SOC density (SOCD) at the initial observation; however, these variables depended on the climatic zone. According to the SEM, frost-free period, mean annual temperature (MAT) and MAP are the dominant driving factors affecting R_SOC in Chinese plantations. MAT has a positive effect on R_SOC , and global warming may increase R_SOC of temperate plantations in China. Our findings highlight the determinants of SOC sequestration and quantitatively reveal the substantial global contribution of SOC sequestration to ecosystem carbon sink provided by planted forests. Our results help managers identify and control key factors to increase carbon sequestration in forest ecosystems.

Exploring critical factors influencing nurses' intention to use tablet PC in Patients' care using an integrated theoretical model

The use of health information technology (HIT) is expected to deliver benefits for patients, nurses, physicians, and organizations, but the benefits of HIT can only be attained if nurses accept and intend to use it as they are the leading user-group. The use of the tablet is becoming commonplace in healthcare organizations to improve patient care. The current study incorporates Technology Acceptance Model2 (TAM2) with two antecedents, facilitating condition and personal, to identify and understand the factors that influence nurses' intention to use the Tablet PC. The survey methodology was used to collect data from the nurses working in a regional healthcare center in Taiwan. The structural equation modeling (SEM) technique was employed to analyze the research framework. A total of 110 valid responses for analysis. The results suggest that the modified proposed research framework explains about 41.7% of the variance of nurses' behavioral intention. The partial least squares (PLS) regression indicated that perceived usefulness, subjective norm, and personal a positive and significant influence on nurses' intention to use the Tablet PC. But concerning the perceived ease of use, the insignificant path coefficient was reported. The finding also indicated that personal on the research model is much stronger than the subjective norm on Tablet PC performance. The proposed research framework contributes to the conclusive explanation for understanding nurses' intention to use. The current study brings perspectives from the technological and attitudinal differences that have largely been missing in the existing literature of the nurses' intention to use HIT. Thus, health care providers must take these factors into consideration as the findings of the current study advance theory and contribute to the basis for future study intended for enhancing our understanding of nurses' adoption behavior regarding HIT.

Examination of the Causality Relationship between Psychological Distress and Social Participation in Elderly People: A Pilot Study

Few studies have considered the causal relationship between psychological distress and social participation in elderly people. Here we investigated this relationship based on an initial survey and a follow-up survey. In 2016, a survey was distributed to 86 participants. A follow-up survey of 80 of those participants was performed in 2017. We adopted the following variables: psychological distress and social participation as represented by the Kessler psychological distress scale and social participation scores, respectively. By using cross-lagged and synchronous effects models, we found that the 2016 Kessler psychological distress scale had a significant influence on the 2017 social participation scores (standardization factor=-0.221, p=0.020) and the 2017 Kessler psychological distress scale significantly influenced the 2017 social participation scores (standardization factor=-0.345, p=0.039). The results suggest that psychological distress may affect social participation one year later.

The Perilous Use of Proxy Variables

It is often not stated or quantified how well measured proxy variables account for the variance in latent constructs they are intended to represent. A sensitivity analysis was run using data from the Survey of Health, Ageing and Retirement in Europe to estimate models varying in the degree to which proxy variables represent intended constructs. Results showed that parameter estimates differ substantially across different levels of variable representation. When variables are used with poor construct validity, an insufficient amount of variance is removed from the observed spurious relationship between design variable and outcome. The findings from this methodological demonstration underscore the importance of selecting proxy variables that accurately represent the underlying construct for which control is intended.

Lagged Coupled Changes Between White Matter Microstructure and Processing Speed in Healthy Aging: A Longitudinal Investigation

Age-related differences in white matter (WM) microstructure have been linked to lower performance in tasks of processing speed in healthy older individuals. However, only few studies have examined this link in a longitudinal setting. These investigations have been limited to the correlation of simultaneous changes in WM microstructure and processing speed. Still little is known about the nature of age-related changes in WM microstructure, i.e., regionally distinct vs. global changes. In the present study, we addressed these open questions by exploring whether previous changes in WM microstructure were related to subsequent changes in processing speed: (a) 1 year later; or (b) 2 years later. Furthermore, we investigated whether age-related changes in WM microstructure were regionally specific or global. We used data from four occasions (covering 4 years) of the Longitudinal Healthy Aging Brain (LHAB) database project (N = 232; age range at baseline = 64–86). As a measure of WM microstructure, we used mean fractional anisotropy (FA) in 10 major WM tracts averaged across hemispheres. Processing speed was measured with four cognitive tasks. Statistical analyses were conducted with bivariate latent change score (LCS) models. We found, for the first time, evidence for lagged couplings between preceding changes in FA and subsequent changes in processing speed 2 years, but not 1 year later in some of the WM tracts (anterior thalamic radiation, superior longitudinal fasciculus). Our results supported the notion that FA changes were different between regional WM tracts rather than globally shared, with some tracts showing mean declines in FA, and others remaining relatively stable across 4 years.

Modeling Measurement as a Sequential Process: Autoregressive Confirmatory Factor Analysis (AR-CFA)

To model data from multi-item scales, many researchers default to a confirmatory factor analysis (CFA) approach that restricts cross-loadings and residual correlations to zero. This often leads to problems of measurement-model misfit while also ignoring theoretically relevant alternatives. Existing research mostly offers solutions by relaxing assumptions about cross-loadings and allowing residual correlations. However, such approaches are critiqued as being weak on theory and/or indicative of problematic measurement scales. We offer a theoretically-grounded alternative to modeling survey data called an autoregressive confirmatory factor analysis (AR-CFA), which is motivated by recognizing that responding to survey items is a sequential process that may create temporal dependencies among scale items. We compare an AR-CFA to other common approaches using a sample of 8,569 people measured along five common personality factors, showing how the AR-CFA can improve model fit and offer evidence of increased construct validity. We then introduce methods for testing AR-CFA hypotheses, including cross-level moderation effects using latent interactions among stable factors and time-varying residuals. We recommend considering the AR-CFA as a useful complement to other existing approaches and treat AR-CFA limitations.

Comparison of Bootstrap Confidence Interval Methods for GSCA Using a Monte Carlo Simulation

Generalized structured component analysis (GSCA) is a theoretically well-founded approach to component-based structural equation modeling (SEM). This approach utilizes the bootstrap method to estimate the confidence intervals of its parameter estimates without recourse to distributional assumptions, such as multivariate normality. It currently provides the bootstrap percentile confidence intervals only. Recently, the potential usefulness of the bias-corrected and accelerated bootstrap (BCa) confidence intervals (CIs) over the percentile method has attracted attention for another component-based SEM approach—partial least squares path modeling. Thus, in this study, we implemented the BCa CI method into GSCA and conducted a rigorous simulation to evaluate the performance of three bootstrap CI methods, including percentile, BCa, and Student's t methods, in terms of coverage and balance. We found that the percentile method produced CIs closer to the desired level of coverage than the other methods, while the BCa method was less prone to imbalance than the other two methods. Study findings and implications are discussed, as well as limitations and directions for future research.

Relationship between Psychological Distress and Continuous Sedentary Behavior in Healthy Older Adults

Background: Our purpose is to clarify whether psychological distress (PD) affects the rate of continuous sedentary behavior (CSB). Materials and Methods: In this secondary analysis, a sample population of 80 healthy older adults aged 65 years or older participated in a health club of college A from 2016 to 2017. We conducted Structural Equation Modeling (SEM) using the cross-lagged and synchronous effects models. We adopted the following as proxy variables: CSB (based on the ratio of 1.5 METs sessions or more continuing for over 30 min) CSB and PD (based on the Kessler psychological distress scale: K6). Results: "2016 K6" had a significant influence on "2017 CSB" (standardization factor (β) = 0.136, p = 0.020) using the cross-lagged effects model, and "2017 K6" significantly influenced "2017 CSB" (β = 0.166, p = 0.039) using the synchronous effects model. Fit indices were Adjusted Goodness-of-Fit Index (AGFI) = 0.990, Confirmatory Fit Index (CFI) = 1.000, and Root Mean Square Error of Approximation (RMSEA) = 0.000. Conclusion: The results suggest that PD may affect the ratio of CSB one year later.

Understanding the Model Size Effect on SEM Fit Indices

This study investigated the effect the number of observed variables (p) has on three structural equation modeling indices: the comparative fit index (CFI), the Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA). The behaviors of the population fit indices and their sample estimates were compared under various conditions created by manipulating the number of observed variables, the types of model misspecification, the sample size, and the magnitude of factor loadings. The results showed that the effect of p on the population CFI and TLI depended on the type of specification error, whereas a higher p was associated with lower values of the population RMSEA regardless of the type of model misspecification. In finite samples, all three fit indices tended to yield estimates that suggested a worse fit than their population counterparts, which was more pronounced with a smaller sample size, higher p, and lower factor loading.

Evaluating the accessibility of essential medicines in China

OBJECTIVE

To evaluate the accessibility of essential medicines in China through a new system which integrated the structure, process, and effect of the National Essential Medicine Policy (NEMP).

METHODS

A structural equation model was built to verify the reliability of the evaluation system. This study utilized the Delphi method to obtain the structure and process index data, and used the WHO/HAI standard method for the effect index data to evaluate the NEMP. Six regions were selected for empirical analysis so that suggestions for optimization could be put forward.

RESULTS

The structural equation model consisted of three parts: organization structure, executive process, and effect. The factor loading of the three indicators exceeded 0.5, indicating that this model complied with the preliminary fit criteria. In the organizational structure, rules and regulations and resource investment accounted for a large proportion, indicating that they had a great impact on the effect. As for the executive process, the weight of the seven indicators were similar, and they accounted for a large proportion, indicating that each indicator had a non-negligible impact on the effect. The "p" of all the three hypothesizes was less than .01, especially the "p" of hypothesis 3 was less than .001, indicating that the structure and process of NEMP affected the accessibility of the essential medicines, and three components of the model were positively correlated.

LIMITATIONS

Some errors may exist in achieving appropriate expert selection because of potential researcher bias in the Delphi approach. The results from only six provinces in China may not be generalized nationwide.

CONCLUSION

The structural indicators and process indicators have a significant impact on outcome indicators, and they also have correlations. That is, the formulation and implementation of the national drug policy and related supporting measures play an important role in improving the accessibility of essential medicines.

A Transcultural Structural Equation Modeling (SEM) Study

Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.

A Cross-Lagged Panel Analysis of Psychometric Intelligence and Achievement in Reading and Math

A cross-lagged panel analysis of Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) intelligence test scores and reading and math achievement test scores of 337 students twice assessed for special education eligibility across a test-retest interval of 2.85 years was conducted. General intelligence (g) was loaded by the four WISC-IV factor index scores whereas reading and math were composite scores. After confirming measurement invariance, it was found that g, reading, and math were stable across time and synchronously correlated. The cross-lagged paths from g at time 1 to reading and math at time 2 (0.26 and 0.39, respectively) were both significantly greater than zero whereas the paths from reading and math at time 1 to g at time 2 (0.03 and 0.23, respectively) were not statistically significant. Given this pattern of relationships and extant research on the correlates of general intelligence, it was tentatively inferred that general intelligence was the temporal precursor to reading and math achievement.

Progressive Bidirectional Age-Related Changes in Default Mode Network Effective Connectivity across Six Decades

The default mode network (DMN) is a set of regions that is tonically engaged during the resting state and exhibits task-related deactivation that is readily reproducible across a wide range of paradigms and modalities. The DMN has been implicated in numerous disorders of cognition and, in particular, in disorders exhibiting age-related cognitive decline. Despite these observations, investigations of the DMN in normal aging are scant. Here, we used blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) acquired during rest to investigate age-related changes in functional connectivity of the DMN in 120 healthy normal volunteers comprising six, 20-subject, decade cohorts (from 20–29 to 70–79). Structural equation modeling (SEM) was used to assess age-related changes in inter-regional connectivity within the DMN. SEM was applied both using a previously published, meta-analytically derived, node-and-edge model, and using exploratory modeling searching for connections that optimized model fit improvement. Although the two models were highly similar (only 3 of 13 paths differed), the sample demonstrated significantly better fit with the exploratory model. For this reason, the exploratory model was used to assess age-related changes across the decade cohorts. Progressive, highly significant changes in path weights were found in 8 (of 13) paths: four rising, and four falling (most changes were significant by the third or fourth decade). In all cases, rising paths and falling paths projected in pairs onto the same nodes, suggesting compensatory increases associated with age-related decreases. This study demonstrates that age-related changes in DMN physiology (inter-regional connectivity) are bidirectional, progressive, of early onset and part of normal aging.

Applying Electronic Medical Records in Health Care: Physicians' Perspective

BACKGROUND

In order to fulfill comprehensive interoperability and recognize the electronic medical records (EMRs') benefits, physicians' attitudes toward using and applying EMR must be recognized.

OBJECTIVES

The purpose of this study was to present an integrated model of applying EMRs by physicians.

METHODS

This was a cross sectional study in which a sample of 330 physicians working in hospitals affiliated to the Tehran University of medical sciences (TUMS) was selected. Physicians' attitudes toward using and accepting EMR in health care have been analyzed by an integrated model of two classical theories i.e. technology acceptance model (TAM) and diffusion of innovation (DOI). The model was tested using an empirical survey. The final model was tested by structural equation modeling (SEM) and represented by Analysis of Moment Structures (AMOS).

RESULTS

The results suggest that the hybrid model explains about 43 percent of the variance of using and accepting of EMRs (R2=0.43). The findings also evidenced that Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Relative Advantage, Compatibility, Complicatedness and Trainability have direct and significant effect on physicians' attitudes toward using and accepting EMRs. But concerning observeability, significant path coefficient was not reported.

CONCLUSIONS

The integrated model supplies purposeful intuition for elucidates and anticipates of physicians' behaviors in EMRs adoption. The study identified six relevant factors that affect using and applying EMRs that should be subsequently the major concern of health organizations and health policy makers.

Continuous Glucose Monitoring in Type 1 Diabetes

BACKGROUND

Continuous glucose monitoring (CGM) patient systems have been shown to improve diabetes self-treatment when used consistently. The meaningful integration of this technology into everyday life, however, can vary greatly among CGM users and not all people with diabetes use CGM to its full potential. To address this issue, the study pursued 2 aims: first, to identify patient characteristics that underlie the acceptance of CGM in people with type 1 diabetes and, second, to examine the effects of different levels of experience with CGM use.

METHODS

Guided by a model based on the technology acceptance model (TAM), structural equation modeling (SEM) was employed to model the patient characteristics as predictors of CGM acceptance. In all, 111 participants (60.4% female, mean = 37.6 years, SD = 11.2) participated in a web-based survey; 40 were current CGM users, 18 were former users and 53 had no experience with CGM systems.

RESULTS

In general, participants evaluated CGM positively; however, the feeling of information overload represented a major barrier to the sustained use of CGM, while perceptions of usefulness and ease of use constituted incentives for using this technology. Moreover, patients without CGM experience imagined more information overload than current users reported. Current users showed more intention to use CGM than former users.

CONCLUSION

This study highlights the importance of CGM user experience for the effective use of this technology.

English language usage pattern in China mainland doctors: AME survey-001 initial analysis results

PURPOSE

English is the most widely used language in medical community worldwide. Till now there is no study yet on how English language is being used among mainland Chinese doctors. The present survey aimed to address this question.

METHODS

An online cross-sectional survey was carried out during the period of 23 Oct 2014 to 13 November 2014, totaling 22 days. This survey was conducted on the platform provided by DXY (www.dxy.cn), which is the largest medical and paramedical related website in China with registered medical doctor users of slightly more than one million. E-mails were sent to all DXY registered users to invite them to participate the survey which lasts approximately five-minute. The questionnaire included three major aspects: (I) the demographic characteristics of participants; (II) English reading pattern; and (III) paper publishing experience in international journals. To accommodate the complexity of relationships among variables, structural equation modeling (SEM) was employed to build the model.

RESULTS

In total 1,663 DXY users completed the survey, which counted for ≈1% of the total registered medical doctor users. There were more participants from relatively economically developed eastern coast areas. The age of participants was 33.6±7.4 years. There were 910 respondents from teaching hospitals (54.72%), followed by tertiary care hospitals (class-III hospital, 22.37%). Mainland Chinese doctors were more likely to consult medical materials in Chinese (63.5%) when they encounter clinical difficulties. Participants who were able to list English journals of their own specialty up to four were 44.02% for 0, 13.77% for one journal, 13.89% for two journals, 9.26% for three journals, and 19.06% for four journals. Most participants (82.86%) have read at least one English paper or one professional book in English, while 17.14% responded they never read a single English paper or professorial book in English. About 30.42% participants published at least one paper in English journals, and approximately half of them require professional English editing service.

CONCLUSIONS

This limited survey shows Mainland Chinese doctors are more likely to use Chinese medical materials. Overall their familiarity with international English journals is relatively low. Improving English education at the undergraduate and post-graduate levels is recommended.

Measurement bias detection with Kronecker product restricted models for multivariate longitudinal data: an illustration with health-related quality of life data from thirteen measurement occasions

Highlights

Longitudinal measurement invariance is usually investigated with a longitudinal factor model (LFM). However, with multiple measurement occasions, the number of parameters to be estimated increases with a multiple of the number of measurement occasions. To guard against too low ratios of numbers of subjects and numbers of parameters, we can use Kronecker product restrictions to model the multivariate longitudinal structure of the data. These restrictions can be imposed on all parameter matrices, including measurement invariance restrictions on factor loadings and intercepts. The resulting models are parsimonious and have attractive interpretation, but require different methods for the investigation of measurement bias. Specifically, additional parameter matrices are introduced to accommodate possible violations of measurement invariance. These additional matrices consist of measurement bias parameters that are either fixed at zero or free to be estimated. In cases of measurement bias, it is also possible to model the bias over time, e.g., with linear or non-linear curves. Measurement bias detection with Kronecker product restricted models will be illustrated with multivariate longitudinal data from 682 bone metastasis patients whose health-related quality of life (HRQL) was measured at 13 consecutive weeks.