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PubMed1996

Nurses' representations of the positive and negative features of nursing.

Nurses' representations of their work are defined as their cognitive 'work spaces', a theoretical concept derived from Newell & Simon's (1977) problem-solving model and Lewin's (1935) concept of interacting positive and negative valences. Using a structural equation modelling technique, a network of positive and negative features in nurses' work spaces is described in patterns of response to a questionnaire eliciting nurses' ratings of their professional opportunities and difficulties. The modelling technique revealed the dominance of positive over negative features, and the overall significance of social recognition for encouraging nurses to remain in nursing. Comparative analyses revealed that dominant features of work space representations did not differ for nurses from four city and country hospitals, nor in relation to positions in the nursing hierarchy. The importance of understanding the perceptions of nurses is discussed in relation to changes and development in nursing as a profession.

Adult↗
PubMed2001

Toward an integrative model of suicide attempt: a cognitive psychological approach.

Applying a cognitive approach, the purpose of the present study was to expand previous research on stress-vulnerability models of depression and problem-solving deficits, as it relates to suicide attempt. Structural equation modelling, involving latent variables, was used to evaluate (a) whether low self-esteem, a low sense of self-efficacy, loneliness, and divorce constituted vulnerability factors for the development of depression; (b) whether hopelessness and suicidal ideation mediated the relationship between depression and suicide attempt; and (c) whether problem-solving deficits mediated the relationship between the vulnerability factors and suicide attempt, separate from depression/hopelessness. A total of 123 individuals, aged 18-75 years, participated in the study (72 suicide attempters and 51 psychiatric outpatients with no history of suicidal behavior). The results indicated a two path model of suicide attempt. The first path began with low self-esteem, loneliness, and separation or divorce, which advanced to depression, and was further mediated by hopelessness and suicidal ideation which led to suicide attempt. The second path developed from low self-esteem and a low sense of self-efficacy and advanced to suicide attempt, mediated by a negative appraisal of one's own problem-solving capacity, and poor interpersonal problem-solving skills. The importance of addressing both depression/hopelessness, and problem-solving deficits when working with suicide attempters is noted.

Adolescent↗
PubMed1999

The social class determinants of income inequality and social cohesion.

The authors argue that Wilkinson's model omits important variables (social class) that make it vulnerable to biases due to model mis-specification. Furthermore, the culture of inequality hypothesis unnecessarily "psychopathologizes" the relatively deprived while omitting social determinants of disease related to production (environmental and occupational hazards) and the capacity of the relatively deprived for collective action. In addition, the hypothesis that being "disrespected" is a fundamental determinant of violence has already been refuted. Shying away from social mechanisms such as exploitation, workplace domination, or classist ideology might avoid conflict but reduce the income inequality model to a set of useful, but simple and wanting associations. Using a nonrecursive structural equation model that tests for reciprocal effects, the authors show that working-class position is negatively associated with social cohesion but positively associated with union membership. Thus, current indicators of social cohesion use middle-class standards for collective action that working-class communities are unlikely to meet. An erroneous characterization of working-class communities as noncohesive could be used to justify paternalistic or punitive social policies. These criticisms should not detract from an acknowledgment of Wilkinson's investigations as a leading empirical contribution to reviving social epidemiology at the end of the century.

Authoritarianism↗
PubMedDate not supplied

An organizational tool to describe and evaluate group performance in the health care setting.

OBJECTIVE: To develop and test a tool for evaluating the performance of working groups in the institutional health care setting and to discuss its utility for pharmacists and other health care providers. DESIGN: A model for understanding how groups make decisions in health care settings was developed based on theories derived from organizational research. Our general group decision-making model was based on data collected from a national survey of members of hospital pharmacy and therapeutics (P&T) committees. Members were asked to describe how they interacted when making decisions regarding whether to add or delete drugs from their hospital's formulary. The relationships were examined using structural equation modeling. SETTING: Large teaching hospitals. PARTICIPANTS: Key members of P&T committees. MAIN OUTCOME MEASURES: Committee members' responses about committee structure, organizational environment, quality of their interactions with each other, and the committee's decision-making abilities. Individual responses were aggregated into group measures to improve reliability and validity. RESULTS: Responses were received from 114 of the 222 hospitals surveyed (51.3%), and analysis was conducted on 95 hospitals (42.8%) for which three or more group members responded. Positive interactions among group members had the greatest influence on the group's decision-making abilities (beta = 0.92). These interactions were facilitated by a well-designed group (gamma = 0.71) and the support of the environment within which the committee operates (gamma = 0.29). CONCLUSION: The general group decision-making model tested in this study may be useful in understanding how the internal processes of health care groups such as P&T committees influence group performance and, hence, group outputs. Health care providers who apply a systematic approach to assessing group performance will find this model useful because it provides a starting point for examining the process, a way to show interrelationships among various group activities, and a guide to which strategies may be most effective for improving the decision-making process.

Decision Making↗
PubMedDate not supplied

Modeling incomplete longitudinal and cross-sectional data using latent growth structural models.

In this paper we describe some mathematical and statistical models for identifying and dealing with changes over age. We concentrate specifically on the use of a latent growth structural equation model approach to deal with issues of: (1) latent growth models of change, (2) differences in longitudinal and cross-sectional results, and (3) differences due to longitudinal attrition. This is a methodological paper using simulated data, but we base our models on practical and conceptual principles of modeling change in developmental psychology. Our results illustrate both benefits and limitations using structural models to analyze incomplete longitudinal data.

Aging↗
PubMed1999

A model of war zone stressors and posttraumatic stress disorder.

We present a theoretical model of field placement, war zone stressors (fighting, death and injury of others, threat of death or injury to oneself, killing others, participating in atrocities, harsh physical conditions and insufficiency of resources in the environment) and posttraumatic stress disorder (PTSD). Theater veterans from the National Vietnam Veterans Readjustment Study were divided randomly into two subsamples of 599 each. The model was developed on the first subsample and cross-validated on the second using structural equation modeling. The model provides a theoretically and empirically satisfactory description of the anatomy of war zone stressors and their role in the etiology of PTSD, but it leaves unanswered important questions regarding the etiological role of insufficiency of resources in the environment.

Adult↗
PubMed1997

The effects of positive and negative social exchanges on aging adults.

This study tested various models of the effects of positive and negative exchanges on positive and negative affect using structural equation modeling. Based on a probability sample of middle-aged and older adults, the relationships between social exchanges and psychological well-being were examined both within the total sample and within subgroups of individuals who had experienced few vs many life events. Within the general population, the Domain Specific Model resulted in the best fit. That is, positive exchanges were associated with positive affect, and negative exchanges were associated with negative affect. However, among the subgroup that had experienced more life events, there was a significantly stronger relationship between negative exchanges and negative affect. These findings suggest that, to understand the effects of social exchanges, it is important to consider the context of life events.

Adaptation, Psychological↗
PubMed1983

A causal model for physician utilization: analysis of Norwegian data.

This article contains a causal model for physician utilization in Norway. The model relates enabling factors, predisposing factors, and perceived illness to physician utilization in a linear structural equation model. Our aim has been to study the effect of variables other than perceived illness on physician utilization. The results of the analysis indicate that the number of disability days because of illness and psychologic well-being are almost exclusively the only important variables in the explanation of physician utilization in Norway.

Costs and Cost Analysis↗
PubMed1993

Linking retirement experiences and marital satisfaction: a mediational model.

The authors propose and test a mediational model linking the experience of retirement with marital satisfaction. The experience of retirement (financial strain, time structure, a sense of purposefulness, and interpersonal contacts) is held to predict marital satisfaction indirectly through its sequential effects on context-specific well-being (retirement-specific satisfaction with health, activities, and peers) and context-free well-being (depressive symptoms). Both this model and a revised model in which retirement satisfaction also exerted a direct effect on marital satisfaction were supported using structural equation modeling on data from 164 retirees (mean age = 69 years). An alternative model in which depressive symptoms assume a predictive rather than mediational role was not supported; cross-lagged regression analyses excluded the possibility that marital dissatisfaction resulted in depressive symptoms. The conceptual and practical implications of these findings are discussed.

Aged↗
PubMed2001

Maternal milk consumption predicts the tradeoff between milk and soft drinks in young girls' diets.

Milk intake constitutes an important source of dietary calcium for young girls but declines throughout childhood. Recent work shows that the intake of soft drinks may contribute to this decline. Influences on the apparent tradeoff between soft drinks and milk in young girls' diets are not well described. The objective of this research was to test a model depicting maternal beverage choices as predictors of their daughters' milk and soft drink intake. A structural equation model describing maternal influences on daughters' milk, soft drink and calcium intakes was tested using data from 180 non-Hispanic, white families with 5-y-old daughters. Mothers' calcium, milk and soft drink intakes were evaluated as predictors of their daughters' intakes. Mothers' and daughters' soft drink intakes were also examined as predictors of their own milk and calcium intakes. The model provided a good fit to the data, revealing mother-daughter similarities in beverage intake. Mothers who drank milk more frequently had daughters who drank milk more frequently and drank fewer soft drinks. For both mothers and daughters, soft drink consumption was negatively related to both milk and calcium intake. This research provides evidence that mothers' beverage choices influence the tradeoff between milk and soft drinks in their daughters' diets. In particular, mothers' milk and soft drink intakes may affect their daughters' calcium adequacy in early childhood by influencing the frequency with which their daughters consume those beverages.

Adult↗
PubMed1995

The measurement structure of the Center for Epidemiologic Studies Depression Scale.

This study examined the temporal stability of the measurement structure of the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) in 813 individuals with rheumatoid arthritis. Participants completed the CES-D (Radloff, 1977) on three occasions 1 year apart. Structural equation models and polyserial correlations were used to address methodological limitations of previous studies. Four competing measurement structures were tested with one factor, three factors, four factors, and a single second-order factor underlying the four-factor model. The four-factor and the second-order-factor models provided the best fit at Time 1. When cross-validated at Times 2 and 3, the four-factor and the second-order-factor models remained invariant. Researchers can now more confidently use the CES-D to examine how distress changes in chronic physical disorders.

Affect↗
PubMed1998

Sexual risk behavior among youth: modeling the influence of prosocial activities and socioeconomic factors.

Sexual activity among high-school-aged youths has steadily increased since the 1970s, emerging as a significant public health concern. Yet, patterns of youth sexual risk behavior are shaped by social class, race, and gender. Based on sociological theories of financial deprivation and collective socialization, we develop and test a model of the relationships among neighborhood poverty; family structure and social class position; parental involvement; prosocial activities; race; and gender as they predict youth sexual risk behavior. We employ structural equation modeling to test this model on a cross-sectional sample of 370 sexually active high-school students from a midwestern city; 57 percent (n = 209) are males and 86 percent are African American. We find that family structure indirectly predicts sexual risk behavior through neighborhood poverty, parental involvement, and prosocial activities. In addition, family class position indirectly predicts sexual risk behavior through neighborhood poverty and prosocial activities. We address implications for theory and health promotion.

Adolescent↗
PubMed1999

Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness.

OBJECTIVE: The authors tested a model linking specific leader-empowering behaviors to staff nurse perceptions of workplace empowerment, occupational stress, and work effectiveness in a recently-merged Canadian acute care hospital. SUMMARY BACKGROUND DATA: An integration of Kanter's organizational empowerment theory and Conger and Kunungo's model of the leader empowerment process constituted the theoretical framework for the study. Few published studies were found in which specific leader behaviors were linked empirically to staff nurses' workplace empowerment. METHODS: Staff nurses (n = 537) were surveyed shortly after a merger of two large tertiary hospitals. Structural equation modeling techniques were used to test the proposed model. RESULTS: Leader-empowering behaviors significantly influenced employees perceptions of formal and informal power and access to empowerment structures (information support, resources, and opportunity). Higher perceived access to empowerment structures predicted lower levels of job tension and increased work effectiveness. The amount of explained variance in the final model was 42%. CONCLUSIONS: Support for the model tested in this study highlights the importance of nurse managers' leadership behaviors within current turbulent healthcare organizations.

Adult↗
PubMed1978

The effects of demographic factors, family background, and early job achievement on age at marriage.

National data for ever-married men age 20 to 65 in March 1973 are utilized to estimate least squares and log-linear structural equation models of age at marriage. We demonstrate that most characteristics of family background (including both the family structure and its socioeconomic standing) are irrelevant in their effect on age at marriage. Intercohort trends are not explicable with reference to the changing socioeconomic, ethnic, or nativity compositions of the cohorts. Regional differences in age at marriage have persisted over the years in only slightly diminished form and cannot be explained by reference to the nativity, ethnic, or socioeconomic compositions of the regions. Early job status relates only weakly to age at marriage. Only those activities that are time-consuming or otherwise disruptive of the smooth operation of normal life-cycle processes during the transition from adolescence to adulthood (such as college attendance and service in the military) seriously affect the age at which a man marries.

Achievement↗
PubMedDate not supplied

A structural model of the relationships among stage of disease, age, coping, and psychological adjustment in women with breast cancer.

The present study used structural equation modeling to examine the relationships among disease stage (i.e. Stage II versus Stage IV), age, coping style, and psychological adjustment in 100 women diagnosed with breast cancer. Five separate models were examined: a full model, a mediational model, a demographic-disease model, a coping style model, and a regression model The analyses revealed that the present data best fit the mediational model in which age and stage of disease were not directly associated with psychological adjustment but, instead, were mediated by coping style (chi 2(25) = 45.776, AASR = 0.05, CFI = 0.94). The mediational model accounted for 56% of the variance in psychological adjustment. In particular, the model showed that younger women and women with an earlier disease stage used greater levels of the coping strategy characterized as a fighting spirit and lower levels of the coping strategies characterized as hopelessness/helplessness, anxious preoccupation, and fatalism which, in turn, were related to better psychological adjustment. Overall, these findings may offer an explanation for the conflicting findings regarding the relationship between age, stage of disease, and psychological adjustment to breast cancer by illustrating that coping strategies may be an essential mediating factor; in turn, a mediating model of psychological adaptation may offer useful information for clinicians as they implement interventions designed to improve patients coping efforts.

Adaptation, Psychological↗
PubMed1994

Medical students' motivation for internal medicine.

OBJECTIVE: To verify that motivational concepts tested in other educational settings are relevant to understanding medical students' choice of a career in internal medicine. More specifically, to compare the effects of "facilitating students' interest" versus "controlling students' learning" as educational models during the internal medicine clerkship. DESIGN: An observational retrospective study of 89 fourth-year medical students. Structural equation modeling compared the two models statistically. MAIN OUTCOME MEASURE: Student choice of internal medicine residency. RESULTS: Instructors who supported students' autonomy engendered in students greater feelings of competence and interest in internal medicine than did controlling instructors. Perceived competence further enhanced students' interest in internal medicine. In turn, interest predicted students' choosing an internal medicine residency. Overall, the facilitating students' interest model better explained students' choice of internal medicine than did the controlling students' learning model. CONCLUSIONS: The results verify that the nature of the learning climate during the internal medicine clerkship is an important predictor of students' subsequent pursuit of internal medicine training. Instructors who teach in an autonomy-supportive manner enhance students' perceived competence and interest in internal medicine, which increases the likelihood they will select an internal medicine residency.

Career Choice↗
PubMed1998

Genetic influences on childhood hyperactivity: contrast effects imply parental rating bias, not sibling interaction.

BACKGROUND: Previous twin studies of hyperactivity have supported a 'contrast effect', whereby the more hyperactive the rating of one twin, the less the rating of the other. It has not been clear whether contrast effects occur in the twins' behaviour or in the ratings made of their behaviour but the implications for hyperactivity are different under the two models. METHOD: We use hyperactivity ratings from mothers and teachers for 1644 twin pairs in the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) to explore the origin of contrast effects, making use of independent teacher reports in a proportion of twins. Models were fitted separately for the two informants and jointly to ratings combined through a latent variable, using structural equation modelling. RESULTS: Models for maternal data confirm the contrast effect previously reported. Teacher ratings show a different form of bias, with both twin confusion and correlated errors representing alternative but not mutually exclusive explanations of the data. Latent variable modelling of the joint responses allowed comparison of a model in which the contrast effect was placed on maternal ratings, representing bias, versus one in which the contrast occurred in the underlying 'true' phenotype. The fit of the former model was significantly better. CONCLUSIONS: Support is provided for the notion of contrast effects as a form of rater bias in maternal hyperactivity ratings. Different bias in teacher reports highlight that no one report can be considered a gold standard. The extent to which such biases may distort information for other data sources such as sib-pair studies of concordance/discordance is discussed.

Adolescent↗
PubMed2000

The role of personality, coping style and social support in health-related quality of life in HIV infection.

OBJECTIVE: To determine the role of health status, personality and coping style, on self-report health-related quality of life (QoL). METHODS: Participants were HIV seropositive individuals at all disease stages from three samples (a) gay/bisexual men from the UK, (b) injecting drug users from the UK, (c) injecting drug users from Italy. All participants completed questionnaires evaluating QoL, personality, coping style and social support. Explicit models of the relationships between the measured variables based on a review of the literature were tested using structural equation modelling. RESULTS: Health status was modestly associated with the physical but not the psychological aspects of QoL (beta = 0.44). Neuroticism was strongly associated with psychological QoL (beta = -0.73) but only weakly with physical QoL (beta = -0.21). The samples did not differ in either the pattern or the magnitude of these relationships. Mediating factors such as coping style, social support and other personality variables had only a weak influence on the role of Neuroticism. CONCLUSIONS: Neuroticism had a strong influence on health-related QoL that was independent of health status. Neuroticism was more strongly associated with the psychological aspects of QoL than health status. Coping styles and the other psychological variables assessed had only a weak mediating influence on this relationship.

Adaptation, Psychological↗