Investigating invariant item ordering in the Mental Health Inventory : an illustration of the use of different methods

Invariant item ordering is a property of scales whereby the items are scored in the same order across a wide range of the latent trait and across a wide range of respondents. In the package ‘mokken’ in the statistical software R, the ability to analyse Mokken scales for invariant item ordering has recently been available and techniques for inspecting visually the item response curves of item pairs, have also been included. While methods to assess invariant item ordering are available, there have been indications that items representing extremes of distress in mental well-being scales, such as suicidal ideation, may lead to claiming invariant item ordering where it does not exist. We used the Mental Health Inventory to see if invariant item ordering was indicated in any Mokken scales derived and to see if this was being influenced by extreme items. A Mokken scale was derived indicating invariant item ordering. Visual inspection of the item pairs indicated that the most difficult item (suicidal ideation) was located far from the remaining cluster of items. Removing this item lowered invariant item ordering to an unacceptable level

Violations of local stochastic independence exaggerate scalability in Mokken scaling analysis of the Chinese Mandarin SF-36

Background: Previous work using Mokken scaling analysis with the SF-36 has found subscales appearing to show excellent Mokken scaling properties. However, the values of scalability of the subscales are very large, raising the possibility that these are artificially high and this may result from violations of local stochastic independence between items. Objectives: To analyse selected items from the Chinese Mandarin form of the SF-36 scale using Mokken scaling and to investigate if violations of local stochastic independence exaggerate scalability. Methods: Exploratory Mokken scaling analysis was run using the online public domain software R by entering 19 items from the Chinese Mandarin form of the SF-36 items into the analysis. The items in the resulting scales, judged by the size of Loevinger’s coefficient, were analysed for violations of monotony, 95% confidence intervals and invariant item ordering, including inspection of item pair plots. Results: Two Mokken scales were obtained, one including items from the Physical Functioning subscale, and one including items from the Mental Health subscale of the Chinese Mandarin form of the SF-36. The Physical Functioning scale was very strong according to Loevinger’s coefficient with high invariant item ordering; the Mental Health scale was moderately strong with weak invariant item ordering. Conclusion: The strength of the Physical Functioning Mokken scale derived from the Chinese Mandarin form of the SF-36 is probably the result of an item chain and item overlap which violate local stochastic independence. This is due to the nature of the items in the Physical Functioning subscale, all of which relate to physical ability and some of which can only be achieved if previous items in the subscale have been achieved

The Chinese version of the cardiac depression scale: Mokken scaling

<p>Abstract</p> <p>Background</p> <p>Myocardial infarction is a major cause of death and morbidity in many countries, including China. The aim of this study was to analyse a Mandarin Chinese translation of the Cardiac Depression Scale for a hierarchy of items according to the criteria of Mokken scaling.</p> <p>Findings</p> <p>Data from 438 Chinese participants who completed the Chinese translation of the Cardiac Depression Scale were analysed using the Mokken scaling procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlations between Mandarin Chinese items and Chinese translations of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory were also analysed. Fifteen items from the Mandarin Chinese Cardiac Depression Scale were retained in a weak but reliable Mokken scale; invariant item ordering was evident but of low accuracy and the Mokken scaled items of the Chinese Cardiac Depression Scale correlated with the Hospital Anxiety and Depression Scale and the Beck Depression Inventory.</p> <p>Conclusions</p> <p>Items from the Mandarin Chinese Cardiac Depression Scale form a Mokken scale and this offers further insight into how the items of the Cardiac Depression Scale relate to the measurement of depression in people with a myocardial infarction.</p

Factors deterring dentistry, medical, pharmacy, and social science undergraduates from pursuing nursing as a healthcare career: a cross-sectional study in an Asian university

Background: Globally more registered nurses need to be recruited to meet the needs of aging populations and increased co-morbidity. Nursing recruitment remains challenging when compared to other healthcare programs. Despite healthcare students having similar motivation in joining the healthcare industry, many did not consider nursing as a career choice. This study aims to identify the deterrents to choosing nursing among healthcare undergraduates by examining the differences in the factors influencing healthcare career choices and nursing as a career choice. Methods: A cross sectional study was conducted using a 35-parallel items instrument known as Healthcare Career Choice and Nursing Career Choice scale. Six hundred and four (n = 604) first year medical, pharmacy, dentistry and social science students from a university in Singapore completed the survey. Results: Nursing as a career was perceived by healthcare students to be more likely influenced by prior healthcare exposure, the nature of the work, job prospects, and social influences. Lack of autonomous decision making, perceived lower ability to make diagnosis, having to attend to patients’ hygiene needs, engendered stigma, and lack of parental support were identified as deterring factors to choosing nursing as a career. Conclusion: An understanding of the deterrents to choosing nursing as career allows policy makers and educational leaders to focus on recruitment strategies. These include providing more exposure to nurses’ roles in early school years, helping young people to overcome the fear of providing personal hygiene care, promoting nurses’ autonomous nursing practice, addressing gender stigma, and overcoming parental objection

The Chinese version of the Myocardial Infarction Dimensional Assessment Scale (MIDAS): Mokken scaling

<p>Abstract</p> <p>Background</p> <p>Hierarchical scales are very useful in clinical practice due to their ability to discriminate precisely between individuals, and the original English version of the Myocardial Infarction Dimensional Assessment Scale has been shown to contain a hierarchy of items. The purpose of this study was to analyse a Mandarin Chinese translation of the Myocardial Infarction Dimensional Assessment Scale for a hierarchy of items according to the criteria of Mokken scaling. Data from 180 Chinese participants who completed the Chinese translation of the Myocardial Infarction Dimensional Assessment Scale were analysed using the Mokken Scaling Procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlation between Mandarin Chinese items and a Chinese translation of the Short Form (36) Health Survey was also analysed.</p> <p>Findings</p> <p>Fifteen items from the Mandarin Chinese Myocardial Infarction Dimensional Assessment Scale were retained in a strong and reliable Mokken scale; invariant item ordering was not evident and the Mokken scaled items of the Chinese Myocardial Infarction Dimensional Assessment Scale correlated with the Short Form (36) Health Survey.</p> <p>Conclusions</p> <p>Items from the Mandarin Chinese Myocardial Infarction Dimensional Assessment Scale form a Mokken scale and this offers further insight into how the items of the Myocardial Infarction Dimensional Assessment Scale relate to the measurement of health-related quality of life people with a myocardial infarction.</p

Sleep quality, social rhythms, and depression among people living with HIV: a path analysis based on social zeitgeber theory

BackgroundPeople living with HIV frequently report sleep disturbances. The social zeitgeber theory, which proposes that stressful life events can interfere with sleep and even depression by destabilizing daily routines, provides new insights into identifying predictors of sleep disturbances and improving sleep in people living with HIV.ObjectiveTo explain the pathways affecting sleep quality in people living with HIV based on social zeitgeber theory.MethodsA cross-sectional study was conducted to assess sleep quality, social rhythms, depression, social support, and coping styles from December 2020 to February 2021. The hypothetical model was tested and respecified by performing path analysis and a bias-corrected bootstrapping method using IBM AMOS 24 software. The report of this study followed the STROBE checklist.ResultsA total of 737 people living with HIV participated in the study. The final model presented a good fit (goodness of fit = 0.999, adjusted goodness of fit index = 0.984, normed fit index = 0.996, comparative fit index = 0.998, Tucker–Lewis index = 0.988, root mean square error of approximation = 0.030, chi-squared/degree of freedom = 1.646), explaining 32.3% of the variance in sleep quality among people living with HIV. Lower social rhythm stability was directly associated with poorer sleep quality, and depression mediated the relationship between social rhythms and sleep quality. Social support and coping styles affected sleep quality through social rhythms and depression.LimitationThe cross-sectional study design precludes making assumptions about causality among factors.ConclusionThis study validates and extends the applicability of the social zeitgeber theory in the HIV context. Social rhythms have direct and indirect effects on sleep. Social rhythms, sleep, and depression is not simply linked in a cascading sequence but is theoretically linked in a complex way. More studies are needed to explore the predictors of social rhythms, and interventions for stabilizing social rhythms have the potential to alleviate sleep disturbances and depression in people living with HIV

Evaluation of LOXL1 polymorphisms in exfoliation syndrome in a Chinese population

Purpose: To evaluate the association profiles of the lysyl oxidase-like 1 (LOXL1) gene polymorphisms with exfoliation syndrome in a Chinese population. Methods: Fifty unrelated patients with exfoliation syndrome and 125 control subjects were included. Genotypes of the three single nucleotide polymorphisms (SNPs) of LOXL1 (rs1048661, rs3825942, and rs2165241) were analyzed by direct sequencing, and a case-control association study was performed. Results: The three SNPs were significantly associated with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG) individually. After controlling for rs3825942 and rs2165241, the association between rs1048661 and XFS/XFG remained significant (p=3.6x10(-7)). At this SNP, the T allele and TT genotype conferred a 7.59-(95% confidence interval [CI]: 3.87-14.89, p=6.95x10(-11)) and 8.69-(95% CI: 4.15-18.20, p&lt;1.00x10(-7)) fold increased risk to the disease. The alleles of T at rs1048661 and C at rs2165241 were found to be risk alleles in Chinese subjects, which were opposite to Caucasian individuals. The haplotypes T-G, defined by SNPs rs1048661 and rs3825942, and T-C by SNPs rs1048661 and rs2165241, were also significantly associated with the disorder. However when the genotypic or allelic frequencies of the three SNPs were compared between XFS and XFG, no significant difference was detected. Conclusions: LOXL1 is a susceptibility gene of XFS/XFG in the Chinese population, and the association is mainly attributed to SNP rs1048661. The risk alleles of rs1048661 and rs2165241 in Chinese subjects were found to be opposite to that of Caucasians. The genotypic and allelic distributions of these SNPs are similar between XFS and XFG.Biochemistry &amp; Molecular BiologyOphthalmologySCI(E)30ARTICLE250-522349-23571

SFI, a sex hormone binding globulin based nomogram for predicting non-alcoholic fatty liver disease in the Chinese population

BackgroundThe purpose of this study is to establish a novel nomogram model for accurate detection of non-alcoholic fatty liver disease (NAFLD) in the Chinese population based on sex hormone binding globulin (SHBG) and other routine laboratory tests.MethodsA total of 1417 participants (1003 testing and 414 validations) were enrolled into the study. Risk factors independently associated with NAFLD were identified and incorporated in the new nomogram, SFI. The performance of nomogram was assessed by analysis of receiver operating characteristic (ROC) curve, calibration curve, and decision curve.ResultsWe formulated a new nomogram incorporating four independent factors: SHBG, body mass index (BMI), ALT/AST, and triglycerides (TG). The nomogram achieved good indexes of area under ROC 0.898 (95% confidence interval 0.865–0.926) in predicting NAFLD, which was significantly superior to previously reported models of FLI, HSI, LFS, and LAP. The calibration curve and decision curve demonstrated high performance and clinical utility of the nomogram in predicting NAFLD.ConclusionThe nomogram SFI has high performance in predicting NAFLD in Chinese population and may be used as a cost-effective screening model to assess NAFLD in the general population