Psychosocial Stress and Changes in Estimated Glomerular Filtration Rate Among Adults with Diabetes Mellitus

Background: Psychosocial stress has been hypothesized to impact renal changes, but this hypothesis has not been adequately tested. The aim of this study was to examine the relationship between psychosocial stress and estimated glomerular filtration rate (eGFR) and to examine other predictors of eGFR changes among persons with diabetes mellitus (DM). Methods: Data from a survey conducted in 2005 by a major health maintenance organization located in the southeastern part of the United States, linked to patients’ clinical and pharmacy records (n ¼ 575) from 2005 to 2008, was used. Study participants were working adults aged 25–59 years, diagnosed with DM but without advanced microvascular or macrovascular complications. eGFR was estimated using the Modification of Diet in Renal Disease equation. A latent psychosocial stress variable was created from five psychosocial stress subscales. Using a growth factor model in a structural equation framework, we estimated the association between psychosocial stress and eGFR while controlling for important covariates. Results: The psychosocial stress variable was not directly associated with eGFR in the final model. Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure. Conclusion: Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates. Predictors of eGFR change in our population included age, race, insulin use, and mean arterial pressure

Child Care Assistance for Families Involved in the Child Welfare System: Predicting Child Care Subsidy Use and Stability

Early child care and education programs have the potential to play a supportive role in the lives of vulnerable children and families involved in the child welfare system. Child care subsidies can help low-income families to access these programs. The current study examines the use and stability of child care subsidies among children from families involved in the child welfare system. Administrative data were obtained from the Oregon Department of Human Services through two linked datasets: Child Welfare Services and Employment Related Day Care (Oregon's child care subsidy program). Results indicate that children placed out of their biological homes through child welfare services, and those with more instability in child welfare placements, are less likely to receive subsidized child care than those protected in their homes. Findings further suggest that children involved in child welfare services have even less stability in child care subsidy use than other children from low-income families, evidenced by shorter durations of subsidy use. These findings provide a platform for future research in this area, and have implications for the well-being of children and families involved in child welfare services, whose lives involve a host of challenges, risks, and instabilities.Keywords: Child welfare, Child care, Subsidy, Stability, Foster car

Evaluating a Method to Estimate Mediation Effects With Discrete-Time Survival Outcomes

The utility of evaluating mediation effects spans across research domains. The model facilitates investigation of underlying mechanisms of event timing and, as such, has the potential to help strengthen etiological research and inform intervention work that incorporates the evaluation of mediating variables. In order for the analyses to be maximally useful however, it is critical to employ methodology appropriate for the data under investigation. The purpose of this paper is to evaluate a regression-based approach to estimating mediation effects with discrete-time survival outcomes. We empirically evaluate the performance of the discrete-time survival mediation model in a statistical simulation study, and demonstrate that results are functionally equivalent to estimates garnered from a potential-outcomes framework. Simulation results indicate that parameter estimates of mediation in the model were statistically accurate and precise across the range of examined conditions. Type 1 error rates were also tolerable in the conditions studied. Adequate power to detect effects in the model, with binary X and continuous M variables, required effect sizes of the mediation paths to be medium or large. Possible extensions of the model are also considered

Addressing Change Trajectories and Reciprocal Relationships: A Longitudinal Method for Information Systems Research

This paper makes a focused methodological contribution to the information systems (IS) literature by introducing a bivariate dynamic latent difference score model (BDLDSM) to simultaneously model change trajectories, dynamic relationships, and potential feedback loops between predictor and outcome variables for longitudinal data analysis. It will be most relevant for research that aims to use longitudinal data to explore longitudinal theories related to change. Commonly used longitudinal methods in IS research – linear unobserved effects panel data models, structural equation modeling (SEM), and random coefficient models – largely miss the opportunity to explore rate of change, dynamic relationships, and potential feedback loops between predictor and outcome variables while incorporating change trajectories, which are critical for longitudinal theory development. Latent growth models help address change trajectories, but still prevent researchers from using longitudinal data more thoroughly. For instance, these models cannot be used for examining dynamic relationships or feedback loops. BDLDSM allows IS researchers to analyze change trajectories, understand rate of change in variables, examine dynamic relationships between variables over time, and test for feedback loops between predictor and outcome variables. The use of this methodology has the potential to advance theoretical development by enabling researchers to exploit longitudinal data to test change-related hypotheses and predictions rigorously. We describe the key aspects of various longitudinal techniques, provide an illustration of BDLDSM on a healthcare panel dataset, discuss how BDLDSM addresses the limitations of other methods, and provide a step-by-step guide, including Mplus code, to develop and conduct BDLDSM analyses

The Intersection of Alcohol Use, Gender Based Violence and HIV: Empirical Findings among Disadvantaged Service-Seeking Youth in Kampala, Uganda

The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the “Kampala Youth Survey 2014,” a cross-sectional survey conducted in the spring of 2014, consisting of a convenience sample (N = 1134) of urban youth (12–18 years of age). Descriptive statistics were computed for hypothesized risk factors and demographic variables among the 8 typologies of GBV, HIV, and alcohol use. Multinomial logistic regression was conducted to determine statistically significant correlates with each typology. The overall prevalence of GBV was 31.7%, whereas the overall prevalence of alcohol use in the past 12 months was 31.2%. HIV-Positive youth comprised 10.5% of the total sample. Females comprised the majority of the typology with no SAVA components compared to males (55% vs. 45%, respectively), as well as the SAVA syndemic typology (GBV + HIV + ALC +) (58% vs. 42%, respectively). Engaging in commercial sex work (36%), witnessing parental abuse (61%), and depression/suicidality (81%) were all highly prevalent among youth in the SAVA syndemic typology (GBV, HIV, and alcohol use). Sex work and observing parental abuse were associated with the SAVA syndemic typology in the multivariable model. In our study, alcohol rarely coexisted without GBV among the typologies. Therefore, prevention efforts including structural interventions may be particularly warranted in vulnerable populations to address alcohol use, which may directly or indirectly impact GBV and HIV