Category: Statistics

PLoS One. 2023 Apr 11;18(4):e0283963. doi: 10.1371/journal.pone.0283963. eCollection 2023.

ABSTRACT

BACKGROUND: The factors influencing tourist loyalty are widely highlighted in the literature. However, we find that the relationship between some influencing factors and loyalty is still inconsistent, and we don’t yet know the strength and magnitude of the relationships. To address this issue, this study examined a meta-analysis of the five factors (satisfaction, motivation, perceived value, perceived quality, and experience quality) influencing tourist loyalty and its sub-dimensions.

METHODS: The samples included articles from major academic databases, including Web of Science, Wiley Online, EBSCO, SAGE, Taylor and Francis, and Elsevier. Studies written in Chinese were retrieved from CNKI.com. We used the following keywords for retrieval: loyalty, behavioral intention, recommendation intention, word-of-mouth, revisit intentions, intention to revisit, willingness to recommend, and similar related terms. Conceptual and empirical studies published between January 1989 and September 2021 were extracted. To test whether there was publication bias, we used Fail-Safe-Number (FSN) to verify the stability of the results. The homogeneity test of the selected statistical model was based on the Q test and I2. The results were obtained by combining multiple single effect values into the combined effect value.

RESULTS: We developed 21 hypotheses and proposed a theoretical framework and analyzed 114650 accumulated sample sizes from 242 independent empirical studies. Among the 21 hypotheses proposed in this paper, the remaining 20 hypotheses have been proved except for hypothesis H6.

CONCLUSIONS: The findings showed that the five factors had varying degrees of positive and significant relationships with tourist loyalty and its sub-dimensions. In the descending order of effects, the five factors are degree of satisfaction, quality of experience, perceived value, perceived quality and motivation. We discussed the significance of the meta-analysis, theoretical and practical implications for destination marketing.

PMID:37040349 | DOI:10.1371/journal.pone.0283963

Am J Audiol. 2023 Apr 11:1-5. doi: 10.1044/2023_AJA-22-00195. Online ahead of print.

ABSTRACT

PURPOSE: When a bilateral evaluation is conducted with the integrated speech protocol described in Punch and Rakerd (2019), testing for the first ear concludes with a measurement of the uncomfortable loudness level for speech (UCL). The purpose of this study was to assess the possibility that exposure to the high speech intensities required for that UCL test might bias the subsequent measurement of a listener’s most comfortable loudness level for speech (MCL) in the opposite ear.

METHOD: Across 32 test runs, the left and right ear MCLs were established for 16 young adult listeners with normal hearing (five women, 11 men). The MCL assessed on each test run was measured twice. The first measurement was made at the start of the run and before a full integrated speech evaluation was conducted in the opposite ear (pretest); the second was made after that evaluation (posttest).

RESULTS: The difference between the MCL means measured on the pretest (37.7 dB) and the posttest (38.5 dB) was less than 1 dB, and it did not approach statistical significance, t(15) = 0.69, p = .50.

CONCLUSIONS: There was no evidence that UCL testing done in one ear on a bilateral speech test will have carryover effects that bias the subsequent measurement of a listener’s MCL in the other ear. The results, therefore, support the potential clinical use of an integrated protocol when conducting bilateral speech audiometric evaluations.

PMID:37040328 | DOI:10.1044/2023_AJA-22-00195

J Speech Lang Hear Res. 2023 Apr 11:1-14. doi: 10.1044/2023_JSLHR-22-00201. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the acoustic changes in vowel production with different forms of auditory feedback via cochlear implant (CI), hearing aid (HA), and bimodal hearing (CI + HA).

METHOD: Ten post-lingually deaf adult bimodal CI users (aged 50-78 years) produced English vowels /i/, /ɛ/, /æ/, /ɑ/, /ʊ/, and /u/ in the context of /hVd/ during short-term use of no device (ND), HA, CI, and CI + HA. Segmental features (first formant frequency [F ₁], second formant frequency [F ₂], and vowel space area) and suprasegmental features (duration, intensity, and fundamental frequency [f _o]) of vowel production were analyzed. Participants also categorized a vowel continuum synthesized from their own productions of /ɛ/ and /æ/ using HA, CI, and CI + HA.

RESULTS: F ₁s of all vowels decreased; F ₂s of front vowels but not back vowels increased; vowel space areas increased; and vowel durations, intensities, and f _os decreased with statistical significance in the HA, CI, and CI + HA conditions relative to the ND condition. Only f _os were lower, and vowel space areas were larger with CI and CI + HA than with HA. Average changes in f _o, intensity, and F ₁ from the ND condition to the HA, CI, and CI + HA conditions were positively correlated. Most participants did not show a typical psychometric function for vowel categorization, and thus, the relationship between vowel categorization and production was not tested.

CONCLUSIONS: The results suggest that acoustic, electric, and bimodal hearing have a measurable impact on vowel acoustics of post-lingually deaf adults when their hearing devices are turned on and off temporarily. Also, changes in f _o and F ₁ with the use of hearing devices may be largely driven by changes in intensity.

PMID:37040323 | DOI:10.1044/2023_JSLHR-22-00201

Lang Speech Hear Serv Sch. 2023 Apr 11:1-15. doi: 10.1044/2023_LSHSS-22-00116. Online ahead of print.

ABSTRACT

PURPOSE: Developmental language disorder (DLD) is a relatively new, internationally promoted term to describe individuals with language impairments not secondary to a biomedical condition. This study aimed to better understand speech-language pathologists’ (SLPs’) current level of comfort using DLD terminology and knowledge of DLD in the United States to help SLPs better understand how and why they should consider adopting DLD terminology in their clinical practice.

METHOD: After completing an online presurvey to evaluate current comfort levels in using DLD terminology and current knowledge of DLD, currently practicing SLPs viewed a 45-min prerecorded educational video on DLD. Following this viewing, participants completed a postsurvey nearly identical to the presurvey to measure change in their comfort levels with DLD terminology use and in DLD knowledge.

RESULTS: After filtering to remove likely fraudulent responders, we included 77 participants in all analyses. Presurvey Likert scale responses indicated at least some comfort in using DLD terminology. Additionally, presurvey results of true/false DLD knowledge questions revealed high variability in respondents’ knowledge of DLD. A McNemar chi-square test indicated statistically significant changes in participants’ comfort levels in using DLD terminology from pre- to postsurvey for each question. A paired t test indicated statistically significant changes in DLD knowledge from pre- to postsurvey.

CONCLUSION: Despite some limitations, it was concluded that diffusion efforts, such as educational presentations, are likely to increase SLPs’ comfort levels in using DLD terminology and SLPs’ knowledge of DLD.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22344349.

PMID:37040315 | DOI:10.1044/2023_LSHSS-22-00116

J Palliat Med. 2023 Apr 11. doi: 10.1089/jpm.2022.0268. Online ahead of print.

ABSTRACT

Background: Early advance care planning (ACP) conversations are essential to deliver patient-centered care. While primary care is an ideal setting to initiate ACP, such as Serious Illness Conversations (SICs), many barriers exist to implement such conversations in routine practice. An interprofessional team approach holds promises to address barriers. Objective: To develop and evaluate SIC training for interprofessional primary care teams (IP-SIC). Design: An existing SIC training was adapted for IP-SIC and then implemented and evaluated for acceptability and effectiveness. Setting/Context: Interprofessional teams in 15 primary care clinics in five US states. Measures: Acceptability of the IP-SIC training and participants’ self-reported likelihood to engage in ACP after the training. Results: The 156 participants were a mix of physicians and advanced practice providers (APPs) (44%), nurses and social workers (31%), and others (25%). More than 90% of all participants rated the IP-SIC training positively. While nurse/social worker and other groups were less likely than physician and APP group to engage in ACP before training (4.4, 3.7, and 6.4 on a 1-10 scale, respectively), all groups showed significant increase in likelihood to engage in ACP after the IP-SIC training (8.5, 7.7, and 9.2, respectively). Both physician/APP and nurse/social worker groups showed significant increase in likelihood to use the SIC Guide after the IP-SIC training, whereas an increase in likelihood to use SIC Guide among other groups was not statistically significant. Conclusion: The new IP-SIC training was well accepted by interprofessional team members and effective to improve their likelihood to engage in ACP. Further research exploring how to facilitate collaboration among interprofessional team members to maximize opportunities for more and better ACP is warranted. ClinicalTrials.gov ID: NCT03577002.

PMID:37040304 | DOI:10.1089/jpm.2022.0268

J Nerv Ment Dis. 2023 Apr 11. doi: 10.1097/NMD.0000000000001653. Online ahead of print.

ABSTRACT

Suicide rates differ over time. Our objective was to determine when significant changes occurred by age, race, and ethnicity in the United States between 1999 and 2020. National Center for Health Statistics WONDER data were used in joinpoint regression. The annual percent change in suicide rate increased for all race, ethnic, and age groups, except for those 65 years and older. For American Indian/Alaska Natives, the largest increase occurred between 2010 and 2020 for those with ages 25 to 34 years. For Asian/Pacific Islander, the largest increase occurred among those 15 to 24 years old between 2011 and 2016. For Black/African-Americans, the largest increases occurred between 2010 and 2020 among 15- to 34-year-olds. For Whites, the largest increase occurred between 2014 and 2017 among 15- to 24-year-olds. Between 2018 and 2020, suicide rates significantly declined among Whites 45 to 64 years of age. Among Hispanics, significant increases in suicide rate occurred between 2012 and 2020 among those with ages 15 to 44 years. Between 1999 and 2020, the contour of suicide burden varied by age groups, race, and ethnicity.

PMID:37040181 | DOI:10.1097/NMD.0000000000001653

JMIR Res Protoc. 2023 Apr 11;12:e43193. doi: 10.2196/43193.

ABSTRACT

BACKGROUND: Anxiety and depression are common in the perinatal period and negatively affect the health of the mother and baby. Our group has developed “Happy Mother-Healthy Baby” (HMHB), a cognitive behavioral therapy-based psychosocial intervention to address risk factors specific to anxiety during pregnancy in low- and middle-income countries (LMICs).

OBJECTIVE: The purpose of this study is to examine biological mechanisms that may be linked to perinatal anxiety in conjunction with a randomized controlled trial of HMHB in Pakistan.

METHODS: We are recruiting 120 pregnant women from the Holy Family Hospital, a public facility in Rawalpindi, Pakistan. Participants are assessed for at least mild anxiety symptoms using the Hospital Anxiety and Depression Scale (ie, a score ≥8 on the anxiety scale is necessary for inclusion in the anxiety groups and <8 for inclusion in the healthy control group). Women who meet the criteria for an anxiety group are randomized into either the HMHB intervention group or an enhanced usual care (EUC) control group. Participants receive HMHB or EUC throughout pregnancy and undergo blood draws at 4 time points (baseline, second trimester, third trimester, and 6 weeks post partum). We will assess peripheral cytokine concentrations using a multiplex assay and hormone concentrations using gas chromatography and mass spectrometry. The statistical analysis will use generalized linear models and mixed effects models to assess the relationships across time among anxiety, immune dysregulation, and hormone levels, and to assess whether these biological factors mediate the relationship between anxiety and birth and child development outcomes.

RESULTS: Recruitment started on October 20, 2020, and data collection was completed on August 31, 2022. The start date for recruitment for this biological supplement study was delayed by approximately half a year due to the COVID-19 pandemic. The trial was registered at ClinicalTrials.gov (NCT03880032) on September 22, 2020. The last blood samples were shipped to the United States on September 24, 2022, where they will be processed for analysis.

CONCLUSIONS: This study is an important addition to the HMHB randomized controlled trial of an intervention for antenatal anxiety. The intervention itself makes use of nonspecialist providers and, if effective, will represent an important new tool for the treatment of antenatal anxiety in LMICs. Our biological substudy is one of the first attempts to link biological mechanisms to antenatal anxiety in an LMIC in the context of a psychosocial intervention, and our findings have the potential to significantly advance our knowledge of the biological pathways of perinatal mental illness and treatment efficacy.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43193.

PMID:37040167 | DOI:10.2196/43193

JMIR Res Protoc. 2023 Apr 11;12:e44275. doi: 10.2196/44275.

ABSTRACT

BACKGROUND: Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods.

OBJECTIVE: We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use.

METHODS: This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated.

RESULTS: Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior.

CONCLUSIONS: Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44275.

PMID:37040162 | DOI:10.2196/44275

Ned Tijdschr Tandheelkd. 2023 Apr;130(4):173-181. doi: 10.5177/ntvt.2023.04.23004.

ABSTRACT

This study investigated the effect of initial nonsurgical treatment in patients with peri-implantitis with or without prescription of an antibiotic regimen consisting of amoxicillin and metronidazole. For this purpose, patients with peri-implantitis were randomized into a group of initial treatment with antibiotics and a group without antibiotics. They were re-evaluated 12 weeks after treatment. Analyses were performed at the patient level at 1 peri-implant pocket per patient. Both groups showed significant peri-implant pocket depth reductions after initial treatment. Treatment with antibiotics resulted in a higher mean reduction in peri-implant pocket depth than when no antibiotics were used, but this difference did not reach statistical significance. Only 2 implants, 1 in each group, showed a successful outcome of a peri-implant pocket depth ofunder ≤ 5 mm and with an absence of bleeding and pus after probing. Initial treatment with or without antibiotics is ultimately not sufficient to fully treat peri-implantitis; additional surgical procedures will often be required.

PMID:37040152 | DOI:10.5177/ntvt.2023.04.23004

J Nerv Ment Dis. 2023 May 1;211(5):386-392. doi: 10.1097/NMD.0000000000001618.

ABSTRACT

In the early 1990s, a research group that included Holly Prigerson and Charles Reynolds established that disordered grief overlaps with depression and anxiety but is not the same. They also developed a research inventory for studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniques. Because treatment for grief-related depression reduced symptoms of depression but not grief, Katherine Shear was recruited to develop a more effective therapy. Prigerson came to conceptualize disordered grief as prolonged grief that is associated with negative outcomes. Shear came to conceptualize disordered grief as intense grief that is complicated by features that interfere with adaption to the loss. In 2013 a hybrid disorder composed of criteria from both groups was placed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) appendix. Under the leadership of the DSM Steering Committee, a summit meeting in 2019 helped break an impasse, and a revised prolonged grief disorder became an official DSM diagnosis.

PMID:37040140 | DOI:10.1097/NMD.0000000000001618