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Is there a gender difference in a factorial structure of the positive and negative syndrome scale? A test by structural equation modeling.

By means of the multisample structured means strategy, we examined gender differences in a five-factorial structure model of Positive and Negative Syndrome Scale (PANSS) ratings of 308 patients of both sexes with DSM-IV schizophrenia with comparable age at investigation and overall symptomatic severity across sex. The test indicated that the factors and component symptoms were common across sex, whereas the factor loadings might be different. However, the model that incorporated the difference in the factor loadings did not improve model fit indices. Therefore, it is concluded that this investigation elicited only minimal gender differences, and on the whole confirmed the PANSS five-factor structure for both sexes.

Adult↗

Determinants of work injuries in mines - an application of structural equation modelling.

In spite of stringent regulations and much attention towards reducing risks in the physical environment, the mining industry continues to be associated with high levels of accidents, injuries and illnesses. Only engineering solutions to accident prevention are inappropriate unless coupled with focused attention to the attitudes and behaviours of the mineworkers in coping with the inherent physical, technical and situational risks. The present study identified these various risk factors and analysed their influences on work injury in a causal framework. Data were collected from an underground coalmine of India. The pattern and strength of relationships of 16 causal factors with work injuries were assessed through structural equation modelling. The case study results showed that negatively personified individuals are of major concern for safety improvement in the mine studied. They not only fail to avoid work injuries, they are unable to extend safe work behaviours in their work. The variable safety environment is negatively affected by personality, whereas social support has a positive relationship with safety environment. The variable job hazards appeared to have a significant relationship with job involvement, which has a negative relationship with work injury. Elimination of negative behaviours must be focused and committed by the mine safety management. Long term planning through (i) identification of negative individuals, (ii) proper councelling of adverse effects of negative behaviours, and (iii) special training with psychological treatment is highly required. Identification may begin while recruiting new workers through interview. Proper allocation of jobs (right person for right job) may be a judicial solution to this end.

Accidents, Occupational↗

Using structural equation model to illustrate the relationship between metabolic risk factors and cardiovascular complications in Taiwan.

BACKGROUND: The objective of this study was to perform a population-based screening programme to determine the prevalence of the metabolic syndrome (MetS) and the relationship between metabolic risk factors and prevalent cardiovascular complications in Taiwan. DESIGN: A screening programme recruited residents aged 40 years and older in Sanchih, Taipei County, Taiwan, and collected demographic data, blood and urine samples. Fasting plasma glucose level, serum total cholesterol, high-density lipoprotein cholesterol, and triglyceride were measured. Atherosclerotic complications, including myocardial infarction, stress-positive angina, ischaemic stroke, and proteinuria were confirmed. METHODS: A structural equation model (SEM) was constructed to identify the association between metabolic abnormality and atherosclerosis. RESULTS: A total of 1494 subjects, 776 male and 718 female, were recruited in this study. The crude prevalence of the MetS was 19.3% for men [95% confidence interval (CI) 16.3-22.2%] and 18.7% for women (95% CI 15.6-22.0%). The presence of the MetS posed a substantial risk to microvascular complications in both sexes [odds ratio (OR) 3.29, P<0.001] and to macrovascular complications in men (OR 1.95, P=0.04) and also a trend in women (OR 2.24, P=0.089). There was a positive association between metabolic abnormality and atherosclerosis (B=0.55, P<0.001). CONCLUSIONS: This study has found the prevalence of the MetS and the association with atherosclerotic complications in Taiwan. The SEM approach has demonstrated a positive correlation between metabolic abnormality and atherosclerosis and can be used to explore new risk factors for cardiovascular diseases.

Adult↗

Assessing the working memory network: studies with functional magnetic resonance imaging and structural equation modeling.

A considerable body of evidence supports the notion that the neurofunctional substrate of working memory is not only related to the integrity of the prefrontal cortex, but also to the concerted interplay of widespread interacting networks including the parietal cortex, subcortical regions and cerebellar areas. Modern functional brain imaging techniques such as functional magnetic resonance imaging (fMRI) have provided a detailed picture of functional neuroanatomy subserving working memory functions. Most of the earlier functional studies were directed toward the identification of brain areas subserving specific cognitive domains in terms of a functional segregation. More recently, different multivariate techniques were employed to specifically address measures of functional or effective connectivity. Structural equation modeling (SEM) or path analysis is one of the most often used methods to model interactions among covarying brain areas in an explicitly model-based approach. The present review will focus on basic methodological issues of SEM for the analysis of fMRI datasets in studies of working memory. Aside from a discussion of previous studies and their essential findings, advanced methodological issues and caveats as well as future perspectives of the method will be addressed.

Brain↗

The structural equation modeling technique did not show a response shift, contrary to the results of the then test and the individualized approaches.

BACKGROUND AND OBJECTIVE: Persons experiencing changes in their physical health may change their values and rerate the importance of basic elements of health-related quality of life (HRQL), a process known as response shift. Developing an estimator of HRQL that differentiates between objective change and response shift is essential for the interpretation of the results. The purpose of the present article was to contrast three methodologic approaches for evaluating response shift to develop a proposed set of HRQL measurement recommendations under circumstances where response shift is expected to occur. METHODS: The three approaches compared were a structural equation modeling (SEM) technique, the then test, and an individualized approach. The data collection procedures for these methods were incorporated into a poststroke randomized controlled trial. RESULTS: The SEM did not show a response shift, contrary to the results of the then test and the individualized approaches. We discuss factors that effect the selection of a methodologic approach including feasibility, subjects' memory and more advanced cognitive tasks, and whether response shift was evaluated at the group or individual level. CONCLUSION: The evaluation of response shift is an integral part of HRQL evaluations, and further comparisons between methodologic approaches are needed.

Activities of Daily Living↗

Physicians' perceptions of managed care: a structural equation model assessment of key dimensions.

OBJECTIVES: To assess the interrelationship of physicians' own interest with that of the methods and the anticipated benefits of managed care, the authors developed a new instrument to assess physician's perception of job satisfaction, risk, need to adapt their practice behavior, quality of care, cost of care, and access under managed care. METHODS: One hundred sixty-one attending physicians of an urban public hospital in a metropolitan area with low to moderate managed care penetration participated. A 24-item questionnaire with good psychometric properties was developed based on literature reviews, qualitative interviews with the key informants, and focus group discussion among a group of selected physician representatives. Confirmatory factory analysis and structural equation models were applied. RESULTS: The study reveals that when physicians perceived that high job satisfaction would ensue, they also perceived that quality and access to care would improve under managed care. Physician's perception of the need to modify their practice behavior was associated with a perception of increasing the cost of care. Risk sharing, from the physician's perspective, did not translate to cost savings as expected by managed care organizations, and only resulted in a fractional improvement on a perception of quality and access of care. CONCLUSIONS: Although this study reports the perceptions of a small group of physicians from a single hospital, the data suggest that increasing quality and decreasing cost may be included in the same equation, if physician job satisfaction also is included through organizational support and user-friendly work environment.

Adult↗

Estimation of the effective and functional human cortical connectivity with structural equation modeling and directed transfer function applied to high-resolution EEG.

Different brain imaging devices are presently available to provide images of the human functional cortical activity, based on hemodynamic, metabolic or electromagnetic measurements. However, static images of brain regions activated during particular tasks do not convey the information of how these regions are interconnected. The concept of brain connectivity plays a central role in the neuroscience, and different definitions of connectivity, functional and effective, have been adopted in literature. While the functional connectivity is defined as the temporal coherence among the activities of different brain areas, the effective connectivity is defined as the simplest brain circuit that would produce the same temporal relationship as observed experimentally among cortical sites. The structural equation modeling (SEM) is the most used method to estimate effective connectivity in neuroscience, and its typical application is on data related to brain hemodynamic behavior tested by functional magnetic resonance imaging (fMRI), whereas the directed transfer function (DTF) method is a frequency-domain approach based on both a multivariate autoregressive (MVAR) modeling of time series and on the concept of Granger causality. This study presents advanced methods for the estimation of cortical connectivity by applying SEM and DTF on the cortical signals estimated from high-resolution electroencephalography (EEG) recordings, since these signals exhibit a higher spatial resolution than conventional cerebral electromagnetic measures. To estimate correctly the cortical signals, we used a subject's multicompartment head model (scalp, skull, dura mater, cortex) constructed from individual MRI, a distributed source model and a regularized linear inverse source estimates of cortical current density. Before the application of SEM and DTF methodology to the cortical waveforms estimated from high-resolution EEG data, we performed a simulation study, in which different main factors (signal-to-noise ratio, SNR, and simulated cortical activity duration, LENGTH) were systematically manipulated in the generation of test signals, and the errors in the estimated connectivity were evaluated by the analysis of variance (ANOVA). The statistical analysis returned that during simulations, both SEM and DTF estimators were able to correctly estimate the imposed connectivity patterns under reasonable operative conditions, that is, when data exhibit an SNR of at least 3 and a LENGTH of at least 75 s of nonconsecutive EEG recordings at 64 Hz of sampling rate. Hence, effective and functional connectivity patterns of cortical activity can be effectively estimated under general conditions met in any practical EEG recordings, by combining high-resolution EEG techniques and linear inverse estimation with SEM or DTF methods. We conclude that the estimation of cortical connectivity can be performed not only with hemodynamic measurements, but also with EEG signals treated with advanced computational techniques.

Adult↗

An investigation of factors influencing patients' use of new complete dentures using structural equation modelling techniques.

UNLABELLED: A review of the literature demonstrated that research had not identified a set of prognostic indicators for prospective complete denture patients, with different authors publishing contradictory results. OBJECTIVE: To investigate possible relationships between patient and clinical factors and denture wear and use of dentures for eating. METHODS: Patients attending Guy's Dental Hospital, London, for provision of complete dentures were recruited. For each patient relevant history was recorded and an examination of the edentulous mouth and existing dentures, where present, was undertaken at the beginning of treatment. At the first post-insertion appointment the edentulous mouth, previous and new dentures were examined. Three months after the review appointment patients were sent a postal questionnaire to assess patient use of dentures and patient satisfaction. Data were analysed using structural equation modelling techniques. RESULTS: 723 patients were recruited. Significant relationships were found between quality of complete dentures and patients' use of complete dentures and between quality of residual edentulous ridges and patients' use of complete dentures. These results contrast with most previous research into prognostic indicators for success in complete denture treatments. CONCLUSIONS: Quality of residual edentulous ridges and quality of new complete dentures predict patients' use of new complete dentures.

Aged↗

Otitis media, fluctuant hearing loss, and speech-language outcomes: a preliminary structural equation model.

The goals of this study were to estimate the risk for lowered speech-language outcomes associated with early recurrent otitis media with effusion (OME) with and without hearing loss and to develop a preliminary descriptive-explanatory model for the findings. Three statistical approaches were used to assess associations among OME, hearing loss, and speech-language outcomes. Participants were a subsample of 70 children followed prospectively in the Dallas Cooperative Project on Early Hearing and Language Development (Friel-Patti & Finitzo, 1990). Findings indicated that hearing levels at 12-18 months were significantly associated with speech delay and low language outcomes at 3 years of age. The risk for subclinical or clinical speech delay at 3 years of age was 2% for children with less than 20 dB average hearing levels at 12-18 months and 33% for children with greater than 20 dB average hearing levels at 12-18 months. A structural equation model (Jöreskog & Sörbom, 1993) indicated that the significant and substantial effects of hearing levels at 12-18 months on speech status at 3 years were significantly mediated by language status at 3 years. Discussion includes implications of these findings for alternative speech perception models linking early OME and hearing loss to later speech-language disorder.

Child, Preschool↗

Relationships between thought-action fusion, thought suppression and obsessive-compulsive symptoms: a structural equation modeling approach.

Research has shown that there are strong similarities in content between the obsessions and compulsions that characterize obsessive-compulsive disorder and nonclinical obsessions and compulsions. However, clinical and nonclinical obsessions and compulsions do differ with respect to characteristics like frequency, intensity, discomfort and elicited resistance. Two separate concepts have been invoked to explain how normal obsessions and compulsions may develop into clinical phenomena. First, it is suggested that thought-action fusion (TAF) contributes to obsessive-compulsive symptoms. Second, thought suppression may intensify obsessive-compulsive symptoms due to its paradoxical effect on intrusive thoughts. Although both phenomena have been found to contribute to obsessive-compulsive symptoms, possible interactions between these two have never been investigated. The current study explored how TAF and thought suppression interact in the development of obsessive-compulsive symptoms. Undergraduate psychology students (N = 173) completed questionnaires pertaining to TAF, thought suppression and obsessive-compulsive symptoms. Covariances between the scores on these questionnaires were analyzed by means of structural equation modeling. Results suggest that TAF triggers thought suppression, while thought suppression, in turn, promotes obsessive-compulsive symptoms.

Adolescent↗

The developmental antecedents of sexual coercion against women: testing alternative hypotheses with structural equation modeling.

A unified model of the origin of sexual aggression against women on both adult and juvenile sexual offender samples has been developed and successfully tested. This model proposed three major causal paths to sexual coercion against women. In the first path, physical and verbal abuse was hypothesized to produce callousness and lack of emotionality, which disinhibited sexual drive and sexual fantasies. These in turn disinhibited hostile sexual fantasies, and led to sexual coercion. In the second causal path, sexual abuse contributed directly to the disinhibition of sexual drive and sexual fantasies, which through hostile sexual fantasies led to sexual coercion. The third path operated through early antisocial behavior, including aggressive acts. It developed as a result of both physical/verbal abuse and callousness/lack of emotion. It in turn directly affected sexual coercion and worked indirectly through the hostile sexual fantasies path. In the present study, the anonymous responses of a group of 168 blue-collar, community males to an inventory (the Multidimensional Assessment of Sex and Aggression) were used in a structural equation model to test the validity of this model. Moreover, this model was pitted against (Malamuth's (1998)) two-path model. Whereas the three-path model had an excellent fit with the data (CFI =.951, RMSEA =.047), the two-path model fit less well (CFI =.857, RMSEA =.079). These results indicate the superiority of the three-path model and suggest that it constitutes a solid, empirically disconfirmable heuristic for the etiology of sexual coercion against women.

Adolescent↗

Altered effective connectivity during working memory performance in schizophrenia: a study with fMRI and structural equation modeling.

The present study aimed to explore altered effective connectivity in schizophrenic patients while performing a 2-back working memory task. Twelve right-handed, schizophrenic patients treated with typical or atypical antipsychotics and 6 healthy control subjects were studied with fMRI while performing a "2-back" working memory task. Effective connectivity within a cortical-subcortical-cerebellar network for mnemonic information processing was assessed and compared between both groups. The path model included cortico-cortical connections comprising the parietal association cortex, ventrolateral prefrontal cortex (VLPFC), and the dorsolateral prefrontal cortex (DLPFC) as well as a cortico-cerebellar feedback loop comprising prefrontal cortex, contralateral cerebellum, and thalamus. Group differences were analyzed with a stacked models approach. Relative to normal controls, both patient groups revealed a pattern of reduced connectivity within the prefrontal-cerebellar and the cerebellar-thalamic limbs but enhanced connectivity in the thalamo-cortical limb of the cortical-cerebellar circuit. Moreover, a direct comparison of both treatment groups revealed enhanced connectivity in the interhemispheric connections between the cortical association areas in patients treated with atypical antipsychotics. However, right prefrontal and left parieto-frontal path coefficients were lower in the patient group receiving atypical antispychotic drugs. The findings suggest that the relationship between pathology in cortical-subcortical cerebellar networks and associated functional connectivity is complex and may include aspects of increased and decreased levels of connectivity consistent with the notion of "cognitive dysmetria" in schizophrenia. The observed pronounced connectivity within thalamo-cortical projections could be attributed to a compensatory increase of thalamic input in the presence of disrupted effective connectivity within the preceding limb of the cortical-cerebellar circuitry. The study demonstrated the feasibility of structural equation modeling for the investigation of group and treatment-related differences in effective connectivity and provides a promising approach to further disentangle the relationship between altered functional capacity and associated fMRI signal changes.

Adult↗

A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics.

Nonhomosexual male gender dysphorics often make their first requests for clinical assessment when they are in or approaching middle age. This study investigated how well patients' explanations for the timing of these requests fit the objective data. Subjects were 194 outpatients presenting for the first time at a gender identity clinic. Their common explanations for the timing of their requests were incorporated into a formal path model, which was tested using Bentler's structural equations program. The model provided an acceptable fit to the data. The more times a patient has been married and the more children he has fathered, the older he is likely to be when first presenting for clinical attention. This outcome is consistent with the claims of patients that they would have come to a gender clinic sooner if they had not been restrained by commitments to wives and children.

Adolescent↗

An informative Bayesian structural equation model to assess source-specific health effects of air pollution.

A primary objective of current air pollution research is the assessment of health effects related to specific sources of air particles or particulate matter (PM). Quantifying source-specific risk is a challenge because most PM health studies do not directly observe the contributions of the pollution sources themselves. Instead, given knowledge of the chemical characteristics of known sources, investigators infer pollution source contributions via a source apportionment or multivariate receptor analysis applied to a large number of observed elemental concentrations. Although source apportionment methods are well established for exposure assessment, little work has been done to evaluate the appropriateness of characterizing unobservable sources thus in health effects analyses. In this article, we propose a structural equation framework to assess source-specific health effects using speciated elemental data. This approach corresponds to fitting a receptor model and the health outcome model jointly, such that inferences on the health effects account for the fact that uncertainty is associated with the source contributions. Since the structural equation model (SEM) typically involves a large number of parameters, for small-sample settings, we propose a fully Bayesian estimation approach that leverages historical exposure data from previous related exposure studies. We compare via simulation the performance of our approach in estimating source-specific health effects to that of 2 existing approaches, a tracer approach and a 2-stage approach. Simulation results suggest that the proposed informative Bayesian SEM is effective in eliminating the bias incurred by the 2 existing approaches, even when the number of exposures is limited. We employ the proposed methods in the analysis of a concentrator study investigating the association between ST-segment, a cardiovascular outcome, and major sources of Boston PM and discuss the implications of our findings with respect to the design of future PM concentrator studies.

Air Pollution↗

Appropriateness of composites in structural equation models.

The appropriateness of using composites instead of multiple indicators in a structural model of physical health was evaluated. Liang's (1986) specification of self-reported physical health is a relatively complex multiple indicators model which may not be practical in actual application. To simplify this formulation, a two-stage strategy was used. First, reliability was estimated for each composite to fix the measurement error variance and the regression of the composite on the latent variable. Second, the model was reestimated by constraining these parameters. Regression analyses were undertaken to assess the impact of using composites instead of multiple indicators. Parameter estimates for causal linkages and residual error variances based on multiple indicators approach were closely reproduced by using composites, thus providing justification for the proposed strategy.

Activities of Daily Living↗

Personal characteristics of adolescent prostitutes and rearing attitudes of their parents: a structural equation model.

The aim of this study was to investigate the risk factors of family structure, personality traits, and other variables among adolescent prostitutes. The subjects comprised 158 adolescent prostitutes in a halfway house as the case group and 65 high school girls as the control group. Data were collected by using questionnaires about demographic information, the Junior Eysenck Personality Questionnaire and the Parental Bonding Instrument. A high rate of tobacco, alcohol and drug use was found in the case group. Numerous factors distinguished the cause-effect relationship among adolescent prostitutes. Of all risk factors studied, maternal protection, paternal care, neurotic characteristics, tobacco use, discontinuous schooling and a dysfunctional family had the most direct effect. These results provide useful information for the evaluation of and interventions with adolescent prostitution.

Adolescent↗

Normal theory based test statistics in structural equation modelling.

Even though data sets in psychology are seldom normal, the statistics used to evaluate covariance structure models are typically based on the assumption of multivariate normality. Consequently, many conclusions based on normal theory methods are suspect. In this paper, we develop test statistics that can be correctly applied to the normal theory maximum likelihood estimator. We propose three new asymptotically distribution-free (ADF) test statistics that technically must yield improved behaviour in samples of realistic size, and use Monte Carlo methods to study their actual finite sample behaviour. Results indicate that there exists an ADF test statistic that also performs quite well in finite sample situations. Our analysis shows that various forms of ADF test statistics are sensitive to model degrees of freedom rather than to model complexity. A new index is proposed for evaluating whether a rescaled statistic will be robust. Recommendations are given regarding the application of each test statistic.

Humans↗

Communication skills knowledge, understanding and OSCE performance in medical trainees: a multivariate prospective study using structural equation modelling.

AIM: To test the stability of medical student communication skills over a period of 17 months as exhibited by performance in objective structured clinical examinations (OSCEs) and to determine the strength of prediction of these skills by initial levels of knowledge and understanding. DESIGN: This is a prospective study using a 2-wave cohort. PARTICIPANTS: Medical undergraduates (n = 383) from 2 years intake (1996 and 1997) were followed through the first 3 years of a medical curriculum. PROCEDURE: The study procedure involved the objective structured video examination (OSVE) conducted at formative and summative examinations during the first year. Two OSCE measures were employed: expert examiners and simulated patients completed the Liverpool Communication Skills Assessment Scale (LCSAS) and the Global Simulated Patient Rating Scale (GSPRS), respectively. The OSCE data were collected at Level 1 and 17 months later at Level 2 examinations. RESULTS: The measurement model followed prediction. A causal model using latent variables was fitted with Level 2 OSCE performance regressed on Level 1 OSCE and OSVE marks. Expert and simulated patient OSCE data were fitted separately and combined to determine strength of model fit according to professional and patient opinion of student skills. The overall fit of the models was acceptable. Communication skills performance showed a high level of stability. Some negative effect of cognitive factors on future skills performance was found. CONCLUSION: Early development of communication skills shows stable performance following an introductory course. Knowledge of communication skills has a small but significant influence on performance, depending on the time of testing. New assessments of cognitive factors are required to include both tacit and explicit knowledge.

Clinical Competence↗