Multiple imputation of a randomly censored covariate improves logistic regression analysis

Randomly censored covariates arise frequently in epidemiologic studies. The most commonly used methods, including complete case and single imputation or substitution, suffer from inefficiency and bias. They make strong parametric assumptions or they consider limit of detection censoring only. We employ multiple imputation, in conjunction with semi-parametric modeling of the censored covariate, to overcome these shortcomings and to facilitate robust estimation. We develop a multiple imputation approach for randomly censored covariates within the framework of a logistic regression model. We use the non-parametric estimate of the covariate distribution or the semi-parametric Cox model estimate in the presence of additional covariates in the model. We evaluate this procedure in simulations, and compare its operating characteristics to those from the complete case analysis and a survival regression approach. We apply the procedures to an Alzheimer's study of the association between amyloid positivity and maternal age of onset of dementia. Multiple imputation achieves lower standard errors and higher power than the complete case approach under heavy and moderate censoring and is comparable under light censoring. The survival regression approach achieves the highest power among all procedures, but does not produce interpretable estimates of association. Multiple imputation offers a favorable alternative to complete case analysis and ad hoc substitution methods in the presence of randomly censored covariates within the framework of logistic regression.     

‘McDonald’s Is Good for My Social Life’. Developing Health Promotion Together with Adolescent Girls from Disadvantaged Neighbourhoods in Amsterdam

There is limited knowledge about key factors that enable adolescent girls with a low socioeconomic position (SEP) to adopt a healthy lifestyle. This paper aims to better understand the complexity of addressing health behaviour of adolescent girls with a low SEP by gaining insights into (i) the perspectives of adolescent girls with a low SEP (n = 26) on a healthy lifestyle, (ii) how to develop health promotion that fits these girls’ daily realities, by using participatory action research (PAR) in which girls developed health promotion materials. The study offers an understanding of girls’ daily lives and how health promotion could be improved.     

An integrated dietary assessment increases feeding event detection in an urban carnivore

Urban Ecosystems - Urbanisation radically changes habitats and alters available resources. Populations of large, highly mobile species are often extirpated at the urban-wildland interface, while...     

“I can be a mum or a professional,but not both”: What women say about their experiences of juggling paid employment with motherhood

Past research has identified the salience of the notion of “good motherhood” in countries such as Australia, where women are expected to invest significant time and energy, often through self‐sacrifice, to raise their children. We analysed free‐text comments provided in response to an open‐ended question from the Australian Longitudinal Study on Women's Health (ALSWH) to examine whether the discourse of “good motherhood” played any role in how women articulate their experiences of juggling paid employment with motherhood. Eighty women from the cohort born 1973–78 were included, providing 223 comments. “Good motherhood” underpinned many of the accounts about combining motherhood with paid employment. Women reported life as stressful and hectic as they attempted to juggle the demands of childcare with paid employment and domestic chores. Although some identified “good motherhood” as an unachievable ideal, most were largely unable to disengage with this discourse. Broader social structures, such as inflexible working conditions, were found to reinforce and support this ideal, contributing to the strength of the discourse.     

Launching Medical Foster Home Programs: Key Components to Growing This Alternative to Nursing Home Placement

Objective: The objective of this research was to examine and explain elements that enhanced or thwarted program growth of the United States Veterans Health Administration Medical Foster Home program. Methods: This qualitative study was conducted nationally through individual interviews over the phone and in-person (n = 22) with coordinators (n = 15 at slow-growth programs; n = 6 at fast-growth programs), program support assistants (PSAs) (n = 1 at slow-growth program), and home-based primary care team members (n = 3), as well as three in-person focus groups (n = 28 total participants) with home-based primary care team members. All participants (N = 53) were involved with programs in existence for at least two years. Results: Facilitators and barriers that enhanced or thwarted program growth emerged around four themes: A full-time coordinator; Unmitigated home-based primary care team engagement; Pursuit and receipt of appropriate referrals; and Match between caregiver, home, and Veteran. Conclusions: To facilitate program growth, program leaders should consider themes identified and how to foster situations and shape policies that put themes into practice.     

Promoting walking among older adults living in retirement communities

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.     

Successful aging: how does physical activity influence engagement with life?

With the increasing number of individuals over the age of 65?years worldwide, it is critical for society to recognize the importance of helping seniors maintain their health, physical, and cognitive functioning as well as their engagement with life. These three dimensions provide the foundation for successful aging (SA). The positive role of engagement with life has been understated to date in the literature. This review highlights the components of SA with particular emphasis on engagement and how physical activity positively impacts engagement which in turn positively influences health and physical function.     

Exploring the relationship between experiential avoidance, alcohol use disorders, and alcohol-related problems among first-year college students

Abstract Objective: This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems. Participants: Cross-sectional data were collected from 240 undergraduate college students in their first year in college between December 2009 and April 2010. Methods: Participants completed a diagnostic interview and online self-report survey. Results: Students with a history of alcohol abuse or dependence had significantly higher levels of experiential avoidance relative to students with no alcohol use disorder diagnosis. A hierarchical linear regression analysis found that experiential avoidance significantly predicted alcohol-related problems, even after controlling for gender and psychological distress. Furthermore, experiential avoidance mediated the relationship of psychological distress to alcohol-related problems. Conclusions: These findings suggest that experiential avoidance may play a role in problematic alcohol use among college students.     

‘I want them better than me’: Pedagogical strategies employed by four immigrant parents in the face of perceived forms of exclusion by school authorities

In Australia, students from Chinese and Arabic language backgrounds form the largest minority language groups in the New South Wales (NSW) public school system. Yet the mainstream academic performance of students from these two communities show marked differences in their levels of attainment. This article explores the home literacy practices of two immigrant families – one from a Chinese background and the other of Lebanese heritage – in order to obtain insights into how parents support their children in the acquisition of mainstream literacies. It documents parents’ perceptions of their interactions with school authorities in relation to their children’s educational needs. Findings indicate that despite a plethora of inclusive policies adopted by the children’s schools, the families in our study perceived school authorities as exclusionary in their practices. The article chronicles the sense of powerlessness and alienation experienced by both families when confronted with the rigidity of a school system they neither knew nor understood. Despite the similarities in their experiences, the Chinese family succeeded in the acquisition of mainstream literacies while the Lebanese family continues to struggle with the demands of the school curriculum. We present the contrasting solutions adopted by the two families to meet the educational needs of their children and indicate how their culturally derived responses go part way in explaining the different levels of school achievement experienced by the two families.