Wan-Chin Kuo

Introduction: Current preventive screening reminders use generic due-date notifications that lack personalization. Targeted reminders allow personalized messages and resource allocation, yet the accuracy of behavioral forecasting with cholesterol screening behaviors remains unconfirmed. Therefore, this study aims to examine the accuracy of machine learning in predicting adults’ future cholesterol screening behavior. Methods: This study included 8,288 participants from the Health and Retirement Study. Never receiving cholesterol screening over 12 years of follow-up (2007-2018) was identified as the target outcome. Predictors were constructed based on the Social-Ecological Model. Four machine learning (ML) algorithms were compared: logistic regression, random forests, gradient boosting machine (GBM), and eXtreme Gradient Boosting (XGBoost). Model performance was evaluated by Recall, Precision, and false-negative rate (FNR). Results: Among the four ML algorithms, XGBoost performed best, with higher Recall (average: 0.8850) and the lowest FNR (0.1311), but suboptimal precision (average: 0.6228). The top five predictors were past cholesterol screening behavior, diagnosis of hypertension, osteoarthritis or rheumatoid arthritis, number of private insurance plans, and gender. Conclusion: ML might be used to predict individuals’ cholesterol screening behavior. Future research is needed to examine whether leveraging ML in targeted reminders might enhance cholesterol screening behaviors.

Background: Workplace violence towards healthcare workers impacts workforce stability and patient care delivery. California passed a workplace violence prevention standard, phased in during 2017‐2018, requiring enhanced tracking and training in healthcare workplaces. Workers' compensation claims provide a tool to track frequency of violence over time. Methods: This descriptive study synthesizes data from the California Workers' Compensation Information System (WCIS) covering all healthcare workplaces in the state. Claims included were filed from 2013 to 2021. We tabulated the annual rate of workplace violence‐related claims, types of workplaces with high rates of claims, and types of injuries caused by violence. Results: We identified 46,762 violence‐related workers' compensation claims over the study period from a total of 418,278 total claims (11%). The highest rate of violence‐related claims was in 2019 (5.6 claims per 1000 healthcare workers). Residential care facilities for children reported 31% of their total claims as violence‐related, and psychiatric and substance‐use hospitals reported 35% of their total claims as violence‐related. Most healthcare industry claims were from individuals working in hospitals, and employees in these workplaces reported between 11% and 13% of total claims as violence‐related. Conclusions: Workers' compensation claims provide an important description of workplace violence exposure among healthcare workers, and the relative stability of measurement makes it a useful way to track the impact of mitigation strategies over time. It would be valuable for workers' compensation claims managers to capture an assessment of whether an incident involved violence to facilitate appropriate connection to needed resources, including psychological support, for an injured worker.

Introduction: Cardiovascular disease is the leading cause of death in the Black population, accounting for over 22% of fatalities. Health equity science aims to explore this for evidence of social determinants that can eliminate cardiovascular health disparities. Methods: This study explored associations between three American Heart Association constructs of positive psychological health that reflect cultural strengths (environmental well-being, Black identity, and spirituality) with three modifiable health behaviors (blood pressure checking, exercise, and physical activity) in 470 Black adults living in racially marginalized communities. Results: Environmental well-being significantly predicted physical activity (β = 0.033, p = .04) and exercise (β = 0.045, p < .001). Black identity and spirituality demonstrated weaker and non-significant associations with the measured behaviors. Discussion: Environmental well-being emerged as a key cultural strength promoting physical activity and exercise among Black adults. Black identity and spirituality may play nuanced roles influenced by systemic factors. Findings emphasize incorporating culturally relevant strategies into heart health promotion.

Background: Uncontrolled dyslipidemia contributes to cardiovascular diseases, the leading cause of death among American workers, while influenza leads to significant absenteeism and presenteeism. Despite the potential productivity loss due to cardiorespiratory illness, few studies have examined occupational disparities in preventive care utilization. This study aimed to assess the influence of occupation and job characteristics on cholesterol screening and influenza vaccination utilization. Methods: Data from the Health and Retirement Study (HRS) 2003–2018 were analyzed, representing past and current workers ( N = 7,022). Occupation was coded based on the U.S. Census 1980 and 2000 and configured into five groups: management/science, social services, general services, health services, and industrial workforce. Participants who never reported job information were included in the sensitivity analysis. Job characteristics, including psychological and physical strains at work, ergonomic risk, lifting of heavy loads, and job stability, were based on self-reported questions. The influences of job category and job characteristics on cholesterol screening and influenza vaccination utilization were examined using multivariable logistic regression, multinomial logit model, and multinomial probit models. Results: Industrial workers and general services workers were less likely to receive cholesterol screenings and influenza vaccinations than management and science workers after controlling for social-demographic and health statuses. Frequent job-related heavy lifting and lower job-related mental strain were linked to lower cholesterol screening rates. Higher job-related physical strain and job instability were associated with reduced influenza vaccination uptake. Those outside the labor force were also less likely to undergo periodic cholesterol screening and influenza vaccination. Conclusion: This study demonstrated an underutilization of preventive care services among industrial and general services workers, as well as those outside the labor force. Our findings underscore the need to promote access to preventive care services while addressing cardiovascular disease awareness and vaccination hesitancy in these populations.

Introduction: Troxel’s Chronic Stressor Scale (CSS) is widely used in survey-based comparative research to investigate racial or gender differences in stress-health relationships, but its measurement invariance remains untested. This study aimed to examine the measurement invariance of CSS across age, gender, race, ethnicity, and temporality. Methods: This analysis used the longitudinal data from the Health and Retirement Study ( N = 2,263). Model fit was evaluated using infit/outfit statistics, person/item separation, and reliability indices. Differential Item Functioning (DIF) was assessed using Rasch’s Rating Scale Model. Results: CSS demonstrated strong item reliability but poor person reliability. Significant DIF was identified in housing stress between Black and White Americans, in self-health stress and occupational stress between younger and older groups, and financial stress between 2012 and 2020. Discussion: Despite strong item reliability, CSS’s significant DIF across race, age, and temporality suggests caution when directly comparing composite or item scores across diverse populations and time points.

Early classification of time series aims to predict class labels as promptly as possible while maintaining sufficient accuracy. Existing approaches often rely on multiple classifiers for different input lengths, increasing training cost and complexity. We propose a unified framework comprising: 1) a subsequence classification model for variable-length inputs; 2) a subsequence information enough model; 3) a reliable label module; and 4) a confidence estimation mechanism. Our method dynamically determines when sufficient information is available for reliable classification. Experiments on 45 UCR datasets demonstrate superior performance over baseline methods, especially on SIMULATED, MOTION, and SENSOR tasks.

Background: Reports from patient experience and satisfaction surveys are currently being used to target health quality improvement. The patient’s healthcare experience is indicative of the interpersonal quality of care and significantly correlates with patient satisfaction as an evaluative measure. Guided by Self-Determination Theory (SDT), this study aims to explore the association of predictor constructs in the theoretical model of STD—perceived provider communication (PPC) and other innate psychological constructs of competence and autonomy with self-rated health (SRH) and healthcare satisfaction (HS). Of particular interest is the SDT construct of relatedness. For this study, it was operationalized as the perceived health communication of a provider. Items relevant to SDT in the Health and Retirement Study (HRS) survey were tested, first, for whether they fall into the predicted SDT constructs and, second, whether and how these constructs were associated with self-reported health and patient HS. Methods: Two-stage data were analyzed using subsamples from the 2018 and 2019 HRS. Independent variables included items measuring SDT constructs about PPC, psychological well-being, and self-efficacy. Outcome variables included SRH and dimensions of HS, such as cost, quality, and providers. In the first stage, descriptive analyses and exploratory factor analysis were performed to identify the underlying factor structure. Principal axis factoring was used to extract factors. In the second stage, these factors were used in structural equation modeling to examine the relationship between SRH and HS. Results: Three factors with high internal consistencies (a > 0.8) and item-total correlations (r > 0.5) were identified. Data from the sample fit the structural model (χ2 = 0.00, CFI = 0.954, TLI = 0.946, RMSEA = 0.058, SRMR = 0.047). The structural phase indicated that PPC and competence were positively associated with SRH and HS. However, autonomy was only significantly associated with SRH but not with HS. Discussion/Conclusion: Individuals who rated PPC behaviors and their sense of competence more highly also showed higher satisfaction with multiple healthcare domains and their SRH status. Patient-centered determinants of health outcomes are complex, and more studies are needed to understand their nuances.

Background: The wear and tear from chronic stress exposure has been linked to premature aging through allostatic load; however, it is unclear how chronic stress exposure affects physical functioning and physical activity in older adults. Objectives: The study aims were to examine the behavioral and functional adaptation to chronic stress in older adults and its mediational pathways. Methods: Data from the Health and Retirement Study 2016 and 2020 (N = 3075, mean age 66 years) were analyzed. Chronic and perceived stress exposure was quantified using Troxel’s Chronic Stressors Scale and Cohen’s Perceived Stress Scale. Physical activity was quantified using self-reported questionnaires, including light, moderate, and vigorous physical activity. Physical functioning was operated as a latent construct with four perceived physical limitations (i.e., difficulty in movement, hand strength, shortness of breath, and balance). The cross-sectional data were analyzed using latent regression analysis. The longitudinal data were analyzed using serial mediation based on MacKinnon’s bias-corrected bootstrap confidence intervals. Results: Cross-sectionally, psychological stress, as a latent construct indicated by stress exposure and stress perception, explained more variances in perceived physical limitation than physical activity. Longitudinally, perceived stress and physical activity mediated the relationship between chronic stress exposure and perceived physical limitation with significant indirect effects. Furthermore, perceived physical limitation suppressed the effect of chronic stress exposure on physical activity levels. The effects of mediation and suppression remained significant after the adjustment for age, gender, years of education, race, number of comorbidities, working status, and marital status. Discussion: The promotion of physical activity and physical functioning in older adults might not achieve the optimal outcome if the program design overlooks the target population’s chronic stress process and functional limitations.

Background: Although evidence from birth cohort analysis has indicated the metabolic risk of early-life exposure to the Great Leap Forward Famine (GLFF) in China, three confounding effects, including the exposure windows, aging, and geographical variations in famine severity, have been brought to debates for a decade. This study aimed to address these confounding effects and extensively examine how GLFF exposure is associated with diabetes risk in mid-to-late life and its interaction with urban-rural migration. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed with age-stratification and stepped wedge approaches. Weighted prevalence and multivariable logistic regression were used to investigate the effects of GLFF exposure and urban-rural migration on mid-to-late life diabetes risk and the interaction between GLFF exposure and urban-rural migration. Birth provinces were controlled as a fixed effect to account for variations in famine severity across provinces. Results: Compared to those who were never exposed to GLFF, fetal GLFF exposure was associated with a higher risk of adult-onset diabetes after controlling for provinces, demographics, and health statuses. Yet, after adding the proxy of childhood growth environments into the model, fetal exposure to GLFF was not significantly associated with adult-onset diabetes risk (OR = 1.22, p = 0.10), compared to those who were never exposed to GLFF. Across the three age-stratification groups, static urban residents, in general, had a higher risk of diabetes compared to static rural residents. Interaction effects between GLFF exposure and urban-rural migration were insignificant across all three age-stratification groups. Conclusion: Fetal exposure to GLFF might have a traceable effect on adult-onset diabetes risk. Yet, the growth environment and urban lifestyle outweigh and further confound the impact of GLFF exposure on adult-onset diabetes risk.