Analyzing and Comparing Univariate, Multivariate, and Bifactor Generalizability Theory Designs for Hierarchically Structured Personality Traits.

We demonstrate how to use structural equation models to represent generalizability theory-based univariate, multivariate, and bifactor model designs. Analyses encompassed multi-occasion data obtained from the recently expanded form of the Big Five Inventory (BFI-2) that measures the broad personality domain constructs Agreeableness, Conscientiousness, Extraversion, Negative Emotionality, and Open-Mindedness along with three nested subdomain facets within each global domain. Results overall highlighted the importance of taking both item and occasion effects into account but underscored additional benefits of the multivariate and bifactor designs in providing more appropriate indices of generalizability for composite scores and effective ways to gauge subscale added value. Bifactor models further extended partitioning of universe score variance to separate general and group factor effects at both composite and subscale levels, expanded score consistency indices to distinguish or combine such effects, and allowed for further evaluation of score dimensionality and subscale viability. We provide guidelines, formulas, and code in R for analyzing all illustrated designs within the article and extended online Supplemental Material.

Applying multivariate generalizability theory to psychological assessments.

Multivariate generalizability theory (GT) represents a comprehensive framework for quantifying score consistency, separating multiple sources contributing to measurement error, correcting correlation coefficients for such error, assessing subscale viability, and determining the best ways to change measurement procedures at different levels of score aggregation. Despite such desirable attributes, multivariate GT has rarely been applied when measuring psychological constructs and far less often than univariate techniques that are subsumed within that framework. Our purpose in this tutorial is to describe multivariate GT in a simple way and illustrate how it expands and complements univariate procedures. We begin with a review of univariate GT designs and illustrate how such designs serve as subcomponents of corresponding multivariate designs. Our empirical examples focus primarily on subscale and composite scores for objectively scored measures, but guidelines are provided for applying the same techniques to subjectively scored performance and clinical assessments. We also compare multivariate GT indices of score consistency and measurement error to those obtained using alternative GT-based procedures and across different software packages for analyzing multivariate GT designs. Our online supplemental materials include instruction, code, and output for common multivariate GT designs analyzed using mGENOVA and the gtheory, glmmTMB, lavaan, and related packages in R. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Expanding bifactor models of psychological traits to account for multiple sources of measurement error.

Over the last decade, applications of bifactor modeling within clinical settings have increased markedly but typically rely on data collected on single occasions. A shortcoming of such research is that reliability coefficients are likely inflated because key sources of measurement error are inadequately modeled and/or confounded with construct variance. We address these problems using three variations of multi-occasion bifactor models with Bayesian-derived parameter estimates to separate systematic variance into general and group factor effects and measurement error into three subcomponents (transient, specific-factor, and random-response). Collectively, these models produce indices of reliability and validity aligned with both standard confirmatory factor models and generalizability designs that extend interpretations of results to the broader domains from which items and occasions are sampled. We demonstrate how these techniques can provide new insights into psychometric properties of scores using Negative Emotionality domain and facet scales from the newly updated Big Five Inventory (BFI-2; Soto & John, 2017). Overall, the two-occasion congeneric bifactor model provided the best fit to the data and most informative indices for revising measures, examining dimensionality of composite and subscale scores, and evaluating the viability of those scores. We include code in R for analyzing all models in our extended online Supplemental Material. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Uterine Leiomyoma Is Associated with Female Sexual Dysfunction in Postmenopausal Women.

PURPOSE: To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women. MATERIALS AND METHODS: The study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status. RESULTS: In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables. CONCLUSION: The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.

Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors.

OBJECTIVE: The aim of this study was to evaluate the secular trends of incidence of gestational diabetes mellitus (GDM) and insulin treatment for GDM in a Korean population and to determine the factors that contribute to the trends in the incidence of GDM. STUDY DESIGN: We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from women who had given birth from 2006 to 2010. We evaluated the trends in the incidence of GDM and GDM requiring insulin treatment and the changes in risk factors. RESULTS: There were 1,824,913 births during the study period, which included 129,666 cases of GDM, an incidence of 7.11% over this period. The incidence of GDM increased from 3.86% in 2007 to 11.83% in 2010, with a continuous increase after adjustment for age. However, the number of GDM cases that required insulin treatment decreased significantly from 13.87% in 2007 to 5.94% in 2010. The proportion of patients who were at an older age and multiparity, 2 GDM risk factors, increased during the study period. CONCLUSIONS: In Korea, the incidence of GDM, especially mild GDM, increased dramatically during the period from 2006 to 2010. Further efforts are needed to monitor this trend and to identify associated factors.

Subclinical Hypothyroidism is not a Risk Factor for Female Sexual Dysfunction in Korean Middle-Aged Women.

BACKGROUND: Previous studies have suggested that subclinical hypothyroidism is associated with the risk of anxiety or depression and can affect quality of life. However, there is a paucity of information regarding the relationship between subclinical hypothyroidism and female sexual dysfunction. METHODS: The study population consisted of sexually active middle-aged women (≥40 years old) who visited the center for health promotion and optimal aging at Seoul National University Hospital for a health check-up between 2010 and 2011. Sexual function was evaluated by the female sexual function index (FSFI) questionnaire, and female sexual dysfunction was defined as a FSFI score of ≤26.55. FSFI scores and female sexual dysfunction frequencies were compared between cases with subclinical hypothyroidism and healthy controls. Nonparametric methods were used for statistical analysis. RESULTS: A total of 1086 women were included, and the frequency of subclinical hypothyroidism and female sexual dysfunction was 138 (12.7%) and 741 (68.2%), respectively. The total FSFI score and the scores in each domain were not different between the two groups (median total FSFI score (interquartile range): 23.8 (20.2-27.5) for normal thyroid status vs. 24.4 (20.6-27.6) for subclinical hypothyroidism, p=n.s.). The frequency of female sexual dysfunction was not different between the two groups, either (68.4% for normal thyroid status vs. 67.4% for subclinical hypothyroidism, p=n.s.). These findings were consistent even after adjustment for confounding variables. CONCLUSIONS: Subclinical hypothyroidism is not a risk factor for sexual dysfunction in middle-aged women.

The neuroprotective effect of magnesium sulfate in preterm fetal mice.

OBJECTIVE: To investigate the use of magnesium sulfate (MgSO4) as a neuroprotective agent in a mouse model of inflammation-associated and noninflammation-associated preterm birth. METHODS: On embryonic day 15 of gestation, lipopolysaccharide (LPS) and mifepristone (RU486) were used, respectively, to create mouse models of inflammation and noninflammation-associated preterm birth. After intraperitoneal injection of LPS, RU486, or normal saline solution (NS), dams were randomized to intraperitoneal MgSO4 or NS injection. From the 6 treatment groups (NS+NS, LPS+NS, NS+MgSO4, LPS+MgSO4, RU486+NS and RU486+MgSO4), fetal brains were collected for Western blot analysis and neuronal cultures. Protein expression of S100B was assessed, and immunohistochemistry was performed to detect NeuN. The numbers of NeuN-labeled cells were counted using confocal laser scanning microscopy. RESULTS: The expression of S100B significantly differed among the groups and was decreased in the LPS+MgSO4 group compared to the LPS+NS group. The expression of S100B did not differ between the RU486+NS and RU486+MgSO4 groups. NeuN-labeled cells were increased in the LPS+MgSO4 group compared with the LPS+NS group. NeuN-labeled cells were decreased in the RU486+MgSO4 group compared with the RU486+NS group. CONCLUSIONS: We observed that prenatal treatment with MgSO4 was associated with decreased expression of S100B and increased numbers of NeuN-labeled cells in an inflammation-associated preterm mouse model but not in a noninflammation-associated preterm mouse model. Our results suggest that prenatal treatment of MgSO4 reduces inflammation-associated brain injury in fetal mice.

Decreased umbilical orexin-A level is associated with idiopathic polyhydramnios.

OBJECTIVE: To evaluate the association between orexin-A level and idiopathic polyhydramnios. DESIGN: Case-control study. SETTING: Tertiary-level university hospital. POPULATION: Ten term pregnant women with idiopathic polyhydramnios and, as the control group, 20 pregnant women with normal amniotic fluid levels. METHODS: Amniotic fluid level was measured at admission for delivery using enzyme-linked immunosorbent assay. Maternal blood was obtained from a cannulated vein immediately before delivery, and umbilical blood was collected at the time of delivery, before the separation of the placenta. MAIN OUTCOME MEASURES: Maternal and umbilical levels of orexin-A. RESULTS: Mean umbilical serum orexin-A level was significantly lower than maternal serum orexin-A level. Umbilical serum orexin-A level was positively correlated with maternal serum orexin-A level, but negatively correlated with amniotic fluid index and birthweight. Umbilical serum orexin-A level was lower in the idiopathic polyhydramnios group than in the control group. However, no difference in maternal serum orexin-A level was observed between the two groups. CONCLUSIONS: Idiopathic polyhydramnios was associated with decreased umbilical serum orexin-A levels. Our results provide evidence that orexin-A expression may be involved in amniotic fluid regulation, causing polyhydramnios by downregulation.

Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days.

OBJECTIVE: To investigate the relationship between angle of progression (AoP) on ultrasonography at 37-40 weeks' gestation and delivery within 7 days. METHODS: This prospective study was conducted between January 2013 and May 2013 at Korea University Guro Hospital, Korea. Nulliparous women between 37/0 and 40/3 weeks' gestation with a singleton fetus, intact membrane, and cephalic presentation from January 2013 to May 2013 were enrolled. To evaluate the cervical parameters of cervical length and AoP, transvaginal and transperineal ultrasonography were performed, respectively. We then assessed the relationship between cervical parameters and onset of labor within 7 days by multivariate logistic regression analysis. RESULTS: Women who underwent spontaneous onset of labor within 7 days had a significantly shorter cervical length and AoP than those who underwent labor after 7 days. Logistic regression analysis showed that a larger AoP was an independent predictor of spontaneous labor within 7 days. CONCLUSIONS: A larger AoP was significantly associated with spontaneous onset of labor within 7 days. These findings may be useful for counseling patients regarding the management of term pregnancies.

Muscle weakness and myalgia as the initial presentation of serous ovarian carcinoma: a case report.

INTRODUCTION: Epithelial ovarian cancer (EOC) has one of the worst prognoses among gynecologic cancers. An appropriate screening method is not available for EOC, and the initial symptoms such as abdominal pain or bloating, anorexia, and urinary urgency are vague. As a result, most cases of EOC are diagnosed at an advanced stage. CASE PRESENTATION: We report novel insights gained from the case of a 45-year-old, gravida 0, para 0 woman who presented to the emergency department with complaints of general weakness, fatigue, and myalgia over the previous two months. She reported progressive muscle weakness of the upper and lower extremities leading to difficulty walking. Serum muscle enzymes, such as creatine phosphokinase, were markedly elevated. No evidence of malignancy was detected upon imaging. A biopsy of the left vastus medialis muscle was performed, and the results were consistent with primary myopathy with myofibrillar disarray, suggesting paraneoplastic necrotizing myopathy. Explorative laparotomy was performed to evaluate these results, and histopathological analysis of the full specimen revealed a grade 3 ovarian serous adenocarcinoma with direct invasion to the rectum. CONCLUSIONS: Because of the lack of screening tools for EOC, any clinical findings suggesting its presence are valuable, and the possibility of EOC should be considered in unknown primary malignancies with initial complaints of muscle weakness or myalgia.

High-risk human papillomavirus infection is associated with premature rupture of membranes.

BACKGROUND: Human papillomavirus (HPV) is known to be more prevalent in spontaneous abortions than in elective terminations of pregnancy. More recently, placental infection with HPV was shown to be associated with spontaneous preterm delivery. However, no study has evaluated the prevalence of HPV infection in pregnant Korean females and its association with adverse pregnancy outcomes. METHODS: We conducted a cross-sectional study of 311 females who gave birth at Korea University Medical Center. Our sample included 45 preterm deliveries, 50 cases of premature rupture of the membranes (PROM), 21 preeclampsia cases, and 8 gestational diabetes mellitus (GDM) patients. We used the Hybrid Capture II system to detect high-risk (HR)-HPV infection at six weeks postpartum. RESULTS: The prevalence of HR-HPV infection was 14.1%. Women with HR-HPV infection had a higher incidence of PROM than those without HR-HPV. HR-HPV infection was associated with an increased risk of PROM (OR, 2.380; 95% CI, 1.103-5.134). The prevalence of preterm delivery, preeclampsia, or GDM was not different between the two groups. CONCLUSIONS: We observed a high prevalence of HR-HPV infection in pregnant women. Moreover, HR-HPV infection was associated with a risk of PROM at term. Further studies are needed to evaluate mechanisms by which HR-HPV infection induces PROM.

Trends in the rates of peripartum hysterectomy and uterine artery embolization.

The objective of this study was to determine the trends in national rates of peripartum hysterectomy (PH) and uterine arterial embolization (UAE) in Korea. We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from patients who gave birth during the period from 2005 to 2008. There were 1785,178 deliveries during the study period, including 2636 cases of PH (1.48 per 1000 deliveries). The PH rate in 2005 was 1.57 per 1000 deliveries and in 2008 it was 1.33 per 1000 deliveries. UAE was performed in 161 women (incidence, 0.38 per 1000 deliveries) and 447 women (incidence, 0.98 per 1000 deliveries) in 2005 and 2008, respectively. In Korea, the rate of PH decreased slightly, while the rate of UAE rate increased dramatically during the period from 2005 to 2008. Further studies are needed to evaluate the effects of UAE on the rate of PH performed.

Comparison of the Seeplex HPV4A ACE and the Cervista HPV assays for the detection of HPV in hybrid capture 2 positive media.

OBJECTIVE: To validate the efficacy of Seeplex HPV4A ACE for the detection of high-risk (HR) human papillomavirus (HPV) and HPV 16 and/or HPV 18 genotypes as compared to the PCR method and the Cervista HPV assays in cervical swab samples. METHODS: Besides liquid-based cytology, additional 97 cervical swab samples were collected for HPV genotyping by HPV4A ACE, Cervista HPV assays, and PCR method. To check the statistical differences, we also conducted the paired proportion test, Cohen's κ statistic, and a receiver operating characteristic curve. RESULTS: Seeplex HPV4A ACE and the Cervista HPV HR showed substantial agreement with PCR for detection of HR HPVs (88.3%, κ=0.767 and 81.7%, κ=0.636, respectively). Seeplex HPV4A ACE also showed substantial agreement with the Cervista HPV 16/18 test (89.5%, κ=0.628). Additionally, the sensitivity and specificity of Seeplex HPV4A ACE and Cervista HPV HR were 91.4% vs. 84.5% and 73.4%, vs. 72.7%, respectively, when those higher than low-grade squamous intraepithelial lesions were regarded as abnormalities. HPV genotyping for HPV 16/18 detected cervical intraepithelial neoplasias (CINs) better than HR HPV tests (66.7% vs. 24.6% by HPV4A ACE, 52.6% vs. 25.9% by Cervista HPV assays in CIN II or more, relatively). CONCLUSION: Seeplex HPV4A ACE is an effective method as the PCR and the Cervista HPV assays for the detection of HR HPVs and for genotyping of HPV 16 and 18.