The effect of deliberative process on the self-sacrificial decisions of utilitarian healthcare students.

BACKGROUND: The COVID-19 pandemic has highlighted prosocial behavior as a professional healthcare core competency. Although medical students are expected to work in the best interests of their patients, in the pandemic context, there is a greater need for ethical attention to be paid to the way medical students deal with moral dilemmas that may conflict with their obligations. METHODS: This study was conducted in the spring semester of 2019 on 271 students majoring in health professions: medicine, dentistry, and veterinary medicine. All participants provided informed consent and completed measures that assessed utilitarian moral views, cognitive reflections, cognitive reappraisal, and moral judgment. RESULTS: The healthcare-affiliated students who scored higher on the instrumental harm subscale in the measurement of utilitarian moral views were more likely to endorse not only other-sacrificial actions but also self-sacrificial ones for the greater good in moral dilemma scenarios. In particular, those engaged in deliberative processes tended to make more self-sacrificial judgments. The mediation analysis also revealed that the effect of deliberative processes on self-sacrificial judgments was mediated by cognitive reappraisal. CONCLUSIONS: These findings suggested that cognitive reappraisal through deliberative processes is involved when the students with utilitarian inclination make prosocial decisions, that it is necessary to consider both moral views and emotional regulation when admitting candidates, and that moral education programs are needed in the healthcare field.

Identifying Trajectories of Maltreatment Revictimization and Juvenile Justice Outcome: A Latent Class Analysis of Subtype, Timing, and Chronicity.

Continued exposure to abuse or neglect is a strong predictor for immediate and long-term negative developmental outcomes including developmental delays, disabilities, poor school performance, criminal behavior, and mental health issues. The purpose of this study was to identify distinct subgroups of children with repeat victimization based on maltreatment timing, subtype, and chronicity and to examine how the unique subgroups are related to youth's juvenile justice outcome. Using data from Longitudinal Studies of Child Abuse and Neglect, this study included 286 children (47% males, 41% blacks) with more than one report for substantiated maltreatment from birth to age 17. Latent class analysis was employed to identify heterogeneity in the patterns of maltreatment revictimization. Four latent classes emerged: (a) Prevailing Early Neglect (52.6%); (b) Co-occurring Maltreatments in Preschool Age (20.1%); (c) Incremental Neglect with Sexual Abuse in School Age (18.7%); and (d) Co-occurring Maltreatments in School Age (8.6%). Black children were overrepresented in Incremental Neglect with Sexual Abuse in School Age compared to white and other racial groups of children. Ordinal logistic regression analysis indicated that there was no significant difference in the juvenile justice outcome across four subgroups of children with revictimization. Our person-centered investigations of maltreatment subtype, timing, and chronicity highlight the need for precise assessment and prevention strategies based on a more nuanced understanding of various patterns of childhood maltreatment revictimization.

Unraveling motives: identifying the impact of university attendance motives on learning behaviors among dental students.

PURPOSE: Students report various motives for attending university (MAU) grouped under five categories, namely, personal-intellectual development (PER), humanitarian (HUM), careerist-materialist (CAR), expectation-driven (EXP), and uncertain motives. Although the literature demonstrates that these motives exert an influence on learning and achievement, relatively less attention is given to this issue in the context of dental students. This study aimed to examine the relationship among the mindsets, MAU, academic engagement (AE), and DAL of dental students and to test the mediating effect of AE on the relationship between MAU and deep approach to learning (DAL). METHODS: The study recruited 226 dental students at various levels of the curriculum, who responded to four questionnaires for measuring MAU, DAL, mindsets, and AE. The study employed structural equation modeling to analyze the mediation effects of AE on the relationship between MAU and DAL and to determine the influence of mindsets on MAU. RESULTS: This model reveals the significant relationships of a growth mindset with CAR, PER, and HUM. Moreover, the study finds that a fixed mindset was associated with CAR, EXP, and uncertain motives. Furthermore, AE only fully mediated the significant positive relationship between PER and DAL, whereas CAR negatively predicted DAL without a mediator. CONCLUSIONS: These findings suggest that administering the inventories in a dental school setting can facilitate a more comprehensive understanding of students' mindsets toward learning and effective processes related to learning. This understanding can inform instructors' pedagogical practices, enabling them to provide more effective guidance to students navigating the complexities of academic coursework.

Recurrence of Substantiated Maltreatment Reports between Low-Income Parents With Disabilities and Their Propensity-Score Matched Sample Without Disabilities.

Using the Longitudinal Studies of Child Abuse and Neglect dataset, 127 low-income parents with disabilities and a propensity score matched sample of 254 parents without disabilities were compared for the rates of repeated substantiated child maltreatment allegations and potentially distinct risks for substantiated child maltreatment recurrence. The number of substantiated child maltreatment allegations was not significantly higher for low-income parents with disabilities (M = 1.17, SD = 1.83) than their matched sample (M = .93, SD = 1.44) (t = -1.29, p = .197). Findings from the negative binomial regression indicated that parental disability was also not a significant predictor for repeated substantiated child maltreatment allegations among low-income parents after controlling other risk factors (Exp(B) = 1.16, p < .353). In both groups, black parents were more likely to have repeated substantiated maltreatments than white parents. For parents with disabilities, being an older parent, receiving SNAP benefits, having a daughter, and having a child in continued out-of-home care significantly increased the risk for repeated substantiations while having a GED or higher education degree and living with a larger number of family decreased the risk. For parents without disabilities, family instability was the only additional risk factor for repeated maltreatment substantiations.

Event history analysis on racial disparities in the path to adoption for Black and White children.

BACKGROUND: Black children are significantly overrepresented in many phases of the U.S. child welfare system. OBJECTIVE: The purpose of this study is to investigate racial disproportionality and disparities in the adoption process and factors that predict the length of time to adoption. PARTICIPANTS AND SETTING: This study utilized administrative data from the 2014 year of the Adoption and Foster Care Analysis and Reporting System (AFCARS) collected in 50 States, the District of Columbia, and Puerto Rico. METHODS: The disproportionality metric (DM) and disparity index (DI) were constructed for Black and White children, and event history analyses were conducted to calculate the probability of adoption while considering the time to adoption finalization. RESULTS: DM indicated that Black children (0.81) were underrepresented in adoption, and DI indicated that the likelihood of adoption for Black children (0.73) was one third lower than that for White children. The event history analyses revealed that White children were 1.27 times more likely to be adopted than Black children. White children had considerably fewer days from termination of parental rights to adoption finalization with a median time of 273.5 days compared to 328 days for Black children. Factors that extended adoption time included child intellectual, physical, and emotional/behavioral disabilities, visual and hearing impairments, parental alcohol abuse and disability, and child maltreatment histories, while parental drug abuse and longer stays in out-of-home care shortened the adoption process. We also found a significant interaction effect of race and neglect on adoption. Neglected Black children had a longer time to adoption than neglected White children. CONCLUSIONS: More dedicated outreach programs and resources must be developed to ensure the effectiveness of adoption services and cultural continuity for Black children.

Students' Risks for Out-of-School Suspensions: Indigenous Heritage and Child Protective Services Involvement.

Disproportionality in out-of-school suspensions (OSS) is a persistent social and racial justice issue. Available research indicates that Indigenous children are disproportionately represented in both OSS and the child protective services (CPS) system. This secondary data analysis followed a cohort of 3rd grade students (n = 60,025) in Minnesota public schools from 2008- 2014. It examined the relationship between CPS involvement, Indigenous heritage, and OSS. Results from a zero-inflated negative binomial regression indicated that Indigenous students had two times the odds of suspension compared to white students (OR = 2.06, p < .001). Furthermore, there was a significant interaction between CPS involvement and Indigeneity on frequency of OSS (OR = 0.88, p < .05). Indigenous students showed a much higher odds ratio of OSS compared to white students, but the distance between the odds ratios of the two groups decreased as the number of child maltreatment allegations increased. Indigenous students may experience relatively high levels of both CPS and OSS due to systematic racism. We discussed implications for practice and policy to reduce discipline disparities.

High physical activity alleviates the adverse effect of higher sedentary time on the incidence of chronic kidney disease.

BACKGROUND: Low physical activity (PA) increases the prevalence of chronic kidney disease (CKD). This study aimed to investigate the effects of PA and sedentary time (ST) on the changes in renal function and the development of CKD in the middle-aged Korean population. METHODS: From the Korean Genome and Epidemiology Study Database, 7988 participants in their 40s and 60s were identified and stratified by (1) PA: high-PA (>24 MET-h/day), moderate-PA (9-24 MET-h/day) and low-PA (<9 MET-h/day); and (2) ST: high-ST (>6 h/day), moderate-ST (3-6 h/day) and low-ST (<3 h/day). Incident CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 following the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS: The mean age of the participants was 52.0 years. The overall incidence of CKD was 16.8 per 1000 person-years over a median of 12 years. The lower the PA and the higher the ST, the lower the baseline eGFR. Relative to the high-PA, the coefficients of the annual eGFR decline were -0.12 (95% confidence interval [CI]: -0.26 to 0.001, P = 0.081) and -0.13 (95% CI: -0.27 to 0.01, P = 0.078) in the moderate- and low-PA groups, respectively. Similarly, relative to the low-ST, the coefficients of annual eGFR decline were -0.07 (59% CI: -0.19 to 0.05, P = 0.236) and -0.14 (95% CI: -0.28 to -0.01, P = 0.039) in the moderate- and high-ST groups, respectively. Incident CKD was higher with lower PA (hazard ratio: high-PA 1.00, moderate-PA 1.13 [1.00, 1.28, P = 0.056] and low-PA 1.25 [1.11, 1.24, P < 0.001]) and higher ST (hazard ratio: low-ST 1.00, moderate-ST 1.04 [0.94, 1.16, P = 0.440] and high-ST 1.19 [1.05, 1.34, P = 0.007]). The high-PA reduced the risk for the CKD development irrespective of the amount of ST. CONCLUSIONS: Low-PA and high-ST are risk factors for the development of CKD in the middle-aged Korean population. High-PA recovers high-ST, inducing a harmful effect on the occurrence of CKD.

Effect of digital divide on people with disabilities during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has reinforced social inequality in marginalized groups. People with disabilities (PWD) are particularly restricted in their activities and lives due to the pandemic and experiencing more difficulties than the general population. OBJECTIVE: This study aims to explore the extent of the digital divide between PWD and people without disabilities (PWOD) during the COVID-19 pandemic in South Korea. METHODS: This study relied on the cross-sectional secondary data from the 2020 Digital Divide Survey conducted in Korea. We performed a series of bivariate analyses on the data of 5575 PWOD and 1781 PWD (18-69 years old) to compare Internet usage and various types of digital services related to the pandemic. RESULTS: We identified significant differences between PWOD and PWD in their Internet usage change during the pandemic. A higher number of PWD reported that their Internet usage with both computers and mobile devices remained similar to the pre-pandemic period while that of PWOD reported that their Internet usage via the same has increased. Significant gaps were found in the usage change of the five digital services with the largest gap in that of social networking services between PWOD and PWD. Further, PWOD were likelier to be aware of, utilize, and perceive the usefulness of digital services during the COVID-19 pandemic including application, information, delivery, and subscription services. CONCLUSION: To ensure better post-pandemic outcomes for marginalized groups including PWD, the governments and authority agencies must facilitate digital access and services with appropriate accommodations needed by those populations.

Exploring the disparity in tangible outcomes of internet use between persons with disabilities and persons without disabilities in South Korea.

BACKGROUND: Societal inequalities caused by the digital divide between people with disabilities and people without disabilities are a social justice issue. Internet use to acquire beneficial outcomes has increasingly been the focus of the digital divide. OBJECTIVE: This study investigates the extent to which outcomes of Internet use differ between individuals with (PWD) and without disabilities (PWOD) and determinants of outcomes of Internet use. METHODS: We conducted a series of multiple linear regression analyses using cross-sectional data of 1762 PWD and 5491 PWOD from the Digital Divide Survey conducted in Korea in 2018. RESULTS: We determined gaps in Internet access, skill, motivation, and outcomes between PWD and PWOD. PWOD reported significantly higher Internet access, skill, and motivation, and they also acquired more beneficial outcomes on all outcome domains than PWD. Further, PWOD with higher education degrees, higher household incomes, higher motivation towards Internet use, and greater digital skills acquired more beneficial outcomes of Internet use. Moreover, disability status, motivation to use the Internet, and digital skills were the most salient determinants of outcomes of Internet use, both collectively and specifically out of the five domains. CONCLUSION: The government should move forward to closing the gap in outcomes of Internet use between PWD and PWOD by providing programs and interventions to promote Internet use and enhance digital skills as well as by increasing web accessibility and incentives system.

Incremental Effect of Aging on Obesity-Related Incident Chronic Kidney Disease in the Korean General Population.

OBJECTIVES: Obesity may increase the risk of kidney function decline. However, few studies have addressed how age modifies obesity-associated risk of chronic kidney disease (CKD) in the Asian general population. DESIGN: A community-based prospective cohort study. SETTING AND PARTICIPANTS: 6538 Korean general population with normal kidney function from the Korean Genome and Epidemiology Study Database. METHODS: Participants were stratified according to age (40-49, 50-59, and 60-69 years old) and body mass index [≥18.5-<23 (normal-weight), ≥23-<27.5 (overweight), and ≥27.5 (obese)]. We conducted Kaplan-Meier and multivariable-adjusted Cox regression analyses to investigate the association of aging and obesity with incident CKD. RESULTS: During the 12-year follow-up, an overall incidence rate of CKD was 6.1 cases per 1000 person-years. Obese, but not overweight, people had an increased risk of incident CKD compared with normal-weight people in multivariable models adjusted for metabolic factors. When analyzed by 10-year increments, this association was significant only in 60-69-year-old individuals. Kaplan-Meier analysis showed that the incidence of CKD associated with overweight or obesity showed an accentuated increase with age. With reference to normal-weight individuals aged 40-49 years, the adjusted hazard ratio of CKD increased with age regardless of body mass index, and the positive association between obesity and incident CKD was more prominent with increasing age. CONCLUSIONS AND IMPLICATIONS: Obesity-associated risk of incident CKD was accentuated in older people, and this association was independent of metabolic abnormalities.

A prospective, longitudinal cohort study: The impact of child maltreatment on delinquency among South Korean youth in middle and high school.

BACKGROUND: Cultural groups vary in how they understand child maltreatment and children's misbehavior and these cultural variations may impact the relationship between maltreatment and delinquency. OBJECTIVE: This study investigated the impact of maltreatment on delinquency among South Korean youth. PARTICIPANTS AND SETTING: Using Korean Children and Youth Panel Survey data, this study followed two cohorts of middle (n = 2,275) and high (n = 2,272) school youth for their first self-reported delinquency over 4 years. METHOD: Discrete-time hazard model was used for the analyses. RESULTS: Approximately 19% of middle and 11% of high school youth engaged in delinquency for 4 years. Maltreatment is associated with delinquency only for high school youth (HR = 1.42). In both cohorts, male youth with high levels of aggression were more likely to engage in delinquency. Additional risk factors included high levels of depression (HR = 1.36) and negative attitudes toward school rules (HR = 0.68), father's education less than high school (HR = 0.63), low levels of self-control (HR = 0.63). Findings also identified culturally unique factors that place Korean youth at heightened risk of delinquency: mother's education more than high school (HR = 1.49) and higher family income (HR = 1.93). CONCLUSION: Preventive interventions need to identify culturally specific risk factors for youth at increased risk of delinquency and thus these preventive interventions should be culturally tailored.