Health Science Reports最新文献

Background and Aims

Applying the clinical scenario teaching method using approaches such as group discussion facilitates the possibility of learning and developing creativity in a real clinical learning environment. However, few studies have been done in this field. The present study aimed to evaluate the effect of scenario-based group discussion training on the creativity level of nursing students.

Material and Methods

This study was a randomized controlled educational trial from January to October 2019 conducted on nursing students at Shiraz University of Medical Sciences. Nursing students were randomly assigned into intervention and control groups (22 per each group). The students in the intervention group participated in a training program consisting of three 60-min sessions per week for two consecutive weeks. In each session, 2–3 scenarios were presented, and the students discussed about it. Each student was asked to submit a practical activity in a written story. In the control group, the training was conducted in the usual way (Students' presentation and discussion of presented content without scenario presentation). Data were collected using a validated creativity questionnaire. Data were analyzed in SPSS software, version 22, using Chi-square and t-test and the significance level was considered p < 0.05.

Results

The results showed that immediately after the intervention, a difference was observed between the groups concerning the mean score of fluency (p = 0.02) and originality (p = 0.03), but there was not a significant difference between the groups concerning the overall score of creativity (p = 0.09).

Conclusion

It can be concluded that scenario-based group discussion training is effective for improving the dimensions of the fluency and originality creativity of nursing students. It seems that scenario-based education is an appropriate radical method for traditional education methods.

Trial Registration: IRCT Registration Number: IRCT20140503017546N13; Registration Date: 09.05.2018.

Background and Aim

The present study aimed to develop and psychometrically evaluate the exercise self-efficacy tool within the Health Action Process Approach (HAPA) framework among heart failure patients undergoing cardiac rehabilitation.

Methods

This study assessed 205 patients who had suffered heart attacks at the Shahid Chamran Cardiac Rehabilitation Center of Isfahan. Exploratory factor analysis (EFA) was employed to evaluate the construct. Internal reliability was determined using Cronbach's alpha. Additionally, external reliability was measured through a test-retest approach.

Results

EFA identified four factors within the self-efficacy questions (task self-efficacy 1, task self-efficacy 2, coping self-efficacy, and recovery self-efficacy), which accounted for 70.1% of the total variance explained. The Cronbach's alpha coefficients were as follows: 0.836 for the first factor, 0.896 for the second factor, 0.921 for the third factor, 0.914 for the fourth factor, and 0.9 for the overall instrument. The intra-class correlation coefficient was 0.901 for the first factor, 0.887 for the second factor, 0.826 for the third factor, and 0.885 for the fourth factor.

Conclusion

The cardiac rehabilitation self-efficacy questionnaire exhibited high validity, reliability, and desirable item commonalities. Therefore, it can be effectively employed in pertinent HAPA-based studies involving heart failure patients.

Background and Aims

Preprocedural ultrasound (PPU) reduces the risk of technical failure in non-obese patients and when technical difficulty is predicted. We conducted this review to determine if PPU improves first-pass needle insertion success for neuraxial anesthesia in patients with obesity.

Methods

We conducted a systematic review without meta-analysis, due to the small number of included studies. The study protocol was registered (PROSPERO: CRD42022368271). We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library from January 1, 1980 to October 1, 2022 for peer-reviewed randomized controlled or observational studies comparing PPU versus landmark techniques in patients with body mass index >30 kg/m². The quality of evidence was assessed using the revised Cochrane risk-of-bias tool for randomized trials and Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

There were nine randomized controlled studies, comprising 866 patients having lumbo-sacral neuraxial techniques. Three studies utilized a small handheld ultrasound device called Accuro™ and six utilized non-handheld ultrasound devices. Certainty of evidence was low for improving the first-pass success rate. There was evidence (moderate certainty) that PPU decreased number of passes, increased first insertion attempt success, and reduced number of insertion attempts. There was no evidence that PPU affected identifying time, needling time, or overall procedural time. There was no evidence that PPU influenced procedural failure rate (very low certainty evidence) and insufficient evidence to suggest that artificial intelligence-supported handheld devices were superior to conventional ultrasound devices.

Conclusions

In patients with obesity, there is evidence of very-low to moderate certainty that PPU improves markers of insertion success, with no indication of increased adverse effects. PPU should be used to reduce attempts. Further studies adhering to standardized outcome definitions are required for definitive recommendations.

Registration

The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022368271).

Background and Aims

Physical activity (PA) is associated with higher gait speed. We aimed to examine the associations between PA and change in spatial and temporal gait measures as well as fall risk in community-dwelling individuals free of dementia.

Methods

Longitudinal study among 4173 individuals aged ≥50 years (mean age 71 years; 2078 males; median follow-up 4 years) enrolled in the Mayo Clinic Study of Aging. Self-reported late-life PA was used to calculate overall PA and moderate-vigorous PA (MVPA) scores. Gait was assessed using GAITRite® and Zeno™ systems. Incident falls information was based on diagnostic codes retrieved from medical records. We ran linear mixed effects models to examine associations between z-scored PA variables and longitudinal gait parameters, adjusted for age, sex, education, body mass index (BMI), medical comorbidities, and including interactions between PA and time since baseline. In secondary analyses, we calculated Cox Proportional hazard models with age as time scale predicting incident falls by PA, adjusting for sex, education, BMI, medical comorbidities, and falls history.

Results

At baseline, higher PA was associated with higher velocity (overall PA: estimate 2.9935; MVPA: 2.2961; p < 0.001), higher cadence (overall PA: 1.0665; MVPA: 0.9073; p < 0.001), greater stride length (overall PA: 2.0805; MVPA: 1.4726; p < 0.001), shorter double support time (overall PA: −0.0257; MVPA: −0.0205; p < 0.001), and lower stance time variability (overall PA: −0.0204, p < 0.001; MVPA: −0.0152; p = 0.006). Overall PA was longitudinally associated with less decline in cadence, and MVPA with less increase in intraindividual stance time variability. Overall PA (Hazard ratio 0.892, 95% confidence interval 0.828–0.961, p = 0.003) and MVPA (HR 0.901; 95% CI 0.835–0.973, p = 0.008) were associated with a decreased risk of incident falls.

Conclusion

Late-life PA was associated with favorable gait outcomes and decreased risk of incident falls. Thus, late-life PA may help to maintain gait performance and decrease fall risk in old age.

Background and Aims

Rates of psychosis in the homeless population are markedly higher compared to the general population. Understanding potential psychological mechanisms underpinning links between psychosis and homelessness is important for the development of effective care pathways for this highly marginalised group. This study aimed to examine the housing status of a sample of people with psychosis admitted to psychiatric inpatient hospital in one UK mental health trust. We further aimed to examine the presence and relevance of symptoms which were directly related to housing (e.g., persecutory beliefs about neighbours).

Methods

A cross-sectional study was conducted using an electronic healthcare database, containing anonymised patient records (Clinical Record Interactive Search). Information on housing status, symptoms, and content of symptoms relating to housing were extracted and independently double-coded from clinical notes at the person's admission.

Results

351 service users were in the sample, which covered discharges over a 12-month period (1st April 2021 to 31st March 2022). There was a higher proportion of individuals living without a fixed address in the sample (10%) compared to population estimates (1%–2%). Housing-related thematic content of symptoms was evident in 34% of the sample (e.g., attributing voices to neighbours, feeling under surveillance at home). The only variable significantly associated with housing status was gender, with men at higher odds of unstable housing compared to women. Individuals with concerns directly related to their housing or housing instability were no more likely to have a longer length of admission than those without housing-related concerns.

Conclusion

A significant proportion of individuals with psychosis admitted for psychiatric inpatient treatment, experienced housing instability. For some of the sample, symptom content directly related to housing. This raises important considerations for how social needs are assessed on admission to psychiatric hospital. Further research in this area is encouraged.

Background and Aims

This Australian population-based study investigated statin intensity after hospitalization for ischemic stroke in a matched cohort of people living with and without dementia.

Methods

We identified all patients aged ≥ 30 years hospitalized in the state of Victoria, Australia, for ischemic stroke from July 1, 2013 to April 30, 2018 from the Victorian Admitted Episodes Data set. People with dementia were matched 1:4 for sex, 5-year age group and index date ± 90 days with people without dementia. Records of statin dispensing within 60 days postdischarge were extracted from prescription claims data. The intensity of the first postdischarge statin dispensing was determined. Odds ratios for high versus low-moderate intensity and no statin dispensing were estimated using multinomial logistic regression adjusted for factors including age, sex, and comorbidity.

Results

The cohorts comprised 11,105 people (dementia: N = 2221; without dementia: N = 8884 and 52% were female. Compared to people without dementia, people with dementia had 35% (95% confidence interval [CI]: 24%–44%) lower odds of receiving a high intensity versus a low-moderate intensity statin and 54% (95% CI: 48%–59%) lower odds of receiving a high intensity versus no statin. Compared to men, women with and without dementia had 16% (95% CI: 5%–25%) lower odds of receiving a high- versus low-moderate intensity statin and 28% (95% CI: 19%–35%) lower odds of receiving a high intensity versus no statin.

Conclusions

People living with dementia are less likely to receive high-intensity statins post-discharge compared to people without dementia. There is a gender gap in receipt of guideline-recommended high-intensity statin therapy for secondary prevention after ischemic stroke.

Clinical Implications

Guidelines recommend all people with reasonable life expectancy receive a high-intensity statin after stroke to reduce the risk of recurrent stroke and other adverse cardiovascular events. More research is needed to understand why people living with dementia might not receive guideline recommended care, and how statin use and statin intensity impact the health outcomes of people living with dementia and stroke.

Background and Aims

Intimate partner violence (IPV), perpetrated by male partners, inflicts physical, sexual, or psychological harm on women. During pregnancy, it becomes a significant public health concern and human rights violation, especially in conflict-affected areas, affecting both mother and fetus negatively. Research in Ethiopia often overlooks nonusers of antenatal services, primarily conducted in health facilities. This study addresses this gap, aiming to provide valuable insights into community dynamics. Hence, this study assessed the prevalence and factors associated with IPV during pregnancy in the conflict-affected district of Northeast Ethiopia.

Methods

A community-based cross-sectional study surveyed 603 postpartum women in the Argoba district, Amhara region Northeast Ethiopia, from March 26 to April 25, 2023, utilizing a multistage sampling technique. Data collection employed a structured questionnaire, coded, and entered into Epi-data 4.6, then analyzed using SPSS version 26. Descriptive and Binary logistic regression analyses were conducted. Adjusted odds ratios were computed at a 95% confidence interval [CI], with a significance level set at p < 0.05. Model fit and multicollinearity were assessed for validity.

Result

The study found an overall prevalence of 45.1% (95% CI: 41.1–49.1) for IPV during pregnancy, with psychological violence being the most prevalent (38.0%), followed by physical (24.7%) and sexual violence (18.6%). Factors significantly associated with IPV included unwanted pregnancy (AOR = 1.94; 95% CI: 1.10–3.47), women's acceptance of violence (AOR = 2.39; 95% CI: 1.64–3.48), having a partner who chews khat (AOR = 1.99; 95% CI: 1.31–3.03), and spouse's engagement in multiple sexual partners (AOR = 1.63; 95% CI: 1.03–2.58).

Conclusion

The study's findings indicate a higher prevalence compared to others, with key factors including unwanted pregnancy, acceptance of violence, khat chewing, and multiple sexual partners. Recommendations include comprehensive sex education, awareness campaigns, relationship counseling, community engagement, improved healthcare access, stronger legal frameworks, and empowerment programs.

Background and Aims

Given the importance of social determinants on health outcomes, training medical sciences students in addressing social determinants of health can enhance their effectiveness and social accountability. The aim of this study was to assess the effect of an educational program on the knowledge and attitude of medical sciences students regarding social determinants of health.

Methods

Using a one-group pretest-posttest quasi-experimental design, this study selected 200 students from a medical university in Iran through simple random sampling. A tailored educational intervention, grounded in the conceptual framework for action on social determinants of health, was implemented. To assess the program's effect, data were collected using a validated questionnaire that measured the students' knowledge and attitudes towards social determinants of health both at baseline (pretest) and 1 month following the intervention (posttest).

Results

The application of the Wilcoxon Signed-Ranks Test revealed a significant increase in the median scores for knowledge and attitude postintervention. Specifically, the posttest median scores were significantly elevated compared to the pretest knowledge score (Z = −11.89, p < 0.001) and attitude score (Z = −11.60, p < 0.001). This indicates that the educational intervention significantly improved the students' knowledge and attitudes concerning social determinants of health.

Conclusion

The study outcomes suggest that educational interventions focused on social determinants of health effectively improve students' knowledge and attitudes. We recommend integrating such programs into the medical sciences curriculum and experiential training. By doing so, we can better prepare future healthcare professionals to address social determinants of health-related issues. This approach has the potential to reduce health disparities and also addresses broader social challenges affecting population health.

Background and Aims

There is a demand for additional data regarding the impact of coronavirus disease 2019 (COVID-19) on the pediatric population. This study sought to determine the clinical and epidemiological features of pediatric COVID-19 in Iran.

Methods

A retrospective study was performed to assess medical records of children with COVID-19 admitted to Abuzar Hospital in Ahvaz (Iran). Their clinical and demographic data were recorded.

Results

In this study, 600 medical records of pediatric COVID-19 patients were evaluated. Over 50% of them were boys. Mild, moderate, and severe manifestations of COVID-19 were identified in 250, 200, and 150 children, respectively. Patients with severe or moderate COVID-19 had substantially higher levels of various inflammatory markers (C-reactive protein (CRP), fibrinogen, and d-dimer), alanine transaminase (ALT), creatine kinase (CPK), blood urea nitrogen (BUN), neutrophils, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatinine (Cr), bilirubin, and gamma-glutamyl transferase (GGT) compared to children with mild COVID-19 (p < 0.001); they also had lower levels of lymphocytes, hemoglobin (Hb), and vitamin D than patients with mild COVID-19 (p < 0.001). In addition, children with severe or moderate COVID-19 had a notably higher incidence of fever or dry cough and longer hospital stays than those with mild COVID-19 (p < 0.001). The prevalence of malnutrition and anemia in patients was 50.6% and 31.5%, respectively. A significant proportion of children who were underweight and stunted experienced moderate to severe COVID-19. Furthermore, there was a considerably higher prevalence of malnutrition, anemia, and vitamin D insufficiency, or deficiency in children with moderate-to-severe COVID-19 compared to patients with mild COVID-19 (p < 0.001).

Conclusion

The outcomes of this study revealed a significantly higher prevalence of malnutrition, anemia, vitamin D insufficiency or deficiency, elevated liver and kidney function test results, and increased inflammatory markers in children with moderate to severe COVID-19 compared to those with mild COVID-19.