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Foreward 前言
Q3 Nursing Pub Date : 2022-03-17 DOI: 10.2427/12847
Walter Ricciardi
        
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引用次数: 0
The Heterogeneous Effects of Family Structure on Early Child Health 家庭结构对幼儿健康的异质性影响
Q3 Nursing Pub Date : 2022-02-21 DOI: 10.2427/12706
M. C. Mulenga
Background Ending preventable deaths of newborns and children under 5 years of age by 2030 is one of the targets of the Sustainable Development Goals. Data from the 2013-14 Zambia Demographic and Health Survey shows that there has been improvements in some indicators of child health over the years and this has coincided with the widespread demographic changes in family formation. It’s hypothesized that children from monogamous households tend to have much better health outcomes compared to single or polygynous households. This study therefore set out to examine the effect of heterogeneous family structures on early child health. Methods Using data from the 2013-14 ZDHS, the study employed the Kids Recode (KR) data file which contains information about children under the age of five (5) of interviewed women. The analysis was conducted at three levels: descriptive, bivariate and multivariate.  Results The study established that family structure had a statistically significant effect on early child health and that there was heterogeneity in the health outcomes of the children from different forms of marriage, with the ever married and polygamous marriage categories showing higher odds of having underweight children. The study also established that mother’s nutrition status, region, sex of child, mother’s age at birth of the child and child vaccination were also among other factors associated with the early child health in Zambia.  Conclusion There is need for the government to implement policies that will limit the exposure of children to adverse health which would require more costly interventions later in life.
到2030年消除新生儿和5岁以下儿童可预防的死亡是可持续发展目标的具体目标之一。2013- 2014年赞比亚人口与健康调查的数据显示,多年来儿童健康的一些指标有所改善,这与家庭组成方面的广泛人口变化相吻合。据推测,一夫一妻制家庭的孩子比单身或一夫多妻制家庭的孩子健康状况要好得多。因此,本研究旨在探讨异质家庭结构对儿童早期健康的影响。方法采用2013- 2014年儿童健康调查(ZDHS)数据,采用儿童记录(Kids Recode, KR)数据文件,该文件包含受访妇女5岁以下儿童的信息。分析在三个层面进行:描述性、双变量和多变量。结果研究表明,家庭结构对儿童早期健康有显著的影响,不同婚姻形式的儿童的健康结果存在异质性,已婚和一夫多妻婚姻类型的儿童体重不足的几率更高。该研究还确定,母亲的营养状况、地区、儿童性别、母亲的出生年龄和儿童接种疫苗也是与赞比亚儿童早期健康有关的其他因素。政府有必要实施限制儿童接触不良健康的政策,这将需要在以后的生活中采取更昂贵的干预措施。
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引用次数: 0
Intermediate care units in progressive patient care model: a systematic literature review 渐进式病人护理模式的中间护理单位:系统的文献回顾
Q3 Nursing Pub Date : 2022-02-15 DOI: 10.2427/12915
V. Colamesta, Valentina Dugo, D. L. Milia, L. Sommella, G. B. Orsi, Roberto Bucci, C. Vito, G. Torre, P. Laurenti, S. Mancinelli, M. Maurici, G. Damiani, L. Palombi, P. Villari, E. Vito, W. Ricciardi
Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model. Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review. Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model. Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.
背景:渐进式患者护理(PPC)被定义为基于患者的医疗和护理需求对患者进行系统的分类和隔离。本研究的目的是对现有的医疗中间护理单位组织模式及其绩效优势和劣势进行系统的文献综述,并特别关注意大利的实施,尊重美国模式。方法:检索PubMed、Cinahl、Google和Google Scholar数据库至2017年9月。研究仅限于意大利语和英语研究。所有的研究设计都包含在综述中。结果:纳入10项研究。美国的研究表明,在PPC重组后,满意度和护理水平都有所提高,平均住院时间、成本和护士之间的紧张关系都有所减少,护士与医生的沟通也有所改善。意大利的一项研究报告了在三个案例研究(Forlì、Foligno和Pontedera医院)中开展的一个项目的结果,该项目围绕护理强度的概念重新设计了医院的病人流动物流:在所有三个案例中,重组后,床位占用率增加(之前:71%、81%、65%;术后:分别为78%、84%、82%)和院内病例混合复杂性(平均DRG权重-术前:0.99、1.07、1.12;后分别为1.19、1.09、1.61),周转率降低(前分别为2.5、1.4、2.8;分别记录1.5、1.2、1.7)。考虑到意大利医疗专业人员的观点,大多数内科医生支持医院按照PPC模式进行改造。结论:在美国理论化的PPC模式在意大利的地区现实中已经找到了一些应用。观察到采用PPC方案的医疗机构在护理质量、适当性和生产力方面的改进。
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引用次数: 0
Extent, duration and predictors of exclusive breastfeeding in a longitudinal study: adjusting for missing data using an accelerated failure time model and multiple imputation 纵向研究中纯母乳喂养的范围、持续时间和预测因素:使用加速失效时间模型和多重输入来调整缺失数据
Q3 Nursing Pub Date : 2022-02-11 DOI: 10.2427/13008
Havi Murad, Samah Hayek, A. Ifrah, T. Shohat, L. Freedman
Background: The World Health Organization recommends at least 6 months of exclusive breastfeeding (EBF). Longitudinal studies facilitate estimation of EBF duration, but often suffer from loss to follow-up and missing information. The study estimates the prevalence of EBF, duration and predictors of EBF duration while adjusting for missing data using multiple imputation (MI). Methods: A longitudinal study was conducted on all women giving birth between September 2009-February 2010 in selected hospitals (N=2119). Data on EBF and socio-demographic and other characteristics were collected at birth, and at 2, 6, 12 and 24 months. Information on EBF status and duration was missing for 29%. To deal with missing data, we generated multiple datasets using logistic regression-based MI to impute missing EBF practice, and an accelerated failure time (AFT) model to impute missing duration of EBF. The latter model also identified factors associated with EBF duration. Results: The observed 64% of women practicing EBF (95%CI; 62%-66%) was adjusted, after imputation, to 62% (95%CI; 60%-65%). After imputation, the estimated median time of EBF among women practicing EBF was 4.9 months. Predictors of EBF duration were stated intention to breastfeed, religious observance, and giving formula milk while in hospital. Conclusion: Adjusting estimates of EBF practice and duration using MI is feasible and potentially important. Using an AFT model for EBF duration enables the execution of MI in such studies and allows direct interpretation of the impact of various factors on EBF duration. 
背景:世界卫生组织建议至少6个月的纯母乳喂养(EBF)。纵向研究有助于估计EBF持续时间,但往往存在随访缺失和信息缺失的问题。该研究估计了EBF的患病率、持续时间和EBF持续时间的预测因子,同时使用多重插值(MI)对缺失的数据进行了调整。方法:对2009年9月至2010年2月在选定医院分娩的所有妇女进行纵向研究(N=2119)。在出生时、2个月、6个月、12个月和24个月时收集EBF、社会人口统计学和其他特征的数据。29%的EBF状态和持续时间信息缺失。为了处理缺失数据,我们使用基于逻辑回归的MI来计算缺失的EBF实践,并使用加速失效时间(AFT)模型来计算EBF的缺失持续时间。后一种模型还确定了与EBF持续时间相关的因素。结果:观察到64%的女性进行EBF (95%CI;62%-66%),经归算后调整为62% (95%CI;60% - -65%)。算入后,实施EBF的女性中位时间估计为4.9个月。EBF持续时间的预测因子是表示母乳喂养的意图、宗教仪式和住院期间使用配方奶。结论:利用心肌梗死调整EBF实践和持续时间的估计是可行的,并且具有潜在的重要性。使用AFT模型计算EBF持续时间,可以在此类研究中执行MI,并可以直接解释各种因素对EBF持续时间的影响。
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引用次数: 1
The European network staff eXchange for integrAting precision health in the health Care sysTems (ExACT): a Marie Curie Research and Innovation Staff Exchange (RISE) project 将精准医疗纳入医疗保健系统(ExACT)的欧洲网络人员交流:居里夫人研究与创新人员交流(RISE)项目
Q3 Nursing Pub Date : 2022-02-07 DOI: 10.2427/13122
S. Boccia, R. Pastorino, M. Mariani, W. Ricciardi
  
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引用次数: 3
A multi-sectoral intervention model to scale up family planning services utilization at the primary health care level: evidence from a priority district, Fayoum governorate, Egypt 在初级卫生保健一级扩大计划生育服务利用的多部门干预模式:来自埃及法尤姆省一个重点地区的证据
Q3 Nursing Pub Date : 2022-02-07 DOI: 10.2427/12990
N. M. Elden, W. Khairy, Tarek Tawfik Amin
Background: Egypt is one of the most populous countries in the Middle East and Africa. Evidence from developing countries revealed that increasing family planning use is associated with substantial declines in fertility and population growth. The objective of this study was to assess the impact of implementing a multisectoral intervention model on the family planning utilization at the Primary Health Care (PHC) level in a priority district, Fayoum governorate, Egypt.  Methods: A quasi-experimental design was conducted from July 2016 to September 2016. The model targeted 10 PHC units out of 23 at Tamia district, with two types of interventions; health sector and non-health sector related interventions carried out in the intervention units and their catchment areas. The family planning utilization of the intervention units (n=10) was compared to the control units (n=13). Additionally, the overall family planning utilization at the district level was measured.  Results: Following the implementation of the interventions, the overall family planning utilization at the district level showed a significant increase in mean ± Standard Error of the Mean (SEM) of new family planning clients (44.4±11.0vs. 63.3±13.8; P= 0.006) recording 43% change. The mean ± SEM of intrauterine devices dispensed from the intervention units significantly increased by 391% (3.5±1.0 vs. 17.2±3.3; P=0.002). Findings from the control units didn't reveal significant increase regarding the dispense of any family planning method.  Conclusion: Mobilizing and optimizing resources use, empowering district authorities and strengthening collaboration across sectors were key drivers of the success of this model in scaling up family planning services utilization.   
背景:埃及是中东和非洲人口最多的国家之一。来自发展中国家的证据表明,计划生育使用的增加与生育率和人口增长的大幅下降有关。本研究的目的是评估在埃及法尤姆省一个重点地区实施多部门干预模式对初级卫生保健(PHC)一级计划生育利用的影响。方法:2016年7月~ 2016年9月采用准实验设计。该模式针对塔米亚县23个初级保健单位中的10个,采取两种干预措施;在干预单位及其集水区开展与卫生部门和非卫生部门有关的干预。将干预单位(n=10)与对照单位(n=13)的计划生育利用率进行比较。此外,还测量了地区一级计划生育的总体利用情况。结果:干预措施实施后,区级计划生育总体利用率显著提高,新增计划生育客户的均数±标准误差(SEM)为44.4±11.0vs。63.3±13.8;P= 0.006),变化43%。干预单元配发的宫内节育器平均±SEM显著增加391%(3.5±1.0 vs. 17.2±3.3;P = 0.002)。控制单位的调查结果没有显示任何计划生育方法的使用有显著增加。结论:动员和优化资源利用、赋予地区当局权力和加强跨部门合作是该模式在扩大计划生育服务利用方面取得成功的关键驱动因素。
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引用次数: 0
Prevalence of nicotine dependence among university students in Jordan: a cross-sectional study 约旦大学生尼古丁依赖患病率:一项横断面研究
Q3 Nursing Pub Date : 2022-02-07 DOI: 10.2427/13075
M. Khatatbeh, Sireen M Alkhaldi, Y. Khader, W. Momani, O. Omari, K. Kheirallah, Laila Matalqa, N. Bataineh, M. Bashtawy, Ghaith Al-Taani
Tobacco epidemic is one of the biggest public health threats the world has ever encountered. The objective of this study was to identify the prevalence of nicotine dependence among university students in Jordan and assess factors associated with this dependence.  A cross-sectional study using simple random sampling was conducted among university students from 3 public and 3 private universities selected for their convenience from central, middle, and east Jordan via administering a questionnaire between October 2016 and January 2017. The total number of participants was 892.  The overall nicotine dependence was 51.2%. Correlates to nicotine dependence were studying at an undergraduate level (OR=3.6; 95% CI: 1.4-8.1); studying humanities (OR=1.73; 95% CI: 1.2-2.1); existing of a smoking family member (OR=1.63; 95% CI: 1.5-1.9); starting smoking before age of 15 years (OR=1.60; 95% CI: 1.2-2.1); water pipe smoking (OR=1.48; 95% CI: 1.1-2.0); and studying at governmental universities (OR=1.36; 95% CI: 1.0-1.8).  Several socio-demographic characteristics had an impact on nicotine dependence. Future research is necessary to further improve our understanding of motives for smoking and dependence. 
烟草流行是世界有史以来面临的最大公共卫生威胁之一。本研究的目的是确定约旦大学生中尼古丁依赖的流行程度,并评估与这种依赖相关的因素。2016年10月至2017年1月期间,通过问卷调查,采用简单随机抽样的方法对来自约旦中部、中部和东部3所公立大学和3所私立大学的大学生进行了横断面研究。参与者总数为892人。总体尼古丁依赖性为51.2%。与尼古丁依赖相关的是本科水平的研究(OR=3.6;95% ci: 1.4-8.1);学习人文学科(OR=1.73;95% ci: 1.2-2.1);有吸烟的家庭成员(OR=1.63;95% ci: 1.5-1.9);15岁前开始吸烟(OR=1.60);95% ci: 1.2-2.1);水管吸烟(OR=1.48;95% ci: 1.1-2.0);在公立大学学习(OR=1.36;95% ci: 1.0-1.8)。一些社会人口特征对尼古丁依赖有影响。未来的研究有必要进一步提高我们对吸烟动机和依赖的理解。
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引用次数: 9
Bayesian model averaging: improved variable selection for matched case-control studies. 贝叶斯模型平均:改进匹配病例对照研究的变量选择。
Q3 Nursing Pub Date : 2022-02-07 DOI: 10.2427/13048
Yi Mu, I. See, J. Edwards
BackgroundThe problem of variable selection for risk factor modeling is an ongoing challenge in statistical practice. Classical methods that select one subset of exploratory risk factors dominate the medical research field. However, this approach has been criticized for not taking into account the uncertainty of the model selection process itself. This limitation can be addressed by a Bayesian model averaging approach: instead of focusing on a single model and a few factors, Bayesian model averaging considers all the models with non-negligible probabilities to make inference.MethodsThis paper reports on a simulation study designed to emulate a matched case-control study and compares classical versus Bayesian model averaging selection methods. We used Matthews's correlation coefficient to measure the quality of binary classifications. Both classical and Bayesian model averaging were also applied and compared for the analysis of a matched case-control study of patients with methicillin-resistant Staphylococcus aureus infections after hospital discharge 2011-2013.ResultsBayesian model averaging outperformed the classical approach with much lower false positive rates and higher Matthew's correlation scores. Bayesian model averaging also produced more reliable and robust effect estimates.ConclusionBayesian model averaging is a conceptually simple, unified approach that produces robust results. It can be used to replace controversial P-values for case-control study in medical research.
在统计实践中,风险因素建模的变量选择问题一直是一个挑战。选择探索性风险因素子集的经典方法在医学研究领域占主导地位。然而,这种方法由于没有考虑到模型选择过程本身的不确定性而受到批评。这种限制可以通过贝叶斯模型平均方法来解决:而不是专注于单个模型和几个因素,贝叶斯模型平均考虑所有具有不可忽略概率的模型来进行推理。方法本文报道了一项模拟研究,旨在模拟匹配的病例对照研究,并比较经典和贝叶斯模型平均选择方法。我们使用马修斯相关系数来衡量二元分类的质量。对2011-2013年耐甲氧西林金黄色葡萄球菌出院后感染患者的匹配病例对照研究,采用经典模型和贝叶斯模型平均进行对比分析。结果贝叶斯模型平均优于经典方法,具有更低的假阳性率和更高的马修相关分数。贝叶斯模型平均也产生了更可靠和稳健的效应估计。结论贝叶斯模型平均是一种概念简单、统一的方法,可以产生稳健的结果。它可用于医学研究中病例对照研究中有争议的p值。
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引用次数: 6
Co-occurence of risky driving behaviours and associations with seatbelt and helmet use - a descriptive cross-sectional study among young adults 危险驾驶行为的共同发生以及与安全带和头盔使用的关联——一项针对年轻人的描述性横断面研究
Q3 Nursing Pub Date : 2022-02-07 DOI: 10.2427/13041
G. Kritsotakis, M. Papadakaki, Raymond Tumwesigye
Background: Greece exhibits one of the highest rates of deaths and injuries due to motor vehicle crashes in young adults in Europe. The personal, social and financial cost is still very high as road traffic crashes account for 65.8% of all deaths among young people aged 10-24 years, with prominent gender differences that are not fully explained yet.  Methods: using a descriptive cross-sectional study design, we examined the associations of seatbelt and helmet use with the likelihood of manifesting multiple driving violations (fail to stop at STOP signs, running red traffic lights, driving towards the wrong direction, illegal overtaking, speeding, cellphone use while driving, driving under the influence of alcohol) in a sample of 536 1st year university students in Greece. A ‘Risky Driving Index’ score (RDI) was produced by summing the frequencies of all behaviours (range 0-28).  Results: only 8.8% of the students reported not performing any of the driving violations, whereas 8.6% engaged in all 7 of them when driving (male: 11.5%; female: 1.9%; score>8, male: 31.7%; female: 8.1%). Male, but not female participants, who never used seatbelts and helmets, reported significantly higher RDI scores with evidence of a dose-response effect in the increase. In adjusted logistic regression models, those who never used (vs regular use) seat belt ‘as drivers’ and ‘as rear seat passengers’ had increased odds of being in the higher score category of RDI (OR=5.239 95%CI=1.280-21.441 and OR=6.782 95%CI=1.891-24.324, respectively).  Conclusion: young male drivers and riders, but not their female counterparts, that do not take typical safety measures (seatbelt and helmet use), reported more illegal and risky driving behaviours. Preventive interventions using a gender-informed approach are needed to address co-occurring risk driving behaviours.   
背景:希腊是欧洲年轻人因机动车碰撞死亡和受伤比例最高的国家之一。个人、社会和经济成本仍然很高,因为道路交通事故占10-24岁年轻人死亡总数的65.8%,其中性别差异突出,尚未得到充分解释。方法:采用描述性横断面研究设计,我们以536名希腊一年级大学生为样本,研究了安全带和头盔的使用与多种驾驶违规行为(未在停止标志前停车、闯红灯、朝错误方向行驶、非法超车、超速、开车时使用手机、酒后驾驶)的可能性之间的关系。“危险驾驶指数”得分(RDI)是通过将所有行为的频率(范围0-28)相加得出的。结果:只有8.8%的学生报告没有违反任何一项驾驶规则,而8.6%的学生在驾驶时违反了所有7项驾驶规则(男性:11.5%;女:1.9%;得分>8分,男性占31.7%;女:8.1%)。从不使用安全带和头盔的男性参与者报告的RDI得分显著高于女性参与者,这是剂量反应效应增加的证据。在调整后的logistic回归模型中,那些从不使用安全带(与经常使用安全带相比)的“作为司机”和“作为后排乘客”的人在RDI得分较高的类别中的几率增加(OR=5.239 95%CI=1.280-21.441和OR=6.782 95%CI=1.891-24.324)。结论:没有采取典型安全措施(安全带和头盔的使用)的年轻男性司机和乘客报告了更多的非法和危险驾驶行为,而不是他们的女性同行。需要采用性别知情方法的预防性干预措施,以解决同时发生的风险驱动行为。
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引用次数: 2
Epidemiology of miscarriage 流产流行病学
Q3 Nursing Pub Date : 2022-02-02 DOI: 10.2427/13210
C. la Vecchia
Miscarriages account for about one in six/one in seven pregnancies, and probably over one in five excluding induced abortions, i.e. over 20 million events per year. However, any precise and valid estimate is made difficult by uncertainties in diagnosis, ascertainment, distinction in registration between induced and spontaneous abortions, and certification. These uncertainties vary across geographic region, country and socio-economic status...
流产约占怀孕的六分之一/七分之一,不包括人工流产,可能超过五分之一,即每年超过2000万次。然而,由于诊断、确定、人工流产和自然流产登记的区别以及认证方面的不确定性,任何精确和有效的估计都变得困难。这些不确定性因地理区域、国家和社会经济状况而异。
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引用次数: 4
期刊
Epidemiology Biostatistics and Public Health
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