Category: Statistics

BMJ Open. 2024 Apr 10;14(4):e079451. doi: 10.1136/bmjopen-2023-079451.

ABSTRACT

BACKGROUND: Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls’ health and education in Khulna, Bangladesh.

METHODS AND ANALYSIS: AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls’ menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls’ guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools’ water, sanitation and hygiene, and support for menstruation and collect data on participants’ education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

ETHICS AND DISSEMINATION: AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

PMID:38604626 | DOI:10.1136/bmjopen-2023-079451

J Sport Rehabil. 2024 Apr 10:1-7. doi: 10.1123/jsr.2023-0308. Online ahead of print.

ABSTRACT

CONTEXT: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR).

DESIGN: Cross-sectional study.

METHODS: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90-1.00), high (.70-.90), moderate (.50-.70), low (.30-.50), and no correlation (.00-.30).

RESULTS: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27).

CONCLUSIONS: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.

PMID:38604600 | DOI:10.1123/jsr.2023-0308

J Theor Biol. 2024 Apr 9:111824. doi: 10.1016/j.jtbi.2024.111824. Online ahead of print.

ABSTRACT

The human gut microbiota relies on complex carbohydrates (glycans) for energy and growth, primarily dietary fiber and host-derived mucins. We introduce a mathematical model of a glycan generalist and a mucin specialist in a two-compartment chemostat model of the human colon. Our objective is to characterize the influence of dietary fiber and mucin supply on the abundance of mucin-degrading species within the gut ecosystem. Current mathematical gut reactor models that include the enzymatic degradation of glycans do not differentiate between glycan types and their degraders. The model we present distinguishes between a generalist that can degrade both dietary fiber and mucin, and a specialist species that can only degrade mucin. The integrity of the colonic mucus barrier is essential for overall human health and well-being, with the mucin specialist Akkermanisa muciniphila being associated with a healthy mucus layer. Competition, particularly between the specialist and generalists like Bacteroides thetaiotaomicron, may lead to mucus layer erosion, especially during periods of dietary fiber deprivation. Our model treats the colon as a gut reactor system, dividing it into two compartments that represent the lumen and the mucus of the gut, resulting in a complex system of ordinary differential equations with a large and uncertain parameter space. To understand the influence of model parameters on long-term behavior, we employ a random forest classifier, a supervised machine learning method. Additionally, a variance-based sensitivity analysis is utilized to determine the sensitivity of steady-state values to changes in model parameter inputs. By constructing this model, we can investigate the underlying mechanisms that control gut microbiota composition and function, free from confounding factors.

PMID:38604595 | DOI:10.1016/j.jtbi.2024.111824

Joint Bone Spine. 2024 Apr 9:105733. doi: 10.1016/j.jbspin.2024.105733. Online ahead of print.

ABSTRACT

INTRODUCTION: National and international scientific societies advocate for a regular, systematic, and standardized global evaluation of axial spondyloarthritis (axSpA) patients. However, there are no recommendations specifying the content of this global evaluation. This initiative aimed to propose a standardized reporting framework, using evidence-based and consensus approaches, to collect data on all domains of axSpA.

METHODS: A literature review and consensus process involved a steering committee and an expert panel of 37 rheumatologists and health professionals. The first steering committee took place in March 2022 and identified the main domains for inclusion in the standardized report. A hierarchical literature review was conducted to identify items within these domains and tools for assessment. The items and tools for assessment were discussed and consensus was reached through a vote session during an expert meeting that took place in March 2023.

RESULTS: The steering committee identified four main domains to include in the standardized reporting framework: disease assessment, comorbidities, lifestyle, and quality of life. Items and tools for assessment were adopted after the expert meeting. Additionally, recommendations regarding digital tools (websites, apps, social media) were provided.

CONCLUSION: This initiative led to a consensus, based on evidence and expertise, on a reporting framework for use during periodic systematic global evaluations of axSpa in daily practice.

PMID:38604594 | DOI:10.1016/j.jbspin.2024.105733

Heart Rhythm. 2024 Mar 27:S1547-5271(24)02277-X. doi: 10.1016/j.hrthm.2024.03.1783. Online ahead of print.

ABSTRACT

BACKGROUND: The utility of atrioventricular (AV) optimization (AVO) algorithms remains in question. A substudy of the SMART-AV trial found patients with prolonged interventricular (RV-LV) delays ≥70 ms were more likely to benefit from CRT with AVO. The SMART-CRT trial evaluated AVO based on these results, but the study was underpowered.

OBJECTIVE: To increase statistical power, data from SMART-AV patients meeting the inclusion criteria of RV-LV ≥70 ms were pooled with data from SMART-CRT to reassess AVO.

METHODS: SMART-CRT and SMART-AV were prospective, randomized, multicenter clinical trials. Patients in both studies were randomized to be programmed with an AVO algorithm (SmartDelay) or fixed AV delay (120 ms). Paired echocardiograms obtained at baseline and six months were compared, with CRT response defined as ≥15% reduction in left ventricle end systolic volume (LVESV).

RESULTS: A total of 451 complete patient datasets were pooled and analyzed. The baseline demographics between studies did not differ statistically in terms of age, sex, LV ejection fraction, or LVESV. The AVO group had a greater proportion of CRT responders (SmartDelay: 73.9%, Fixed: 63.1%, p=0.014) and greater changes in measures of reverse remodeling. SmartDelay patients with a recommended sensed AV delay outside the nominal range (100-120 ms) had 2.3 greater odds of CRT response than fixed AV delay patients.

CONCLUSION: Greater CRT response and measures of reverse remodeling were observed in patients with SmartDelay enabled versus a fixed AV delay. The present study supports the use of SmartDelay in patients with a CRT indication and interventricular delay ≥70 ms.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00677014 and NCT03089281.

PMID:38604592 | DOI:10.1016/j.hrthm.2024.03.1783

Brain Res. 2024 Apr 9:148931. doi: 10.1016/j.brainres.2024.148931. Online ahead of print.

ABSTRACT

This study aims to explore the therapeutic effect and possible mechanisms of icariin in schizophrenia. SD rats were divided into five groups, a control group, a MK801-induced schizophrenia model group, and three icariin treatment groups, with twelve rats in each group. Morris water maze and open field were used to observe the spatial learning and memory ability of rats. Compared with the control group, rats in the MK801-induced model group showed an increase in stereotypic behavior score, distance of spontaneous activities, escape latency, malondialdehyde (MDA) content, and IL-6, IL-1β, TNF-α expression, but a decrease in platform crossing times and superoxide dismutase (SOD) activity (P < 0.05). Furthermore, all the above changes of the model group were reversed after icariin treatment in a dose-dependent manner (P < 0.05). Network pharmacology found that icariin can exert anti-schizophrenic effects through some signaling pathways, such as relaxin, estrogen, and TNF signaling pathways. MAPK1, MAPK3, FOS, RELA, TNF, and JUN were the key targets of icariin on schizophrenia, and their expression was detected in animal models, which was consistent with the predicted results of network pharmacology. Icariin treatment may improve the spatial learning and memory ability of schizophrenic rats through TNF signaling pathway.

PMID:38604555 | DOI:10.1016/j.brainres.2024.148931

Front Neuroendocrinol. 2024 Apr 9:101133. doi: 10.1016/j.yfrne.2024.101133. Online ahead of print.

ABSTRACT

The incorporation of sex and gender (S/G) related factors is commonly acknowledged as a necessary step to advance towards more personalized diagnoses and treatments for somatic, psychiatric, and neurological diseases. Until now, most attempts to integrate S/G-related factors have been reduced to identifying average differences between females and males in behavioral/ biological variables. The present commentary questions this traditional approach by highlighting three main sets of limitations: 1) Issues stemming from the use of classic parametric methods to compare means; 2) challenges related to the ability of means to accurately represent the data within groups and differences between groups; 3) mean comparisons impose a results’ binarization and a binary theoretical framework that precludes advancing towards precision medicine. Alternative methods free of these limitations are also discussed. We hope these arguments will contribute to reflecting on how research on S/G factors is conducted and could be improved.

PMID:38604552 | DOI:10.1016/j.yfrne.2024.101133

Nurse Educ Today. 2024 Apr 1;138:106189. doi: 10.1016/j.nedt.2024.106189. Online ahead of print.

ABSTRACT

AIM: The purpose of this study was to analyze the effectiveness of virtual reality technology in nursing education.

BACKGROUND: Virtual reality technology is regarded as one of the advanced and significant instructional tools in contemporary education. However, its effectiveness in nursing education remains a subject of debate, and there is currently limited comprehensive research discussing the impact of varying degrees of virtual technology on the educational effectiveness of nursing students.

DESIGN: Systematic review and meta-analysis.

METHODS: The present systematic review and meta-analysis were applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The PubMed, Embase, CINAHL, ProQuest, Cochrane Library, Web of Science, and Scopus were searched for relevant articles in the English language. The methodologies of the studies evaluated were assessed using Cochrane Risk of Bias2 (ROB 2) tool and Joanna Briggs Institute (JBI) assessment tool. We took the learning satisfaction, knowledge, and skill performance of nursing students as the primary outcomes, and nursing students’ self-efficacy, learning motivation, cognitive load, clinical reasoning, and communication ability were assessment as secondary outcomes. The meta-analysis was performed using R 4.3.2 software according to PRISMA guidelines. Heterogeneity was assessed by I² and P statistics. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were used as effective indicators.

RESULTS: Twenty-six studies were reviewed, which involved 1815 nursing students. The results showed that virtual reality teaching, especially immersive virtual reality, was effective in improving nursing students’ learning satisfaction (SMD: 0.82, 95%CI: 0.53-1.11, P < 0.001), knowledge (SMD: 0.56, 95%CI: 0.34-0.77, P < 0.001), skill performance (SMD: 1.13, 95 % CI: 0.68-1.57, P < 0.001), and self-efficacy (SMD: 0.64, 95%CI: 0.21,1.07, P < 0.001) compared to traditional teaching methods. However, the effects of virtual reality technology on nursing students’ motivation, cognitive load, clinical reasoning, and communication ability were not significant and require further research.

CONCLUSIONS: The results of this study show that virtual reality technology has a positive impact on nursing students. Nonetheless, it is crucial not to underestimate the effectiveness of traditional education methods, and future research could analyze the impact of different populations on nursing education while improving virtual reality technology, to more comprehensively explore how to improve the quality of nursing education. Moreover, it is imperative to emphasize the integration of virtual education interventions with real-world experiences promptly. This integration is essential for bridging the gap between the virtual learning environment and real-life scenarios effectively.

REGISTRATION NUMBER: CRD42023420497 (https://www.crd.york.ac.uk/PROSPERO/#recordDetails).

PMID:38603830 | DOI:10.1016/j.nedt.2024.106189

Nurse Educ Today. 2024 Mar 24;138:106155. doi: 10.1016/j.nedt.2024.106155. Online ahead of print.

ABSTRACT

BACKGROUND: Good nursing leadership management positively correlates with patient care quality and an organization’s performance. Plans to nurture top-notch talents and strengthen management functions are essential to retain key talents and achieve sustainability. The leadership training for nursing staff should begin early to cope with complex clinical situations.

OBJECTIVES: To compare the impact of leadership training on high-performing young nurses’ (young nursing elite) management functions and team behavior.

SETTING: A public teaching hospital in Taipei, Taiwan.

METHODS: This research implemented a longitudinal quasi-experimental study with a fixed time series design; the target subjects were youth nursing elites who received training, along with their direct managers and peers, for a total of 102 participants. The training course intervention included the classroom teaching of leadership management functions, arranging internships in the hospital’s internal administrative units and professional nursing institutions, and the direct managers sharing their experiences during teaching. We measured the outcome indicators before the course intervention, at the end of the course intervention, and three months after using the management function and team behavior scales.

RESULTS: The mean score of the direct managers’ assessments regarding the youth nursing elite’s pre-test team behavior was 4.18. This improved by 0.68 points (p < .001) after the program intervention and improved by 0.65 points (p < .001) three months after the program compared to the pre-test. There was no statistically significant difference between the two groups as analyzed using GEE. The mean score of the pre-test self-assessment management function of the young nursing elite was 3.27. This improved by 1.06 points (p < .001) after the program intervention and by 1.14 points (p < .001) three months after the program compared to the pre-test. There was no statistically significant difference between the three groups using GEE analysis.

CONCLUSIONS: Leadership training enhances young nursing professionals’ leadership function and team behavior.

PMID:38603829 | DOI:10.1016/j.nedt.2024.106155

Nurse Educ Today. 2024 Apr 6;138:106196. doi: 10.1016/j.nedt.2024.106196. Online ahead of print.

ABSTRACT

BACKGROUND: One in four newly graduated registered nurses leave their employment positions within the first year. To reduce this attrition, nursing stakeholders could focus on the final year of nursing education because students at this stage make professional career plans, including their practice destination for the graduate year and their commitment to the profession. Previous studies provide evidence of nursing students’ career preferences and specialty choices. However, there is a dearth of data that focuses on the students’ career decision-making process.

AIM: This study examined the self-efficacy or confidence of final-year nursing students in making career decisions and the factors that influence their career decision-making process.

SETTING AND PARTICIPANTS: Final year pre-registration nursing students (N = 222) at two public universities in Western Australia.

METHODS: An online survey was used to collect cross-sectional data. The Career Decision Self-Efficacy Scale – Short Form was used to investigate nursing students’ confidence in making career decisions. Career decision-making self-efficacy refers to the confidence to successfully complete career decision-making tasks. Descriptive statistics were used to describe the participants’ characteristics. The chi-square test was used to assess the significance of the difference between categorical data, and binary logistic regression was used to determine the odds of the factors that predict career decision self-efficacy.

RESULTS: Forty-seven percent of participants who answered all Career Decision Self-Efficacy Scale – Short Form questions had good confidence in making career decisions. Factors such as the setting of the final clinical placement, the intention to be employed in the specialisation or organisation of their final placement and the students’ assessment of their clinical experience were associated with career decision-making confidence.

CONCLUSIONS: Most participants had low confidence in making career decisions. This study provides ideas for nursing stakeholders to implement measures to improve students’ confidence to make informed career decisions.

PMID:38603828 | DOI:10.1016/j.nedt.2024.106196