Category: Statistics

BMC Health Serv Res. 2022 Jun 22;22(1):808. doi: 10.1186/s12913-022-08168-y.

ABSTRACT

BACKGROUND: Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by programme fidelity) and care providers’ perceptions of implementation factors during an implementation process and to investigate whether these perceptions are affected by systematic implementation support.

METHODS: Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Programme fidelity and care providers’ perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups at baseline, 6-, 12- and 18-months. Associations and group differences were tested by means of descriptive statistics (mean, standard deviation and confidence interval) and linear mixed effect analysis.

RESULTS: Including 33 mental health centres or wards, we found care providers’ perceptions of a set of implementation factors to be associated with fidelity but not at baseline. After 18 months of implementation effort, fidelity and care providers’ perceptions were strongly correlated (B (95% CI) = .7 (.2, 1.1), p = .004). Care providers perceived implementation factors more positively when implementation support was provided than when it was not (t (140) = 2.22, p = .028).

CONCLUSIONS: Implementation support can facilitate positive perceptions among care providers, which is associated with higher programme fidelity. To improve implementation success, we should pay more attention to how care providers constantly perceive implementation factors during all phases of the implementation effort. Further research is needed to investigate the validity of our findings in other settings and to improve our understanding of ongoing decision-making among care providers, i.e., the mechanisms of sustaining the high fidelity of recommended practices.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03271242 (registration date: 05.09.2017).

PMID:35733211 | DOI:10.1186/s12913-022-08168-y

Arch Public Health. 2022 Jun 23;80(1):158. doi: 10.1186/s13690-022-00913-3.

ABSTRACT

BACKGROUND: The incidence of any medical condition (e.g., sight, hearing, and speech problems, blackouts, chronic pain etc.) or disability (e.g., limited use of arms or fingers, legs, and feet, or other physical long-term health condition limiting everyday activities etc.) have been increasing among Australian children in recent decades.

OBJECTIVES: This study assessed whether infant or child health characteristics might be predictors of subsequent medical conditions or disabilities in children in the first 15 years of life.

METHODS: Using time to event data of 5107 children, obtained from the Birth cohort of the Longitudinal Study of Australian Children, the study estimated the incidence of any medical condition or disability using the survival analysis technique. This study followed up the children from birth to 14 or 15 years of age (2004-2018) and assessed the association of infant and child health characteristics (birthweight, gestational age, use of intensive care unit or ventilator during their neonatal age and obesity) with hazard of any medical condition or disability using the random effect parametric survival regression model. The infant characteristics were measured in the Wave 1 while the children were aged 0/1 year and obesity characteristics were measured longitudinally over all the waves up to 14/15 years of age.

RESULTS: The hazard rate of any medical condition or disability for all participants was 26.13 per 1000 person-years among children in Australia. This hazard incidence rate was higher among low birthweight (39.07) children compared to the children of normal birthweight (24.89) children. The hazard rate also higher among obese (34.37) children compared to the normal weight children (24.82) and among those who had received after-birth ventilation or intensive care unit emergency services (36.87) compared to those who have not received these services (24.20). The parametric panel regression model also suggests that children with low birthweight were 1.43 times (Hazard Ratio: 1.43, 95% Confidence Interval: 1.05-1.94) more likely to have any medical condition or disability than children with normal birthweight. The time to event analyses also revealed that being recipient of after-birth emergencies (HR: 1.47, 95% CI: 1.23-1.75), being male children (HR: 1.30, 95% CI: 1.14-1.48) or being obese (HR: 1.38, 95% CI: 1.07-1.79) significantly increased the likelihood of the incidence of a medical condition or disability among children. The regression model was adjusted for socio-demographic characteristics of children and mothers..

CONCLUSIONS: The study findings suggest that infants with low birth weight, hospital emergency service use and children with obesity would benefit from additional health care monitoring to minimize the risk of any medical condition or disability.

PMID:35733191 | DOI:10.1186/s13690-022-00913-3

Clin Epigenetics. 2022 Jun 22;14(1):78. doi: 10.1186/s13148-022-01296-6.

ABSTRACT

Adverse birth outcomes, such as early gestational age and low birth weight, can have lasting effects on morbidity and mortality, with impacts that persist into adulthood. Identifying the maternal factors that contribute to adverse birth outcomes in the next generation is thus a priority. Epigenetic clocks, which have emerged as powerful tools for quantifying biological aging and various dimensions of physiological dysregulation, hold promise for clarifying relationships between maternal biology and infant health, including the maternal factors or states that predict birth outcomes. Nevertheless, studies exploring the relationship between maternal epigenetic age and birth outcomes remain few. Here, we attempt to replicate a series of analyses previously reported in a US-based sample, using a larger similarly aged sample (n = 296) of participants of a long-running study in the Philippines. New pregnancies were identified prospectively, dried blood spot samples were collected during the third trimester, and information was obtained on gestational age at delivery and offspring weight after birth. Genome-wide DNA methylation was assessed with the Infinium EPIC array. Using a suite of 15 epigenetic clocks, we only found one significant relationship: advanced age on the epigenetic clock trained on leptin predicted a significantly earlier gestational age at delivery (β = – 0.15, p = 0.009). Of the other 29 relationships tested predicting gestational age and offspring birth weight, none were statistically significant. In this sample of Filipino women, epigenetic clocks capturing multiple dimensions of biology and health do not predict birth outcomes in offspring.

PMID:35733189 | DOI:10.1186/s13148-022-01296-6

BMC Med Educ. 2022 Jun 23;22(1):487. doi: 10.1186/s12909-022-03538-w.

ABSTRACT

BACKGROUND: Previous studies have primarily implemented problem-based learning (PBL) or flipped classroom (FC) teaching models in different majors; however, research on the combined PBL-FC teaching method in clinical medicine is scarce. Therefore, we investigated the combined PBL-FC teaching method in teaching ocular trauma on students’ competencies.

METHOD: About 75 ophthalmology postgraduates were randomly divided into PBL-FC and traditional teaching groups. Students completed pre-and post-class theoretical examinations, skills evaluation, learning ability scales, and feedback questionnaires.

RESULTS: Both groups showed significantly higher theoretical scores and improved learning ability. Feedback questionnaire scores of the PBL-FC group’s postgraduates without clinical experience were significantly higher than the traditional group’s for some items; there was no difference between groups in postgraduates with clinical experience. PBL-FC group’s pre-class preparation time was significantly longer than the traditional group’s, but the post-class review time was significantly shorter. PBL-FC group’s post-class theoretical performance was significantly higher than the traditional group’s. There was no statistical difference between the groups regarding skill operation. Among postgraduates without clinical experience, the PBL-FC group’s skill operation performance was significantly higher than the traditional group’s; for postgraduates with clinical experience, the traditional group’s skill operation performance was significantly higher than the PBL-FC group’s.

CONCLUSIONS: PBL-FC teaching is better for students without clinical experience or knowledge of ophthalmic diseases. Meanwhile, traditional teaching is a good choice for students with clinical experience who need more relevant knowledge.

PMID:35733187 | DOI:10.1186/s12909-022-03538-w

BMC Med Educ. 2022 Jun 23;22(1):486. doi: 10.1186/s12909-022-03548-8.

ABSTRACT

BACKGROUND: Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia.

METHODS: The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher’s exact tests.

RESULTS: The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students’ performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05).

CONCLUSION: The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.

PMID:35733185 | DOI:10.1186/s12909-022-03548-8

BMC Public Health. 2022 Jun 23;22(1):1243. doi: 10.1186/s12889-022-13660-5.

ABSTRACT

BACKGROUND: The simultaneity of undernourishment among child and overweight/obesity among mothers in lower-and-middle-income-countries (LMICs) introduces a new nutrition dilemma, known as double burden of malnutrition (DBM). Amidst of such paradox, the hike of caesarean section (CS) delivery is also triggering child undernutrition and maternal obesity. A gap of knowledge regarding the effect of mode of delivery on DBM still persists. The study aims to explore the association between DBM at household level and mode of delivery over time in LMICs.

METHOD: The study used data from recent four consecutive waves of Bangladesh Demographic and Health Survey (BDHS) ranging from BDHS 2007 to BDHS 2017. It considered the mother-child pairs from data where mothers were non-pregnant women aged 15-49 years having children born in last 3 years preceding the survey. Bivariate analysis and Logistic Regression were performed to explore the unadjusted and adjusted effect of covariates on DBM. An interaction term of mode of delivery and survey year was considered in regression model.

RESULTS: The study evinces a sharp increase of DBM rate in Bangladesh from 2007 to 2017 (2.4% vs. 6.4%). The prevalence of DBM in household level among the children delivered by CS is more than two times of those born by normal delivery (8.2% vs. 3.5%). The multivariate analysis also indicates that the children born by CS delivery are more likely to be affected by DBM at household level significantly than those born by normal delivery in each waves. Moreover, the odds ratio (OR) of DBM at household is increased by 43% for one unit change in time for normal delivery whereas CS delivery births have 12% higher odds of DBM at household level with one unit change in time.

CONCLUSION: The study discloses a drastic increase of rate of DBM among mother-child pairs over the time. It stipulates inflated risk of DBM at household with time for both mode of delivery but the children with CS delivery are at more risk to the vulnerability of DBM at household level. The study recommends a provision of special care to the mothers with CS delivery to reduce DBM at household.

PMID:35733171 | DOI:10.1186/s12889-022-13660-5

BMC Vet Res. 2022 Jun 22;18(1):235. doi: 10.1186/s12917-022-03320-6.

ABSTRACT

BACKGROUND: In Ethiopia, the majority of animal owners throughout the country depend on traditional healthcare practices to manage their animals’ health problems. This ethnoveterinary study was carried out in Ensaro District, North Showa Zone, and Amhara Region, Ethiopia, to identify medicinal plant species used by the local community to treat various livestock ailments.

METHODS: To collect ethnobotanical information, a total of 389 informants (283 men and 106 women) were selected. Among these 95 traditional medicine practitioners were purposely chosen, while the remaining 294 were selected through a systematic random sampling method. Ethnobotanical data were collected through semi-structured interviews, participant observation, guided filed walks and focus group discussions. The Informant Consensus Factor (ICF) and Fidelity Level (FL) values, preference, and direct matrix exercise ranking were determined using quantitative methods. Statistical tests were used to compare indigenous knowledge of medicinal plants among different informant groups.

RESULTS: A total of 44 ethnoveterinary medicinal plant species were collected and identified that were distributed across 43 genera and 28 families. The family Solanaceae stood first by contributing 4 species followed by Amaranthaceae, Asteraceae, Euphorbiaceae, Fabaceae and lamiaceae with 3 species each. Thirty- seven (88.09%) medicinal plants were collected from wild habitats, 6 medicinal plant species were collected from home garden. The most frequently used life form was shrubs (23 species, 54.76%) followed by herbs (13 species, 30.95%). The widely used parts of medicinal plants were leaves followed by roots. Prepared remedies were administered through drenching, dropping, smearing, eating, wrapping, fumigating and washing. There was significant difference in the indigenous knowledge of medicinal plants between gender, urban and rural people, general and key informants and among age groups.

CONCLUSION: Ensaro District is a relatively rich in diversity of ethnoveterinary medicinal plants together with a rich indigenous knowledge in the local communities to collect and effectively utilize for the management different livestock diseases. On the other hand, these days, agricultural expansion, fuel wood collection, cutting plants for fence, furniture and charcoal production are the major threatening factors of these plant resources. Thus, people of the study area must implement in situ and ex-situ conservation strategies to ensure sustainable utilization of these species.

PMID:35733153 | DOI:10.1186/s12917-022-03320-6

BMC Oral Health. 2022 Jun 22;22(1):248. doi: 10.1186/s12903-022-02274-3.

ABSTRACT

BACKGROUND: Diamond particles have recently been used as abrasives in toothpastes, which raises questions about its abrasive behaviour towards enamel. This study was carried out to investigate the abrasive enamel wear caused by three diamond-loaded toothpastes (Candida White Diamond: CWD, Swiss Smile Diamond Glow: SSDG, Emoform F Diamond: EFD) and to compare it with a traditional toothpaste with silica abrasive (Colgate Total Original CTO).

METHODS: Eighty bovine enamel samples were divided into four groups (n = 20) and brushed for 21,600 cycles (60 cycles/min) for 6 h at 2.5-N brushing force. The abrasive enamel wear was recorded with a contact profilometer. The median and interquartile range (IQR) of the abrasive enamel wear was calculated in each group. Pairwise comparisons were conducted using Wilcoxon signed rank exact test and the p value was adjusted according to Holm. Significance level was set at 0.05.

RESULTS: Diamond-loaded toothpastes caused statistically significantly higher abrasive wear than the traditional toothpaste (p < 0.0001). SSDG caused statistically significantly higher enamel wear (19.0 µm (11.2)) than CWD (8.4 µm (4.6)) and EFD (7.3 µm (3.9)) (p < 0.0001).

CONCLUSIONS: Diamond-loaded toothpastes cause higher enamel wear than toothpastes with traditional abrasives and also exhibit different abrasivity behaviour compared to each other.

PMID:35733139 | DOI:10.1186/s12903-022-02274-3

BMC Nurs. 2022 Jun 23;21(1):161. doi: 10.1186/s12912-022-00939-6.

ABSTRACT

BACKGROUND: To implement developmental care accurately, neonatal intensive care unit nurses should have a proper understanding and sufficient knowledge in this field. Applying new approaches in education such as offline and online education help nurses improve their skills and knowledge. This study aimed to investigate the effect of virtual education on the perception and knowledge of neonatal developmental care in nurses working in neonatal intensive care units.

METHODS: This quasi-experimental study was conducted using a pretest-posttest design with two groups. The participants were 60 nurses working in neonatal intensive care units who were selected using convenience sampling (30 persons in each group). The data were collected before and 1 month after the intervention. The participants in the intervention group received developmental care training using an electronic file uploaded to Navid Learning Management System, while the members of the control group received no intervention. The instruments used to collect the data were the Demographic Information Questionnaire, the Developmental Care Knowledge Scale, and the Developmental Care Perception Scale. The collected data were analyzed using SPSS V25 software. All statistical tests were performed at the significance level of 0.05.

RESULTS: The Developmental Care perception scores before the intervention in the control and intervention groups were 83.40 ± 11.36 and 84.53 ± 9.48, respectively, showing no statistically significant difference (P = 0.67). Also, Developmental Care perception scores after the intervention in the control and intervention groups were 83.16 ± 13.73, and 94.70 ± 6.89, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant (P < 0.903), while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention (P < 0.001). The Developmental Care Knowledge scores before the intervention in the control and intervention groups were 52.66 ± 18.08 and 77.16 ± 17.20, respectively, showing a statistically significant difference (P = 0.001). Also, Developmental Care Knowledge scores after the intervention in the control and intervention groups were 53.66 ± 26.55and 90.33 ± 13.82, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant, while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention.

CONCLUSION: The results of this study showed that virtual education for the developmental care of premature infants plays an effective role in the perception and knowledge of nurses working in the neonatal intensive care unit. Therefore, the development of e-learning packages for developmental care and their availability for nurses can be a step to improve the quality of nursing care for infants admitted to the NICU.

PMID:35733128 | DOI:10.1186/s12912-022-00939-6

BMC Pediatr. 2022 Jun 22;22(1):359. doi: 10.1186/s12887-022-03222-4.

ABSTRACT

BACKGROUND: Febrile seizures are the commonest type of seizure in occurring in the first few years of life, mostly affecting children aged six months to five years old. While largely benign, the incidence of each febrile seizure increases the risk of recurrence, afebrile seizures and epilepsy. Viruses are the most frequent cause of febrile illnesses in which a febrile seizure occurs. Febrile seizure presentation patterns appear to follow a seasonal trend.

AIMS: To identify patterns of febrile seizure incidence across different seasons with specific viral activity, and to establish a framework for analysing virus circulation data with common illnesses within a shared region and population.

SETTING: Our study was a study of febrile seizure presentations in Victoria, Australia and respiratory virus detection.

PARTICIPANTS: We obtained independent datasets of emergency department febrile seizure presentations at Monash Health and all respiratory multiplex PCR tests performed at Monash Health from January 2010-December 2019 to observe common trends in virus circulation and febrile seizure incidence.

STUDY DESIGN: Trends were studied temporally through mixed effects Poisson regression analysis of the monthly incidence of febrile seizures and the rate of positive PCR tests. Peak viral seasons (95th centile incidence) were compared to median viral circulation (50th centile incidence) to calculate peak season risk ratios.

RESULTS: We found a 1.75-2.06 annual risk ratio of febrile seizure incidence in June-September. Temporal analysis of our data showed this peak in febrile seizures was attributable to circulating viruses in this season, and virus modelling showed correlation with increased rates of positive Influenza A (1.48 peak season risk ratio), Influenza B (1.31 peak season risk ratio), Human metapneumovirus (1.19 peak season risk ratio) and Respiratory Syncytial Virus (1.53 peak season risk ratio) on PCR testing.

CONCLUSION: Our ecological study statistically demonstrates the recognised winter peak in febrile seizure incidence and ascribes the seasonal relationship to several viral infections which affect the community, including a novel association with Human metapneumovirus.

PMID:35733118 | DOI:10.1186/s12887-022-03222-4