Tag: pubmed

BMC Health Serv Res. 2024 Dec 21;24(1):1636. doi: 10.1186/s12913-024-12038-0.

ABSTRACT

BACKGROUND: Maternal and child health remains a global priority, with antenatal care (ANC) recognized as essential for ensuring positive pregnancy outcomes. Despite significant improvements, in low- and middle-income countries, ANC service utilization remains low in Sub-Saharan Africa. This paper contributes to the understanding of the evolution and determinants of ANC service utilization among women of reproductive age in Rwanda.

METHODS: This review focused on studies published between 2010 and 2024 and examined the factors associated with ANC utilization in Rwanda. Two reviewers independently performed screening of the abstracts and full texts and conducted data extraction and synthesis. The aggregated odds ratios for various factors associated with ANC service utilization were presented in forest plots, created using GraphPad Prism version 10.

RESULTS: The review included 11 studies and 1 report on ANC service utilization in Rwanda. By 2019-2020, 47% of women had received ANC in the first trimester, and 59% had four or more visits. Higher education levels, better wealth status, health insurance coverage, and small household size are associated with adequate ANC service utilization. Conversely, a significant distance from health facilities and unwanted pregnancies were associated with lower odds of adequate ANC utilization. Delayed ANC was more likely among women with higher parity, those who lacked social support, and those with no or only primary education.

CONCLUSION: Rwanda has made considerable strides in improving ANC services. Addressing barriers such as distance to healthcare facilities, education, and economic disparities is crucial for enhancing maternal and child health outcomes. This review underscores the need for targeted interventions to achieve the World Health Organization recommendations of 8 antenatal care visits and sustainable development goals related to maternal and child health in Rwanda.

PMID:39709445 | DOI:10.1186/s12913-024-12038-0

J Ethnobiol Ethnomed. 2024 Dec 21;20(1):107. doi: 10.1186/s13002-024-00748-y.

ABSTRACT

BACKGROUND: Ethiopia is recognized as a significant center of origin for a wide variety of plant species, particularly those with medicinal properties. A substantial segment of the population across the nation depends on these therapeutic plants for their primary healthcare needs. Many communities, both rural and urban, engage in traditional medicine practices, passing down their knowledge orally from one generation to the next. Consequently, this study was undertaken to record the traditional medicinal plants and the related indigenous knowledge in the Yeki district of Southwest Ethiopia.

METHODS: Between March 2024 and August 2024, semi-structured interviews, in-person meetings, group discussions, and escorted field trips were used to gather quantitative ethnobotanical data. A total of 132 informants 100 men and 32 women were interviewed in order to gather ethnobotanical data. The informant consensus factor (ICF), fidelity level (FL), plant part value, preference ranking, and direct matrix ranking were among the quantitative techniques that were employed. Furthermore, the study used a variety of statistical tests, such as independent t-tests, one-way ANOVA, correlation, and regression with R software version 4.3.2, to compare the ethnobotanical knowledge of various informant groups.

RESULT: A total of 98 species of traditional medicinal plants from 81 genera and 45 plant families were identified in the current study. The Asteraceae (11 species) were the largest family used by local peoples, followed by Solanaceae (8 species). The most commonly used plant parts were leaves and roots, and the primary technique for making remedies was crushing. The respiratory systems disease categories had the second highest consensus score (ICF: 0.90), after the dermal disease category (ICF: 0.91). The number of medicinal plants reported by respondents across gender, age groups, educational level, and informant’s type varied significantly (P < 0.05). Various medicinal species can be found in the area’s vegetation, but they are threatened by deforestation, agricultural extension, firewood, modernization, IAS, charcoal production, and material culture.

CONCLUSION: The results highlight the extensive variety of medicinal plants and the accompanying traditional knowledge present in the Guraferda district. The elevated ethnobotanical indices justify the need for additional phytochemical and pharmacological research. It is advisable to implement integrated conservation strategies to tackle the challenges confronting these precious plant resources.

PMID:39709441 | DOI:10.1186/s13002-024-00748-y

BMC Womens Health. 2024 Dec 21;24(1):660. doi: 10.1186/s12905-024-03507-z.

ABSTRACT

BACKGROUND: Central obesity and breast cancer (BC) have been identified as relevant by empirical research. The weight-adjusted-waist index (WWI) is a novel methodology for quantifying central obesity. Inspection of the association between WWI and BC in American adult women was the primary goal of the current investigation.

METHODS: Cross-sectional assessments were conducted on information gathered from 10,193 National Health and Nutrition Examination Survey (NHANES) participants from 2011 to 2018. The waist circumference was divided by the square root of the body’s mass to compute WWI. Data were assessed via descriptive statistics to present data distributions according to BC grouping and WWI grouping, receiver operating characteristic curves (ROCs) to evaluate the obesity indicators’ applied value, logistic regression to reflect associations between WWI and BC prevalence, and restricted cubic splines (RCSs) and subgroup analysis forest plots to visualise and complement the relationships.

RESULTS: This study enrolled 10,193 participants whose WWI ranged from 8.38 to 14.41, 259 of whom were diagnosed with BC, and the results revealed significant differences in baseline characteristics between the groups. With an area under the curve (AUC) value (95% confidence interval) (CI)of 0.611 (0.577-0.644), WWI was a promising indicator of BC with good application value rather than waist circumference (WC), body mass index (BMI), or waist-height ratio (WHtR). WWI and BC laid out a substantial relationship, yielding an odds ratio (OR) of 1.54 and a 95% CI of (1.34, 1.79), which remained at 1.19 (1.00, 1.42) after considerable adjustments were made, according to the logistic regression analysis. Compared with the lowest quartile of WWI, the highest quartile had a 62% greater in the probability of suffering from BC. With the RCS’s inverted U-shape highlighting the importance of considering the nonlinear nature of the relationship and subgroup analyses reflecting variations among populations, all the results demonstrated that WWI was a well-suggestive indicator of BC hazard.

CONCLUSION: The current investigation revealed a meaningful association between the prevalence of BC and WWI, which was superior to other obesity indicators, albeit one that was more complex than the positive relationship initially derived. There existed a turning point for BC prevalence at WWI of approximately 12 cm/√kg. Nevertheless, maintaining WWI in the lower range is critical for preventing and administering BC and minimizing disease risk.

PMID:39709439 | DOI:10.1186/s12905-024-03507-z

BMC Nurs. 2024 Dec 21;23(1):943. doi: 10.1186/s12912-024-02618-0.

ABSTRACT

BACKGROUND: While efforts to improve the educational preparedness of nurses to care for lesbian, gay, bisexual, transgender, and queer (LGBTQ +) people have increased, the influence of role-modeled behaviors by healthcare professionals working with nursing students and recent graduates is not well understood. The purpose of this study is to describe the role-modeled behaviors of healthcare professionals observed by nursing students and recent graduates caring for LGBTQ + patients in clinical settings.

METHODS: A cross-sectional, online survey was conducted. Recruitment of nursing students who had completed one or more clinical rotations or were recent graduates (≤ 2 years) was performed through university emails and social media. Items included measurement of stigmatizing attitudes, observed stigmatizing behaviors, and ability to provide inclusive/affirming care for LGBTQ + patients. Open-text items prompted participants to describe observed behaviors. Data were analyzed using descriptive statistics and Wilcoxon signed rank sum tests to evaluate differences between LGB (lesbian, gay, bisexual) and T + (transgender and gender diverse) subscales. Open-text responses were analyzed using thematic analysis to identify relevant themes.

RESULTS: Participants (N = 73) had a low level of stigmatizing attitudes toward LGBTQ + people (M = 1.8, SD = 0.4), although higher stigmatizing attitudes toward T + people were reported (M = 3.0, SD = 0.2; Z = -7.254, p < .001). Half of the participants reported that they observed LGBTQ + stigmatizing behaviors role-modeled by two + healthcare professional roles; approximately one-third of participants personally engaged in one + LGBTQ + stigmatizing behaviors, most commonly toward T + people. Themes from participants’ examples of observed stigmatizing behaviors included: cis-heteronormative bias, non-affirmation of chosen name/pronouns, outing patients, and rejected competency.

CONCLUSIONS: The majority of participants described observing stigmatizing behaviors toward LGBTQ + people in clinical settings. Poorer attitudes and a higher frequency of stigmatizing behaviors observed towards T + people point to deficits in healthcare provided to T + people in particular. Efforts to address LGBTQ + stigma in healthcare should be expanded to include clinical settings to address role-modeled behaviors and socialization of nurses.

PMID:39709436 | DOI:10.1186/s12912-024-02618-0

BMC Palliat Care. 2024 Dec 21;23(1):297. doi: 10.1186/s12904-024-01629-7.

ABSTRACT

BACKGROUND: Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this. Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics’ current practice and experiences providing end-of-life care was undertaken.

METHODS: A cross-sectional online survey design. Quantitative data were analysed using descriptive statistics and qualitative free text responses using Framework Analysis. The survey link was distributed to registered paramedics employed by all 11 NHS Trusts employing paramedics in England, United Kingdom.

RESULTS: Nine hundred and twenty responses were received. They reported shortfalls in availability of healthcare professionals for advice and/or referral. Respondents often, always or sometimes: lacked patient medical history (91%, 839), access to existing advance care planning documentation (98%, 900) and specific medicines needed (80%, 737); encountered conflicting views (89%, 819); and reported lack of pre-registration training (81%, 743) or continuing professional development (77%, 708) influenced their ability to meet patient needs.

CONCLUSIONS: This first national survey of paramedic practice and experiences in delivering end-of-life care provides new evidence and insight into the challenges faced by paramedics and the potential impact of these challenges on their perceived levels of competence and confidence. Respondents reported multiple challenges, which potentially impact their ability to provide good quality end-of-life care and increase the risk of hospital conveyance. Paramedic practice at end-of-life must be supported via improved access to: patient records; anticipatory medicines and authority to administer; 24/7 palliative care advice (for shared decision-making); and paramedic specific palliative and end-of-life care training and education (including via integrative ways of working between palliative care and ambulance services). Action is required to integrate paramedicine within the wider healthcare professional team, with robust education and training to support care delivery.

PMID:39709434 | DOI:10.1186/s12904-024-01629-7

BMC Nurs. 2024 Dec 21;23(1):944. doi: 10.1186/s12912-024-02634-0.

ABSTRACT

AIM: This study aimed to translate and evaluate the psychometric properties of the Persian version of the Innovative Behavior Inventory-20 (IBI-20) among clinical nurses in northwest Iran.

METHODS: A descriptive survey with psychometric analysis was conducted involving 321 nurses from Ardabil medical training centers. The study employed a stratified proportional sampling method. Data were collected using standard questionnaires, including a demographic profile form and the innovative behavior questionnaire. Descriptive statistics, such as mean, standard deviation, frequency, and percentage, were calculated using IBM SPSS Statistics for Windows, version 26.0. Reliability was assessed through Cronbach’s alpha, McDonald’s omega, and Coefficient H. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) was performed using IBM SPSS version 26.0 and AMOS version 24.0, with a significance level set at p < 0.05.

RESULTS: The findings indicate that the IBI-20 possesses good face validity, content validity, construct validity, convergent and discriminant validity, and reliability. CFA confirmed the accuracy of the tool’s six-factor structure, with all factors exhibiting factor loadings greater than 0.3. Internal consistency was excellent, as demonstrated by a high Cronbach’s alpha, McDonald’s omega, and Coefficient H. The test-retest reliability of the IBI was also robust, with an intraclass correlation coefficient (ICC) of 0.942.

CONCLUSION: Our study validated the Persian version of the Innovative Behavior Inventory-20 (IBI-20) for assessing innovative behaviors among Iranian nurses. The IBI-20 is a vital tool for addressing healthcare challenges. The validation process, including face validity, content validity, and confirmatory factor analysis, demonstrated excellent validity, establishing it as a reliable instrument for evaluating innovative behaviors among nurses. These findings significantly impact nursing practice and research, ultimately enhancing patient outcomes.

PMID:39709430 | DOI:10.1186/s12912-024-02634-0

J Hematol Oncol. 2024 Dec 21;17(1):129. doi: 10.1186/s13045-024-01653-3.

NO ABSTRACT

PMID:39709429 | DOI:10.1186/s13045-024-01653-3

World J Surg Oncol. 2024 Dec 21;22(1):347. doi: 10.1186/s12957-024-03618-9.

ABSTRACT

BACKGROUND: Postmastectomy radiation therapy (PMRT) can influence the outcome of implant-based breast reconstruction (IBBR). This study aims to investigate the complications and patient-reported outcomes (PROs) following PMRT between direct-to-implant (DTI) and tissue expander-to-implant (TEI) reconstruction.

METHODS: The retrospective study included breast cancer patients undergoing IBBR and PMRT. Patients were divided into a permanent implant group (PI-PMRT) and a tissue expander group (TE-PMRT). Complications, reconstruction failure, and reoperation were compared between the two groups. PROs were assessed using the BREAST-Q scale.

RESULTS: A total of 203 patients were included: 99 in the PI-PMRT group and 104 in the TE-PMRT group. The incidence of severe capsular contracture was significantly higher in the PI-PMRT group compared to the TE-PMRT group (37.4% vs. 24.0%, p = 0.039). The PI-PMRT group had a significantly lower rate of reconstruction failure (9.1% vs. 19.2%, p = 0.039) and reoperation (13.1% vs. 24.0%, p = 0.046). Multivariate analysis revealed that the absence of mesh (OR = 2.177, p = 0.040) and DTI reconstruction (OR = 1.922, p = 0.046) were independent predictors of severe capsular contracture; the absence of mesh (OR = 4.699, p = 0.015) and TEI reconstruction (OR = 2.429, p = 0.043) were independent predictors of reconstruction failure. BREAST-Q scores indicated greater breast satisfaction in the PI-PMRT group (p = 0.031).

CONCLUSIONS: Although DTI reconstruction resulted in a higher risk of severe capsular contracture, the higher risk of reconstruction failure and reoperation in patients undergoing TEI reconstruction was even more concerning. Furthermore, patients were more likely to report greater breast satisfaction with DTI reconstruction. Therefore, DTI reconstruction may be a more appropriate option for patients anticipating PMRT.

PMID:39709427 | DOI:10.1186/s12957-024-03618-9

Respir Res. 2024 Dec 21;25(1):438. doi: 10.1186/s12931-024-03056-x.

ABSTRACT

To optimize patient outcomes, healthcare decisions should be based on the most up-to-date high-quality evidence. Randomized controlled trials (RCTs) are vital for demonstrating the efficacy of interventions; however, information on how an intervention compares to already available treatments and/or fits into treatment algorithms is sometimes limited. Although different therapeutic classes are available for the treatment of chronic obstructive pulmonary disease (COPD), assessing the relative efficacy of these treatments is challenging. Synthesizing evidence from multiple RCTs via meta-analysis can help provide a comprehensive assessment of all available evidence and a “global summary” of findings. Pairwise meta-analysis is a well-established method that can be used if two treatments have previously been examined in head-to-head clinical trials. However, for some comparisons, no head-to-head studies are available, for example the efficacy of single-inhaler triple therapies for the treatment of COPD. In such cases, network meta-analysis (NMA) can be used, to indirectly compare treatments by assessing their effects relative to a common comparator using data from multiple studies. However, incorrect choice or application of methods can hinder interpretation of findings or lead to invalid summary estimates. As such, the use of the GRADE reporting framework is an essential step to assess the certainty of the evidence. With an increasing reliance on NMAs to inform clinical decisions, it is now particularly important that healthcare professionals understand the appropriate usage of different methods of NMA and critically appraise published evidence when informing their clinical decisions. This review provides an overview of NMA as a method for evidence synthesis within the field of COPD pharmacotherapy. We discuss key considerations when conducting an NMA and interpreting NMA outputs, and provide guidance on the most appropriate methodology for the data available and potential implications of the incorrect application of methods. We conclude with a simple illustrative example of NMA methodologies using simulated data, demonstrating that when applied correctly, the outcome of the analysis should be similar regardless of the methodology chosen.

PMID:39709425 | DOI:10.1186/s12931-024-03056-x

BMC Womens Health. 2024 Dec 21;24(1):656. doi: 10.1186/s12905-024-03481-6.

ABSTRACT

BACKGROUND: Hysteroscopy is considered the standard for evaluating the uterine cavity. Limited data exists regarding hysteroscopy in Ethiopia. Therefore, the objective of the study was to describe the diagnostic and operative hysteroscopic procedures at St. Paul’s Hospital.

METHODOLOGY: A three-year retrospective descriptive study examined patients who underwent diagnostic and therapeutic hysteroscopy at the Center for Fertility and Reproductive Medicine, St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from June 2018 to June 2021. Descriptive statistics were employed to summarize the findings observed during the hysteroscopy procedures.

RESULT: A total of 328 patient records underwent review and analysis in the study. The mean participant age was 31.9 years (31.9 ± 5.1 years), with about 81.4% being nulliparous. Primary infertility (48.5%) was the leading indication for hysteroscopic evaluation, followed by secondary amenorrhea (18%), secondary infertility (17.4%), and abnormal uterine bleeding (8.8%). Concerning hysteroscopic procedures, 6.1% of participants exhibited no uterine cavity abnormalities. Primary hysteroscopy findings comprised intracavitary adhesions (48.2%), endometrial polyps (18%), and submucosal myomas (9%). Adhesiolysis stood out as the foremost surgical procedure, conducted in 48.2% of patients, followed by polypectomy in 20.7%, and fibroid removal in 9%. The complication rate was 2.4%, exclusively during operative hysteroscopy, with uterine perforation observed in six patients.

CONCLUSION: Our hysteroscopic evaluation was predominantly requested for primary infertility cases, with secondary amenorrhea, secondary infertility, and abnormal uterine bleeding also being commonly encountered indications. Adhesiolysis was the leading intervention during hysteroscopy, while uterine perforation was the main complication. The hysteroscopy procedures exhibited a strong safety profile, with few complications noted. Future studies should address factors affecting outcomes in diagnostic and operative hysteroscopy, and common factors linked to intrauterine adhesions.

PMID:39709420 | DOI:10.1186/s12905-024-03481-6