bluuebunny/crossref_metadata_2025 huggingface dataset:
Usability of a wearable device for home-based upper limb telerehabilitation in persons with stroke: A mixed-methods study
Authors: Toh Sharon Fong Mei , Gonzalez Pablo Cruz , Fong Kenneth N K
Published: February 2023

Background

The use of wearable technology offers a promising home-based self-directed option for upper limb training. Although product usability is a crucial aspect of users’ acceptance of a wearable device, usability studies in wearable devices are rare, with most studies focusing primarily on clinical validity.

Objective

This study aimed to explore the usability of a wristwatch device called “Smart reminder” for home-based upper limb telerehabilitation for persons with stroke.

Methods

Eleven stroke participants used the proposed wristwatch for at least two weeks and underwent a home-based telerehabilitation program. A mixed-methods design was used to explore the usability of the wristwatch. Quantitative data were collected through the System Usability Scale (SUS) questionnaire, and the participants’ rate of therapy compliance (gathered from the device) was reported descriptively. In addition, qualitative data were collected through semi-structured interviews with the participants and were analyzed using thematic analysis.

Results

The results demonstrated that the usability of the proposed wristwatch and telerehabilitation system was rated highly by the participants, with a high SUS mean score of 84.3 (12.3) and high therapy compliance rate (mean  =  91%). Qualitatively, all participants reported positive experiences with the wristwatch and indicated keenness to use it again. Participants reported physical improvements and felt motivated to exercise after using the wristwatch. They found the device easy and convenient and appreciated the remote monitoring function. Meanwhile, they highlighted critical considerations for the design of the device and program, including technical support, a wearable design of the device, graded exercise content according to ability, and flexibility in exercise schedules. Finally, they suggested that an interim review with the therapist on their progress might help them continue using the wristwatch.

Conclusions

This study's results supported the proposed wearable device's usability and showed strong acceptance by the participants for using it as a home-based upper limb telerehabilitation intervention.
Data sovereignty and platform neutrality – A comparative study on TikTok’s data policy
Authors: Su Chunmeizi , Tang Wenjia
Published: February 2023

Digital sovereignty has attracted growing attention as governments around the world attempted to exert national influence over international platforms. Agenda of nation-states becomes apparent when the Chinese-based platform TikTok achieved global success. Under geopolitical, social and cultural dynamics, this paper examines the data sovereignty of TikTok, its sister app Douyin and its international competitor Facebook, aiming at differentiating data related policies between TikTok, Douyin and other global platforms. This study employs comparative views to comprehend data privacy, data portability and data storage. The preliminary finding suggests a stakeholder approach to balancing governance and sovereignty.
Creation of a Neo-Mitral Valve With Right Atrial Appendage Tissue in an Infant
Authors: Sebastian Vinod A , Miller Jacob R , Eghtesady Pirooz
Published: February 2023

Mitral valve replacement in neonates and infants is a challenging operation with few good options. Neo-mitral valve reconstruction with right atrial appendage (RAA) may overcome some of the limitations of existing options.
Measuring Response of Stock Market to Central Bank Independence Shock
Authors: Anwar Cep Jandi , Suhendra Indra
Published: February 2023

This paper examines the responses of stock traded and economic activity in relation to central bank independence shocks. The analysis is based on a panel Vector Autoregressive estimation covering 25 developing countries for a quarterly period between 1990 Q1 and 2021 Q4. Panel VAR estimation is known to be potentially biased in a dynamic panel data model if the coefficient on the endogenous variables differs across countries. To test the pooling assumption of the model, this paper applies the Chow and Roy-Zellner tests. The results establish that the models contain the heterogeneity among samples; thus, mean-group estimation for panel VAR is performed as a solution for heterogeneity problem. The results show that there is a delayed effect of CBI to increase stock traded. This demonstrates that CBI takes around six quarters to strengthen the financial market. By dividing the sample into two groups, we find that CBI has a different effect on stock traded for countries that have high and low stock traded.
Empathic Accuracy and Shared Depressive Symptoms in Close Relationships
Authors: Brown Casey L. , Grimm Kevin J. , Wells Jenna L. , Hua Alice Y. , Levenson Robert W.
Published: February 2023

Empathic accuracy, the ability to accurately understand other people’s emotions, is typically viewed as beneficial for mental health. However, empathic accuracy may be problematic when a close relational partner is depressed because it promotes shared depression. Across two studies, we measured empathic accuracy using laboratory tasks that capture the ability to rate other people’s emotional valence accurately over time: first in a sample of 156 neurotypical married couples (Study 1; total N = 312), and then in a sample of 102 informal caregivers of individuals with dementia (Study 2). Across both studies, the association between empathic accuracy and depressive symptoms varied as a function of a partner’s level of depressive symptoms. Greater empathic accuracy was associated with (a) fewer depressive symptoms when a partner lacked depressive symptoms, but (b) more depressive symptoms when a partner had high levels of depressive symptoms. The ability to accurately detect changes in other people’s emotional valence may underpin shared depressive symptoms in dyads.
Prevalence and Risk Factors of Degenerative Spondylolisthesis and Retrolisthesis in the Thoracolumbar and Lumbar Spine – An EOS Study Using Updated Radiographic Parameters
Authors: Hey Hwee Weng Dennis , Low Tian Ling , Soh Hui Ling , Tan Kimberly-Anne , Tan Jun-Hao , Tan Tuan Hao , Thomas Andrew Cherian , Ka-Po Liu Gabriel , Wong Hee-Kit , Tan Jiong Hao Jonathan
Published: February 2023

Study design

Single centre, cross-sectional study.

Objectives

The objective is to report the prevalence of spondylolisthesis and retrolisthesis, analyse both conditions in terms of the affected levels and severity, as well as identify their risk factors.

Methods

A review of clinical data and radiographic images of consecutive spine patients seen in outpatient clinics over a 1-month period is performed. Images are obtained using the EOS® technology under standardised protocol, and radiographic measurements were performed by 2 independent, blinded spine surgeons. The prevalence of both conditions were shown and categorised based on the spinal level involvement and severity. Associated risk factors were identified.

Results

A total of 256 subjects (46.1% males) with 2304 discs from T9/10 to L5/S1 were studied. Their mean age was 52.2(± 18.7) years. The overall prevalence of spondylolisthesis and retrolisthesis was 25.9% and 17.1% respectively. Spondylolisthesis occurs frequently at L4/5(16.3%), and retrolisthesis at L3/4(6.8%). Majority of the patients with spondylolisthesis had a Grade I slip (84.3%), while those with retrolisthesis had a Grade I slip. The presence of spondylolisthesis was found associated with increased age ( P < .001), female gender (OR: 2.310; P = .005), predominantly sitting occupations (OR:2.421; P = .008), higher American Society of Anaesthesiology grades ( P = .001), and lower limb radiculopathy (OR: 2.175; P = .007). Patients with spondylolisthesis had larger Pelvic Incidence ( P < .001), Pelvic Tilt ( P < .001) and Knee alignment angle ( P = .011), but smaller Thoracolumbar junctional angle ( P = .008), Spinocoxa angle ( P = .007). Retrolisthesis was associated with a larger Thoracolumbar junctional angle ( P =.039).

Conclusion

This is the first study that details the prevalence of spondylolisthesis and retrolisthesis simultaneously, using the EOS technology and updated sagittal radiographic parameters. It allows better understanding of both conditions, their mutual relationship, and associated clinical and radiographic risk factors.
Navigating the policy borrowing process of general education among the eight publicly funded universities in Hong Kong
Authors: Man-Ho Adrian Lam
Published: February 2023

Since the introduction of the learning-to-learn reform in 2000, Hong Kong policy-makers indicated that they would engage extensively and continuously in policy borrowing based on other high-performing jurisdictions worldwide. An illustrative example is the introduction of the 3 + 3 + 4 New Academic Structure since 2009. However, one of the areas that remain unexplored is the introduction of a broadening General Education among all eight publicly funded universities in the additional year of the four-year undergraduate education. Through narrative review on the basis of Ochs and Phillips’s theoretical model of policy borrowing in education, this article aims to offer an overview of the introduction of General Education among these universities and how it has been undergoing the four respective stages of (1) cross-national attraction; (2) decision; (3) implementation; and (4) internalisation or indigenisation. This will touch upon evaluating the key features being borrowed, adapted, and implemented, reviewing the relevant processes and outcomes, as well as highlighting the issues and challenges that have been and will be experienced. All these evidence-based perspectives can allow practitioners, policymakers, and researchers to better understand the complex policy borrowing process of General Education as a global educational initiative.
A Rare Case Presentation of Vitiligo Associated With Atezolizumab
Authors: Nwanwene Kemnasom , Abdallah Mahmoud , Pacioles Toni
Published: February 2023

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies used in the treatment of solid and hematologic malignancies. Immune checkpoint inhibitors target the T-cell deactivation system via the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) receptor, programmed cell death protein 1 (PD-1) receptor, and programmed cell death ligand 1 (PD-L1). As a result, the activated T-cell enhances the host tumor response. However, even with their essential clinical benefits, ICIs are associated with a broad spectrum of adverse effects that can be generalized or tissue-specific inflammatory responses known as immune-related adverse events (irAEs). The most common dermatologic toxicity manifests mainly as maculopapular rash and pruritus. Understanding the complexity of immune-mediated response and the importance of clinical histopathologic correlation in recognizing irAEs allows for appropriate intervention and patient care due. We present the case of a 71-year-old African American male diagnosed with a large-cell poorly differentiated neuroendocrine tumor in the gastroesophageal junction of the stomach with mediastinal lymphadenopathy. He was treated with carboplatin, etoposide, and atezolizumab for 4 cycles. However, he developed vitiligo while on maintenance atezolizumab, which is rarely seen with atezolizumab use. Despite the improving clinical outcomes in oncology with ICIs, their adverse effects should not be ignored. When promptly recognized and treated, patients on ICI monotherapy may not need treatment interruption or discontinuation.
Collective decision strategies in the presence of spatio-temporal correlations
Authors: Winklmayr Claudia , Kao Albert B , Bak-Coleman Joseph B , Romanczuk Pawel
Published: February 2023

Background: Models of collective decision-making typically assume that individuals sample information independently and decide instantaneously. In most natural and sociological settings, however, decisions occur over some timescale in which group members gather information—often from multiple sources. Information sources may persist for varying lengths of time or be viewed concurrently and identically by multiple group members. These tendencies introduce spatio-temporal correlations in gathered information with poorly understood consequences.

Research Design: Here, we develop a collective decision-making model in which individuals’ access and switch between two conflicting cues that differ in their spatio-temporal properties.

Results: Our model reveals that spatially and temporally correlated cues can profoundly affect collective decisions. Specifically, we observe that spatially correlated cues are dominant when individuals rarely switch between sources of information. Temporally correlated cues, on the other hand, have the strongest impact when individuals frequently switch between information sources. We also discuss how much the usage of independent information must be increased to counter the impact of correlation.

Conclusions: The present model represents a first step toward more accurately capturing the complex mechanisms underlying collective decision-making in natural systems and reveals multiple ways in which the properties of environmental cues can impact collective behavior.
Efficacy of transversalis fascia plane block as a novel ındication for varicocelectomy surgery: prospective randomized controlled study
Authors: Celik Erkan Cem , Ozbey Isa , Aydin Muhammed Enes , Yayik Ahmet Murat , Oral Ahiskalioglu Elif , Tor Ibrahim Hakki , Ahiskalioglu Ali
Published: February 2023

Background

Varicocele occurs as a result of dilatation of the pampiniform plexus in the spermatic veins. In this study, our primary aim was to evaluate the effect of Transversalis Fascia Plane Block (TFPB) on pain scores in the postoperative period in patients undergoing varicocelectomy surgery, and our secondary aim was to evaluate the effect of TFPB on analgesic consumption.

Methods

The study was initiated following local ethics committee approval, and sixty ASA I-II patients > 18y scheduled to undergo varicocelectomy and who consented to participation were enrolled. Before the procedure, the patients were randomly assigned two groups: Transversalis Fascia Plan block group (Group TFPB) or surgical incision site infiltration group (Group I).All surgeries were carried out under general anesthesia, and microsurgery using the subinguinal approach. After surgical suturing, TFPB and local infiltration blocks were applied prior to termination of anesthesia.For each block, 20 mL of 0.25% bupivacaine was utilized. Patients' demographic information, passive and active VAS ratings after surgery, usage of non steroidal anti-inflammatory medications and rescue analgesia, and the requirement for rescue analgesia, were recorded.

Results

A total of 60 patients were included in the study. In terms of demographic data, there was no difference between the groups. At all hours, there was a statistically significant decrease in favor of Group TFPB in terms of active and passive VAS scores (p < 0.001), non steroidal anti-inflammatory analgesic use (p < 0.05), and tramadol requirement (p < 0.001).

Conclusion

This study has shown that TFPB can provide a more effective analgesia when compared to surgical site infiltration.
Development and validation of care stress management scale in family caregivers for people with Alzheimer: a sequential-exploratory mixed-method study
Authors: Sharif Nia Hamid , Hosseini Lida , Ashghali Farahani Mansoureh , Froelicher Erika Sivarajan
Published: February 2023

Background

Caring for a person with Alzheimer’s disease is stressful for caregivers. So that, considering all the emotional and financial costs imposed on the families of Alzheimer’s patients, stress from caring is an issue that cannot be ignored and plans need to be developed to help these caregivers to manage the care properly. The current study was designed to develop a valid and reliable care stress management scale for family caregivers of patients with Alzheimer’s.

Methods

This study is a methodological study with a sequential-exploratory mixed-method approach that was performed in two-phase: develop the caring stress management scale and evaluate the psychometric properties of the scale. In the first phase, 14 semi-structured face-to-face interviews were performed with family caregivers of patients with Alzheimer’s. The interviews were transcribed immediately and an item pool with 275 items was prepared. After removing the duplicate or overlapping code, the initial format of the caring stress management scale (CSMS) was designed. In the second step, the items of the CSMS were evaluated using face and content validity. After that, the construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis, and convergent and divergent validity respectively. Finally, the reliability was assessed by stability and internal consistency. The sample size was 435 and data was gathered via an online form questionnaire.

Results

This study designed the CSMS with two factors including emotional-focused coping (4 items) and problem-focused coping (4 items) that explained 51.00% of the total variance. The results of the confirmatory factor analysis showed a good model fit. Furthermore, the internal consistency and stability of this scale were acceptable.

Conclusion

The results showed that the care stress management scale has two factors in Iranian family caregivers and it is valid and reliable and can be used by therapists and researchers.
Barriers to childhood tuberculosis case detection and management in Cambodia: the perspectives of healthcare providers and caregivers
Authors: An Yom , Teo Alvin Kuo Jing , Huot Chan Yuda , Tieng Sivanna , Khun Kim Eam , Pheng Sok Heng , Leng Chhenglay , Deng Serongkea , Song Ngak , Nonaka Daisuke , Yi Siyan
Published: February 2023

Background

Diagnosis and treatment of tuberculosis (TB) in children remain challenging, particularly in resource-limited settings. Healthcare providers and caregivers are critical in improving childhood TB screening and treatment. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia.

Method

We conducted this qualitative study between November and December 2020. Data collection included in-depth interviews with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriologically confirmed pulmonary TB residing in the catchment areas of the selected health centers. Data were analyzed using thematic analyses.

Results

Mean ages of healthcare providers and caregivers were 40.2 years (standard deviation [SD] 11.9) and 47.9 years (SD 14.6), respectively. Male was predominant among healthcare providers (93.8%). Three-fourths of caregivers were female, and 28.6% were grandparents. Inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers in different units on TB screening and management, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines due to maldistribution from higher levels to health facilities were the key barriers to childhood TB case detection and management. Caregivers reported transportation costs to and from health facilities, out-of-pocket expenditure, time-consuming, and no clear explanation from healthcare providers as barriers to childhood TB care-seeking. Aging caregivers with poor physical conditions, lack of collaboration from caregivers, ignorance of healthcare provider's advice, and parent movement were also identified as barriers to childhood TB case detection and management.

Conclusions

The national TB program should further invest in staff development for TB, scale-up appropriate TB diagnostic tools and ensure its functionalities, such as rapid molecular diagnostic systems and X-ray machines, and strengthen childhood TB drug management at all levels. These may include drug forecasting, precise drug distribution and monitoring mechanism, and increasing community awareness about TB to increase community engagement.
The exploration of B cell maturation antigen expression in plasma cell dyscrasias beyond multiple myeloma
Authors: Xu Yanjie , Mao Xia , Que Yimei , Xu Menglei , Li Chunhui , Almeida Varlene Daniela Fernandes , Wang Di , Li Chunrui
Published: February 2023

Background

B cell maturation antigen (BCMA) targeted immunotherapies have demonstrated remarkable clinical efficacy in multiple myeloma (MM). Here, we evaluated the BCMA expression in MM and other plasma cell dyscrasias (PCDs), hoping to provide a potential treatment strategy for the relapsed/refractory PCDs besides MM.

Methods

From January 2018 to August 2021, 377 patients with PCDs were enrolled in this study, including 334 MM, 21 systemic light chain amyloidosis (AL), 5 POEMS syndrome, 14 monoclonal gammopathy of undetermined significance (MGUS), and three monoclonal gammopathy of renal significance (MGRS). The membrane-bound BCMA expression measured by multiparameter flow cytometry was defined by BCMA positivity rate and the mean fluorescence intensity (MFI).

Results

The patients with MM had a median BCMA positive rate of 88.55% (range, 0.2% - 99.9%) and median BCMA MFI of 1281 (range, 109 - 48586). While the median BCMA positive rate in other PCDs was 55.8% (6.2% -98.9%), and the median BCMA MFI was 553 (182- 5930). BCMA expression level was negatively associated with hemoglobin concentration in multivariate analysis in terms of BCMA positive rate and MFI.

Conclusions

In conclusion, BCMA has the potential to be a therapeutic target for other PCDs besides MM.
Telephone treatments in Improving Access to Psychological Therapies services: an analysis of use and impact on treatment uptake
Authors: Saxon David , Barkham Michael , Bee Penny , Gellatly Judith , Faija Cintia , Bower Peter
Published: February 2023

Background

There is debate about how best to increase access to psychological therapy and deliver mental healthcare effectively and efficiently at a national level. One trend is the increased use of the telephone to deliver therapy. However, there is the potential to disadvantage certain patient groups and/or impact on uptake of help. This study aims to answer three questions: (i) Which factors are associated with being offered an assessment by telephone? (ii) Which factors are associated with attendance at assessment? and (iii) What is the impact of an assessment by telephone on subsequent treatment appointment?

Methods

Routine outcome data was provided by seven UK Improving Access to Psychological Therapy services. The analysis sample comprised 49,923 patients who referred to 615 general practices in 2017. Multilevel modelling, including service and GP practice as random factors, was used to answer the three research questions.

Results

The offer of an initial assessment by telephone was strongly associated with local service configuration. Patient self-referral, a shorter wait, greater age and lower deprivation were associated with attendance at assessment and subsequent treatment session. Telephone mode assessment had no impact on the uptake of the assessment but may influence the uptake of further treatment if this was also by telephone. The practitioner carrying out the assessment had a significant effect on subsequent treatment uptake.

Conclusion

Offering telephone assessments does not have a negative impact on uptake of assessment and services may benefit by facilitating and integrating telephone assessments into their systems. The COVID-19 pandemic has accelerated the use of telephone and other remote means of delivery, and results from this study can inform services to consider how best to re-configure post-pandemic.
Nexus between genome-wide copy number variations and autism spectrum disorder in Northeast Han Chinese population
Authors: Qiu Shuang , Qiu Yingjia , Li Yong , Zhu Xiaojuan , Liu Yunkai , Qiao Yichun , Cheng Yi , Liu Yawen
Published: February 2023

Background

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder, with an increasing prevalence worldwide. Copy number variation (CNV), as one of genetic factors, is involved in ASD etiology. However, there exist substantial differences in terms of location and frequency of some CNVs in the general Asian population. Whole-genome studies of CNVs in Northeast Han Chinese samples are still lacking, necessitating our ongoing work to investigate the characteristics of CNVs in a Northeast Han Chinese population with clinically diagnosed ASD.

Methods

We performed a genome-wide CNVs screening in Northeast Han Chinese individuals with ASD using array-based comparative genomic hybridization.

Results

We found that 22 kinds of CNVs (6 deletions and 16 duplications) were potentially pathogenic. These CNVs were distributed in chromosome 1p36.33, 1p36.31, 1q42.13, 2p23.1-p22.3, 5p15.33, 5p15.33-p15.2, 7p22.3, 7p22.3-p22.2, 7q22.1-q22.2, 10q23.2-q23.31, 10q26.2-q26.3, 11p15.5, 11q25, 12p12.1-p11.23, 14q11.2, 15q13.3, 16p13.3, 16q21, 22q13.31-q13.33, and Xq12-q13.1. Additionally, we found 20 potential pathogenic genes of ASD in our population, including eight protein coding genes (six duplications [DRD4, HRAS, OPHN1, SHANK3, SLC6A3, and TSC2] and two deletions [CHRNA7 and PTEN]) and 12 microRNAs-coding genes (ten duplications [MIR202, MIR210, MIR3178, MIR339, MIR4516, MIR4717, MIR483, MIR675, MIR6821, and MIR940] and two deletions [MIR107 and MIR558]).

Conclusion

We identified CNVs and genes implicated in ASD risks, conferring perception to further reveal ASD etiology.
A discourse and content analysis of representation in the mainstream media of the South African National Health Insurance policy from 2011 to 2019
Authors: Bust Lynn , Whyle Eleanor , Olivier Jill
Published: February 2023

Background

Media is a crucial factor in shaping public opinion and setting policy agendas. There is limited research on the role of media in health policy processes in low- and middle-income countries. This study profiles South Africa as a case example, currently in the process of implementing a major health policy reform, National Health Insurance (NHI).

Methods

A descriptive, mixed methods study was conducted in five sequential phases. Evidence was gathered through a scoping review of secondary literature; discourse analysis of global policy documents on universal health coverage and South African NHI policy documents; and a content and discourse analysis of South African print and online media texts focused on NHI. Representations within media were analysed and dominant discourses that might influence the policy process were identified.

Results

Discourses of ‘health as a global public good’ and ‘neoliberalism’ were identified in global and national policy documents. Similar neoliberal discourse was identified within SA media. Unique discourses were identified within SA media relating to biopolitics and corruption. Media representations revealed political and ideological contestation which was not as present in the global and national policy documents. Media representations did not mirror the lived reality of most of the South African population. The discourses identified influence the policy process and hinder public participation in these processes. They reinforce social hierarchy and power structures in South Africa, and might reinforce current inequalities in the health system, with negative repercussions for access to health care.

Conclusions

There is a need to understand mainstream media as part of a people-centred health system, particularly in the context of universal health coverage reforms such as NHI. Harmful media representations should be counter-acted. This requires the formation of collaborative and sustainable networks of policy actors to develop strategies on how to leverage media within health policy to support policy processes, build public trust and social cohesion, and ultimately decrease inequalities and increase access to health care. Research should be undertaken to explore media in other diverse formats and languages, and in other contexts, particularly low- and middle-income countries, to further understand media’s role in health policy processes.
Assessing data availability of NCD prevention and control in six ASEAN countries based on WHO global monitoring framework and the progress monitor indicators
Authors: Sornpaisarn Bundit , Limmade Yuriko , Pengpid Supa , Jayasvasti Isareethika , Chhoun Pheak , Somphet Vathsana , Mustapha Feisul Idzwan , Kaung Kyaw Kan , Chailek Chanatip , Bao Tran Quoc , Rehm Jürgen
Published: February 2023

Background

To tackle noncommunicable disease (NCD) burden globally, two sets of NCD surveillance indicators were established by the World Health Organization: 25 Global Monitoring Framework (GMF) indicators and 10 Progress Monitoring Indicators (PMI). This study aims to assess the data availability of these two sets of indicators in six ASEAN countries: Cambodia, Lao PDR, Malaysia, Myanmar, Thailand, and Vietnam.

Methods

As data on policy indicators were straightforward and fully available, we focused on studying 25 non-policy indicators: 23 GMFs and 2 PMIs. Gathering data availability of the target indicators was conducted among NCD surveillance experts from the six selected countries during May-June 2020. Our research team found information regarding whether the country had no data at all, was using WHO estimates, was providing ‘expert judgement’ for the data, or had actual data available for each target indicator. We triangulated their answers with several WHO data sources, including the WHO Health Observatory Database and various WHO Global Reports on health behaviours (tobacco, alcohol, diet, and physical activity) and NCDs. We calculated the percentages of the indicators that need improvement by both indicator category and country.

Results

For all six studied countries, the health-service indicators, based on responses to the facility survey, are the most lacking in data availability (100% of this category’s indicators), followed by the health-service indicators, based on the population survey responses (57%), the mortality and morbidity indicators (50%), the behavioural risk indicators (30%), and the biological risk indicators (7%). The countries that need to improve their NCD surveillance data availability the most are Cambodia (56% of all indicators) and Lao PDR (56%), followed by Malaysia (36%), Vietnam (36%), Myanmar (32%), and Thailand (28%).

Conclusion

Some of the non-policy GMF and PMI indicators lacked data among the six studied countries. To achieve the global NCDs targets, in the long run, the six countries should collect their own data for all indicators and begin to invest in and implement the facility survey and the population survey to track NCDs-related health services improvements once they have implemented the behavioural and biological Health Risks Population Survey in their countries.
Sense of loneliness of veterans in Southern Iran: a cross-sectional study
Authors: Asadollahi Abdolrahim , Mojadam Mehdi , Cheraghi Maria , Hasanshahi Mariam , Nazari Narges , Keshtkar Alimohammad , Arastoo Aliasghar , Khafaie Morteza Abdulatif
Published: February 2023

Aims

More than three decades have passed since the end of the Iraq-Iran war, and this period has been concurrent with a rapid growth of the older community in Iran which includes the community of veterans who often suffer from serious psychological and behavioral problems. The study aimed to investigate the prevalence and determinants of loneliness in middle and older veterans in southern Iran.

Materials & methods

A cross-sectional study conducted among 583 middle and older male veterans (50 years <) who were selected by the census method in 2021. Data collection was done using UCLA Loneliness Scales. The collected data were entered into SPSS version-26 and Amos-24 and analyzed by multivariate ANOVA, multivariate regression, and structural equation at a threshold significance level of 0.05.

Findings

The mean score of feeling lonely in the veterans was 51.08 ± 4.74. The study found a significant relationship between the participants’ education and their feeling of loneliness (P-value = 0.01, effect size = -0.31). Multivariate regression demonstrated that demographic variables (i.e., age, employment status, level of education, type of living) and the severity and type of injury predict 31% of the variance in the middle and older veterans’ feeling of loneliness.

Conclusion

The mental, psychological and physical effects of war disability were associated with the social functions of veterans in the family and community. Strategies such as increasing social support and psychological counseling for veterans along with improving their pension and income can be effective in promoting public health, especially the mental health of this group.
Assessment of an instrument scale measuring the knowledge of antiretroviral therapy among people living with HIV
Authors: Xu Di , Shi Yuhua , Pan Ling , Duan Qiongli , Huang Nengmei , Liu Pengcheng , Han Jing , Liu Zhongfu , Li Jian , Liu Hongjie
Published: February 2023

Background

Antiretroviral therapy (ART) is currently the most effective way to treat people living with human immunodeficiency virus (PLHs) and reduce HIV transmission. While there are many factors that reduce adherence to ART, PLHs’ knowledge about ART may determine the level of adherence. It is necessary to design and assess an instrument scale that measures the knowledge of antiretroviral therapy among PLHs.

Method

A cross-sectional study was conducted among PLHs in Honghe Hani and Yi Autonomous Prefecture, China. Both exploratory and confirmatory factor analyses were used to examine the latent factors of antiretroviral therapy knowledge scale. Internal consistency was assessed separately for the scale and its dimensions by estimating Cronbach’s alphas, split-half reliability and Spearman’s correlation coefficient. ANOVAs were used to compare the scores of different dimensions with sociodemographic characteristics.

Results

Four factors were extracted according to factor loadings. They had high internal consistency reliability (Cronbach’s alpha: 0.70–0.95) and good construct validity (standardized factor loading range: 0.46–0.86) in the scale. Goodness of fit indices indicated that a four-factor solution fit the data at an accepted level (χ2/degree ratio = 1.980, RMSEA = 0.069, GFI = 0.909, CFI = 0.957, NFI = 0.917, TLI = 0.944). ANOVAs indicated that the score was higher among PLHs who were Han, had spouses/partners, were non-famers or migrant workers, initiated ART, and had a high school or above education.

Conclusion

The psychometric assessment indicated that this ART knowledge scale had accepted internal consistency and discriminant construct validity. It can be used to assess the knowledge of antiretroviral therapy for PLHs.
A preliminary study of proximal realignment combination surgery in the treatment of adolescent habitual patellar dislocation
Authors: Li Wei , Zhang De-Bao , Xu Sheng-Ming , Bi Huang-Yi , Gu Gui-Shan
Published: February 2023

Objective

A combination of lateral soft tissue release, medial soft tissue contraction, vastus medialis anterior placement, medial patellofemoral ligament reconstruction, and rectus femoris insertion reconstruction are introduced in the treatment of habitual patellar dislocation in adolescents.

Methods

A retrospective analysis was performed on 12 patients (17 knees) with habitual patellar dislocation and unclosed epiphyses who underwent surgical treatment at the First Hospital of Jilin University from May 2017 to November 2021. The Lysholm scores and Q angle were collected preoperatively and at final follow-up and were compared.

Results

Twelve patients (4 boys and 8 girls) aged 10–15 years were retrospectively analysed, who followed up for an average of 21 months (5–48 months). The range of motion of the knee joint returned to normal in all patients, and no cases of complications including surgical site infection, joint stiffness, or patellar re-dislocation occurred. The mean Lysholm scores and Q angles improved from 73.9, and 19.6° preoperatively to 91.7, and 13.9° at the final follow-up, respectively.

Conclusion

The preliminary effect of the combination surgery for habitual patellar dislocation in adolescents was satisfactory.
A novel maxillary transverse deficiency diagnostic method based on ideal teeth position
Authors: Ma Ting , Wang Yan-hai , Zhang Chun-xi , Liu Dong-xu
Published: February 2023

Background

This study proposed a novel maxillary transverse deficiency diagnostic method and evaluated the skeletal Class I and the mild skeletal Class III groups.

Methods

Pre-treatment data from 30 mild skeletal Class III and 30 skeletal Class I patients were collected and uploaded to the Emeiqi Case Management System to design the ideal teeth positions. On these positions, the first bi-molars width was measured at the central fossa and center resistance, the maxillary first bi-premolars width was measured at the central fossa, and the mandibular first bi-premolars width was measured at the distal contact point by Mimics, then width differences of two groups were calculated respectively.

Results

At ideal teeth positions, there was no statistically significant difference in the maxillomandibular width in the premolar area between the two groups, but there was in the molar area, and this difference was caused by the difference in mandible width between the two groups.

Conclusions

We proposed a new transverse diagnostic method and found that even the Class I group was not quite up to standard in the molar area on ideal teeth positions, and the Class III group had more severe maxillary transverse deficiency than the Class I group. Meanwhile, the maxillary transverse deficiency in the Class III group was mainly caused by the larger width of the mandible.
Boosting for insight and/or boosting for agency? How to maximize accurate test interpretation with natural frequencies
Authors: Feufel Markus A. , Keller Niklas , Kendel Friederike , Spies Claudia D.
Published: February 2023

Background

Many physicians do not know how to accurately interpret test results using Bayes’ rule. As a remedy, two kinds of interventions have been shown effective: boosting insight and boosting agency with natural frequencies. To boost insight, test statistics are provided in natural frequencies (rather than conditional probabilities), without instructions on how to use them. To boost agency, a training is provided on how to translate probabilities into natural frequencies and apply them in Bayes’ rule. What has not been shown is whether boosting agency is sufficient or if representing test statistics in natural frequencies may additionally boost insight to maximize accurate test interpretation.

Methods

We used a pre/posttest design to assess test interpretation accuracy of 577 medical students before and after a training on two Bayesian reasoning tasks, one providing conditional probabilities, the other natural frequencies. The pretest assessed baseline abilities versus the effect of natural frequencies to boost insight. After participants received a training on how to translate conditional probabilities into natural frequencies and how to apply them in Bayes’ rule, test interpretation skills were assessed using the same tasks again, comparing the effects of training-induced agency with versus without additionally boosting insight (i.e., test statistics in natural frequencies versus conditional probabilities).

Results

Compared to the test question formatted in conditional probabilities (34% correct answers), natural frequencies facilitated Bayesian reasoning without training (68%), that is, they increased insight. The training on how to use natural frequencies improved performance for tasks formatted in conditional probabilities (64%). Performance was maximal after training and with test statistics formatted in natural frequencies, that is, with a combination of boosting insight and agency (89%).

Conclusions

Natural frequencies should be used to boost insight and agency to maximize effective use of teaching resources. Thus, mandating that test statistics are provided in natural frequencies and adopting short trainings on how to translate conditional probabilities into natural frequencies and how to apply them in Bayes’ rule will help to maximize accurate test interpretation.

Trial registration

The study was a registered with the German Clinical Trial Registry (DRKS00008723; 06/03/2015).
Development and psychometric testing of a clinical reasoning rubric based on the nursing process
Authors: Ramazanzadeh Nargess , Ghahramanian Akram , Zamanzadeh Vahid , Valizadeh Leila , Ghaffarifar Saeideh
Published: February 2023

Background

To facilitate the development of clinical reasoning skills in nursing students, educators must possess the ability to teach and evaluate them. This study aimed to describe the development and validation process of an analytic rubric of clinical reasoning skills based on the nursing process in undergraduate nursing students.

Methods

A seven-step method was used for rubric development. The initial validation process of the rubric of clinical reasoning was performed with the participation of key stakeholders to assess its face and content validity as well as applicability in the classroom and bedside. An initial pilot test was performed based on scenario-based examinations in the nursing process training course so that convergent validity was used to show how closely the new scale is related to the previous measure for evaluating students’ tasks. Internal consistency and inter-rater correlation coefficient measurement for reliability were assessed.

Results

The rubric to assess clinical reasoning skills was developed into eight categories according to the five stages of the nursing process. Content and face validity of the rubric were done qualitatively and resulted in a clear, simple rubric relevant to clinical reasoning skills assessment. The convergent validity was confirmed by the conventional method. The reliability was approved by a high inter-rater correlation coefficient based on the assessment by two random independent raters.

Conclusion

The clinical reasoning meta-rubric developed in this study meets the purpose of the study. This analytical rubric can be applied to guide teaching and learning as well as evaluate clinical reasoning based on the findings. Testing the applicability confirmed its validity and reliability for assessing clinical reasoning skills in nursing process education during the undergraduate nursing program.
Student nurses’ perceptions and experiences in caring for people living with HIV/AIDS: a qualitative study
Authors: Shi Chunhong , Cleofas Jerome V.
Published: February 2023

Background

Caring for people living with HIV/AIDS (PLWHA) requires clinical experience and quality care delivery skills. This study aimed to explore the perceptions and experiences of nursing students in caring for PLWHAs.

Methods

This qualitative descriptive study interviewed 18 student nurses who had cared for PLWHAs from 14 tertiary hospitals across 7 provinces in China through semi-structured telephone interviews.

Results

Two themes emerged from the narratives: student nurses’ perceptions and attitudes toward PLWHAs and student nurses’ practical experiences with PLWHAs. Five theme clusters were revealed, namely “negative attitudes held before the care-giving,” “a series of psychological struggles in care-giving,” “favorable attitudes increased after the care-giving,” “consensus on care delivery for PLWHAs,” and “considerations regarding contamination reduction.”

Conclusions

Findings shed light on the development and changes in student nurses' perspectives on PLWHAs throughout their clinical experiences. Student nurses' perceptions and attitudes toward PLWHAs progressed through three distinct stages, and positive changes were observed after care-giving. Participants' perceptions and practical experiences with patients with AIDS enable patients to receive fair and high-quality care and provide valuable insights for nursing educators better prepare HIV nurses.
A multi-granular stacked regression for forecasting long-term demand in Emergency Departments
Authors: James Charlotte , Wood Richard , Denholm Rachel
Published: February 2023

Background

In the United Kingdom, Emergency Departments (EDs) are under significant pressure due to an ever-increasing number of attendances. Understanding how the capacity of other urgent care services and the health of a population may influence ED attendances is imperative for commissioners and policy makers to develop long-term strategies for reducing this pressure and improving quality and safety.

Methods

We developed a novel multi-granular stacked regression (MGSR) model using publicly available data to predict future mean monthly ED attendances within Clinical Commissioning Group regions in England. The MGSR combines measures of population health and health service capacity in other related settings. We assessed model performance using the R-squared statistic, measuring variance explained, and the Mean Absolute Percentage Error (MAPE), measuring forecasting accuracy. We used the MGSR to forecast ED demand over a 4-year period under hypothetical scenarios where service capacity is increased, or population health is improved.

Results

Measures of service capacity explain 41 ± 4% of the variance in monthly ED attendances and measures of population health explain 62 ± 22%. The MGSR leads to an overall improvement in performance, with an R-squared of 0.79 ± 0.02 and MAPE of 3% when forecasting mean monthly ED attendances per CCG. Using the MGSR to forecast long-term demand under different scenarios, we found improving population health would reduce peak ED attendances per CCG by approximately 1000 per month after 2 years.

Conclusion

Combining models of population health and wider urgent care service capacity for predicting monthly ED attendances leads to an improved performance compared to each model individually. Policies designed to improve population health will reduce ED attendances and enhance quality and safety in the long-term.
Barriers to nurses’ therapeutic communication practices in a district hospital in Ghana
Authors: Appiah Evans Osei , Oti-Boadi Ezekiel , Ani-Amponsah Mary , Mawusi Dorcas Goku , Awuah Dorothy Baffour , Menlah Awube , Ofori-Appiah Cindy
Published: February 2023

Background

Patients accessing health care enter the hospital environment with extreme anxiety, fear and distress which impacts their interactions with nurses and other health care professionals who are expected to help allay these anxieties in order to enhance patients care satisfaction. However, evidence suggests that there is a lack of effective therapeutic nurse-patient interaction in hospitals and the clinical environment globally, especially in sub-Saharan Africa.

Methods

A qualitative research approach with an exploratory design was used to purposively select 30 participants who were engaged in face-face interactions. A semi-structured interview guide was used to conduct five audio-recorded FGDs with the 30 participants (6 in each group—2 males and 4 females) after which the discussions were transcribed verbatim, and content analyzed.

Findings

Two (2) main themes and 10 sub-themes emerged from the analysis of the data. The two themes were: Therapeutic communication practices and Barriers to therapeutic communication. Some of the factors identified by patients to impede therapeutic nurse-patient interaction include family interference, negative attitude from patients, patient condition, a discriminatory attitude of nurses, increased workload, and stress.

Conclusion

Communication practices identified in this study include nurses’ manner of communication, use of touch, positive reassurance, and nurses’ demeanor. Several obstacles affect communication practices, hence the need to implement measures to improve nurse-patient interaction.