Differences In Mean Scores Research Articles

Nutritional risk screening by the emergency medical services: Agreement with in-hospital assessment

IntroductionEarly recognition of nutritional risk is important to prevent the adverse consequences of malnutrition. However, nutritional risk screening is often disregarded in hospitals. PurposeTo evaluate the agreement of nutritional risk screening results between screening performed by emergency medical services (EMS) and at the hospital ward. MethodsThe EMS used the Nutritional Risk Screening 2002 (NRS-2002) to screen the nutritional risk of community-dwelling patients aged ≥ 70 years transported to the emergency department of a large Finnish hospital. The NRS-2002 results from the EMS were compared to results obtained during hospitalization. ResultsThe EMS screened 472 patients and recognized nutritional risk in 81 (17 %). NRS-2002 was repeated at hospital ward in 97 of the screened. In about two-thirds of the cases (69 %), the EMS and ward personnel agreed on whether the patient had nutritional risk or not, and one-third of patients (31/97, 32 %) had the exact same score. The EMS tended to give lower scores (mean difference 0.70 ± 1.29, p < 0.001). Twenty-four patients considered not to be at nutritional risk according to the EMS were recognized as risk patients at the ward. ConclusionNutritional risk screening by the EMS could help in identifying persons requiring more detailed assessment of nutritional status.

Medication Compliance and Affecting Factors in Elderly Type 2 Diabetic Patients in Turkey

Objective: This research was conducted to determine medication compliance and factors affecting compliance with type 2 diabetes patients in public hospitals. Method: This research is a descriptive type of research, which is one of the Quantitative research types. There was no sample selection in the study, and the study was conducted with 100 patients who met the Inclusion criteria. Research data was collected between December 2022 and June 2023. Results: The patients ' compliance with the medication appears to be at a moderate level. The difference in the Medication Compliance Reporting scale mean scores difference According to the patients' genders, whom they live with, marital status, diabetes duration, treatment method, and daily insulin application the status is not statistically significant. Conclusion: In this study, it was determined that the medication compliance of elderly type 2 diabetic patients was at a moderate level. It is recommended That nurses organize awareness training on the factors affecting medication compliance of elderly type 2 diabetic patients and That the research be conducted​ with a larger sample group.

Effectiveness of geriatric rehabilitation in inpatient and day hospital settings: a systematic review and meta-analysis

BackgroundGeriatric rehabilitation is a multidisciplinary intervention that promotes functional recovery in older adults. Our objective was to assess the efficacy of geriatric rehabilitation in inpatient and geriatric day hospital settings.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, PEDro and AgeLine from inception to September 30, 2022 for randomized controlled trials (RCTs) including older adults (age ≥ 65 years) undergoing geriatric rehabilitation (inpatient or day hospital) with a usual care comparator group. Primary outcome measures included mortality, long-term care home (LTCH) admission, and functional status. Secondary outcomes included discharge/remaining at home, functional improvement, length of stay, cognition, mood, and quality of life. Records were screened, abstracted and assessed for risk of bias (Cochrane Risk of Bias [RoB] 2) by two reviewers independently. We conducted a random effects meta-analysis to summarize risk ratios (RR, dichotomous outcomes) and standardized mean differences (SMD, continuous outcomes).ResultsOf the 5304 records screened, 29 studies (7999 patients) met eligibility criteria. There were 23 RCTs of inpatient geriatric rehabilitation (6428 patients) and six of geriatric day hospital (1571 patients) reporting outcomes of mortality (26 studies), LTCH admission (22 studies), functional status (19 studies), length of stay (18 studies), cognition (5 studies), mood (5 studies) and quality of life (6 studies). The primary outcome of mortality at longest follow up was lower in the rehabilitation group (RR 0.84, 95% confidence interval [CI] 0.76 to 0.93, I2 = 0%). LTCH admission was lower in the rehabilitation group at longest follow up (RR 0.86, 95% CI 0.75 to 0.98, I2 = 8%). Functional status was better in the rehabilitation group at longest follow up (SMD 0.09, 95% CI 0.02 to 0.16, I2 = 24%). Cognition was improved in the rehabilitation group (mean difference of mini-mental status exam score 0.97, 95% CI 0.35 to 1.60, I2 = 0%). No difference was found for patient length of stay, mood, or quality of life.ConclusionsGeriatric rehabilitation in inpatient and day hospital settings reduced mortality, LTCH admission, and functional impairment. Future studies should explore implementation of this intervention for older adults.Review registrationPROSPERO: CRD42022345078.

Effectiveness of Dialectical Behaviour and Schema-Focused Therapies in the Management of Depressive Disorders among In-School Adolescents in Edo State

The study investigated the effectiveness of Dialectical Behaviour and Schema-Focused Therapies in managing depressive disorders in in-school adolescents in Benin Metropolis. The study was a quasi-experimental research design that adopted the pre-test-post-test, non-equivalent control group. The population for this study consisted 14,473 senior secondary school students in all the public secondary schools in Benin Metropolis. A sample size of seventy-six (76) adolescents was used. The instrument for the study was Adolescent Depressive Disorder Questionnaire (ADDQ). Three (3) research questions were raised, their corresponding hypotheses were formulated and tested at 0.05 alpha level of significance. The data obtained were analyzed using t-test and Analysis of Variance (ANOVA). The findings of the study revealed no significant effect of both Dialectical Behaviour and Schema-Focused Therapies in managing depressive disorders in in-school adolescents. However, there was a significant effect of Dialectical Behaviour on the depressive disorders of in-school adolescents than those not exposed to any treatment (Control Group). It was concluded that although both Dialectical Behaviour and Schema-Focused Therapies were not statistically significant in managing depressive disorders in in-school adolescents in Benin Metropolis, there was a difference in the depressive disorders mean scores at pre-test and post-test. Received: 2 September 2024 / Accepted: 3 November 2024 / Published: 20 November 2024

Comparative Efficacy of Antipsychotic Medication for Stereotypic Behavior in Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Background: Stereotypic movements in autism form core symptoms under the rubric of repetitive and restricted patterns of behavior. Aim: The systematic review was aimed to find which antipsychotic has better efficacy in treating stereotypic behavior in autism spectrum disorder. Methods: We searched for journal publications in the English from PubMed and Cochrane databases (CENTRAL), January 1992–June 2024, for randomized controlled trials that compared antipsychotics with a placebo of at least 6 weeks’ trial, with the outcome measure being a change in stereotypy score. Quality assessment of the included studies in the meta-analysis was done using Cochrane risk of bias tool version 2. We followed PRISMA guidelines for systematic review. The mean difference in change of stereotypy symptoms score was calculated between antipsychotic and placebo participants along with 95% confidence interval (CI) using the random-effects model. Results: 146 studies were screened, and 25 studies were deemed eligible to retrieve full-length articles for review. A total of nine studies were included in the systematic review that had used aripiprazole, risperidone, or lurasidone as an antipsychotic. Six studies (n = 726) that had all data on mean difference in stereotypy scores on the Aberrant Behavior Checklist (ABC)-Stereotypy subscale and four studies (n = 554) that reported stereotypy scores using Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)-Compulsions subscale were included in the meta-analysis. Antipsychotics showed a significant reduction in ABC-Stereotypy scores (−1.84 [−2.84, −0.85; 95% CI], Z = 3.83, P &lt; 0.001) with moderate heterogeneity between the studies (I 2 = 53%). Whereas, antipsychotics did not show significant improvement in compulsions as measured on CY-BOCS (−0.87 [−1.89, 0.16; 95% CI], Z = 1.65, P = 0.10). Conclusion: Stereotypy in autism is difficult to measure, and no uniform measure exists. Trials are limited to short duration and limited to few antipsychotics. Among antipsychotics, risperidone has robust efficacy in reducing stereotypic behaviors.

Generic vs. Disease-Specific Patient Reported Outcome (PRO) Instruments for Assessing HRQoL Burden Among Patients Diagnosed with Alopecia Areata: Evidence from TARGET-DERM AA

Introduction Alopecia areata (AA) is a chronic, autoimmune disease characterized by patchy hair loss. Compared to other disease areas, recent work has signaled a potential shortcoming, that generic quality of life (QOL) questionnaires are not sufficiently sensitive to the impact of AA disease severity. This cross-sectional analysis investigates the Short-Form 36, the dermatology life quality index (DLQI), and the Alopecia Areata Patient Priority Outcomes (AAPPO) for similar shortcomings. Methods Patients of all ages enrolled from December 2021 to June 2024 in TARGET-DERM AA (data collection on-going) in the United States and Canada were grouped by Severity of Alopecia Tool (SALT) score (1-20, 21-49, or 50-100). At enrollment, patients completed the AAPPO and DLQI questionnaire as well as the RAND MOS Short-Form 36. The SF-36 has 8 subdomain scores (vitality, physical function, bodily pain, general health, physical role function, emotional role function, social role function, mental health) along with the physical component summaries (PCS), mental component summaries (MCS), and the SF-6D utility index score. The Kruskal-Wallis test compared differences in mean scores across SALT subgroups defined by severity. Results Of the 141 AA patients, 61.7% were female; 95.0% adults, and 67.4% Non-Hispanic White. When comparing the SALT 1-20 and the &gt;50 subgroups, significant differences in SF-36 derived mean scores were only observed in the PCS and the physical function score (p&lt;0.05). None of the other scores (MCS, SF-6D, or other SF-36 subdomains) showed any differences. Mean DLQI scores were similar across subgroups (p&gt;.05) Notably, the hair loss and activity limitation domains of the AAPPO demonstrated significant differences between the patient subgroups (p&lt;.0001 and p&lt;.05, respectively) Discussion In this real-world cohort, generic QoL instruments, namely the SF-36 and DLQI, did not capture differences in the underlying health-related QoL burden of AA patients with different AA severity. Such differences were clear when HRQoL was measured for AA patients with mild hair loss AAPPO.

Effect of health education on knowledge, perception, and intended contraceptive use for family planning among university students in Pakistan

Approximately one billion women require family planning services worldwide, 842 million women are currently using modern contraceptives, and 80 million are using traditional contraceptive methods for family planning (FP). Health literacy (HL) can significantly make women aware of contraceptives for family planning. This study aims to assess the effectiveness of health education in determining perceptions and intended contraceptive use among university students in Pakistan. A pre-and post-approach with cross-sectional study design was conducted in the public sector University of Islamabad from July to December 2022. A self-administered and structured questionnaire comprising variables on knowledge level and intended contraceptive use was conducted among randomly selected students (n = 396). Survey respondents were given Health Education Intervention (HEI), which included a lecture regarding contraception use for family planning, and a posttest assessment was conducted on the same group of students. Statistical Package for Social Science (SPSS) version 24 was used for statistical data analysis. An Institutional Review Board (IRB) of the Health Services Academy (HSA) approved this study. A majority, 217 (55%), were female respondents. There was a significant difference in the overall mean score between pretest and posttest assessments after the intervention. Hence, the findings proved that this intervention successfully improved the knowledge and intention of the participants to use FP. Moreover, after the HEI, 99% of respondents had improved knowledge about family planning methods and the benefits of contraceptive use. Knowledge, perceived benefits, and intended use of contraceptives for FP were significantly improved after the HEI (P < 0.05). In the posttest, the most learned methods were intrauterine devices, injections, implants, and withdrawal. Most of the participants were already well aware of condoms and oral pills. The study concludes that health education is an effective intervention to improve the knowledge, perception, and intended contraceptive use among undergraduate university students regarding family planning.

The Efficacy of Topical Cosmetic Containing Alpha-Arbutin 5% and Kojic Acid 2% Compared With Triple Combination Cream for the Treatment of Melasma: A Split-Face, Evaluator-Blinded Randomized Pilot Study.

While the gold standard treatment for melasma is triple combination cream (TCC), arbutin and kojic acid demonstrate their benefits and may be used as an alternative. To investigate the efficacy of cream containing alpha-arbutin 5% and kojic acid 2% (AAK) compared with TCC for melasma treatment. A split-faced, randomized study was conducted among 30 participants with melasma, and all were randomized to receive AAK or TCC on each side of their face for 12-week along with 4-week follow-up period. The melanin index (MI), modified Melasma Area Severity Index (mMASI), and physician global assessment (PGA) scores were used to measure the effectiveness of interventions. Recurrence of melasma after treatment discontinuation was evaluated by MI and mMASI. Patient satisfactions and adverse effects were also evaluated. In the analysis, the mean difference (MD) was used for MI and mMASI, while Wilcoxon signed-rank test was for the PGA scores, adverse effects, and patient satisfaction. The MD of MI and mMASI scores were not different between groups (mMASI [p = 0.344] and MI [p = 0.268]). The PGA scores only showed improvement on the TCC-treated side (p = 0.032). Compared to the AKK group, the subjects with TCC showed higher severity of recurrence (MI [p = 0.004] and mMASI [p = 0.045]). No difference in patient satisfaction score between the groups, but erythema and stinging were higher in the TCC group. The AAK cream appeared to be effective for melasma treatment, highlighting a lower recurrent rate and fewer adverse events than standard therapy. thaiclinicaltrials.org: TCTR20230124004.

Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies.

Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations.

Meta-Analysis: Evaluating Placebo Rates Across Outcomes in Eosinophilic Oesophagitis Randomised Controlled Trials.

High placebo responses have limited drug development in eosinophilic oesophagitis. The optimal configuration of trial outcomes is uncertain. To inform more efficient future trial designs, to characterise clinical, endoscopic and histologic placebo responses in eosinophilic oesophagitis randomised controlled trials (RCTs). We updated a Cochrane systematic review and meta-analysis, searching multiple databases to January 1, 2024, to identify placebo-controlled RCTs evaluating medical therapies for patients with eosinophilic oesophagitis. The primary outcome was the pooled proportion of study-defined clinical, endoscopic and histologic responders and remitters randomised to placebo, using an intention-to-treat approach and random-effects model. Sources of heterogeneity were explored using meta-regression. We included 25 RCTs. The pooled proportion of clinical response was 41.0% [95% CI: 29.7%-52.8%] with substantial heterogeneity (I2 = 74.9%). On meta-regression, older age and a higher probability of being randomised to placebo reduced the likelihood of clinical response to placebo. The pooled proportion of histologic remission defined as a peak eosinophil count [PEC] ≤ 6 eosinophils per high power field [HPF] or ≤ 1 eosinophil/HPF was 4.3% [95% CI: 2.6%-6.2%] (I2 = 23.6%) and 1.3% [95% CI: 0.5%-2.5%] (I2 = 0%), respectively. The standardised mean difference in the Eosinophilic Oesophagitis Endoscopic Reference Score to placebo was -0.25 [95% CI: -0.41, -0.10]. Over 40% of patients in eosinophilic oesophagitis trials respond clinically to placebo, and this is associated with trial design factors such as randomisation ratio and trial population. Objective endoscopic and histologic measures are associated with very low placebo responses.

Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure.

Fewer than 20% of eligible patients with heart failure with reduced ejection fraction receive all 4 pillars of guideline-directed medical therapy. Understanding disparities by race, ethnicity, sex, and adverse social determinants of health is necessary to equitably optimize quadruple therapy. Utilizing the American Heart Association's Get With The Guidelines-Heart Failure registry, we examined associations between race and ethnicity, sex, and adverse social determinants of health (insurance type and documented social need [any barrier to accessing health care]) with quadruple therapy optimization (QTO) in patients with heart failure with reduced ejection fraction hospitalized between July 1, 2021, and September 30, 2023, with complete medication data at discharge. We calculated adjusted mean differences (AMDs) in the discharge QTO score (range, 0%-100%) reflecting the proportion of eligible use of renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors and compared across demographic and adverse social determinants of health groups. Among 82 637 patients (median age, 66 years; 32.5% female; 57.0% non-Hispanic White; 76.4% prior heart failure with reduced ejection fraction), the overall mean QTO score was 56.2% (SD, 25.5). After adjustment, compared with non-Hispanic White individuals, Black (AMD, 2.56 percentage points [95% CI, 2.16-2.96]) and Hispanic individuals (AMD, 0.71 percentage points [95% CI, 0.11-1.31]) had higher QTO scores. Females had higher QTO scores than males (AMD, 1.94 percentage points [95% CI, 1.58-2.31]). Patients with no insurance (AMD, -4.90 percentage points [-5.62 to -4.17]), Medicaid (AMD, -0.45 percentage points [-0.89 to -0.01]), and Medicare (AMD, -1.64 percentage points [-2.10 to -1.18]) had lower QTO scores versus private insurance. Those with an identified social need (n=24 651) had lower QTO scores than those without (AMD, -3.40 percentage points [95% CI, -4.10 to -2.71]). Disparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need. Future efforts should focus on reducing gaps to improve equitable guideline-directed medical therapy use.

Use of insitu simulation to improve team performance and utilization of a rapid sequence intubation checklist.

Intubation checklists have emerged as tools to reduce adverse events and improve efficiency during rapid sequence intubation (RSI) in pediatric emergency departments (PEDs). This study aimed to use multidisciplinary simulation (SIM) training as an educational tool to improve PED team performance during RSI scenarios through utilization of an RSI checklist. We created a checklist modeled after previously published PED checklists. PED multidisciplinary teams participated in video-recorded SIM training sessions involving a scenario requiring intubation three times, first without interruption then while receiving our intervention of rapid-cycle deliberate practice (RCDP) debriefing focusing on checklist utilization and team dynamics. Learners went through the scenario once more uninterrupted to apply learned skills. Team performance was evaluated via video review using the Simulation Team Assessment Tool (STAT) focusing on airway management and human factors sections. Scores were compared before and after intervention along with pre- and postintervention surveys. A total of 483 learners participated in 64 SIM training sessions, 44 of whom met inclusion criteria and were included for data analysis. Scores increased postintervention for airway management, human factors and in total. Least-squares mean differences for total, airway, and human factors scores were 9.55 (95% confidence interval [CI] 7.24-11.85), 4.22 (95% CI 2.91-5.52), and 5.33 (95% CI 3.86-6.8), respectively, which was statistically significant with p-value of <0.001 across all categories. Surveys demonstrated improved role understanding and checklist utilization comfort postintervention. This study supports the benefit of multidisciplinary SIM training with RCDP-style methodology as an educational method for improving airway management, teamwork skills, and RSI checklist utilization for PED staff. Incorporation of additional maintenance SIM sessions for ongoing education is likely to be further beneficial and would allow evaluation of degradation of skills over time following initial training.

Effect of treatment on quality of life of rural asthmatic children

Introduction: Medications relieve symptoms of asthma but affected children are significantly bothered by physical, educational and emotional impairments. Urban studies from India evaluated on how this disease affects quality of life. Aim of our study was to evaluate quality of life of rural asthmatic children both before as well as after the treatment. Methods: Asthmatic children 7 to 17 years visiting to rural tertiary care teaching hospital were included. Tool used for the study was Pediatric Asthma Quality of Life Questionnaire - Standard (PAQLQS) which were measured at the time of inclusion and four weeks after treatment. It assessed the QOL (Quality of Life) under symptoms, activity limitation and emotional function domains. Mean difference in pre and post treatment PAQLQ score was assessed. Results: Total 46 children were included from rural setup. Majority were male 60% and had a normal BMI (54%) which was followed by undernutrition (28%). Majority children in both age group 7-11year and 12-17 year, presented with moderate asthma (80%) and (62%) (according to GINA 2022) respectively followed by mild. The rural cohort post treatment showed significant improvement in individual (p&lt;0.005) as well as in overall PAQLQ post treatment (p&lt;0.002). Conclusion: The study has highlighted that good asthma control even after short duration of treatment helped in improvement quality of life of affected children. To maintain quality of life it is expected that the patient remains adhered to proper treatment.

Mean Differences in Test Scores, Gender Bias, and Threats to Fairness

Mean Differences in Test Scores, Gender Bias, and Threats to Fairness

The effect of group counseling based on positive psychology on the WhatsApp social media platform on the severity of premenstrual syndrome symptoms: a randomized clinical trial

BackgroundPremenstrual syndrome (PMS) is a prevalent health issue impacting women, significantly impacting their well-being and fostering a negative attitude of femininity and menstruation. We investigated the effect of group counseling based on positive psychology on the severity of PMS symptoms.MethodsParticipants in the intervention group engaged in six online sessions of group counseling focused on positive psychology via WhatsApp. Data were collected using the Premenstrual Symptoms Screening Questionnaire (PSST) before, immediately, and two months post-intervention. Analytical assessments were performed using SPSS 16 software using Chi-square, independent t-tests, and repeated measures analysis of variance (ANOVA). Comparative analyses were carried out using the Bonferroni post hoc test with a 95% confidence level.ResultsThe mean intensity of PMS symptoms in the intervention group significantly decreased from 21.60 (2.50) to 13.35 (4.727) and 14.750 (5.963) immediately and two months after the intervention; however, the difference was not significant in the control group. The results of repeated measures ANOVA showed that the effect of the intervention over time and the interaction between time and group were significant. The Eta effect size was about 0.20 and 16%, respectively (p = 0.001). According to Bonferroni post hoc test results, the difference in the mean scores of the severity of PMS symptoms before the intervention was statistically significant compared to both follow-up periods (p ≤ 0.007). However, the difference in mean scores immediately after the intervention compared to two months after the intervention was not statistically significant (p = 0.42).ConclusionUsing a positive counseling approach demonstrates efficacy in alleviating the severity of PMS symptoms in the short term. While all women can benefit from such interventions, targeting adolescents is particularly strategic, as early interventions can foster positive attitudes toward menstruation. Additionally, social media platforms like WhatsApp provide a feasible and engaging medium for adolescent health interventions. Integrating this approach into adolescent health promotion package appears to be a viable measure worthy of consideration by relevant policymakers.Trial registrationCurrent Controlled Trials IRCT20201113049377N1, Date of Registration 2020, 12, 08.

Weight-based disparities in perinatal care: quantitative findings of respect, autonomy, mistreatment, and body mass index in a national Canadian survey

BackgroundQualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI.MethodsThe multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care.ResultsOf 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25–25.9, 30–34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased.ConclusionsWhile socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.

Clinical study of different frequency transcranial magnetic stimulation combined with paroxetine in the treatment of poststroke depression with insomnia.

Study the treatment of poststroke depression and insomnia using varied repetitive transcranial magnetic stimulation (rTMS) frequencies alongside paroxetine. Aim to enhance rTMS effectiveness for depression, insomnia, neurological impairment, and daily living skills. Ninety poststroke depression (PSD) patients were randomly divided into a low-frequency group (low-frequency rTMS + enteric-coated paroxetine), a high-frequency group (high-frequency rTMS + enteric-coated paroxetine), and a control group (sham stimulation + enteric-coated paroxetine). The treatment was administered 5 times a week for a total of 2 weeks. Before treatment, at the end of the 2-week treatment, and at the end of the 6-week follow-up, the 3 groups of patients were assessed using the Hamilton Depression Rating Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI). The mean differences of scores measured at different frequencies and at different times were analyzed by repeated measure one-way analysis of variance. The interaction between different frequency and score before and after treatment was significant. HAMD, PSQI, and NIHSS scores of the 3 groups after 2 weeks of treatment and 6 weeks of follow-up were significantly lower than before treatment, while MBI scores were opposite. The main effect of treatment scores in different frequency groups showed that HAMD, NIHSS, and MBI scores were not significantly different among the 3 groups before treatment. The HAMD, PSQI, and NIHSS scores of the low frequency group and the high frequency group were significantly lower than those of the control group after treatment, and the MBI scores were the opposite, except that there was no significant difference in HAMD-17 scores among the 3 groups at the 6-week follow-up. Among them, HAMD score in high-frequency group was significantly lower than that in low-frequency group, and PSQI score was significantly higher than that in low-frequency group. Low-frequency rTMS combined with medication has a better therapeutic effect on the insomnia symptoms of PSD, while high-frequency rTMS combined with medication has a more pronounced therapeutic effect on the depressive symptoms of PSD. Both high-frequency and low-frequency rTMS have an improving effect on neurofunctional deficits and activities of daily living.

Agreement of PROMIS Preference (PROPr) scores generated from the PROMIS-29 + 2 and the PROMIS-16.

Preference-based summary scores are used to quantify values, differences, and changes in health-related quality of life (HRQoL) that can be used for cost-effectiveness analyses. The PROMIS-Preference (PROPr) measure is a preference-based summary score comprised of 7 PROMIS domains. The PROMIS-16 is a new PROMIS profile instrument. We evaluated the measurement properties of PROPr generated from the widely used PROMIS-29 + 2 compared with the PROMIS-16. We performed a secondary analysis of data from an online survey of the general US population, with a longitudinal subsample who reported back pain. The survey included both the PROMIS-16 and the PROMIS-29 + 2 profiles. PROPr scores were calculated from each profile and compared by the distribution of scores, overall mean scores, product-moment correlations with pain measure scores (Oswestry Disability Index, Roland-Morris Disability Questionnaire, Pain Intensity, Interference with Enjoyment of Life, Interference with General Activity Scale, and Graded Chronic Pain Scale), and difference in mean scores in subgroups with 13 chronic health conditions (Cohen's d). Of the 4,115 participants in the baseline survey, 1,533 with any reported back pain were invited for the 6-month follow-up survey and 1,256 completed it. At baseline, the overall mean (SD) PROPr score was 0.532 (0.240) from PROMIS-16 and 0.535 (0.250) from PROMIS 29 + 2. At both time points, the correlations of PROPr scores with physical and mental health summary scores from the PROMIS-29 and 4 pain scales were within 0.01 between profiles. Using subgroups with chronic health conditions and comparing between profiles, Cohen's d estimates of the difference in effect size were small (< 0.2). PROPr scores from the 16-item PROMIS profile measure are similar to PROPr scores from the longer PROMIS-29 + 2.

A Comparative, Individual Values-Based Scoring Approach to the Secure Flourish Index Among Clinical Health Professions Students

Abstract Purpose The purpose of this study was to investigate flourishing among medical (MD), physician assistant (PA), and nurse practitioner (NP) students, using the novel Secure Flourish Index (SFI). Method MD, PA, and NP students from two institutions completed the traditional SFI (tSFI), then applied a percentage weight to each of the six domains (maximum total 100%) based on perceived relative importance to their overall flourishing, creating a novel self-weighted SFI score (swSFI). The Bland–Altman (BA) plot was used to assess the magnitude of agreement between scores. Results The BA plot (n = 281) revealed a mean bias of .07(95% CI -.50,.63). Eighteen participants (6.4%) fell outside of the calculated BA limits of agreement [-9.31 [95% CI - 10.27,-8.45] and 9.45 [95% CI 8.49,10.41]]. Linear regression revealed the mean BA score is predictive of the mean difference between scores [R2 = 0.07, F(1,280) = 21.1, p &lt; .001] indicating bias in agreement between the scoring systems as mean flourishing score changes. Conclusion Accounting for individual values is important when measuring student flourishing but is missing from current operant definitions. The overall mean difference (bias) in tSFI and swSFI scores is minimal (.07, possible range 0–120). However, the bias becomes larger as individual mean flourishing scores move towards both the high and low ends of the flourishing spectrum. This indicates that the influence of weighting flourishing domains is larger for individuals with high or low flourishing than those with moderate flourishing.

Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi; Amid the COVID-19 Pandemic

Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting. Study Design: Cross sectional analytic study. Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22. Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26. Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p= 0.28). Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity.