P-value Research Articles

31 vs 35 mm: a randomized comparison of the pentaspline pulsed field ablation catheter sizes

Abstract Background Pulsed-Field ablation (PFA) is a non-thermal tissue-selective energy source which is increasingly used for pulmonary vein isolation (PVI). A commercially available pentaspline PFA catheter can be transformed between different configurations and is available in two different sizes – 31 and 35 mm of diameter. No clear recommendations for when to choose which catheter size are available to date. Purpose We aimed to assess procedural and outcome differences of the two different catheter sizes. Methods We prospectively included all-comer patients between 07/2022 and 01/2023 who had paroxysmal or persistent atrial fibrillation (AF) and were scheduled for PVI with PFA. There were no exclusion-criteria. 100 patients were randomly assigned to be ablated with either the 31 mm or the 35 mm pentaspline PFA catheter. Patients were routinely scheduled for follow-up visits 6 and 12 months after the ablation. Results Each group consisted of 50 patients and baseline characteristics were comparable. For the 31 mm vs 35 mm group respectively: Mean age 68.5 years vs 68.2 years, mean BMI 28.0 vs 30.3 kg/m², male sex 60% vs 68%, paroxysmal AF 59.6% vs 53.1%, mean LA diameter 40.9 vs 40.3 mm. Acute procedural efficacy defined as accomplishing PVI with the pentaspline PFA catheter was 100% in both groups. The procedural skin-to-skin time was numerically shorter in the 31 mm group (31.4 vs 34.3 minutes, p=0.11), which was attributed to a shorter ablation time (12.5 vs 15.1 minutes, p=0.052). Fluoroscopy time was significantly shorter (5.9 vs 7.1 minutes, p=0.015). The overall freedom of arrhythmia at 180 days was 82,1%. The groups show a numerical difference in freedom of arrhythmia (31 mm: 91,9% vs 35 mm: 73,4%), but no statistically significant difference using the log rank test (p=0.14, Figure 1). A total of 8 repeat procedures were performed in this patient collective for recurrent atrial arrhythmia - 3 in the 31 mm group, 5 in the 35 mm group. While the 3 repeat procedures in the 31 mm group showed no PV reconnections, 4 of the 5 patients in the 35 mm group had reconnected PVs (Fisher exact test p-Value=0.14). Overall, 25% (8/32) of PVs were reconnected, with the RSPV and RIPV being the most commonly reconnected veins (3 times each). Conclusion To the best of our knowledge, we provide the first randomized comparison of the two pentaspline PFA catheter sizes. Our data show longer procedure times and fluoroscopy times using the 35 mm device as well as a higher rate of PV reconnections especially at the septal PVs. Most importantly, we observe a trend towards worse clinical outcomes using the larger catheter. Longer follow-up times will be available at the time of presentation.Freedom from arrhythmia recurrence

Does Religious Fasting Have a Protective Role against Metabolic Syndrome in Individuals Aged >50 Years?

The Christian Orthodox Church (COC) fasting is a periodic vegetarian-type diet lasting 180-200 days annually in which seafood and snails are allowed on all fasting days. Our aim was to investigate the effects of COC fasting on metabolic syndrome (MetS) in adults >50 years. One hundred seventy-six individuals participated in the study (mean age 59.7 ± 6.0 years). Eighty-nine had been following the COC fasting regime since their childhood and eighty-seven were non-fasters. Anthropometric measurements, blood samples, and nutrient intake data were collected at a scheduled appointment, during a non-fasting period. Fasters had significantly higher hip circumference (102 ± 8.5 vs. 98.8 ± 7.5 cm, p = 0.009), low-density lipoprotein (LDL) cholesterol (136 ± 73 vs. 115 ± 51 mg/dL, p = 0.033), and folic acid levels (6.0 ± 4.0 vs. 3.0 ± 1.2 ng/mL, p = 0.018), as well as lower systolic blood pressure (SBP) (131 ± 13 vs. 136 ± 14 mmHg, p = 0.045), diastolic blood pressure (DBP) (80 ± 8 vs. 83 ± 7 mmHg, p = 0.007), glucose (87 ± 16 vs. 93 ± 25 mg/dL, p = 0.039), and triglycerides (143 ± 94 vs. 175 ± 84 mg/dL, p = 0.040). Fasters had significantly less intake of calories (1493.65 ± 363.74 vs. 1614.65 ± 426.28 kcal, p = 0.044) and fat (81.17 ± 25.47 vs. 90.74 ± 24.75 g, p = 0.012), whereas they also consumed significantly less vitamin A-retinol, vitamin B2, vitamin B12, vitamin E, folic acid, pantothenic acid, calcium, phosphorus, zinc, and significantly more vitamin C (p < 0.005 for all comparisons). BP was significantly higher in non-fasters (44.8 vs. 22.5%, p = 0.002), whereas MetS was more frequently present in non-fasters vs. fasters, with a marginal level of significance (35.6 vs. 22.5%, p = 0.055). COC fasting may affect beneficially MetS prevalence in individuals >50 years, although future research is needed before reaching definite conclusions.

#6005 COMPARISON OF SEMAGLUTIDE ORAL VS SUBCUTANEOUS IN CHRONIC KIDNEY DISEASE (CKD)

Abstract Background and Aims The use of GLP-1 receptor agonist (ra) has become one of the cornerstones for CKD type 2 diabetic patients (T2DM) treatment. Oral formulation of semaglutide appeared as new therapeutical tool to increase the use of drugs with proved renal benefit. However, method of administration of the oral formulation and oral absorption limitations in CKD patients could adversely affect drug efficacy. The aim of this study was to compare the efficacy of semaglutide sbc vs oral in CKD patients Method Prospective, real-world study performed in T2DM-CKD patients with indication of initiation of GLP-1ra therapy in which semaglutide sbc or oral was initiated. Patients were assigned to sbc or oral formulation according to drug accessibility and patient preferences. Patients previously treated with any other GLP-1ra were excluded. Results 70 patients were included, 50 with sbc and 20 with oral semaglutide with mean follow up time of 407 [180-753] and 154 [75.5-205] days respectively (mean, IQR) Basal characteristic of the patients are shown in the table. More male patients were included but age eGFR and UACR showed no significant differences between groups. 80% and 50% of the patients were on maximum semaglutide dose (1.0 mg sbc and 14 mg or respectively) and 12% and 45% were on the low dose (0.25 mg sbc and 3mg or respectively). We observed similar percentage of HbA1C reduction sbc: -6.2% [-10.8 a 0] and oral -6.2% [-11.5 a 0] (p 0.9). Differences on BMI and weight loss were slightly higher on sbc group though non-significant. We observed no significant effects on eGFR or UACr, nor on blood pressure during the observation period. and main side effect was gastrointestinal intolerance, similar in both groups (7 (14%) in subc and 3 (20%) in oral group, pv alue 0.9. Conclusion Oral formulation of semaglutide was equally effective in terms of glucose control and body weight in patients with T2DM and CKD even with more patients on the low-medium doses. Gi side effects were similar with both formulations though the lower number of patients on the higher oral dose does not allow further conclusions.

The Interplay between Metabolic Syndrome and Religious Fasting in Postmenopausal Women.

Religious fasting that involves abstinence from specific food(s) is part of many religions worldwide and has been gaining attention by the research community during the last years. The study aimed to investigate whether the periodic Christian Orthodox fasting mitigates the changes in body composition, dietary intake, and metabolic syndrome (MetS) in postmenopausal women. One hundred and thirty-four postmenopausal women aged 57.3 ± 6.7 years participated in this study. The Christian Orthodox fasting was followed by 68 postmenopausal women since their childhood, whereas 66 postmenopausal women were non-fasters. Data collection involved anthropometric, biochemical, clinical, and dietary information. Postmenopausal women who fasted according to Christian Orthodox Church recommendations had significantly higher mean fat free mass (45 vs. 44 kg, p = 0.002), hip circumference (104 vs. 99 cm, p = 0.001), and diastolic blood pressure (79 vs. 82 mmHg, p = 0.024). No other differences were found with regards to anthropometric data. Fasters also consumed significantly less fat (78 vs. 91 g, p = 0.006), as well as saturated (19 vs. 23 g, p = 0.015), monounsaturated (41 vs. 47 g, p = 0.018), and polyunsaturated fat (8.5 vs. 10 g, p = 0.023), trans fatty acids (0.5 vs. 2.3 g, p = 0.035), and cholesterol (132 vs. 176 g, p = 0.011). In terms of MetS features, non-fasters had more frequently elevated fasting blood glucose (11.8 vs. 24.2%, p = 0.039) and elevated blood pressure (13.2 vs. 36.4%, p = 0.041) compared with fasters. MetS was more common in non-fasters versus fasters with a marginal level of significance (30.3 vs. 23.5%, p = 0.052). Postmenopausal women who follow the Christian Orthodox fasting regime had lower fat intake, and no other difference in nutrient intake, compared with non-fasters. The latter were more likely to have MetS and some of its components. Overall, periodic abstinence from meat, dairy products, and eggs might play a protective role in postmenopausal women with regard to MetS.

Japan and the United Kingdom: The Inflation Irrelevance Proposition

This paper is about the generalized proposition of inflation irrelevance. The weak-form version of inflation irrelevance holds that stock prices are independent of inflation rates. The semi-strong form version is that stock prices are independent of both domestic and foreign inflation rates. The strong, or generalized, version is that stock returns are independent of all three rates, domestic and foreign inflation rates, and changes in foreign exchange rates. Overall, the three forms fail to be rejected separately and jointly under conventional marginal significance levels. The conclusion from this paper is that inflation irrelevance, or nominal neutrality, is a common characteristic in the two countries studied, Japan and the United Kingdom. Therefore, the statistical evidence is mounting manifestly, and is pervasive and applies to diverse economies, among which Japan and UK. This regularity amounts to an international stylized empirical fact that cannot be ignored.

The Impact of Pandemic on GDP Growth Rate, FDI and Export: A Case Study of Turkey

It has been two years since the outbreak of Covid 19, and we still live with the pandemic. No one knows when the pandemic will finish and how long it will take until all is back to normal and the global economy fully recovers from the pandemic. Undoubtedly, the Corona crisis has had devastating effects on the global economy. The global GDP decreased by 3.5%, the global FDIs were below $ 1 trillion for the first time in the last 20 years in 2020, falling 35% compared to 2019, and the global trade dropped 5.3% at the same time. The main objective of this paper is to discover the impact of a pandemic on the Turkish economy, or more precisely, on the Turkish GDP growth rate, FDI inflows, and export. To get the most reliable results, a multiple regression analysis has been conducted, using the contemporary economic software EViews 12. World Pandemic Uncertainty Index (WPUI) that was introduced by the International Monetary Fund (IMF) in 2020 was used as a measure of the uncertainty caused by the pandemic. For the robustness of the analysis, World Uncertainty Index (WUI), which measures the overall uncertainty caused by the economic and political factors, was also included. The data about GDP growth rate and export were provided from the World Bank Database, while the data for the FDI inflows from UNCTAD. Different independent variables were used in the research for each dependent variable (GDP growth rate, FDI inflows, and export). The research has shown that Covid 19 pandemic has a significant negative impact on the Turkish GDP growth rate (if we consider a 5% level of significance) and on the Turkish export (if we consider a 10% marginal level of significance). However, the regression analysis has shown that the pandemic has a positive but insignificant impact on FDI inflows to Turkey. The study will be a great benefit for further analysis of the impact of Covid 19 on economies as it is one of the first empirical studies that analyzes the effect of Covid 19 on a specific economy.&#x0D; &#x0D; Received: 16 March 2022 / Accepted: 12 May 2022 / Published: 5 July 2022

Number Of Apheresis Days To Reach Target Stem Cell Dose May Be a Predictor Of Secondary Myelodysplastic Syndrome and Acute Myelogenous Leukemia

Introduction Autologous stem cell transplantation (ASCT) is an effective consolidation therapy for patients with relapsed/refractory Hodgkin's and Non-Hodgkin's lymphoma. Studies have shown that infusion of at least 2 × 106 CD34+ cells/kg recipient body weight is required for reliable neutrophil and platelet engraftment. However there is no published data on the impact of number of apheresis days required to reach the target stem cell dose and incidence of secondary myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML). Methods Consecutive patients who underwent ASCT at M. D. Anderson cancer center from January 2008-July 2011 for Hodgkin's or Non-Hodgkin's lymphoma were evaluated to assess the impact of duration of mobilization on the incidence of secondary MDS/AML. Baseline patient, disease, and transplant characteristics including number of days of mobilization needed to collect target cell dose of 5 × 106 CD34+ cells/kg. The median number of days to reach target was 2 (range 1-5) days. We used the median as cut off to classify patients as slow (> 2 days) or fast (≤ 2 days) mobilizers. The cumulative incidence of secondary MDS/AML was estimated considering death preceding a secondary malignancy as a competing event. Cox's proportional hazards regression analysis was used to evaluate predictors of the rate of secondary MDS/AML. Results A total of 283 patients underwent ASCT during the study period. 153 of these patients were classified as fast mobilizers and 130 patients as slow mobilizers. Indication for transplant, disease status prior to transplant, age and gender distribution are as shown in [Table 1][1]. Twelve patients were diagnosed with secondary MDS/AML after a median follow-up of 39 (range 2-64) months. Only one of these patients had pre-existing pretransplant cytogenetic abnormalities (monosomy 7 in one metaphase). Nine of 12 cases were diagnosed within 3 years post-transplant. On univariate analysis, days to target stem cell dose was the only predictor of the rate of secondary MDS/AML. The rate of secondary MDS/AML within 3 years post-transplant was higher in the slow mobilizer group (n=8, 6% cumulative incidence at 3 yrs) compared with the fast mobilizer group (n=4, 1 % cumulative incidence at 3 yr, HR=0.2, P value 0.05) [Figure 1][2]. None of the remaining factors listed in [Table 1][1] were found to be associated with the rate of secondary MDS/AML on univariate analysis. In patients who did not have active disease at transplant, overall survival tended to be higher in the fast mobilizer group compared with slow mobilizers. However, this effect did not reach statistical significance on multivariate analysis (hazard ratio of 0.6; with P value of 0.1). Absolute neutrophil count of > 500/mm3 was achieved at a median of 10 days in fast mobilizers versus 11 days in slow mobilizers (P value 0.000). Similarly platelet count >20,000 was achieved sooner in fast mobilizers at a median of 11 versus 12.5 days in slow mobilizers (P value 0.000). View this table: Table 1 Conclusions Number of apheresis days required to collect target stem cell may be a predictor of secondary MDS/AML. There is a trend towards better survival among patients who mobilize in two or less than two days. As expected fast mobilizers have quicker neutrophil and platelet engraftment. ![Figure 1][3] Figure 1 Disclosures: Qazilbash: Millennium: Membership on an entity’s Board of Directors or advisory committees; Celgene: Membership on an entity’s Board of Directors or advisory committees. [1]: #T1 [2]: #F1 [3]: pending:yes

What Is The Best Time Sampling For The Two Direct Oral Anticoagulants, Dabigatran and Rivaroxaban?

Introduction Thanks to their predictable pharmacokinetic profile, frequent monitoring of direct oral anticoagulants (DOACs) effects or levels is not recommended in the majority of patients, but it is anticipated that a non-negligible proportion of patients will achieve either insufficient or supra-therapeutic levels of the drug. Moreover, in pharmacokinetic studies with dabigatran etexilate (DE) and rivaroxaban marked interindividual variation in drug levels has been observed. The question about the most appropriate test to assess the treatment response has already been addressed and it was additionally stated that the interval between the drug intake and the blood sampling is mandatory. However, no information regarding the most appropriate delay for monitoring is currently provided. Therefore, the objective of this work is to evaluate the interindividual response at different time points in order to identify which interval between the drug intake and the blood sampling should be preferred for the assessment of the individual response. Methods Series of patients treated with rivaroxaban (AF n=25; VTE n=8) or DE (AF n=18) were included in the study. For each patient, blood was taken at 3 different intervals: - At Ctrough o 22 to 26 hours after the last intake of rivaroxaban o 11 to 13 hours after the last intake of DE - Two hours and three hours after drug administration For rivaroxaban samples, prothrombin time was performed with Triniclot PT Excel S®, RecombiPlasTin 2G® and Innovin®. Rivaroxaban plasma concentration was estimated with the Biophen Direct Factor Xa Inhibitor®. For DE samples, activated Partial Thromboplastin Time (aPTT) was perfomed with STA®-C.K.Prest and SynthasIL®. Plasma dabigatran concentration was estimated with the Hemoclot Thrombin Inhibitor®. Wilcoxon analyses were performed between the different blood sampling intervals. Test for effective pairing was computed with the Spearman non-parametric correlation coefficient with a one-tailed P value. Results Table 1 shows the minimum, the median and the maximum obtained with each tests at each time sampling. [Figure 1][1] provides the box-plot and whiskers (min to max) of the different assays performed on rivaroxaban samples at the different time sampling. [Figure 2][1] provides the box-plot and whiskers (min to max) of the different assays performed on dabigatran samples at the different time sampling. ![Figure 1][2] Figure 1 ![Figure 2][2] Figure 2 Discussion Our results confirm that there is a non-negligible interindividual variation in drug levels at same time points. When comparing intervals, whatever the test used in our study, we can see that results at Ctrough clearly differ from results obtained 2 or 3 hours after the intake of the drug ([Table 1][3]). Interestingly, for rivaroxaban, the median after 2 or 3 hours are closely the same with similar 25th – 75th percentile values whatever the test. Based on our results, we can affirm that for the majority of patients in our study, the Cmax is reached within 2 to 3 hours after the intake. For dabigatran, the plasma concentration is higher at 3h than at 2 hours ([Table 1][3]). However, the power of the study is not sufficient to show a statistically significant effect. Interestingly, this phenomenon is not encountered with the aPTT. This may be due to the well-known flattening curve effect at these higher concentrations. View this table: Table 1 Conclusion Based on our results, we can assert that it seems preferable to take the blood 3 hours after the last intake of DE to avoid missing the Cmax. For rivaroxaban, whatever the blood is taken 2 or 3 hours after the intake, results are similar. Therefore, we recommend to systematically performing blood sampling 3 hours after the intake of the drug to assess the maximal response at these treatments. Sampling at Ctrough is also required to evaluate the clearance. As a limitation, our results should be confirmed in larger cohort studies. Disclosures: No relevant conflicts of interest to declare. [1]: #F1 [2]: pending:yes [3]: #T1

Prevalence of diaper rash and associated factors among babies aged 0 to 24 months in Adama Administrative City, Central Ethiopia: A cross sectional study

The objective of this study was to assess the prevalence of diaper rash and identify associated factors with diaper rash among children between 0 and 24 months of age in Adama Ethiopia. A cross-sectional study was conducted with mothers using structured questionaries during face to face interview to assess risk factors associated with diaper rash. Data were analyzed using SPSS version 21 and Chi-square test was used to establish the association between diaper rash and socio-demographic and socio-economic characteristics at p-value <0.05. Multivariate logistic regressions are used to test the significancy of risk factors. About 62.5% (235/376) of children in the study had experienced diaper rash. Multivariate logistic regression analysis revealed that diarrhea (AOR=0.424; 95%CI=0.203-0.902; P=0.032), food types consumed by baby (AOR=0.21; 95%CI=0.050-0.882; P=0.033), use of barrier cream (AOR=0.012; 95%CI: 0.005-0.029; P=0.000) and frequency of diaper change (AOR=3.174; 95% CI=0.068-9.438; P=0.038) were among factors associated with diaper rash. In this study changing diaper frequently, using cream and breast feeding with baby formula milk were identified as a factor that reduce the prevalence of diaper rash whereas diarrhea was identified as a risk factor that aggravate diaper rash. Thus, educating mothers on the importance of breast feeding, use of cream and diaper change is useful. Key words: Diaper rash, prevalence, babies.

To P or not to P: A P-value Comic.

To P or not to P: A P-value Comic.

Retrospective Cross-Sectional Survey of Patients Diagnosed with Various Types of GI Ulcers at MNH Gastroenterology Unit: A Call for Strategic H. Pylori Screening

Background Peptic ulcer is one of gastrointestinal (GI) disease presenting with dyspeptic symptoms whose cause often overlaps making the etiological diagnosis difficult. Endoscopy remains to be the ideal for identifying organic disease of foregut. Helicobacter pylori (H. pylori) infection has commonly been associated with most and various upper gastrointestinal pathologies. Broad Objective This scholarly cross-sectional study was conducted to determine the association between H. pylori infection and peptic ulcer disease in 116 dyspeptic patients who visited Gastroentorology Unit at Muhimbili National Hospital in Dar es Salaam located in the eastern coast of Tanzania. The study aimed at obtaining data that could be used as bench mark for future H. pylori screening as a preventive measure to control peptic ulcer disease (PUD) in Tanzania. Methods The study included all patients with dyspeptic symptoms visiting and/or referred to Gastroenterology Unit from 1st to 30th August 2015. Dyspepsia was defined as persistent or recurrent pain or discomfort in the upper abdomen. Patients diagnosed with PUD within the observation period were verified through medical records. Information on psychosocial factors, medication and symptoms was obtained from a questionnaire completed at study entry. In this study H. pylori infection status was determined serologically. Results The most commonly identified endoscopic findings were gastritis which accounted for 44 (37.9%) patients, gastro esophageal disease accounting for 35 (30.2%) patients and peptic ulcer disease in 30 (25.9%) patients. Among patients with peptic ulcer disease, 17 (56.7%) had H. pylori infections. The association between peptic ulcer disease and H. pylori infection was statistically significant (p-value < 0.001). Neither gastritis nor GERD was found to be associated with H. pylori infection. Conclusion There is a statistically significant association between H. pylori and PUD (gastric and duodenal ulcers), a signature to previous reports out of our settings. Our study benchmarks the need for further studies focusing on screening, for early diagnosis and predictions to establish the existing relationships and possible cofounders in these proposed relationships. The increasing number of reported PUD at MNH and presence of H. pylori infection warrant studies targeting to investigate the co-existence of these two closely linked GIT conditions. Key words: Peptic Ulcer Disease, GI ulcer types, H. pylori, screening.

Testing the Influence of Social Axioms on Internet Gaming Disorder Tendency with a Cross-Lagged Panel Model: a One-Year Longitudinal Study

Gaming-specific beliefs on the functions and/or consequences of gaming have consistently been shown to be risk factors for Internet gaming disorder (IGD). However, there is a scarcity of research on the effects of generalized beliefs about the world (i.e., social axioms) on IGD tendency. This 1-year longitudinal study was designed to test whether and which social axioms would have a prospective influence on IGD tendency. One hundred ninety-five Chinese university students (Mage = 19.86, female = 72.3%) voluntarily participated in both the baseline and 1-year follow-up surveys. Social cynicism, but not four other social axioms (i.e., fate control, reward for application, social complexity, and religiosity), was found to be significantly associated with baseline and follow-up IGD tendency. Using a cross-lagged panel model, while controlling for baseline IGD tendency and grade point average (GPA), baseline social cynicism belief still had a positive effect on follow-up IGD tendency at a marginal significance level (p = .07). Moreover, students’ baseline GPA predicted lower follow-up IGD tendency (β = −.17, p < .01) but not vice versa. Our findings suggested that preventive interventions may consider modifying not only gaming-specific beliefs but also general beliefs, such as social cynicism. They also shed light on the importance of identifying groups that are at risk for IGD tendency, such as low-achievement students, for interventions.

THE RELATIONSHIP BETWEEN SELF-ESTEEM AND FUTURE ORIENTATION IN EDUCATION CLASS XI STUDENTS AT SMA NEGERI 11 PALEMBANG, INDONESIA

This study aims to determine the relationship between self-esteem and future orientation in education in XI grade students at SMA Negeri 11 Palembang. The dependent variable in this study is the future orientation of education, while self-esteem is the independent variable. This study uses a scale of future orientation in education and a scale of self-esteem. This research uses quantitative methods. The sample used in this study were 142 class XI students at SMA Negeri 11 Palembang. The results of this study indicate a very significant relationship between self-esteem and future orientation in education of class XI students at SMA Negeri 11 Palembang with a value of r = 0.572, R Square = 0.328, p = 0.000. As the result of significance level (p) = 0.000 which the p-value Article visualizations:

Management of Functional Constipation in Pediatrics Based on Nurse Educational Intervention

Back ground: Constipation is a prevalent problem in pediatric patients and one of the ten most common pathological conditions visited by general pediatricians (1). It accounts for up to 25 percent of referrals to a pediatric gastroenterologist. Therefore, this study was done to evaluate the effects of a nurse-based education program on reducing the symptoms of chronic functional constipation in children (2). Methods: This clinical trial study was conducted on 95 children (48 control and 47 intervention group), aged 3 to 14 years old, and selected randomly out of the patients referred to Imam Reza Clinic affiliated to Shiraz University of Medical Sciences in 2014. The control group only received the usual treatment prescribed by the physician; however, the intervention group received a comprehensive nursing program. Then, having completed Rome III Criteria Form immediately after the intervention for one month, two months, and three months, we collected the required data. The significance level in this study was 0.05. Results: The mean age of the samples was 78.30±32.52 months in the intervention group and 74.60±32.26 months in the control group. Also, the average weight of children in the intervention group was 23302.17±12034.96 grams and in the control group 21376.09±9351.80 grams. 18% of the samples from the intervention group and 22% of the control group were males. With a follow-up of 3 months, the percentage of changes in the intervention group in items 1 (two or fewer defecation in the toilet per week) and 4 (history of painful or hard bowel movement) was 48.9% and 74.5%, respectively, and in the control group 22.9% and 52.1%, respectively. Therefore, positive changes in the intervention group were better than the control group. The difference between these two variables was statistically significant (p-value 0.05), despite changes in the percentage of items in different periods of 1, 2, and 3 months. Conclusion: The findings of this study indicate that nursing education programs have a desirable effect on the reduction of some symptoms of chronic functional constipation based on Rome III criteria in children aged 3-14 years.

Two-Stage Artificial Neural Network Regression Modelling for Wheezing Risk Factors Among Children - A Case Study of Gatundu Hospital, Kenya

In Kenya wheezing that leads to asthma development in most cases remain under-diagnosed and under-treated. Currently there is no public supported wheezing and asthma care programmes to optimize care for patients with asthma which greatly compounds diagnosis and treatment of the disease. The aim of this study is therefore to consider and analyse the covariates of childhood wheezing among children below 10 years of age in Kenya, a case study of Gatundu hospital in order to improve the provision of wheezing and asthma care services in medical facilities. The possible risk factors in the study are selected from three major groups of demographic, socioeconomic and geographical location factors related to childhood wheezing. The longitudinal secondary data obtained from Gatundu hospital in Kenya were collected and a total of 584 complete cases were recorded. The predictor variables considered in the study include age of children in months, gender, exclusive breastfeeding, exposure to tobacco smoking, difficult living conditions, residence, atopy, maternal age and preterm births. Due to the binary nature of response variable in which data is recorded as presence or absence of wheezing, the risk factors were modelled using multiple logistic regression and Artificial Neural Network Models. Simple random samples of sizes n = 385 without replacement were selected and p-values at 5% level of significance for the variables were recorded. In multiple logistic regression, the five variables identified as possible risk factors for modelling with p-value less than or equal to 0.05 were selected that includes age of children, exclusive breastfeeding, exposure to tobacco smoking, difficult living conditions and residence that recorded p-values of 0.0151, 0.0000, 0.0071, 0.0274 and 0.0410. The best multiple logistic linear regression model selected was based on Akaike Information Criterion (AIC) criterion that recorded null deviance, residual deviance and AIC of 502.44, 179.57 and 191.57 respectively. The precision and accuracy of the multiple logistic regression model were recorded as 89.2% and 93.3% respectively. The Artificial Neural Network was considered for modelling as well, the model with one-hidden layer with four neurons in the hidden layer recorded precision of 97.1% and accuracy of 39.4% while the rest of the models with one hidden layer recorded precision and accuracy of 0.0% and 65.1% respectively. The Artificial Neural Network model with two-hidden layers were also considered and the Network with one neuron in both layers was selected as better performing model with precision and accuracy of 88.2% and 93.3%. The developed two-stage logistic Artificial Neural Network was found to have better performance compared to multiple linear logistic regression and Artificial Neural Networks since it recorded precision and accuracy of 97.1% and 99.0% respectively and hence recommended for consideration in modelling the risk factor of wheezing among children in Kenya.

Using demographic data to understand the distribution of H1N1 and COVID-19 pandemics cases among federal entities and municipalities of Mexico.

BackgroundThe novel coronavirus disease (COVID-19) pandemic is the second global health emergency the world has faced in less than two decades, after the H1N1 Influenza pandemic in 2009–2010. Spread of pandemics is frequently associated with increased population size and population density. The geographical scales (national, regional or local scale) are key elements in determining the correlation between demographic factors and the spread of outbreaks. The aims of this study were: (a) to collect the Mexican data related to the two pandemics; (b) to create thematic maps using federal and municipal geographic scales; (c) to investigate the correlations between the pandemics indicators (numbers of contagious and deaths) and demographic patterns (population size and density).MethodsThe demographic patterns of all Mexican Federal Entities and all municipalities were taken from the database of “Instituto Nacional de Estadística y Geografía” (INEGI). The data of “Centro Nacional de Programas Preventivos y Control de Enfermedades” (CENAPRECE) and the geoportal of Mexico Government were also used in our analysis. The results are presented by means of tables, graphs and thematic maps. A Spearman correlation was used to assess the associations between the pandemics indicators and the demographic patterns. Correlations with a p value < 0.05 were considered significant.ResultsThe confirmed cases (ccH1N1) and deaths (dH1N1) registered during the H1N1 Influenza pandemic were 72.4 thousand and 1.2 thousand respectively. Mexico City (CDMX) was the most affected area by the pandemic with 8,502 ccH1N1 and 152 dH1N1. The ccH1N1 and dH1N1 were positively correlated to demographic patterns; p-values higher than the level of marginal significance were found analyzing the % ccH1N1 and the % dH1N1 vs the population density. The COVID-19 pandemic data indicated 75.0 million confirmed cases (ccCOVID-19) and 1.6 million deaths (dCOVID-19) worldwide, as of date. The CDMX, where 264,330 infections were recorded, is the national epicenter of the pandemic. The federal scale did not allow to observe the correlation between demographic data and pandemic indicators; hence the next step was to choose a more detailed geographical scale (municipal basis). The ccCOVID-19 and dCOVID-19 (municipal basis) were highly correlated with demographic patterns; also the % ccCOVID-19 and % dCOVID-19 were moderately correlated with demographic patterns.ConclusionThe magnitude of COVID-19 pandemic is much greater than the H1N1 Influenza pandemic. The CDMX was the national epicenter in both pandemics. The federal scale did not allow to evaluate the correlation between exanimated demographic variables and the spread of infections, but the municipal basis allowed the identification of local variations and “red zones” such as the delegation of Iztapalapa and Gustavo A. Madero in CDMX.

SCHOOL MAPPING AS THE DETERMINANT OF THE PROVISION OF EDUCATION RESOURCES IN PUBLIC SECONDARY SCHOOLS

In this study, the researcher investigated school mapping as a determinant for the provision of education resources in public secondary schools in Imo State. Three research questions and three hypotheses guided the study. The instrument used to collect data from the respondents was “School Mapping as a Determinant for the Provision of Education Resources in Public Secondary Schools in Imo State Questionnaire (SMDPERPSSISQ)”. The instrument was validated by three experts. The reliability of the SMDPERPSSISQ was established through a pilot testing and analysis using Cronbach alpha which yielded an average of 0.84 considered high enough for the study. Pearson Product Moment Correlation Coefficients were used to answer the research questions and test the hypotheses. In testing the null hypotheses, when p-value is equal or greater than 0.05 level of significance, the null hypothesis is accepted, but if it is otherwise, the null hypothesis is rejected. The finding of the study, among others is that most of the schools in the study area are concentrated in the urban areas with few of them are cited in the rural areas. It was therefore recommended that more schools should be located at the rural communities to provide education opportunities for children of school age in the rural area. Article visualizations:

Risk of ovarian and cervical cancer in women with positive cancer family history: Results of tabari cohort study

Aim and Background: Positive association between cancer family history and cervical/ovarian cancer could be due to genetic susceptibility or shared environment. The aim of the present study was to identify the association between positive cancer family history and risk of ovarian and cervical cancer. Materials and Methods: In the present case–control study, we have utilized the data collected in the enrollment phase of population-based Tabari cohort study. The case group consisted of participants with ovarian and cervical cancer (17 and 39 individuals, respectively) were selected by the census method. Participants in control groups were matched by age and were selected randomly from the study population. Participants in the control group were twice as participants with cervical cancer and three times as participants with ovarian cancer. Results: There was no association between ovarian cancer family history and other kinds of cancer family history with ovarian cancer (P value: 1.000, 0.146, respectively). Our finding showed no association between cervical cancer family history as well as other kinds of cancer family history with ovarian cancer ovarian (P value: 0.439 and 0.713, respectively). Conclusions: The findings of the present study showed that there is no significant association between cancer family history with ovarian cancer as well as cervical cancer. Among our selected variables, menopause and residency were significantly associated with ovarian and cervical cancer.

INFLUENCE OF TEACHERS’ KNOWLEDGE COMPETENCY ON PUPILS’ ACADEMIC ACHIEVEMENT IN KISUMU COUNTY, KENYA

Academic achievement of pupils’ in Kisumu County has not been encouraging coupled with disparities between the sub-counties. Purpose of the study was to establish the influence of teachers’ knowledge competency on pupils’ academic achievement. The study employed survey research design. The study was conceptualized on principles of high-quality teaching and learning. Study Population comprised 3290 teachers, 658 head teachers, 7 assurance officers and 7 directors. Saunders, Lewis and Thornhill table was used to select sample of 294 teachers and 203 head teachers. Study sample were selected by stratified, random and purposive sampling. Samples selected comprised 294 teachers, 203 head teachers, 7 assurance officers and 7 directors. Informed consent, confidentiality of respondents was observed and data collected at work place. All sources were cited to avoid plagiarism Data was collected using questionnaire, interview schedule and observation checklist. Validity was ensured by comprehensively including all the study variables after which they were presented for assessment to the specialists in Curriculum and Instruction in Kisii University. Reliability of the instruments was determined by test-retest method. Correlation coefficient of teachers’ questionnaire, Head teachers’ questionnaire, QASOs interview schedule, ADDTMs interview schedule and teachers’ observation checklist yielded 0.75, 0.71, 0.73, 0.74 and 0.77 respectively. Level of significance was set at 5%. Data was analyzed using quantitative and qualitative techniques. Quantitative data was sorted, coded and processed using SPSS version 20 to generate frequencies and percentages. Hypotheses were tested using Pearson’s Product-Moment Correlations and Multiple Linear Regressions to establish presence or absence of correlations and association. Qualitative data were sorted into themes and sub-themes, analyzed in an on-going process then reported in prose. Teaching skills and assessment competencies had statistically significant relationship with pupils’ academic achievement at (0.125), p-value (0.027) Article visualizations:

Comparison of Quality Of Life in Thalassemia Major Patients with Injectable and Oral Iron Depletion

Background: One of the reasons that reduce the satisfaction and quality of life in thalassemia is the injection of iron-depleting drugs that always cause complications in these people. But with the advent of oral detoxification drugs are predicted, this problem has improved to some extent. given that this province is one of the regions with the highest prevalence of thalassemia in Iran. Therefore, in this study, we aimed to compare the quality of life in major thalassemia patients receiving oral and injectable iron depleting drugs. Materials and Methods: This cross-sectional descriptive-analytic (Prospective) study was performed during a one-year period (2017-2018) in Ali Asghar Hospital of Zahedan University of Medical Sciences. Demographic information of patients was extracted through history as well as information in their files and recorded in information forms. EQ5D questionnaire was used to assess the quality of life. Data were analyzed using SPSS 18 software. Results: the quality of life score is significantly higher in Patients receiving oral treatment than injecting patients. (p-value:0.02) The issue is also true in terms of the degree of health of patients in both groups. (p-value:0.03) According to the study variables comparison of quality of life score and health status of patients between the two groups receiving injectable and oral iron deprivation, showed that in females, age group less than 15 years and patients with poor acceptance, the degree of health in the group receiving oral decontamination was higher than injectable decontamination. Conclusion: Quality of life in patients with thalassemia treated with oral iron depletion is higher than patients receiving injectable iron depletion treatment, and in females, age group less than 15 years, and patients with poor acceptance, this difference is significant.