Sample Size Estimation Research Articles

Modeling Zero-inflated Count Data Using Generalized Poisson and Ordinal Logistic Regression Models in Medical Research.

In medical research, the study's design and statistical methods are pivotal, as they guide interpretation and conclusion. Selecting appropriate statistical models hinges on the distribution of the outcome measure. Count data, frequently used in medical research, often exhibit over-dispersion or zero inflation. Occasionally, count data are considered ordinal (with a maximum outcome value of 5), and this calls for the application of ordinal regression models. Various models exist for analyzing over-dispersed data such as negative binomial, generalized Poisson (GP), and ordinal regression model. This study aims to examine whether the GP model is a superior alternative to the ordinal logistic regression (OLR) model, specifically in the context of zero-inflated Poisson models using both simulated and real-time data. Simulated data were generated with varied estimates of regression coefficients, sample sizes, and various proportions of zeros. The GP and OLR models were compared using fit statistics. Additionally, comparisons were made using real-time datasets. The simulated results consistently revealed lower bias and mean squared error values in the GP model compared to the OLR model. The same trend was observed in real-time datasets, with the GP model consistently demonstrating lower standard errors. Except when the sample size was 1000 and the proportions of zeros were 30% and 40%, the Bayesian information criterion consistently favored the GP model over the OLR model. This study establishes that the proposed GP model offers a more advantageous alternative to the OLR model. Moreover, the GP model facilitates easier modeling and interpretation when compared to the OLR model.

Pragmatic, feasibility randomized controlled trial of a recorded mental health recovery narrative intervention: narrative experiences online intervention for informal carers (NEON-C).

Informal carers of people with mental health problems often have unmet support needs. Mental health recovery narratives are increasingly accessible, but their relevance to and effect on informal carers have been minimally investigated. The Narrative Experiences Online (NEON) Intervention is a first-in-field intervention that provides informal carers with access to a diverse collection of recorded mental health recovery narratives. This trial aimed to examine the feasibility and acceptability of the NEON Intervention for informal carers. This study involved a two-arm feasibility randomized controlled trial. Carers were randomly assigned to receiving versus not receiving the NEON Intervention. The feasibility aspects investigated included the acceptability of the intervention and of randomization, trial processes, engagement rates, recruitment procedures, attrition, sample size estimation, identification of candidate primary and secondary outcomes, and the feasibility of conducting a definitive trial. A qualitative process evaluation was conducted. A total of 121 carers were eligible, of whom 54 were randomized (intervention: 27, control: 27). Twelve-month follow-up data were available for 36 carers. Carers accessed a mean of 25 narratives over a 12-month period, and the intervention group, compared with the control group, reported a small effect on hope and a moderate effect on the presence of meaning in life. Five modifications were recommended to improve the user experience, applicability, and trial processes. The NEON Intervention is feasible and acceptable. Significant refinement of the NEON Intervention and trial processes is required to personalize and ensure applicability to carers. Further feasibility testing is recommended prior to a definitive trial.

Irritable bowel syndrome in children: the placebo response rate and influencing factors a meta-analysis.

Irritable bowel syndrome is common in children and exhibits a high placebo response. This study was to explore the placebo response rate and its influencing factors in children with irritable bowel syndrome. A systematic search was performed on Pubmed, Embase, MEDLINE, Cochrane Library, CNKI, Wanfang, and CBM from database inception to March 2022. Randomized controlled trials of irritable bowel syndrome in children were included in the study. The primary outcome was the placebo response rate of improvement. Thirteen studies were included, with 445 patients in the placebo group. The rate of improvement and abdominal pain disappearance were 28.2% (95% CI, 16.6-39.9%) and 5% (95% CI, 0-18.4%). The placebo response based on the abdominal pain score was 0.675 (95% CI, 0.203-1.147). The mode of administration (P < 0.01), dosing schedule (P < 0.01), and clinical outcome assessor (P = 0.04) have a significant impact on the magnitude of placebo effect. The placebo response rate for pediatric irritable bowel syndrome was 28.2%. In clinical trials, reducing dosing frequency, selecting appropriate dosage forms, and using patient-reported outcomes can help mitigate the placebo effect. This is the first meta-analysis to assess the placebo response rates for improvement and disappearance in children with IBS. The finding suggested that the mode of administration, dosing schedule, and clinical outcome assessor could potentially influence the magnitude of the placebo effect in children with IBS. This study would provide a basis for estimating sample size in clinical trial design with a placebo control.

Neoadjuvant anlotinib combined with penpulimab for resectable locally advanced esophageal squamous cell carcinoma (ESCC): A prospective, single-arm, phase II trial.

352 Background: Neoadjuvant chemoradiation therapy followed by radical surgery has been extensively recommended for locally advanced esophageal squamous cell carcinoma (ESCC). However, toxicities and challenges to the subsequent surgery limit its wide clinical application. Immune checkpoint inhibitors combined with antiangiogenesis have synergistic effects and have shown good therapeutic effects in previous studies, as well as fewer side effects. Here, we tested a novel combination of anlotinib (an antiangiogenic kinase inhibitor) and penpulimab (an anti-PD-1 antibody), without the use of radio- or chemotherapy, for the neoadjuvant therapy of locally advanced ESCC. Methods: In this prospective, single-arm, phase II clinical trial (ChiCTR2200064848), patients(pts) with resectable locally advanced ESCC (clinical stage III-IVa) were recruited. The study was designed using a two-stage minimax approach. The estimated sample size was 40 pts would provide 80% power at a one-sided alpha error of 5%, threshold pathological complete response (pCR) of 16% and expected pCR of 30%. Here, the first-stage data was included. Notably, 85% (22/25) enrolled pts had medical contraindications (including cardiopulmonary diseases or other underlying medical conditions, along with poor nutritional status and so on). Pts received neoadjuvant therapy with anlotinib (8 mg, po, D1-14, Q3W) combined with penpulimab (200 mg, ivgtt, Q3W) for 2 cycles. Six to eight weeks later, pts underwent radical surgery after exclusion of contraindications. The primary endpoint was pathologic complete response (pCR) rate. Secondary endpoints included tumor regression grade (TRG), R0 resection rate, objective response rate (ORR) and safety profile. Results: From Jan 2023 to Sep 2023, 25 pts (19 males and 6 females) were enrolled with a median age of 67 years (range: 50-74). All pts were available for efficacy assessment and 16 were evaluable for the primary end point. The rest of the pts are waiting for surgery. As of 15 Sep 2023, 19 pts underwent esophagectomy and R0 resection rate was 87.5%. The pCR rate was 18.8% (3/16) and 31.3% of pts had a major pathologic response (MPR). The ORR and DCR were 48.0% and 96.0%, respectively. 84.0% of pts experienced grade 1-2 treatment-related adverse events (TRAEs), 3 (12.0%) pts experienced grade 3 TRAEs (2 elevated blood pressure and 1 elevation of liver enzymes). The safety profile revealed that the most common TRAEs (≥10%) included hypertension (28.0%), hand-foot syndrome (20%), fatigue (20%), abdominal pain (12%), toothache (12%). Conclusions: The preliminary results of this study show promising safety and efficacy of anlotinib combined with penpulimab as neoadjuvant for pts with ESCC, especially for pts not suitable for neoadjuvant chemoradiation or chemotherapy. More ESCC pts would be recruited in the future. Clinical trial information: ChiCTR2200064848 .

The symbolic two-step method applied to cancer care delivery research: Safeguarding against designing an underpowered cluster randomized trial with a continuous outcome by accounting for the imprecision in the within- and between-center variation.

Knowing the predictive factors of the variation in a center-level continuous outcome of interest is valuable in the design and analysis of parallel-arm cluster randomized trials. The symbolic two-step method for sample size planning that we present incorporates this knowledge while simultaneously accounting for patient-level characteristics. Our approach is illustrated through application to cluster randomized trials in cancer care delivery research. The required number of centers (clusters) depends on the between- and within-center variance; the within-center variance is a function of estimates obtained by regressing the log within-center variance on predictive factors. Obtaining accurate estimates of the components needed to characterize the within-center variation is challenging. Using our previously derived sample size formula, our objective in the current research is to directly account for the imprecision in these estimates, using a Bayesian approach, to safeguard against designing an underpowered study when using the symbolic two-step method. Using estimates of the required components, including the number of centers that contribute to those estimates, we make formal allowance for the imprecision in these estimates on which a sample size will be based. The mean of the distribution for power is consistently smaller than the single point estimate that the sample size formula yields. The reduction in power is more pronounced in the presence of increased uncertainty about the estimates with the reduction becoming more attenuated with increased numbers of centers that contribute to the estimates. Accounting for imprecision in the estimates of the components required for sample size estimation using the symbolic two-step method in the design of a cluster randomized trial yields conservative estimates of power.

A study protocol of a comparative mixed study of the T-Control catheter.

Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterization by a multifactorial approach. The general purpose of this study is to determine the effectiveness, comfort, and experience of the patient catheterized with T-Control® compared with patients with a conventional Foley catheter. This trial is a mixed-method study comprising a two-arm, pilot comparative study with random allocation to T-Control catheter or traditional Foley catheter in patients with long-term catheterization and a study with qualitative methodology, through discussion groups. The comfort and acceptability of the T-Control® device (qualitative) and the quality of life related to self-perceived health (quantitative) will be analysed as primary endpoints. As secondary endpoints, the following will be analysed: magnitude and rate of infections (symptomatic and asymptomatic); days free of infection; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterization's healthcare resources; and level of satisfaction and workload of health professionals. Eligible patients are male and female adults aged ≥18 years, who require a change of long-term bladder catheter. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 4 weeks later, plus the time until the discussion groups take place.

Natural course of clinically isolated optic neuritis: implications for trial design

Aims/Purpose: To characterize disease‐induced changes in the first six months after acute optic neuritis and to aid the design of future neuroprotection trials.Methods: Treatment‐independent analysis of the TONE trial cohort (NCT01962571), including 103 patients with acute optic neuritis and baseline high contrast visual acuity &lt;0.5 dec. We analysed study visits at baseline and weeks 1, 4, 16 and 26 with mixed effects linear piece‐wise models to describe the dynamics of low contrast letter acuity, contrast sensitivity, visual fields, visually evoked potentials and macular and peripapillary retinal layer thicknesses. Sample size estimates are based on a two‐sided t‐test with α=0.05, power 80%, and treatment effects equal to 50% of the mean diseased induced change.Results: After baseline visual loss, there was improvement of visual function with thinning of inner and swelling of outer retinal layers. Clinical trials could reduce their required size by more than half when using macular ganglion cell and inner plexiform layer thinning (33 patients/group) over peripapillary retinal nerve fibre layer thinning (79/group) as the primary outcome. Similarly, trials of functional neuroprotection could reduce their size by more than 40% when employing the inter‐eye delta of 2.5% low‐contrast letter acuity (109/group) over the affected eye's value alone (189/group) as their outcome. The respective associations to vision‐related quality of life (NEI‐VFQ overall score) were similar (Pearson's |r| = 0.08 vs. 0.15 and 0.38 vs. 0.39). Because inner retinal layer thicknesses remained stable after four months but functional improvements continued up to month six, trials should follow up accordingly.Conclusions: The negative results of the TONE trial make its participants one of the best‐characterized and largest cohorts of acute optic neuritis. Our data show that future trials may benefit from substantial efficiency gains.

Sample Sizes for 10 Types of Qualitative Data Analysis: An Integrative Review, Empirical Guidance, and Next Steps

There has been a recent explosion of articles on minimum sample sizes needed for analyzing qualitative data. The purpose of this integrated review is to examine this literature for 10 types of qualitative data analysis (5 types of saturation and 5 common methods). Building on established reviews and expanding to new methods, our findings extract the following sample size guidelines: theme saturation (9 interviews; 4 focus groups), meaning saturation (24 interviews; 8 focus groups), theoretical saturation (20–30+ interviews), metatheme saturation (20–40 interviews per site), and saturation in salience (10 exhaustive free lists); two methods where power analysis determines sample size: classical content analysis (statistical power analysis) and qualitative content analysis (information power); and three methods with little or no sample size guidance: reflexive thematic analysis, schema analysis, and ethnography (current guidance indicates 50–81 data documents or 20–30 interviews may be adequate). Our review highlights areas in which the extant literature does not provide sufficient sample size guidance—not because it is epistemologically flawed, but because it is not yet comprehensive and nuanced enough. To address this, we conclude by proposing ways researchers can navigate and contribute to the complex literature on sample size estimates.

"A study to assess the use of ultrasonography in detecting maxillofacial fractures"

Background:-Maxillofacial fractures occur most frequently as an after effect of trauma. Initially during first century, diagnosis of fracture was carried out using conventional radiographs but it has certain shortcomings which includes high radiation exposure, difficulty in detecting hair line &amp; non dislocated fractures due to anatomical superimposition from the para-nasal air sinuses obscuring the visibility of underlying anatomical structures. At the time of this study the literature was focused more about isolated facial fracture and less about complete comprehensive evaluation of maxillofacial fractures using USG. A radiological confirmation is necessary because missed or incorrectly managed cases may encounter serious consequences. The most common causes of these fractures are road traffic accidents. The etiology and incidence of these fractures vary in different countries. The nasal bone being the most prominent bone is often prone to fracture (39% of maxillofacial fractures). The mandible and zygomatico-maxillary complex play an essential role in facial contour and mastication. A fracture in this area can affect facial appearance, function, and quality of life. To restore aesthetics, function, and quality of life, it is essential to completely diagnose these fractures for effective management. Thus we aim to add on more facts to the preexisting context which may further help to utilize ultrasonography as a first line diagnostic tool in detecting various maxillofacial fractures. Materials &amp; Methods:-Thirty four patients who presented with clinical signs &amp; symptoms suggestive of maxillofacial fractures having computed tomography ( GE Revolution 16 slice, 1.25mm slices) &amp; conventional radiographs( GENORAY PAPAYA Plus DP-1S )done as a standard protocol for management of maxillofacial fractures were included in this study. These patients were subjected to ultrasonographic ( VOLUSON 730 PRO )examination using 5-7 MHz frequency linear probe by an experienced sonologist who was blinded to the findings of computed tomography and conventional radiographs. Assessment was carried out in real time. The findings of conventional radiographs &amp; ultrasonography were then correlated with findings on computed tomography. In this study computed tomography was taken as the gold standard &amp; sample size estimation done with “two tailed test’ in EPI INFO SOFTWEAR Results:-The data analysis was performed by diagnostic &amp; sensitivity test. Inferentional statistics was performed using EPI INFO 1.1.1.14. In this study ultrasonography shows sensitivity 86.20%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 20.00%, accuracy of 86.66% in detecting maxillofacial fractures. When correlating the fracture detected by computed tomography &amp; ultrasonography the results were highly significant with P = 0.001893. Conventional radiographs shows sensitivity 50.57%, specificity 66.66%, PPV 97.77%, NPV 4.44%, accuracy of 51.11% in detecting maxillofacial fractures. When correlating fractures detected by USG &amp; CR the results are significant with P = 0.00467. Conclusion:-In the present study ultrasonography has shown better accuracy than conventional radiographs in diagnosing maxillofacial fractures. Though CT scan is the gold standard, we had observed that USG is equal to CT scan in diagnosing most of the superficial fractures. Hence with the availability of well experienced sonologist and high resolution transducer USG can be considered as the first line diagnostic procedure in suspected maxillofacial fractures.

Knowledge of women regarding risk factors, signs and symptoms and breast cancer screening

Objective: To assess the women knowledge regarding breast cancer and screening. Methodology: The quantitative cross-sectional study was used to assess the women knowledge regarding risk factors, signs and symptoms, and breast cancer screening. The estimated sample size was 366, and they were selected using the purposive sampling technique. There are two parts to the data collection tool. The first part of the questionnaire was used to collect the socio demographic data of the participants. The second part of the questionnaire was used to assess knowledge about risk factors, signs, and symptoms and about breast cancer screening. The questionnaire was prepared in English and translated into Arabic for the convenience of the participants. Results: Regarding knowledge related to breast cancer screening, 86.7% had adequate knowledge regarding breast self-screening and the analysis related to the knowledge of the participants regarding risk factors, signs, and symptoms shows they had very low knowledge. There is a significant association found between participants with a family history of breast cancer, age at first birth, age at puberty with knowledge regarding breast cancer screening. Conclusion: According to the findings of this study, overall, most of the participants had adequate knowledge about breast cancer screening, but the knowledge related to risk factors, signs, and symptoms was very low. This study reflects the need for greater efforts to increase breast cancer awareness through health education.

Presenting a Model of the Impact of Elderly Exercise and Health-Oriented Lifestyle on Life Expectancy of the Elderly with the Mediating Role of Social Marketing

The aim of this study is to present a model of the impact of elderly exercise and health-oriented lifestyle on life expectancy of the elderly, with the mediating role of social marketing. The research method is qualitative and based on the thematic analysis approach. Based on qualitative research, the participants in this study included academic elites and experts in the field of elderly exercise. The sample selection in the qualitative section was done theoretically and in a judgmental manner. The estimated sample size was based on the theoretical saturation of the extracted components of the research. The measurement tool was an open interview, and the findings were analyzed using MAXQDA software. Based on the findings, the components of the position of elderly exercise include cultural position, sports support, sports infrastructure, sports security, and social position. The components of life expectancy of the elderly include creative decision-making, goal-setting, spirituality, and constructive communication. The components of a health-oriented lifestyle for the elderly include personal health, mental health, social health, and functional health. The components of social marketing in elderly exercise include access to facilities, media role, participatory engagement, planning, and education. Therefore, it is suggested that in order to achieve the strategic goals of elderly exercise, attention should be paid to a health-oriented lifestyle and social marketing in elderly sports to achieve a hopeful society.

Nurses’ Perception of the Leadership Styles of their Nurse Managers in Riyadh region of Saudi Arabia

Background and Aims: In healthcare, effective patient management relies on leadership skills of nurse managers, which is accomplished by the use of transformational, transactional or laissez-faire leadership styles. The aim of the present study was to explore the perception of the nurses’ about the leadership style of their nurse managers, in Saudi Arabia. Methods: This cross-sectional study utilized a study instrument comprising questions for demographic factors and 21-item-questionnaire to evaluate nurses’ perception of leadership styles of nurse managers. Study participants were recruited based on a convenience random sampling methodology, from a total population of 1500 nurses, until the estimated sample size (300-315 participants) was achieved. Descriptive statistics and one-way ANOVA to evaluate association between different demographic factors and nurses’ perception about leadership styles were evaluated. Results: A total of 312 participants responded, out of which 12 responses were eliminated due to incompleteness of data. Out of the final study sample (N = 300), 79.3% were women, majority were between 31-40 years (48.7%). Most nurses had a bachelor’s degree (76.3%), were married (60.7%) and received salary between 5000-10000 Saudi Riyals. The predominantly perceived leadership style utilization among nurse managers was found to be transformational (64.04%) followed by transactional (63.83%) and laissez-faire (62.08%). Within transformational leadership, nurses’ perceived “idealized influence” as the most commonly used style by nurse managers. One-way ANOVA for statistical association between demographic variables and nurses’ perception about leadership styles, revealed significant differences (p&lt;0.05) only for age and marital status when comparing transformational and transactional leadership styles. Conclusions: Based on the present study, nurses perceived that their nurse leaders predominantly exhibited transformational leadership, followed by transactional leadership, and only minimally a laissez-faire leadership attribute. The current findings enable healthcare leaders, to learn how their staff nurses perceive their leadership styles and apply them for professional policymaking.

Point-Of-Care low-field MRI in acute Stroke (POCS): protocol for a multicentric prospective open-label study evaluating diagnostic accuracy

IntroductionFast and accurate diagnosis of acute stroke is crucial to timely initiate reperfusion therapies. Conventional high-field (HF) MRI yields the highest accuracy in discriminating early ischaemia from haemorrhages and mimics....

Plano experimental para a cultura da cenoura

ABSTRACT: The carrotculture stands out on the world stage due to its nutritional characteristics and economic importance, an aspect that demands the constant development of research aiming greater productivity. Thus, this study proposed an experimental plan, determining the estimates of plot size, sample size, and number of repetitions, with the purpose of increasing the precision and reliability of the results of the experiments with the carrot crop. Six uniformity trials were conducted, using three cultivars in two growing seasons (Season: 2019 and 2021).Each plant was considered a basic experimental unit and in each BEU, the variables shoot height, root length, shoot fresh mass, root fresh mass, and root diameter were measured. The size of the plot, sample, and the number of repetitions was estimated by the method of maximum curvature of the coefficient of variation. The results recommend that for experiments with the carrot crop, plots with twelve plants should be used. For a sampling of carrot plants in the plot, samples of eleven plants must be used in the direction of the row, considering a semi-amplitude of the confidence interval (D%) equal to 20% of the mean, with a confidence level of 95%. For a minimum significant difference in the Tukey test expressed as a percentage of the 50% mean, plots of twelve plants per crop row, with eight replicates, are recommended.

Statistical inference for the bathtub-shaped distribution using balanced and unbalanced sampling techniques

&lt;p&gt;In order to reduce errors and enhance precision while estimating the unknown parameters of the distributions, it is crucial to choose a representative sample. The common estimation methods that estimate the parameters associated with the bathtub-shaped distribution include maximum likelihood (ML), maximum product of spacings estimation (MPSE), and Cramér-von Mises estimation (CME) methods. However, four modifications are used with the sample selection technique. They are simple random sampling (SRS), ranked set sampling (RSS), maximum ranked set sampling (MaxRSS), and double ranked set sampling (DBRSS), which is due to small sample sizes. Based on the estimation methods such as ML, MPSE, and CME, the ranked set sampling techniques do not have simple functions to manage them. The MaxRSS matrix has variable dimensions but requires fewer observations than RSS. DBRSS requires a greater number of observations than MaxRSS and RSS. According to simulation studies, the RSS, MaxRSS, and DBRSS estimators were more effective than the SRS estimator for different sample sizes. Additionally, MaxRSS was discovered to be the most efficient RSS-based technique. Other techniques, however, proved more effective than RSS for high mean squared errors. The CM method estimated the true values of the parameters more accurately and with smaller biases than ML and MPSE. The MPSE method was also found to have significant biases and to be less accurate in estimating the values of the parameters when compared to the other estimate methods. Finally, two datasets demonstrated how the bathtub-shaped distribution could be feasible based on different sampling techniques.&lt;/p&gt;

Knowledge, Attitude, and Perception regarding Dengue Prevention and Control in Puducherry – A Community-based Cross-sectional Study

Abstract Context: Dengue is one of the most dreadful viral diseases of humans, with over half of the world’s population living in the areas of risk. Aims: The aim of this study was to determine the level of knowledge, awareness, and practice of preventive measures regarding dengue fever among people living in Puducherry. Settings and Design: A community-based cross-sectional study was carried out among the individuals residing in Puducherry in the field practice areas of our tertiary care hospital. Subjects and Methods: The study was conducted for a period of 3 months from August to October 2023. The study population included residents of Puducherry in the field practice area of our tertiary care hospital based on the inclusion and exclusion criteria. A simple random sampling method was used with an estimated sample size of 285. Statistical Analysis Used: Continuous variables were presented in the form of frequency and proportion. Chi-square test was used for determining the association. Results: Out of 285 participants, 252 had good knowledge, and 33 had poor knowledge. 94.4% had good attitude and 5.6% had poor attitude. 62.1% (177) had good perception and 108 (37.9) had poor perception. The study showed a significant association between age and knowledge (P = 0.003) regarding dengue awareness. Socioeconomic status of the participants had a significant association with the attitude (P &lt; 0.001). Conclusions: Appropriate use of information education and communication by involving mass media and social network and inclusion of environmental sanitation to the primary school curriculum can go a long way in creating awareness and decreasing the dengue burden in the community.

A National Survey about Online Teaching in Medicine and Dental Medicine in the Universities of Morocco

Introduction: Learning is the process by which we acquire knowledge or expertise. All teaching is done with the objective of transferring factual, conceptual or processual knowledge, acquiring skills, inculcating attitudes or bringing out, appropriating or developing reflexes or routines. Distance learning can be a substitute for face-to-face teaching, a complement or a useful reinforcement to it. Distance learning has emerged as a new teaching method to maintain the continuity of medical education during the closure of educational institutions due to the COVID-19 pandemic. Objectives: The purpose of this study is to explore the status of distance learning among medical students during their clinical years and to identify possible challenges, limitations, satisfaction, and prospects for this approach to learning. Methods: This cross-sectional study was based on a questionnaire that was designed and administered to students in their clinical years from public and private medical and dental schools. For this study, the estimated sample size was 1584. Results: A total of 1584 students completed the questionnaire, among them 1407 respondents (88.8%) stated that they had used the educational platform to access their course. Among these students, 55.4% (878) think that access is easy, 35.3% (550) find it quite difficult and 9.3% (149) difficult. 43.2% (685) of the students prefer the face-to-face system, 35.4% prefer the hybrid system. Only 21.4% (339) prefer the distance learning system. The overall satisfaction rate with medical distance education was 18.2%; with 31.4% being somewhat satisfied with distance education during this period of confinement and 5.7% very satisfied. Discussion: Regardless of the reported benefits, medical students prefer the blended or face-to-face approach to teaching because distance learning was a major challenge to acquiring equivalent clinical medical skills. Satisfaction with distance education is strongly related to students' prior experience with distance education as well as instructors' experiences and interactions. Technical and infrastructural resources were reported as a major challenge to implementing distance learning.

Relationship between Cultural Perspectives and Mental Health Behavior: A Cross-sectional Study

Objectives: There is deep connection between cultural factors and mental health behavior. This study aimed to measure the impact of cultural factors like socio-economic status, traditional health beliefs and social support on the mental health behavior of the Chinese people. Methods: The study adopted a survey- based research design to critically collect data about a population of the Chinese people who are generally individualistic and less prone to collectivism or cultural proximity. A sample of 392 respondents was randomly chosen by following the sample size estimation recommended by Krejcie and Morgan1. Results: The findings of the study confirmed that all three variables social support, traditional health beliefs and socio-economic status proved to be significant predictors influencing the mental health behavior of Chinese people. The study also found the impact of these three variables on the mental health behavior of Chinese people as positive. Meanwhile the study also contributed significantly to the domain of healthcare, which has so far remained an unnoticed factor for the scholarly discussion. Conclusion: The findings reiterate that factors like health beliefs and social support are necessary because they help to develop an understanding between people, and transmission of health-related information. Since the study tested the direct relationships between variables in this research, it showed no multivariate features. Hence, future studies could modify the model with further mediation or moderating factors to show the different dynamics of the model.

Prevalence of Achilles Tendinopathy among Physical Therapists of Pakistan

It is a degenerative disease that affects the tendon of Achilles, which attaches the gastrocnemius muscle to the heel bone. The rate of prevalence in the general population is about 6 percent, in athletes about 24 percent, 36 percent in short-distance runners, and in middle and long-distance runners about 52 percent. Objective: To determine the frequency of Achilles tendinopathy in Physical therapists of Pakistan. Methods: The cross-sectional study was done through an online survey among the Physical Therapists of Pakistan. The estimated sample size calculated from the Raosoft.com software was 449 participants. The sampling technique used in this study was convenient. The data was collected through a validated questionnaire named a Victorian Institute of Sports Assessment- Achilles( VISA-A) measurement tool, ranging from 0 to 100 in which higher scores showed least symptoms while lower scores showed severe symptoms. Statistical analysis was done through SPSS version 23.0. Results: Out of 449 research participants between the ages of 22 to 50 years were evaluated through a validated questionnaire and the result shows 298 (66.36%) of participants participated in sports activities and the level of pain was evaluated as 95(21.15%) of participants fell in healthy, 238(53%) in mild, 97(21.60%) in moderate however 19(4.23%) participants fall in severe category of pain. Conclusions: Our study concluded that the occurance of Achilles tendinopathy is uncommon among the physical therapists population of Pakistan.

An Assessment of Knowledge of Health Workers in Hospitals of Southern Province of Zambia, towards Marketing of Breastmilk Substitutes Regulations

Background: Optimal breastfeeding practices have been undermined by unregulated marketing of breastmilk substitutes worldwide, resulting in about 820, 000 preventable deaths per year among children under five years globally. The International Code (thereafter called the Code) of Marketing breastmilk substitutes was developed by the World Health Organization, the United Nations Children's Emergency Fund, and stakeholders to protect, promote and support breastfeeding. Member states are expected to domesticate the Code. Zambia enacted Statutory Instrument No. 48 of 2006, Regulations on marketing of breastmilk substitutes. Successful implementation calls for a good level of knowledge among health workers. However, we found no study, in Zambia on marketing of breastmilk substitutes Regulations. Objective: To assess the level of knowledge of health workers on Zambia’s Regulations on marketing breastmilk substitutes. Study design and methods: A mixed-method cross-sectional study. Data was collected online and in person. Probability proportional to size calculation yielded an estimated sample size of 384. A sample size of 410 after adjusting upwards assumed non-response rate, 401 participants responded. Quantitative data were analyzed using the Social Statistical Package for Social Sciences. Knowledge results were described by frequencies and percentages. Tests were conducted using univariable linear and multivariable regression analysis. A p-value of &lt;0.05 was considered statistically significant. Thematic analysis was used for qualitative data analysis. Results: The mean overall level of good knowledge of health workers was 0.339 or 34% [SE: 0.0221; 95%CI: (0.2959, 0.3828)]. Conclusion: The level of knowledge among health workers in hospitals of Southern Province, Zambia was poor. Keywords: Breastmilk substitute Regulations, Health worker, Knowledge.