Strengthening The Reporting Of Observational Studies In Epidemiology Research Articles

Evaluation of the NANDA International, Inc. diagnostic classification in Spain: Development and validation of the EVALUAN-I tool.

To develop and validate a tool to evaluate the NANDA International, Inc. diagnostic classification. The tool, EVALUAN-I, was validated in a non-probabilistic sample (N = 460) on Spanish Registered Nurses (September-December 2019) in two phases. First, design and construct the instrument in three steps: (1) literature review to define the construct focusing on the orientation toward nursing concepts and theoretical foundations, the level of scientific evidence, the structural configuration, the applicability, the nurses' clinical reasoning skills, and the attitudes toward nursing diagnosis, (2) substantiation of the questionnaire items and design according to the criteria for a diagnostic classification, (3) expert test to establish the face validity and content validity. The second phase revolved around (4) conducting a pilot test and measuring the temporal stability (test-retest) and Cohen's kappa coefficient; assessing psychometric properties by measuring (5) reliability (internal consistency using Cronbach alpha and interfactor correlation) and (6) construct validity (exploratory and confirmatory factor analysis). The manuscript follows the STROBE checklist. The study was approved by the Research Ethics Committee with registration number 2019-190-1. EVALUAN-I displayed moderate test-retest stability, adequate construct validity, and excellent reliability. The confirmatory factor analysis provided evidence about the configuration of EVALUAN-I in relation to nine analytical dimensions: clinical competence, nurses' reasoning skills, attitudes towards nursing diagnosis, discipline's central concepts, classification's contents, physiopathological attributes, level of scientific evidence, diagnostic precision, and conceptual correspondence between terminologies. EVALUAN-I is a valid and reliable instrument, which can be used to improve the epistemological, normative, and intuitive configuration of NANDA International, Inc. in a structured, systematic manner. Comprehensive evaluation of NANDA International, Inc. in different clinical settings around the world using a validated instrument, like EVALUAN-I, would allow strengths and weaknesses to be identified and contribute to the classification's development and practical application.

Quality of primary health care for quilombolas' Afro-descendant in Brazil: A cross-sectional study.

The aim of this study was to assess the quality of primary health care services through self-reports by caregivers of children and adolescents living in quilombola communities in Brazil. This is a cross-sectional study in accordance with the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology). Exposure variables included sociodemographic characteristics; and outcome variable was the quality of primary health care offered to quilombola children and adolescents. A total of 68 individuals participated in the survey. Quilombolas have a low income, a lower level of education, do not work, and receive government benefits. Our results showed that the quality of primary health care, measured by the experience of caregivers of quilombola children and adolescents, generally presents satisfactory values. The quality of primary health care has generally satisfactory values. However, as these results differ from most studies, more research should be conducted.

Immediate Repair With a Self-Gripping Retromuscular Mesh for Abdominal Wall Defect Following Tumor Resection.

Background: Prosthetic repair is always employed after large abdominal wall tumor resection, while chronic pain is one of the mesh-related complications after traumatic fixation. The objective of this research was to evaluate the outcomes of retromuscular repair with self-gripping mesh after abdominal wall tumor resection.Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with abdominal wall tumor >5cm in diameter undergoing tumor excision and retromuscular repair with self-gripping mesh. Demographic, operative, early postoperative, and follow-up data were noted. Visual Analog Scale, ranging from 0 (no pain) to 10 (very severe pain), was used to estimate the wound pain.Results: 24 patients were included in this study, and the defect following tumor resection was 26.9±10.0cm2. There was no tumor recurrence or incisional hernia in median follow-up of 20months, and the mean VAS score was 0.4. Three had foreign body feeling and no one suffered chronic pain.Conclusions: Immediate repair with a self-gripping retromuscular mesh can be considered as an effective way to treat an abdominal wall defect after resecting an abdominal wall tumor.

Prevalence of Female Sexual Dysfunction in Different Pregnancy Trimesters: A Systematic Review and Meta-Analysis

Introduction: Pregnancy is one of the most sensitive periods in a woman's life. Physical and psychological changes during pregnancy can significantly affect the couples' sexual relations. Healthy sexual desire during pregnancy is essential for the development of couples as parents. Objective: This meta-analysis study estimates the prevalence of sexual dysfunction overall and in different trimesters of pregnancy. Materials and Methods: This research is a systematic review and meta-analysis. A search was conducted in PubMed, Scopus, Science Direct, and Google Scholar databases to find cross-sectional and prospective cohort studies investigating the prevalence of sexual dysfunction in different trimesters using the female sexual function index (FSFI) published from 2000 to 2019. The methodological quality of each study was assessed using the modified from the STROBE (The Strengthening the Reporting of Observational Studies in Epidemiology) checklist to determine the risk of bias. The standard error of prevalence in each study was calculated based on the binomial distribution formula. Based on heterogeneity results, a random effect model was used to estimate the prevalence. Results: Fifteen articles met the inclusion criteria, with a total number of 3569 participants, of which 2538 were in cross-sectional studies and 1031 in prospective cohort studies. In the meta-analysis of both prospective cohort and cross-sectional studies, the prevalence rates of sexual dysfunction in the first, second, and third trimesters, and overall were estimated at 51.33% (95%CI; 37.41-65.25), 51.13% (95%CI; 38.93-63.33), 72.80% (95%CI; 65.78-79.81%), and 58.65% (95%CI; 51.50-65.80), respectively. Conclusion: The trimester of pregnancy has a predictive role in the prevalence of sexual dysfunction during pregnancy. The prevalence of sexual dysfunction is higher in the third trimester.

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit

The prevalence of elder abuse and neglect in rural areas: a systematic review and meta-analysis.

Many epidemiological studies have reported that elder abuse and neglect were prevalent in rural areas. However, none of them has synthesized the literature in this field. Therefore, we aimed to estimate the overall prevalence of elder abuse and neglect in rural areas through a systematic review and meta-analysis. PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched to identify eligible articles, with no language restrictions. Statistical analyses were conducted using Review Manager software (version 5.3). Meta-analyses and sensitivity analysis were performed using a random-effects model. All results were reported as the pooled prevalence of elder and neglect with their 95% confidence intervals (CIs). The quality of the included studies was evaluated by strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Potential publication bias was assessed by the funnel plot. 13 cross-sectional studies involving 10,313 participants were eligible. The prevalence of elder abuse and neglect ranged from 4.5 to 61.7% across the rural areas, and pooled prevalence estimate was 33% (95% CI 23-43). The prevalence of physical abuse was estimated at 7% (95% CI 5-9), financial abuse at 5% (95% CI 4-7), psychological/emotional abuse at 17% (95% CI 11-23), and neglect at 26% (95% CI 17-35). There was significant heterogeneity among the included studies. Stratified analyses revealed that sampling design was part of the heterogeneity source. WHO regions, gender, countries' income classification, and study quality could not explain the potential reasons for heterogeneity. The pooled prevalence of elder abuse and neglect was relatively high in rural areas. Early and targeted screening and prevention are needed. There is an urgent need for high quality studies using agreed definition of elder abuse and neglect to protect the potential high risk populations.

Effect of perceived stress, concern about hypoglycaemia and level of knowledge of management of the disease on glycaemic control in type 1 diabetes mellitus.

To evaluate perceived stress, concern about hypoglycaemia and the level of knowledge of management of the disease in patients with type 1 diabetes mellitus and their relationship with glycaemic control, gender and age. Perceived stress and concern about hypoglycaemia are significant obstacles to achieving adequate glycaemic control in patients with type 1 diabetes mellitus, and notably influence management of the disease itself. A cross-sectional study was carried out in 193 adult patients with type 1 diabetes mellitus. Study quality was scored using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Glycaemic control was evaluated by number and type of hypoglycaemic event and glycosylated haemoglobin. Questionnaires about hypoglycaemia concern (HFS II), perceived stress (PSS), unrecognised hypoglycaemia (Clarke Test) and level of knowledge of the disease were completed. Perceived stress was significantly associated with glycosylated haemoglobin (p<0.001) and concern about hypoglycaemia (p<0.037). With respect to level of knowledge, we observed that an advanced level was associated with lower glycosylated haemoglobin (p<0.001), number (p<0.001) and type (p<0.001) of hypoglycaemic episode, and less perceived stress (p=0.006). In addition, age was negatively correlated with perceived stress (p<0.030) and positively correlated with the number of unrecognised hypoglycaemic episodes (p<0.002), which was associated, in turn, with a higher number of daily glycaemia tests (p<0.037) and concern about hypoglycaemia (p<0.006). In type 1 diabetes mellitus, perceived stress can negatively influence glycaemic control and concern about hypoglycaemia, and level of knowledge about the condition has a bearing on glycosylated haemoglobin levels, perceived stress and number and type of hypoglycaemic events. In addition, higher age is associated with more frequent unrecognised hypoglycaemic events. It is essential to identify and address the psychological needs of patients with type 1 diabetes mellitus with the aim of achieving an adequate management of the disease itself and generating a change in future intervention strategies.

Global Cushing's disease epidemiology: a systematic review and meta-analysis of observational studies.

Cushing's disease (CD), 70% of endogenous hypercortisolism cases, is a rare disease caused by adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. To date, no systematic reviews and meta-analyses on its global epidemiology have been published. We provide a systematic review and meta-analysis of CD global epidemiology, also evaluating the quality of study reporting for the identified studies. MEDLINE and EMBASE databases were searched for studies on CD epidemiology from inception until November 30th, 2020, including original observational studies in English about CD prevalence and/or incidence for well-defined geographic areas. Two reviewers independently extracted data and assessed reporting quality. CD prevalence/incidence pooled estimates were derived from a random-effects meta-analysis. Reporting quality was assessed using a STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist adapted for observational studies on rare diseases, heterogeneity using the Cochran's Q-test and its derived measure of inconsistency (I2). Thirteen studies were included. The pooled CD prevalence was 2.2 [95% CI 1.1-4.8] per 100,000, while the incidence rate was 0.24 [95% CI 0.15-0.33] per 100,000 person-years. For both parameters, considerable between-studies heterogeneity was found (I2 = 78.8% and 87.8%, respectively). The quality of study reporting was rated as medium for 11 (84.6%) studies and as low for 2 (15.4%). Overall, our systematic meta-analysis demonstrated CD epidemiology to be similarly reported across different areas of the world, with some exceptions regarding regional differences or observation period intervals. Keeping into account the methodological differences between each paper, large-scale studies on CD epidemiology are warranted. Setting up national specific registries, based on standardized diagnostic and clinical parameters, with clearly defined selection and analysis criteria, and a strong cooperation between the scientific national societies for endocrinology is crucial to exclude other causes of variability (i.e. geographical differences due to other factors like (epi)genetic changes), and to support public health decision making.

The effect of action modules on resilience and psychological health of stroke patients: A pilot non-randomised control trial.

To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC-AM) platform improve patients' psychological health over a two-month period. Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post-stroke mental health concerns and the need for care information. A non-randomised controlled pilot study was conducted. Participants included 44 post-stroke patients at a medical university hospital, between 1 August 2019-28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC-AM). Data were analysed on an intention-to-treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case-control studies) for this study. There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p<.05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. This preliminary trial suggests that, although action modules may be associated with a decrease in depression post-stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. The STNC-AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible.

Mentoring role effectiveness and satisfaction during internship training: A psychometric evaluation of Saudi nursing interns

BackgroundMentors play significant roles in developing their mentees’ careers. To study how effectively mentors contribute to their mentees’ career development, a valid and reliable measure is needed considering cultural background. PurposeThe twofold aim of this study was to evaluate the psychometric properties of the Ragins and McFarlin Mentor Role Instrument – Saudi version (RMMRI-S) and assess the effectiveness and satisfaction of staff nurses’ mentoring roles as perceived by nursing interns. MethodsThis descriptive study used translation, validation, exploratory factor analysis, and reliability tests. The pretesting data were collected in November 2017 and the main study data were collected between January 2018 and December 2018. A convenience sample of 342 Saudi nursing interns enrolled in the internship programme of three teaching hospitals in Riyadh, Saudi Arabia was recruited to participate in the study. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. ResultsThe RMMRI-S yielded a scale-level index and an item-level index of 1. The factor analysis yielded two components that collectively explained 71.39% of the variances. While the inter-item correlation coefficients of the RMMRI-S and career development subscale were a = 0.97, it was a = 0.88 for the psychosocial subscale. All demographic variables were significantly correlated with the mentoring roles. Likewise, career development and psychosocial roles were significantly correlated with mentoring effectiveness and satisfaction. ConclusionThe study confirmed the robustness of the psychometric properties of the RMMRI-S and showed sound validity and strong reliability for measuring staff nurses’ mentoring role effectiveness and satisfaction according to nursing interns during their internship training. This scale can be utilised across the Arab Gulf region and internationally for Arabic-speaking nursing interns and students.

The relationship between endorsing reporting guidelines or trial registration and the impact factor or total citations in surgical journals.

BackgroundA journal’s impact factor (IF) and total citations are often used as indicators of its publication quality. Furthermore, journals that require authors to abide by reporting guidelines or conduct trial registration generally have a higher quality of reporting. In this study, we sought to explore the potential associations between the enforcement of reporting guidelines or trial registration and a surgical journal’s IF or total citations in order to find new approaches and ideas to improve journal publication quality.MethodsWe examined surgical journals from the 2018 Journal Citation Report’s Expanded Scientific Citation Index to quantify the use of reporting guidelines or study registration. We reviewed the “instructions for authors” from each journal and used multivariable linear regression analysis to determine which guidelines were associated with the journal IF and total citations. The dependent variable was the logarithm base 10 of the IF in 2018 or the logarithm base 10 of total citations in 2018 (the results were presented as geometric means, specifically the ratio of the “endorsed group” results to “not endorsed group” results). The independent variable was one of the requirements (endorsed and not endorsed). Models adjust for the publication region, language, start year, publisher and journal size (only used to adjust total citations).ResultsWe included 188 surgical journals in our study. The results of multivariable linear regression analysis showed that journal IF was associated (P < 0.01) with the following requirements: randomized controlled trial (RCT) registration (geometric means ratio (GR) = 1.422, 95% CI [1.197–1.694]), Consolidated Standards of Reporting Trials (CONSORT) statement (1.318, [1.104–1.578]), Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) statement (1.390, [1.148–1.683]), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (1.556, [1.262–1.919]), Standards for Reporting Diagnostic Accuracy (STARD) statement (1.585, [1.216–2.070]), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement (2.113, [1.422–3.133]). We found associations between the endorsement of RCT registration (GR = 1.652, 95% CI [1.268–2.153]), CONSORT (1.570, [1.199–2.061]), PRISMA (1.698, [1.271–2.270]), STROBE (2.023, [1.476–2.773]), STARD (2.173, [1.452–3.243]), and MOOSE statements (2.249, [1.219–4.150]) and the number of total citations.ConclusionThe presence of reporting guidelines and trial registration was associated with higher IF or more total citations in surgical journals. If more surgical journals incorporate these policies into their submission requirements, this may improve publication quality, thus increasing their IF and total citations.

High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

The role of combined modifiable lifestyle behaviors in the association between exposure to stressors and allostatic load: A systematic review of observational studies.

BackgroundExposure to stressors can evoke psychological, physiological, and behavioral stress responses, which may lead to the adoption of health-damaging behaviors that dysregulate multiple biological systems contributing to a high allostatic load. This review explored the role of combined modifiable lifestyle behaviors in the relationship between stressors and allostatic load among healthy adults. MethodsA systematic search was conducted in Medline Complete, PsycINFO, CINAHL, and Embase databases up to September 2021. The PRISMA guidelines guided reporting and study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist. ResultsDatabase searches identified 319 papers. Eight cross-sectional and two longitudinal studies met our inclusion criteria. Among the ten studies, combined modifiable lifestyle behaviors partly explained the association between exposure to stressors and elevated allostatic load in four cross-sectional and two longitudinal studies. ConclusionSome evidence suggests that combined modifiable lifestyle behaviors may help explain the relationship between stressors and an elevated allostatic load. Further longitudinal studies with mediation analyses would strengthen these findings and help to confirm the mechanistic role of combined modifiable lifestyle behaviors underlying the relationship between stress exposure and allostatic load.

Integrating Placebo Effects in General Practice: A Cross-Sectional Survey to Investigate Perspectives From Health Care Professionals in the Netherlands.

Objectives: Placebo effects, beneficial treatment outcomes due to non-active treatment components, play an important role in the overall treatment response. To facilitate these beneficial effects it is important to explore the perspectives of health care professionals (HCPs) on the integration of placebo effects in clinical care. Three themes were investigated: knowledge about placebo effects and factors that contribute to these, frequency of placebo use, and attitudes toward acceptability and transparency of placebo use in treatment.Methods: A cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was conducted in the Netherlands in 2020. The survey was conducted in two samples: a (nested) short survey in 78 nurses during working shifts (sample 1) and an extended online survey in 47 general HCPs e.g., medical psychologists, oncologists, surgeons (sample 2).Results: Respondents from both samples reported to be somewhat or quite familiar with placebo effects (24.0 and 47.2%, respectively). From the six placebo mechanisms that were presented, mind-body interaction, positive expectations, and brain activity involved in placebo effects were rated as the most influential factors in placebo effects [F(5,119) = 20.921, p < 0.001]. The use of placebo effects was reported in 53.8% (n = 42) of the nurses (e.g., by inducing positive expectations), and 17.4% of the HCPs (n = 8 reported to make use of pure placebos and 30.4% of impure placebos (n = 14). Attitudes toward placebo use in treatment were acceptant, and transparency was highly valued (both up to 51%).Conclusions: The findings from this study address knowledge gaps in placebo effects in practice and provide insights in attitudes toward the integration of placebo effects from HCPs. Altogether, integrating these findings may potentially optimize treatment outcomes.

Quality of Life and Anxiety in Age Macular Degeneration Patients: A Cross-Sectional Study.

(1) Background: Chronic diseases affect patients’ quality of life. Age Macular Degeneration (AMD) is one of the most prevalent chronic ocular diseases. The study aims to measure the anxiety and quality of life related to vision in patients with AMD, as well as the relationship with other visual and demographic parameters. (2) Methods: Prospective cross-sectional study in AMD patients. Visual acuity (VA), contrast sensitivity (CS), line difference in the Colenbrander test, and the degree of pathology were measured. Other variables such as gender, age, and time from the diagnosis were also collected. Anxiety was measured with the Spielberger State-Trait Anxiety Inventory (STAI) and quality of life with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. (3) Results: Patients with higher punctuation in Trait STAI showed lower punctuation in NEI VFQ-25 questionnaire (Spearman coefficient −0.415; p = 0.001). The variables VA, CS, and age were correlated to the quality of life. The relationship between trait anxiety and subscales of NEI VFQ-25 was significant for all subscales (p < 0.05), except for social functioning, peripheral vision, general vision, ocular pain, and driving. (4) Conclusions: AMD patients with higher levels of anxiety show a decrease in their quality of life. The quality of life of AMD patients depends on their VA and CS.

A systematic review of methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines: Advising resource-constrained settings.

Real-world effectiveness studies are important for monitoring performance of COVID-19 vaccination programmes and informing COVID-19 prevention and control policies. We aimed to synthesise methodological approaches used in COVID-19 vaccine effectiveness studies, in order to evaluate which approaches are most appropriate to implement in low- and middle-income countries (LMICs). For this rapid systematic review, we searched PubMed and Scopus for articles published from inception to July 7, 2021, without language restrictions. We included any type of peer-reviewed observational study measuring COVID-19 vaccine effectiveness, for any population. We excluded randomised control trials and modelling studies. All data used in the analysis were extracted from included papers. We used a standardised data extraction form, modified from STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). Study quality was assessed using the REal Life EVidence AssessmeNt Tool (RELEVANT) tool. This study is registered with PROSPERO, CRD42021264658. Our search identified 3,327 studies, of which 42 were eligible for analysis. Most studies (97.5%) were conducted in high-income countries and the majority assessed mRNA vaccines (78% mRNA only, 17% mRNA and viral vector, 2.5% viral vector, 2.5% inactivated vaccine). Thirty-five of the studies (83%) used a cohort study design. Across studies, short follow-up time and limited assessment and mitigation of potential confounders, including previous SARS-CoV-2 infection and healthcare seeking behaviour, were major limitations. This review summarises methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines and highlights the lack of such studies in LMICs, as well as the importance of context-specific vaccine effectiveness data. Further research in LMICs will refine guidance for conducting real-world COVID-19 vaccine effectiveness studies in resource-constrained settings.

Examination of fatigue levels and factors affecting fatigue in operating room nurses

BackgroundOperating rooms have stressful and complex working environments. Working in a stressful environment and exposure to various risk factors could affect human health both physiologically and psychologically and causes fatigue. The purpose of this study was to examine fatigue levels and factors affecting fatigue in operating room nurses. MethodsThis research was a descriptive, cross-sectional study. The study sample comprised 99 nurses working in operating rooms of hospitals in a city in Aegean Region of Turkey. Data were gathered with a descriptive characteristics form and the Checklist Individual Strength between December 2019 and February 2020. Data analysis was performed by using numbers, percentages, mean, standard deviation, Student's t-test, one-way ANOVA, Kruskal-Wallis, Mann-Whitney-U and Pearson correlation tests. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist for cross-sectional studies was used for reporting study data. ResultsThe mean age of the nurses was 30.68±8.78 years, the mean duration of operating room experience was 5.37±4.78 years and the mean working time was 48.65±5.93 h/week. The lowest and the highest fatigue scores of the nurses were 34 and 128 respectively with a mean of 77.53±18.76. A significant difference was found between fatigue levels according to presence of a chronic disease, type of hospital, activity levels, job titles and types of work schedules (p<.05). ConclusionsThe level of general fatigue of the operating room nurses was not high. However, nurses having a chronic disease and a sedentary lifestyle and being always on the daytime shift had higher fatigue levels. Body mass index, weekly working hours, age and duration of operating room experience had a correlation with fatigue levels.

Health Literacy in Patients’ Clinical Records of Hospital Settings: A Systematic Review

IntroductionHealth literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings.MethodsPubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.ResultsFive studies reported HL assessments in hospital patients’ clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs).ConclusionThis review examined how inpatients’ HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.

Positive Consequences of the Hidden Curriculum in Undergraduate Nursing Education: An Integrative Review.

Background:Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education.Materials and Methods:A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology.Results:Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity.Conclusions:Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

The Association between Exposure to Air Pollution and Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to overview the observational studies on the association of exposure to air pollution and type 1 diabetes mellitus (T1DM). Based on PRISMA guidelines, we systematically reviewed the databases of PubMed, Scopus, Embase, and Web of Science databases to determine the association of air pollution exposure and T1DM. Quality assessment of the papers was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the strength of the associations between air pollutants (gases and particulate matter air pollutants including PM10, PM2.5, NO2, volatile organic compound, SO4, SO2, O3) and T1DM. Out of 385 initially identified papers, 6 studies were used for this meta-analysis. Fixed effects meta-analysis showed a significant association between per 10 μg/m3 increase in O3 and PM2.5 exposures with the increased risk of T1DM (3 studies, OR = 1.51, 95% CI: 1.26, 1.80, I 2 = 83.5% for O3 and two studies, OR = 1.03, 95% CI: 1.01, 1.05, I 2 = 76.3% for PM2.5). There was no evidence of association between increased risk of T1DM and exposure to PM10 (OR = 1.02, 95% CI: 0.99-1.06, I 2 = 59.4%), SO4 (OR = 1.16, 95% CI: 0.91-1.49, I 2 = 93.8%), SO2 (OR = 0.94, 95% CI: 0.83-1.06, I 2 = 85.0%), and NO2 (OR = 0.995,95% CI: 1.05-1.04, I 2 = 24.7%). Recent publications indicated that exposure to ozone and PM2.5 may be a risk factor for T1DM. However, due to limited available studies, more prospective cohort studies are needed to clarify the role of air pollutants in T1DM occurrence.