Search

At present, it is still controversial whether patients in intensive care unit (ICU) use tracheal intubation with or without cuff. This paper evaluates the effect of tracheal intubation with and without cuff on overall complication rate of patients with intubation in ICU. The database of PubMed, Embase, Conchrane Library and Web of Science was searched by computer, and the clinical research on intubation with and without cuff in ICU was collected. The time range was from the database establishment to November 2023. Literature was independently screened, information was extracted, and quality was assessed by two researchers. Finally, there were nine studies included, with 11 068 patients (7391 in cuff group and 3677 in non‐cuff group). The results showed that the overall complication rate of cuff group was significantly lower than that of non‐cuff group, and that of cuff group (RR = 0.53, p < 0.01). In addition, compared with the non‐cuff group, the cuff group had a lower number of tracheal intubation changes [RR = 0.05, p < 0.01] and a lower incidence of aspiration pneumonia (RR = 0.45, p = 0.01). Compared with the non‐cuff group, the cuff group had a higher incidence of oral mucosal ulcers and pharyngitis (RR = 1.99, p = 0.04), while the cuff group had a lower incidence of laryngeal edema (RR = 0.39, p < 0.01). In ICU intubation patients, the use of cuffs reduces overall complication rate in comparison to patients without cuffs. Therefore, patients with intubation in ICU can recommend tracheal intubation with cuff. [ABSTRACT FROM AUTHOR]

Based on the theory of change, we gather, organize, and synthesize the evidence on the impact of three language of instruction (LOI) choices (teaching in mother tongue [MT] with later transition, teaching in a non‐MT language, or teaching in two or more languages at one time) on literacy and biliteracy outcomes. We focus on quantitative and qualitative studies of LOI interventions in low‐ and middle‐income countries (LMICs) and consider languages that are commonly spoken in the developing world. As such, we include studies that examine transfers from local languages to English, but not those evaluating transfers from local languages to languages that are less spoken in LMICs (e.g., Swedish). [ABSTRACT FROM AUTHOR]

Background: High rates of youth re‐offending indicate that young custody‐leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre‐, during, and post‐release and generally provide multiple forms of support services to address youths' transitional needs. Objectives: The present review examines (1) the impact of youth aftercare/resettlement programs on crime‐related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost. Search Methods: A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well‐known researchers in the field. The search was completed in January 2023. Selection Criteria: For objectives 1–3, studies were included if they utilized a randomized controlled design or quasi‐experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual‐measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1–4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered. Data Collection and Analysis: Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross‐checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS‐I (Sterne et al., 2016), ROB‐2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1–3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta‐regression. Thematic and narrative analysis was conducted to address objectives 4–6. Results: The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = −1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis. Authors' Conclusions: Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime‐related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects. [ABSTRACT FROM AUTHOR]

Millions of children in low-income and middle-income countries falter in linear growth and neurobehavioral development early in life. This faltering may be caused by risk factors that are associated with both growth and development, such as insufficient dietary intake and infection in infancy. Alternatively, these risk factors may be indicative of an environment that constrains both linear growth and development through different mechanisms. In a cluster-randomized trial in Burkina Faso, we previously found that provision of lipid-based nutrient supplements plus malaria and diarrhoea treatment from age 9 to 18 months resulted in positive effects of ~0.3 standard deviation on length-for-age z-score (LAZ) and of ~0.3 standard deviation on motor, language and personal-social development scores at age 18 months. In this paper, we examined whether the effect of the intervention on developmental scores was mediated by the effect on LAZ, or, alternatively, whether the intervention had independent effects on growth and development. For motor, language, and personal-social z-scores, the effect of the intervention decreased from 0.32 to 0.21, from 0.33 to 0.27 and from 0.35 to 0.29, respectively, when controlling for change in LAZ from 9 to 18 months. All effects remained significant. These results indicate that the intervention had independent positive effects on linear growth and development, suggesting that these effects occurred through different mechanisms. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Background: School‐based law enforcement (SBLE) has become a common intervention. Although SBLE is meant to make schools safer, critics suggest it may not accomplish this purpose, and may have unintended negative consequences such as increasing students' exclusionary discipline or contact with the criminal justice system. There may also be secondary effects related to perceptions of the school or student learning. Objectives: The purpose of this review is to synthesize the literature evaluating the use of SBLE, including outcomes related to (a) crime and behavior problems; (b) perceptions of safety; and (c) learning. Methods: We conducted a systematic literature search to identify studies that examined outcomes associated with SBLE use. Eligible studies used experimental or quasi‐experimental designs; included samples of students, teachers/staff, schools, or school districts; reported on a policing strategy focused on crime prevention or school safety that did not involve officers teaching a curriculum; included a measure that reflects crime and behavior problems, perceptions of safety, or learning; and were in a primary or secondary school. Following a multi‐stage screening process to identify studies eligible for inclusion, we estimated a series of meta‐analytic models with robust variance estimation to calculate weighted mean effect sizes for each of three main categories of outcomes and commonly occurring subsets of these categories. We examined heterogeneity in these estimates across features of the primary studies' design. Results: The search and screening process yielded 1002 effect sizes from 32 reports. There were no true experiments, and the quasi‐experiments ranged from strictly correlational to permitting stronger causal inferences. SBLE use was associated with greater crime and behavior problems in studies that used schools as the unit of analysis. Within this category, SBLE use was associated with increased exclusionary discipline among studies that used both schools (g = 0.15, 95% confidence interval [CI] [0.02, 0.27]) and students (g = 0.003, 95% CI [0.002, 0.003]) as the unit of analysis. SBLE use was not associated with any measures of crime or violence in schools. SBLE use was associated with greater feelings of safety among studies that used schools as the unit of analysis (g = 0.18, 95% CI [0.13, 0.24]), although this estimate was based on only seven effect sizes from two correlational studies. All the other models, including those examining learning outcomes, yielded null results. None of the moderators tested showed meaningful relationships, indicating the findings were consistent across a variety of study design features. Authors' Conclusions: This study's findings provide no evidence that there is a safety‐promoting component of SBLE, and support the criticism that SBLE criminalizes students and schools. Although we found no evidence of differences across methodological features, risk of bias in the primary studies limits our confidence in making causal inferences. To the extent that the findings are causal, schools that invest in strategies to improve safety will likely benefit from divesting from SBLE and instead investing in evidence‐based strategies for enhancing school safety. Schools that continue to use SBLE should ensure that their model has no harmful effects and is providing safety benefits. [ABSTRACT FROM AUTHOR]

Background: Opportunities for social connection between generations have diminished over the last few decades around the world as a result of changes in the way that we live and work. The COVID‐19 pandemic has exacerbated loneliness for many with young and old being kept apart for safety. The Public Health England prevention concordat for better mental health (Office for Health Improvement and Disparities) aims to bring a prevention‐focused approach to improving public mental health. The concordat promotes evidence‐based planning and commissioning to increase the impact on reducing health inequalities using sustainable and cost‐effective interventions that impact on the wider determinants of mental health and wellbeing for children and young people and older people. Intergenerational activities could provide an opportunity to support both populations. In 2023, we produced an evidence and gap map to illustrate the amount and variety of research on intergenerational interventions and the gaps in research that still exist in this area. The review conducted here is based on the evidence in that map. Objectives: This systematic review examines the impact of intergenerational interventions on the wellbeing and mental health of older people and identifies areas for future research as well as key messages for service commissioners. Search Methods: We searched an evidence and gap map published in 2022 (comprehensive searches conducted July 2021 and updated June 2023) to identify randomised controlled trials of intergenerational interventions that report mental health and wellbeing outcomes for older people. Selection Criteria: Randomised controlled trials of intergenerational interventions that involved unrelated younger and older people with at least one skipped generation between them and reported mental health or wellbeing outcomes for older people were included in this review. Data Collection and Analysis: We used standard methodological procedures expected by The Campbell Collaboration. We conducted data extraction and Cochrane risk of bias assessments in EPPI reviewer. Where data allowed meta‐analyses were conducted in STATA. Main Results: This review includes 14 trials from six different countries. The trials had some important methodological weaknesses. Interventions were mainly delivered in‐person and often in groups. They included visiting programmes, school volunteering programmes, music‐based interventions and task‐oriented interventions such as activities set in a multigenerational park, reminiscing activities, aggression management programmes, learning a language, making local environmental changes and in‐school project work. Intergenerational interventions showed a small positive trend towards improving self‐esteem (effect size [ES]: 0.33, 95% confidence interval [CI]: −0.35, 1.01) and depression (ES: 0.19, 95% CI: −0.23, 0.60) for older people participating. However, due to the small study sizes and low number of studies available, we cannot be confident about any effects. The results for other mental health and wellbeing outcomes are reported but due to little overlap in similar assessments across the studies, we could not combine them to assess the strength of evidence. There were no data about social isolation, spiritual health or sense of community. There are no long‐term studies and no data on equity. We still know very little about what works and how or why. Whilst some interventions do use theories and logic to inform their development others do not. More exploration of this is needed. Authors' Conclusions: Commissioners and intervention developers should ensure interventions provide sufficient theoretical evidence for the logic behind the proposed intervention and should improve their consideration of equity within the interventions Research on intergenerational interventions need more consistent and agreed measures for reporting outcomes including community outcomes (core outcome sets). More understanding is needed on how best to measure 'community' outcomes. Research on intergenerational interventions should measure outcomes for BOTH the older and younger population engaged in the intervention—these may or may not be the same outcomes reflected in both populations. Further research is needed on the long‐term impact of interventions on outcomes (whether participants need to keep being involved in an 'intervention' to continue to benefit) and sustainability of interventions beyond the initial funding of the research project. Supporting this our stakeholders highlighted that interventions that are initiated for research and then end (usually within a year) are not helpful. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta‐analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta‐analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence‐type reported and target population under study. [ABSTRACT FROM AUTHOR]

This paper examines age-related differences in work motivation in two samples of 9,388 and 2,512 individuals who completed a comprehensive motivation questionnaire for selection or development purposes. In the first sample, age differences were examined by controlling for gender and investigating whether relationships between age and motivation were non-linear. Statistically significant relationships between motivation and age were found for most motivation scales, explaining up to 12% of the variance in specific scales. The second sample was used to confirm these results and to determine whether differences on these motivation scales could be explained by additional demographic variables, which were not available in the first sample. When controlling for demographic variables, such as gender, managerial experience, and university education, the pattern of results was similar in the second data set although effects were smaller. Results generally support propositions from the literature, which suggest a shift in people's motives rather than a general decline in motivation with age: older employees were less motivated by extrinsically but more by intrinsically rewarding job features. [ABSTRACT FROM AUTHOR]

Objective: The Pulmonary Embolism Quality‐of‐Life (PEmb‐QoL) questionnaire assesses quality of life (QoL) after pulmonary embolism (PE). We aimed to determine whether any clinical or pathophysiologic features of PE were associated with worse PEmb‐QoL scores 1 month after PE. Methods: In this prospective multicenter registry, we conducted PEmb‐QoL questionnaires. We determined differences in QoL domain scores for four primary variables: clinical deterioration (death, cardiac arrest, respiratory failure, hypotension requiring fluid bolus, catecholamine support, or new dysrhythmia), right ventricular dysfunction (RVD), PE risk stratification, and subsequent rehospitalization. For overall QoL score, we fit a multivariable regression model that included these four primary variables as independent variables. Results: Of 788 PE patients participating in QoL assessments, 156 (19.8%) had a clinical deterioration event, 236 (30.7%) had RVD of which 38 (16.1%) had escalated interventions. For those without and with clinical deterioration, social limitations had mean (±SD) scores of 2.07 (±1.27) and 2.36 (±1.47), respectively (p = 0.027). For intensity of complaints, mean (±SD) scores for patients without RVD (4.32 ± 2.69) were significantly higher than for those with RVD with or without reperfusion interventions (3.82 ± 1.81 and 3.83 ± 2.11, respectively; p = 0.043). There were no domain score differences between PE risk stratification groups. All domain scores were worse for patients with rehospitalization versus without. By multivariable analysis, worse total PEmb‐QoL scores with effect sizes were subsequent rehospitalization 11.29 (6.68–15.89), chronic obstructive pulmonary disease (COPD) 8.17 (3.91–12.43), and longer index hospital length of stay 0.06 (0.03–0.08). Conclusions: Acute clinical deterioration, RVD, and PE severity were not predictors of QoL at 1 month post‐PE. Independent predictors of worsened QoL were rehospitalization, COPD, and index hospital length of stay. [ABSTRACT FROM AUTHOR]

Objective: Chronic obstructive airway disease (COPD) is characterized by airflow limitation due to airway and/or alveolar abnormalities with significant extra‐pulmonary manifestations. Bone health impairment is an extra‐pulmonary complication of COPD which is less well studied in India. Moreover, it can contribute to significant morbidity and mortality. Hence, we aim to estimate the prevalence of osteoporosis and metabolic parameters of adverse bone health in patients with COPD. Methods: In this case control study, male subjects aged 40–70 years with COPD attending the respiratory outpatient clinic in a tertiary care hospital were recruited over a period of 2 years and the control population were derived from the historical cohort who were apparently healthy with no obvious diseases. Metabolic parameters of bone health measured from fasting blood samples were calcium, albumin, alkaline phosphatase, phosphorous, parathormone, creatinine, 25‐hydroxy vitamin D, and testosterone. Bone mineral density (BMD) was estimated using DXA scan and the World Health Organization (WHO) criteria was used to categorize into osteoporosis, osteopenia, and normal BMD based on the T‐score at femoral neck, lumbar spine and distal forearm. Pulmonary function tests and 6 minute walk test were performed if they had not been done in the previous 3 months. The associations of COPD with osteoporosis were analyzed using linear regression analysis and effect size are presented as beta with 95% confidence interval. Results: Of the 67 participants with COPD enrolled in the study, osteoporosis was present in 61% (41/67) and osteopenia in an additional 33% (22/67) of the cases, which was higher when compared to the control population (osteoporosis 20% [50/252] and osteopenia 58% [146/252]). In regression modeling, there was a trend toward adverse bone health with advanced age, low body mass index, low forced expiratory volume in 1 second and testosterone deficiency in COPD. Conclusion: Individuals with COPD have a substantially higher prevalence of osteoporosis and osteopenia, up to almost twice that of the general population, with a significant number demonstrating at least one parameter of adverse metabolic bone health on assessment. Hence, bone health assessment should be a part of comprehensive COPD care to prevent adverse consequences due to poor bone health. [ABSTRACT FROM AUTHOR]

Aim: To investigate the perception of undergraduate nursing students in different countries in the Middle East about caring. Design: A cross‐sectional, descriptive, comparative design. Methods: A total of 1,582 nursing students from six different countries in the Middle East completed the Caring Dimensions Inventory. Results: The total mean score of caring was 138.8 (± 15.8), indicating a high level of caring. The highest mean score was for nursing students from Egypt (M = 145.37 ± 15.97), whereas the lowest was for nursing students from Palestine (M = 135.36 ± 13.48). The caring perception was more significant for female students than male students, and no significant correlation was found between students' ages and caring scores. Conclusions: The high level of caring among nursing students reflects the involvement of caring behaviour in the nursing curricula, which motivates nursing schools to continue stressing the importance of caring and to enhance this behaviour among their graduates. Patient or Public Contribution: Improving the students' caring competencies as recommended by the study will influence the caregiving quality in the future that will be reflected in nurse–patient caring relationships and raise the patients' and public satisfaction with nursing care. [ABSTRACT FROM AUTHOR]

Background: The consequences for children born with birth defects and developmental disabilities encompassed by foetal alcohol spectrum disorder (FASD) are profound, affecting all areas of social, behavioural and cognitive functioning. Given the strong evidence for a core deficit in executive functioning, underpinned by impaired self‐regulation skills, there has been a growing focus on the development of interventions that enhance or support the development of executive functions (EFs). Objectives: The primary objective of this review is to synthesise the evidence for structured psychological interventions that explicitly aim to improve EF in children. The review also sought to ascertain if the effectiveness of interventions were influenced by characteristics of the intervention, participants or type of EF targeted by the intervention. Search Methods: Sixteen databases, 18 grey literature search locations and 9 trial registries were systematically searched to locate eligible studies (up to December 2020). These searches were supplemented with reference harvesting, forward citation searching, hand searches of topic‐relevant journals and contact with experts. Selection Criteria: Studies were included in the review if they reported on an impact evaluation of a psychological intervention aiming to improve EF in children 3–16 years who either had confirmed prenatal alcohol exposure or a formal diagnosis falling under the umbrella term of FASDs. Eligible study designs included randomised controlled trials (RCTs) and quasi‐experimental designs with either no treatment, wait list control or an alternative treatment as a comparison condition. Single‐group pre‐post designs were also included. Data Collection and Analysis: Standard methodological procedures expected by the Campbell Collaboration were used at all stages of this review. Standardised mean differences (SMDs) were used to estimate intervention effects, which were combined with random effects meta‐analysis (data permitting). Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2) and Cochrane Risk of Bias in Non‐Randomised Studies‐Interventions tool (ROBINS‐I). Main Results: The systematic search identified 3820 unique records. After title/abstract and full‐text screening, 11 eligible studies (reported in 21 eligible documents) were deemed eligible, with a combined 253 participants. Of the 11 studies, 6 were RCTs, 1 was a quasi‐experiment and 4 were single‐group pre‐post intervention designs. All studies were rated as having an overall high or serious risk of bias, with some variation across domains for RCTs. For RCT and quasi‐experimental studies, the overall effect of EF interventions on direct and indirect measures of EF generally favoured the experimental condition, but was not statistically significant. There was no difference between intervention and comparison groups on direct measures of auditory attention (k = 3; SMD = 0.06, 95% confidence interval [CI] = −1.06, 1.18), visual attention (k = 2; SMD = 0.90, 95% CI = −1.41, 3.21), cognitive flexibility (k = 2; SMD = 0.23, 95% CI = −0.40, 0.86), attentional inhibition (k = 2; SMD = 0.04, 95% CI = −0.58, 0.65), response inhibition (k = 3; SMD = 0.47, 95% CI = −0.04, 0.99), or verbal working memory (k = 1; d = 0.6827; 95% CI = −0.0196, 1.385). Significant heterogeneity was found across studies on measures of auditory attention and visual attention, but not for measures of cognitive flexibility, attentional inhibition or response inhibition. Available data prohibited further exploration of heterogeneity. There was no statistical difference between intervention and comparison groups on indirect measures of global executive functioning (k = 2; SMD = 0.21, 95% CI = −0.40, 0.82), behavioural regulation (k = 2; SMD = 0.18, 95% CI = −0.43, 0.79), or emotional control (k = 3; SMD = 0.01, 95% CI = −0.33, 0.36). Effect sizes were positive and not significant for meta‐cognition (k = 1; SMD = 0.23, 95% CI = −0.72, 1.19), shifting (k = 2; SMD = 0.04, 95% CI = −0.35, 0.43), initiation (k = 1; SMD = 0.04, 95% CI = −0.40, 0.49), monitoring (k = 1; SMD = 0.25, 95% CI = −0.20, 0.70) and organisation of materials (k = 1; SMD = 0.25, 95% CI = −0.19, 0.70). Effect sizes were negative and not statistically different for effortful control (k = 1; SMD = −0.53, 95% CI = −1.50, 0.45), inhibition (k = 2; SMD = −0.08, 95% CI = −0.47, 0.31), working memory (k = 1; SMD = 0.00, 95% CI = −0.45, 0.44), and planning and organisation (k = 1; SMD = −0.10, 95% CI = −0.55, 0.34). No statistically significant heterogeneity was found for any of the syntheses of indirect measures of EF. Based on pre‐post single‐group designs, there was evidence for small to medium sized improvements in EF based on direct measures (cognitive flexibility, verbal working memory and visual working memory) and indirect measures (behavioural regulation, shifting, inhibition and meta‐cognition). However, these results must be interpreted with caution due to high risk of bias. Authors' Conclusions: This review found limited and uncertain evidence for the effectiveness of interventions for improving executive functioning in children with FASD across 8 direct and 13 indirect measures of EF. The findings are limited by the small number of high‐quality studies that could be synthesised by meta‐analysis and the very small sample sizes for the included studies. [ABSTRACT FROM AUTHOR]

Background: Patient participation in patient safety activities in care processes is a fundamental element of safer care. Patients play an important role in preventing patient safety incidents and improving health outcomes. Therefore, healthcare providers need to develop and provide educational materials and actionable tools for patient participation. Objectives: This study aimed to develop a mobile application for health consumers' participation and evaluate the effect of the mobile application on improving health consumers' participation in patient safety. Methods: A quasi‐experimental design was adopted. We developed a mobile application on the basis of a needs assessment, literature review, compilation of patient safety topics, and validity testing of the application. The target population included Korean adults aged between 30 and 65 years who had visited a medical institution more than once within the most recent 6 months. The intervention group received patient participation training by using the mobile application, Application for Patient Participation in Safety Enhancement, for 2 months. The primary outcome variables were patient safety knowledge, self‐efficacy of participation, willingness to participate and experience of patient participation in patient safety activities. End‐user satisfaction was assessed using a questionnaire. To assess participants' experiences with the intervention, qualitative data were collected through a focus group interview and open‐ended responses to an end‐user satisfaction survey. Results: The intervention group (n = 60) had significantly higher overall average scores than the control group (n = 37) with regard to patient safety knowledge (p <.001), self‐efficacy of participation (p =.001), willingness to participate (p =.010) and experience of participation (p =.038) in the post‐survey. The total mean end‐user satisfaction score was 3.56 ± 0.60. The participants expressed the realization that patients could play an important role in improving patient safety. Conclusions: This study demonstrated that educating health consumers through a mobile application with useful information improves patient participation in patient safety activities. Educational materials and patient participation tools could motivate health consumers' health‐related behaviours. Patient or Public Contribution: Patients were involved during the programme development and evaluation. [ABSTRACT FROM AUTHOR]

Research has advanced two perspectives on the fundamental issue of the relationship between member creativity and team creativity: the additive model (predicting with average member creativity) and the disjunctive model (predicting with highest member creativity). Inconsistent evidence raises the question of possible moderators. We address this question by developing moderating roles of task characteristics – task interdependence and task creativity requirement. In a meta‐analytic review of team creativity (and innovation) research, we hypothesized and supported that the additive model is more predictive in tasks with high interdependence and with low creativity requirements, and that the disjunctive model is more predictive for less interdependent tasks. The effectiveness of the disjunctive model, however, did not differ as a function of task creativity requirements. Further, our supplementary analysis showed that the additive model is more effective in tasks requiring only generating creative ideas than in tasks involving both generation and implementation of creative ideas. Practitioner points: Because creative employees are in high demand, it is important to effectively select and assign creative individuals to teams for managing creativity.Managing team creativity by selecting creative individuals for the team can be done following two strategies: an additive strategy prioritizing high levels of average member creativity or a disjunctive strategy prioritizing one particularly creative member.Whether the additive or the disjunctive strategy is more effective is contingent on task characteristics: with high task interdependence, it is better to prioritize mean member creativity; with low task interdependence and with higher creativity requirements, it is better to prioritize one particularly creative team member. [ABSTRACT FROM AUTHOR]

This randomized controlled trial evaluated the effect of a 5‐week daily skin‐to‐skin contact (SSC) intervention between mothers and their full‐term infants, compared with care‐as‐usual, on exclusive and continued breastfeeding duration during the first post‐natal year. Healthy pregnant women (n = 116) from a community sample were enrolled and randomly allocated to the SSC or care‐as‐usual condition. SSC mothers were requested to provide one daily hour of SSC for the first five post‐natal weeks. Twelve months post‐partum, mothers indicated the number of exclusive and continued breastfeeding months. Multiple regression analyses were conducted using intention‐to‐treat, per‐protocol and exploratory dose–response frameworks. In intention‐to‐treat analyses, exclusive and continued breastfeeding duration was not different between groups (exclusive: 3.61 ± 1.99 vs. 3.16 ± 1.77 months; adjusted mean difference 0.28, 95% confidence interval [CI] −0.33 to 0.89; p = 0.36; continued: 7.98 ± 4.20 vs. 6.75 ± 4.06 months; adjusted mean difference 0.81, 95% CI −0.46 to 2.08; p = 0.21). In per‐protocol analyses, exclusive and continued breastfeeding duration was longer for SSC than care‐as‐usual dyads (exclusive: 4.89 ± 1.26 vs. 3.25 ± 1.80 months; adjusted mean difference 1.28, 95% CI 0.31–2.24; p = 0.01; continued: 10.81 ± 1.97 vs. 6.98 ± 4.08 months; adjusted mean difference 2.33, 95% CI 0.13–4.54; p = 0.04). Exploratory dose–response effects indicated that more SSC hours predicted longer exclusive and continued breastfeeding duration. This study demonstrates that for the total group, the 5‐week daily SSC intervention did not extend exclusive and continued breastfeeding duration. However, for mothers performing a regular daily hour of SSC, this simple and accessible intervention may extend exclusive and continued breastfeeding duration by months. Future studies are required to confirm these promising findings. Trial registration: Netherlands Trial Register (NTR5697). [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to conduct an umbrella review of therapeutic studies relevant to emergency medicine, analyzing patterns in effect size, power, and signals of potential bias across an entire field of clinical research. Methods: We combined topic‐ and journal‐driven searches of PubMed and Google Scholar for published articles of systematic reviews and meta‐analyses (SRMA) relevant to emergency medicine (last search in November 2020). Data were screened and extracted by six investigators. Redundant meta‐analyses were removed. Whenever possible for each comparison we extracted one meta‐analysis on mortality with the most events and one meta‐analysis on a nonmortality outcome with the most studies. From each meta‐analysis we extracted all individual study effects; outcomes were converted to odds ratios (ORs) and placed on a common scale where an OR < 1.0 represents a reduction in a harmful outcome with an experimental treatment versus control. Outcomes were analyzed at the level of individual studies and at the level of summary effects across meta‐analyses. Results: A total of 332 articles contained 431 eligible meta‐analyses with a total of 3,129 individual study outcomes; of these, 2,593 (83%) were from randomized controlled trials. The median OR across all studies was 0.70. Within each meta‐analysis, the earliest study effect on average demonstrated larger benefit compared to the overall summary effect. Only 57 of 431 meta‐analyses (13%) both favored the experimental intervention and did not show any signal of small study effects or excess significance, and of those only 12 had at least one study with 80% or higher power to detect an OR of 0.70. Of these, no interventions significantly decreased mortality in well‐powered trials. Although the power of studies increased somewhat over time, the majority of studies were underpowered. Conclusions: Few interventions studied within SRMAs relevant to emergency medicine seem to have strong and unbiased evidence for improving outcomes. The field would benefit from more optimally powered trials. [ABSTRACT FROM AUTHOR]

Aims: To identify the predictors of Registered Nurses' turnover intention and analyse the effect sizes. Design: A systematic review and meta‐analysis of previous research, conducted to comprehensively identify the predictors of turnover intention. Methods: In total, 417 studies from 1 January 2000 to 30 April 2020 that investigated predictors of turnover intention of South Korean nurses were reviewed. The data were analysed using the R statistical package. Network graphs were used to analyse the relationships among turnover predictors, and meta‐analysis was performed to determine the effect sizes of the correlations. Results: This review analysed common predictors identified in previous studies. Burnout (0.541), emotional exhaustion (0.511), job stress (0.390) and career plateau (0.386) showed positive effect sizes, while organizational commitment (−0.540), person−organizational fit (−0.521), career commitment (−0.508), work engagement (−0.503), job satisfaction (−0.491) and job embeddedness (−0.483) showed negative effect sizes. [ABSTRACT FROM AUTHOR]

Foot care education is an important strategy in reducing lower limb complications. There is evidence that contemporary communication approaches can improve patient education outcomes. To inform the potential of such methods in diabetic foot education, we trialled a collaborative approach in patient education counselling in a podiatry clinic. We conducted a single‐blind pragmatic randomised controlled trial on 52 diabetes patients who had an active foot ulcer. Participants were randomised to either collaborative education or traditional didactic education. Outcomes on knowledge and self‐care behaviours were collected via a pre and post study questionnaire (max score: 75). The study ended at 12 weeks or when the wound healed prior. 42 (80.7%) participants completed the study. The collaborative patient education group had a significant increase in score post‐study (38.8 ± 8.5) compared to pre‐study (32.8 ± 6.9; P <.001). The control group had no significant increase in score post study. The difference in scores between groups had a moderate effect size (d = 0.54). The use of a collaborative approach in patient education was able to produce significantly greater increase in knowledge retention and self‐care behaviours, without the need for additional consultation time in a podiatry clinic. [ABSTRACT FROM AUTHOR]

Background: The hemodynamic impact of induction agents is a critically important consideration in emergency intubations. We assessed the relationship between peri‐intubation hypotension and the use of ketamine versus etomidate as an induction agent for emergency department (ED) intubation. Methods: We analyzed ED intubation data for patients aged >14 years from the National Emergency Airway Registry performed in 25 EDs during 2016 through 2018. We excluded patients with preintubation hypotension (systolic blood pressure <100 mm Hg) or cardiac arrest prior to intubation. The primary outcome was peri‐intubation hypotension. Secondary outcomes included interventions for hypotension (e.g., intravenous fluids or vasopressors). We report adjusted odds ratios (aOR) from multivariable logistic regression models controlling for patient demographics, difficult airway characteristics, and intubation modality. Results: There were 738 encounters with ketamine and 6,068 with etomidate. Patients receiving ketamine were more likely to have difficult airway characteristics (effect size difference = 8.8%, 95% confidence interval [CI] = 5.3% to 12.4%) and to undergo intubation with video laryngoscopy (8.1%, 95% CI = 4.4% to 12.0%). Peri‐intubation hypotension incidence was 18.3% among patients receiving ketamine and 12.4% among patients receiving etomidate (effect size difference = 5.9%, 95% CI = 2.9% to 8.8%). Patients receiving ketamine were more likely to receive treatment for peri‐intubation hypotension (effect size difference = 6.5%, 95% CI = 3.9% to 9.3%). In logistic regression analyses, patients receiving ketamine remained at higher risk for peri‐intubation hypotension (aOR = 1.4, 95% CI = 1.2 to 1.7) and treatment for hypotension (aOR = 1.8, 95% CI = 1.4 to 2.0). There was no difference in the aOR of hypotension between patients receiving ketamine at doses ≤1.0 mg/kg versus >1.0 mg/kg or patients receiving etomidate at doses ≤0.3 mg/kg versus >0.3 mg/kg. Conclusions: Pending additional data, our results suggest that clinicians should not necessarily prioritize ketamine over etomidate based on concern for hemodynamic compromise among ED patients undergoing intubation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pediatric out‐of‐hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher‐volume hospitals, teaching hospitals, and trauma centers. The primary objective of this article was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an in situ simulation. Secondary objectives included comparing adherence to other team, provider, and system factors. Methods: This prospective, multicenter, observational study evaluated interprofessional teams in their native emergency department (ED) resuscitation bays caring for a simulated 5‐year‐old child presenting in cardiac arrest. The primary outcome, adherence to the American Heart Association pediatric guidelines, was assessed using a 14‐item tool including three component domains: basic life support (BLS), pulseless electrical activity (PEA), and ventricular fibrillation (VF). Provider, team, and hospital‐level data were collected as independent data. EDs were evaluated in four pediatric volume groups (low < 1,800/year; medium 1,800–4,999; medium‐high 5,000–9,999; high > 10,000). Cardiac arrest adherence and domains were evaluated by pediatric patient volume and other team and hospital‐level characteristics, and path analyses were performed to evaluate the contribution of patient volume, systems readiness, and teamwork on BLS, PEA, and VF adherence. Results: A total of 101 teams from a spectrum of 50 EDs participated including nine low pediatric volume (<1,800/year), 36 medium volume (1,800–4,999/year), 24 medium‐high (5,000–9,999/year), and 32 high volume (≥10000/year). The median total adherence score was 57.1 (interquartile range = 50.0–78.6). This was not significantly different across the four volume groups. The highest level of adherence for BLS and PEA domains was noted in the medium‐high–volume sites, while no difference was noted for the VF domain. The lowest level of BLS adherence was noted in the lowest‐volume EDs. Improved adherence was not directly associated with higher pediatric readiness survey (PRS) score provider experience, simulation teamwork performance, or more providers with Pediatric Advanced Life Support (PALS) training. EDs in teaching hospitals with a trauma center designation that served only children demonstrated higher adherence compared to nonteaching hospitals (64.3 vs 57.1), nontrauma centers (64.3 vs. 57.1), and mixed pediatric and adult departments (67.9 vs. 57.1), respectively. The overall effect sizes for total cardiac adherence score are ED type γ = 0.47 and pediatric volume (low and medium vs. medium‐high and high) γ = 0.41. A series of path analyses models was conducted that indicated that overall pediatric ED volume predicted significantly better guideline adherence, but the effect of volume on performance was only mediated by the PRS for the VF domain. Conclusions: This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium‐high–volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower‐volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient. [ABSTRACT FROM AUTHOR]

Abstract: Maternal undernutrition and mortality remain high in several African countries. Key nutrition and health interventions improve maternal and birth outcomes. Evidence is scarce on how to strengthen health systems to ensure pregnant women and newborns are reached with these interventions. We conducted three quasi‐experimental nonrandomized Community Based Maternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenya to demonstrate how proven nutrition interventions could be integrated into health programs to improve knowledge and practices during pregnancy, birth, and postpartum. We evaluated impact on knowledge and practices related to maternal and neonatal care using logistic regression and repeated‐measures models with districts as a fixed variable and adjusted for covariates. Combined country analyses show significant positive effects of the intervention on women receiving first antenatal care visit (ANC) during first trimester (OR = 1.44; p < .001), those consuming any iron and folic acid supplement during their latest pregnancy (OR = 1.60; p = .005), those whose <6 months infants were exclusively breastfed (OR = 2.01; p=.003), those whose delivery was facility based (OR = 1.48; p=.031), and those whose postnatal care was facility based (OR = 2.15; p<.001). There was no significant differences between intervention and control groups regarding one or more and four or more ANC visits, women consuming iron and folic acid for ≥90 days, and early initiation of breastfeeding. We conclude that integrating proven nutrition interventions into health programs at community level improved components of access to and use of ANC, delivery services, and postnatal care by women in three African countries. [ABSTRACT FROM AUTHOR]

Breastfeeding has many benefits for mother and infant. Whether breastfeeding also protects against type 2 diabetes is unclear. To clarify the role of breastfeeding in type 2 diabetes, we assessed the association of breastfeeding with insulin resistance in late adolescence in a birth cohort from a non-Western setting where breastfeeding was not associated with higher socio-economic position. We used multivariable linear regression, with multiple imputation and inverse probability weighting, to examine the adjusted associations of contemporaneously reported feeding in the first 3 months of life (exclusively breastfed, mixed feeding, or always formula-fed) with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) at 17 years in a subset ( n = 710, 8.6% of entire cohort) of the Hong Kong Chinese birth cohort 'Children of 1997.' We found a graded association of breastfeeding exclusivity in the first 3 months of life with lower fasting insulin and HOMA-IR ( p-for-trend < .05), but not fasting glucose, at 17 years. Exclusively breastfed adolescents (7%) had nonsignificantly lowest fasting insulin and HOMA-IR, adjusted for sex, birth weight, parity, length of gestation, pregnancy characteristics, parents' education, and mother's place of birth. Exclusively breastfeeding for 3 months may be causally associated with lower insulin resistance in late adolescence. Further follow-up studies into adulthood are required to clarify the long-term protection of breastfeeding from type 2 diabetes. [ABSTRACT FROM AUTHOR]

In a previous article, we advocated against using the sum of Akaike weights (SW) as a metric to distinguish between genuine and spurious variables in Information Theoretic (IT) statistical analyses. A recent article (Giam & Olden, Methods in Ecology and Evolution, 2016, 7, 388) criticises our finding and instead argues in favour of SW. It points out that (1) we performed a biased data-generation procedure and (2) we erroneously evaluated SW on its capacity to estimate the proportion of variance in the data explained by a variable. We here respond to these points., Giam and Olden's first concern is unfounded. When using the data-generating code they proposed, SW remains very imprecise. To respond to their second concern, we first list the meanings taken by a variable's importance in the context of IT. Although, SW is presented as an estimate of variable relative importance in methodological textbooks (i.e. a variable's rank in importance or its relative contribution to the variance in the data), it is also used as a metric of variable absolute importance (i.e. a variable's absolute effect size or its statistical significance). We then compare SW to alternative metrics on its ability to estimate variable absolute or relative importance., SW values have low repeatability across analyses. As a result, based on SW, it is hard to distinguish between variables with weak and large effects. For estimations of variable absolute importance, experimenters should prefer model-averaged parameter estimates and/or compare nested models based on evidence ratios. Sum of Akaike weights is also a poor metric of variable relative importance. We showed that correct variable ranking in importance was generally more frequent when using model-averaged standardised parameter estimates, than when using SW., To avoid recurrent errors in ecology and evolution, we therefore warn against the use of SW for estimations of variable absolute and relative importance and we propose that experimenters should instead use model-averaged standardised parameter estimates for statistical inferences. [ABSTRACT FROM AUTHOR]

Objectives Willingness-to-pay ( WTP) provides a broad assessment of well-being, capturing benefits beyond health. However, the validity of the approach has been questioned and the evidence relating to the sensitivity of WTP to changes in health status is mixed. Using menorrhagia (heavy menstrual bleeding) as a case study, this exploratory study assesses the sensitivity to scale of WTP to change in health status as measured by a condition-specific measure, MMAS, which includes both health and non-health benefits. The relationship between EQ-5D and change in health status is also assessed. Methods Baseline EQ-5D and MMAS values were collected from women taking part in a randomized controlled trial for pharmaceutical treatment of menorrhagia. Following treatment, these measures were administered along with a WTP exercise. The relationship between the measures was assessed using Spearman's correlation analysis, and the sensitivity to scale of WTP was measured by identifying differences in WTP alongside differences in MMAS and EQ5D values. Results Our exploratory findings indicated that WTP, and not EQ-5D, was significantly positively correlated with change in MMAS, providing some evidence for convergent validity. These findings suggest that WTP is capturing the non-health benefits within the MMAS measure. Mean WTP also increased with percentage improvements in MMAS, suggesting sensitivity to scale. Conclusion When compared to quality of life measured using the condition-specific MMAS measure, the convergent validity and sensitivity to scale of WTP is indicated. The findings suggest that WTP is more sensitive to change in MMAS, than with EQ-5D. [ABSTRACT FROM AUTHOR]

When operating in multiteam settings, it is important that goals are cohesive between team members, especially in high-stakes, risky, and uncertain environments. This study explored goal consistency during a multiteam emergency response simulation. A total of n = 50 commanders from the UK Police Services, Fire and Rescue Services, and Ambulance Services took part in a simulated terrorism exercise, who were split into n = 13 teams. Each team responded to the same simulated terrorist event, which was based on a 'Marauding Terrorist Firearms Attack' ( MTFA) at a city centre train station. Data were collected using electronically time-stamped 'decision logs' and post-incident questionnaires that measured team members' self-reported goals. Goals that were 'attack' focussed (e.g., 'treat patients') were coded as 'approach' (i.e., focussed on achieving positive outcomes) and goals that were 'defence' focussed (e.g., protect emergency responders) were coded as 'avoid' (i.e., focussed on avoiding negative outcomes). It emerged that different agencies prioritized different goal types; Fire commanders initially prioritized avoid goals but then increased approach orientations, Ambulance commanders were consistently approach oriented, and Police commanders showed goal conflict (tensions between adopting approach and avoid goals). Despite goal differences, participants rated that their interagency goals were consistent in a post-scenario questionnaire, suggesting that commanders were unaware of the nuanced differences between their agency-specific objectives. At the multiteam level, teams who predominantly held attack/approach goals were significantly faster at decision logging early in the incident, yet defend/avoid teams were faster at decision logging later into the incident. Implications for multiteam coordination are discussed. Practitioner points The 'save life' goal in multiteam emergency response settings is vague and open to interpretation. This can impede coordination when agencies assume that they are working towards the same 'save life' goal, but are actually focussed on different and role-specific objectives with regard to how they will achieve it., A joint decision model that helps to clarify agency-specific tactical priorities may be more useful in multiteam contexts than one that uses ambiguous and abstract (i.e., 'save life') interagency goals., A focus on achieving positive outcomes (attack/approach goal; e.g., 'treat patients') can speed up decision-making during the early stages of an incident, but when the situation becomes more complex and dynamic, then a focus on avoiding negative outcomes (defend/avoid goal; e.g., protect emergency responders from harm) might lead to faster action., When responding to complex emergencies, practitioners should focus on satisficing to achieve 'least-worst' outcomes rather trying to maximize gains. [ABSTRACT FROM AUTHOR]

Since the late 1970s, the received wisdom has been that government size (measured as the ratio of total government expenditure to gross domestic product ( GDP) or government consumption to GDP) is detrimental to economic growth. We conduct a hierarchical meta-regression analysis of 799 effect-size estimates reported in 87 primary studies to verify if this assertion is supported by existing evidence. Our findings indicate that the conventional prior belief is supported by evidence mainly from developed countries but not from less developed countries. We argue that the negative relationship between government size and economic growth in developed countries may reflect endogeneity bias. [ABSTRACT FROM AUTHOR]

In many low‐income countries, girls marry early and have children very soon after marriage. Although conveying infant and young child nutrition (IYCN) knowledge to adolescent girls in time is important to ensure the well‐being of their children, little is known about the best ways to convey these messages. This study examines the extent of, and sources from which adolescent girls derive IYCN knowledge in order to inform the design of programmes that convey such information. Data on adolescent girls aged 12–18 was collected in 2013 in 140 clusters of villages in rural areas (n = 436), and 70 clusters of slums in urban areas (n = 345) in Bangladesh. Data were analysed using multivariable Poisson regression models. In both the urban and rural samples, girls' schooling is positively and significantly associated with IYCN knowledge (P < 0.01 and P < 0.10, respectively). IYCN knowledge of adolescent girls' mothers is also associated with adolescents' IYCN knowledge in both urban and rural samples, but the magnitude of association in the urban sample is only half that of the rural sample (P < 0.01 and P < 0.10, respectively). In Bangladesh, efforts to improve knowledge regarding IYCN are typically focused on mothers of young children. Only some of this knowledge is passed onto adolescent girls living in the same household. As other messaging efforts directed towards mothers have only small, or no association with adolescent girls' knowledge of IYCN, improving adolescent girls' IYCN knowledge may require information and messaging specifically directed towards them. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

The cost and difficulty of manipulative field studies makes low statistical power a pervasive issue throughout most ecological subdisciplines. Ecologists are already aware that small sample sizes increase the probability of committing Type II errors. In this article, we address a relatively unknown problem with low power: underpowered studies must overestimate small effect sizes in order to achieve statistical significance. First, we describe how low replication coupled with weak effect sizes leads to Type M errors, or exaggerated effect sizes. We then conduct a meta-analysis to determine the average statistical power and Type M error rate for manipulative field experiments that address important questions related to global change; global warming, biodiversity loss, and drought. Finally, we provide recommendations for avoiding Type M errors and constraining estimates of effect size from underpowered studies. [ABSTRACT FROM AUTHOR]

Nutritional supplementation during pregnancy is increasingly recommended especially in low‐resource settings, but its oral health impacts have not been studied. Our aim was to examine whether supplementation with multiple micronutrients (MMN) or small‐quantity lipid‐based nutrient supplements affects dental caries development or periodontal health in a rural Malawian population. The study was embedded in a controlled iLiNS‐DYAD trial that enrolled 1391 pregnant women <20 gestation weeks. Women were provided with one daily iron–folic acid capsule (IFA), one capsule with 18 micronutrients (MMN) or one sachet of lipid‐based nutrient supplements (LNS) containing protein, carbohydrates, essential fatty acids and 21 micronutrients. Oral examination of 1024 participants was conducted and panoramic X‐ray taken within 6 weeks after delivery. The supplement groups were similar at baseline in average socio‐economic, nutritional and health status. At the end of the intervention, the prevalence of caries was 56.7%, 69.1% and 63.3% (P = 0.004), and periodontitis 34.9%, 29.8% and 31.2% (P = 0.338) in the IFA, MMN and LNS groups, respectively. Compared with the IFA group, women in the MMN group had 0.60 (0.18–1.02) and in the LNS group 0.59 (0.17–1.01) higher mean number of caries lesions. In the absence of baseline oral health data, firm conclusions on causality cannot be drawn. However, although not confirmatory, the findings are consistent with a possibility that provision of MMN or LNS may have increased the caries incidence in this target population. Because of the potential public health impacts, further research on the association between gestational nutrient interventions and oral health in low‐income settings is needed. [ABSTRACT FROM AUTHOR]

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID‐funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length‐for‐age z‐score (LAZ) decreased and weight‐for‐length z‐score (WLZ) increased from 6 to 12 months of age in both regions. One‐quarter of infants were stunted and nearly one‐third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P < 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy‐dense foods. [ABSTRACT FROM AUTHOR]

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self‐reported maternal post‐natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first‐time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04–0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001–0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005–0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01–0.29, P = 0.03) feeding practices (ΔR2 values: 0.02–0.03, P < 0.05). This study provides evidence for the proposed link between maternal post‐natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post‐natal period may improve responsiveness in the child feeding relationship. [ABSTRACT FROM AUTHOR]

Over a decade of research attests to the importance of resilience in the workplace for employee well-being and performance. Yet, surprisingly, there has been no attempt to synthesize the evidence for the efficacy of resilience training in this context. The purpose of this study, therefore is to provide a systematic review of work-based resilience training interventions. Our review identified 14 studies that investigated the impact of resilience training on personal resilience and four broad categories of dependent variables: (1) mental health and subjective well-being outcomes, (2) psychosocial outcomes, (3) physical/biological outcomes, and (4) performance outcomes. Findings indicated that resilience training can improve personal resilience and is a useful means of developing mental health and subjective well-being in employees. We also found that resilience training has a number of wider benefits that include enhanced psychosocial functioning and improved performance. Due to the lack of coherence in design and implementation, we cannot draw any firm conclusions about the most effective content and format of resilience training. Therefore, going forward, it is vital that future research uses comparative designs to assess the utility of different training regimes, explores whether some people might benefit more/less from resilience training, and demonstrates consistency in terms of how resilience is defined, conceptualized, developed, and assessed. Practitioner points Despite conceptual and theoretical support for resilience training, the empirical evidence is tentative, with the exception of a large effect for mental health and subjective well-being outcomes., Most programmes utilize a cognitive-behavioural approach to developing resilience., At this stage, there is no definitive evidence for the most effective training content or format, but it would appear wise to include an element of one-to-one training and support based on individual needs. [ABSTRACT FROM AUTHOR]

Over the past three decades, supply chain management (SCM) has evolved from its origins as a nascent field of study to encompass construct definition, identification of the field's central issues, and establishment of its conceptual boundaries. At this point, a sufficient body of empirical SCM research has been put forward to allow for quantitative assessment of the field. Therefore, we examine three key elements of study design to assess what has happened, what is currently happening, and where we should be heading as a field. To do so, following a pattern of reviews in similar disciplines, we begin with an examination of effect sizes of the relationships under investigation. Results show that effect sizes in SCM research have marginally increased over time and that sub-domains within SCM that receive the most scholarly attention also have higher effect sizes. We also conduct a post hoc analysis of statistical power and empirically examine a range of factors and study contexts that could influence power. Findings suggest that average statistical power in SCM research exceeds the statistical power of most related disciplines and is particularly high in several unique contexts. Lastly, we find that measurement reliability and the use of control variables have increased over time, possibly suggesting the field has matured, instilling a degree of confidence in its research. Overall, our results show that SCM research is becoming more empirically rigorous, but we also uncover key areas that warrant improvement. We describe implications of our review for the design of future SCM empirical studies. [ABSTRACT FROM AUTHOR]

Aim Patient perception measures are gaining increasing interest among scholars and practitioners. The aim of this study was to empirically examine a conceptual model of patient-centred care using patient perception survey data. Background Patient-centred care is one of the Institute of Medicine's objectives for improving health care in the 21st century. Patient interviews conducted by the Picker Institute/ Commonwealth Fund in the 1980s resulted in a theoretical model and survey questions with dimensions and attributes patients defined as patient-centered. Method The present study used survey data from patients with overnight visits at 142 U. S. hospitals. Results Regression analysis found significant support for the theoretical model. Perceptions of emotional support had the strongest relationship with overall care ratings. Coordination of care, and physical comfort were strongly related as well. Conclusion Understanding how patients experience their care can help improve understanding of what patients believe is patient-centred, and of how care processes relate to important patient outcomes. [ABSTRACT FROM AUTHOR]

To understand the process by which a treatment (T) achieves an effect on outcome (O) and thus to improve the effect of T on O, it is vital to detect mediators, to compare the impact of different mediators, and to develop hypotheses about the causal factors (all mediators) linking T and O. An index is needed to facilitate interpretation of the potential clinical importance of a mediator (M) of choice of T on treatment O in randomized clinical trials (RCTs). Ideally such a mediator effect size should (1) be invariant under any rescaling of M and O consistent with the model used, and (2) reflect the difference between the overall observed effect of T on O and what the maximal effect of T on O could be were the association between T and M broken. A mediator effect size is derived first for the traditional linear model, and then more generally for any categorical (ordered or non-ordered) potential mediator. Issues such as the problem of multiple treatments, outcomes and mediators, and of causal inferences, and the correspondence between this approach and earlier ones, are discussed. Illustrations are given of the application of the approach. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Children of HIV-infected mothers experience poor growth, but not much is understood about the extent to which such children are affected. The Research to Improve Infant Nutrition and Growth ( RIING) Project used a longitudinal study design to investigate the association between maternal HIV status and growth among Ghanaian infants in the first year of life. Pregnant women in their third trimester were enrolled into three groups: HIV-negative ( HIV- N, n = 185), HIV-positive ( HIV- P, n = 190) and HIV-unknown ( HIV- U, n = 177). Socioeconomic data were collected. Infant weight and length were measured at birth and every month until 12 months of age. Weight-for-age ( WAZ), weight-for-length ( WLZ) and length-for-age ( LAZ) z-scores were compared using analysis of covariance. Infant HIV status was not known as most mothers declined to test their children's status at 12 months. Adjusted mean WAZ and LAZ at birth were significantly higher for infants of HIV- N compared with infants of HIV- P mothers. The prevalence of underweight at 12 months in the HIV- N, HIV- P and HIV- U were 6.6%, 27.5% and 9.9% ( P < 0.05), respectively. By 12 months, the prevalence of stunting was significantly different ( HIV- N = 6.0%, HIV- P = 26.5% and HIV- U = 5.0%, P < 0.05). The adjusted mean ± SE LAZ (0.57 ± 0.11 vs. −0.95 ± 0.12; P < 0.005) was significantly greater for infants of HIV- N mothers than infants of HIV- P mothers. Maternal HIV is associated with reduce infant growth in weight and length throughout the first year of life. Children of HIV- P mothers living in socioeconomically deprived communities need special support to mitigate any negative effect on growth performance. [ABSTRACT FROM AUTHOR]

We evaluate the claim that individuals exhibit a magnitude effect in their discounting behaviour, where higher discount rates are inferred from choices made with lower principals, all else being equal. If the magnitude effect is quantitatively significant, it is not appropriate to use one discount rate that is independent of the scale of the project for cost-benefit analysis and capital budgeting. Using data from a field experiment in Denmark, we find statistically significant evidence of a magnitude effect that is much smaller than is claimed. This evidence surfaces only if one controls for unobserved individual heterogeneity in the population. [ABSTRACT FROM AUTHOR]

The influence of childhood nutrition on the development of constipation beyond the period of weaning and breastfeeding is relatively understudied. In addition, eating patterns in childhood can be highly correlated with overweight and sedentary behaviour, which may also have an influence on constipation. The aim of this study was to assess whether common dietary patterns, sedentary behaviour and childhood overweight are associated with constipation in childhood. The study was embedded in a population-based prospective birth cohort. Information on dietary intake was obtained by a food frequency questionnaire at the child's age of 14 months ( n = 2420). The adherence scores on a 'Health conscious' and 'Western-like' diet were extracted from principal component analysis. At the age of 24, 36 and 48 months, information on constipation and sedentary behaviour, and weight and height was obtained by parental-derived questionnaires and from the child health centres, respectively. Adherence to a 'Western-like' dietary pattern was associated with a higher prevalence of constipation up to 48 months [adjusted odds ratio (aOR); 95% confidence interval (CI): 1.39; 1.02-1.87], which was not mediated by overweight or sedentary behaviour. Adherence to a 'Health Conscious' dietary pattern was only associated at short term, with a lower prevalence of constipation at 24 months (aOR; 95%CI: 0.65; 0.44-0.96). No association was found between overweight, sedentary behaviour and constipation. Our results suggest that specific dietary patterns in early childhood could be associated with higher or lower risks for constipation, but these effects are time-dependent. Overweight and sedentary behaviour seem to not have a major role on constipation in childhood. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis of available randomised controlled trials ( RCTs) was conducted to evaluate the effect of zinc ( Zn) intake on serum/plasma Zn status in infants. Out of 5500 studies identified through electronic searches and reference lists, 13 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on serum/plasma Zn concentration was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status and risk of bias. The pooled β of status was 0.09 [confidence interval ( CI) 0.05 to 0.12]. However, a substantial heterogeneity was present in the analyses (I2 = 98%; P = 0.00001). When we performed a meta-regression, the effect of Zn intake on serum/plasma Zn status changed depending on the duration of the intervention, the dose of supplementation and the nutritional situation ( P ANCOVA = 0.054; <0.001 and <0.007, respectively). After stratifying the sample according to the effect modifiers, the results by duration of intervention showed a positive effect when Zn intake was provided during medium and long periods of time (4-20 weeks and >20 weeks). A positive effect was also seen when doses ranged from 8.1 to 12 mg day−1. In all cases, the pooled β showed high evidence of heterogeneity. Zn supplementation increases serum/plasma Zn status in infants, although high evidence of heterogeneity was found. Further standardised research is urgently needed to reach evidence-based conclusions to clarify the role of Zn supplementation upon infant serum/plasma Zn status, particularly in Europe. [ABSTRACT FROM AUTHOR]

A theoretical model of safety leadership, which incorporated both transformational and active transactional leadership styles, was tested using meta-analytic path analysis. The final model showed that transformational leadership had a positive association with both perceived safety climate and safety participation, with perceived safety climate partially mediating the effect of leadership on safety participation. Active transactional leadership had a positive association with perceived safety climate, safety participation and safety compliance. The effect of leadership on safety compliance was partially mediated by perceived safety climate and the effect on safety participation fully mediated by perceived safety climate. The findings suggest that active transactional leadership is important in ensuring compliance with rules and regulations, whereas transformational leadership is primarily associated with encouraging employee participation in safety. Therefore, in line with the augmentation hypothesis of leadership, a combination of both transformational and transactional styles appeared to be most beneficial for safety. Avenues for further research and practical implications in terms of leadership training and development are discussed. Practitioner Points Developed and tested a model of safety leadership, which shows that both transformational and active transactional leadership styles are important aspects of effective safety leadership., Study has implications for practitioners who are involved with the design of leadership training and development programmes, as such programmes should be tailored to focus on a range of leader behaviours that encompass active transactional as well as transformational style., Findings suggest that leadership styles have a differential effect on safety compliance and safety participation - thus, training and development programmes should make specific links between leader behaviours and their subsequent influence on employee behaviour. [ABSTRACT FROM AUTHOR]

The relationship between individual-level organizational commitment and employee's performance has been the subject of considerable empirical investigation over several decades. However, few studies have examined the effect of collective organizational commitment on unit or organizational-level performance, even though available theory suggests commitment's effects may be stronger at the unit level. We present results of a study examining the effects of unit-level organizational commitment on the speed and quality of performance, and employee absence, drawing on a sample of 893 service sector employees (representing a 90% response rate) from 39 office units in a UK public sector organization. Results show that unit-level organizational commitment was statistically significantly associated with both unit-level performance quality (i.e., reduced customer complaints per service transaction) and performance speed (i.e., customer average queuing time). Collective organizational commitment was not significantly associated with a unit-level measure of the average time customers spent at service counters with the tellers, nor was it associated with unit-level employee absence. Practitioner Points Bottom-line impact of organizational commitment: unit-level organizational commitment had substantial effects on unit-level performance., Managers must recognize that committed employees have a value beyond their immediate and individual performance as such individuals contribute to unit performance., Unit-level organizational commitment implies different managerial interventions., Our research indicates the value to organizations of analysing survey data at the unit-level: it is easier to ensure participant anonymity and confidentiality of responses and it provides information beyond individual level data. [ABSTRACT FROM AUTHOR]

The present study updates rater training meta-analysis and demonstrates that frame-of-reference (FOR) training is an effective method of improving rating accuracy. The current meta-analysis includes over four times as many studies as included in the Woehr and Huffcutt meta-analysis and also provides a snapshot of current rater training studies. The present meta-analysis also extends the previous meta-analysis by showing that not all operationalizations of accuracy are equally improved by FOR training; Borman's differential accuracy appears to be the most improved by FOR training, along with behavioural accuracy, which provides a snapshot into the cognitive processes of the raters. We also investigate the extent to which FOR training protocols differ, the implications of protocol differences, and if the criteria of interest to FOR researchers have changed over time. [ABSTRACT FROM AUTHOR]

Personal reputation has been argued to demonstrate important influences on work outcomes. However, substantive research on personal reputation is relatively scarce. This two-study investigation empirically supports and extends existing theory regarding the temporal development of personal reputation (i.e., antecedents and consequences), and thus contributes to a more informed understanding of both the construct and criterion-related validity of this important construct. Study 1 is conducted longitudinally, in order to assess the development of personal reputation over time, which is undertaken to demonstrate the effects of human capital and social effectiveness as antecedents of reputation. Study 2 complements and extends the first study by conducting a field investigation examining the effects of time, human capital, and social effectiveness as antecedents of personal reputation, while also exploring the reputation consequences of autonomy, power, and career success. Our findings suggest that human capital, time, and social effectiveness play a part in the development of a reputation. Furthermore, career success, power, and autonomy were shown to be outcomes of the reputation construct. Contributions and strengths of this investigation, limitations, and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Background and objectives Fulfilling patient expectations is central to defining a good quality of life (QoL) in health. The WHOQOL-BREF was developed using novel, person-centred methods and is a generic patient-reported outcomes measure (PROM). However, without robust psychometric performance, PROMs cannot be relied upon to assess individuals. This study investigated the WHOQOL-BREF (UK), with this use in mind. Design Cross sectional with nested repeated measures. Setting and participants Twenty-seven disease groups or health conditions and healthy people were recruited at 38 UK sites, in a wide range of settings ( n = 4628). Interventions 'Treatment as usual'; new and alternative interventions. Outcome measures WHOQOL-BREF (UK); SF-36. Results Respondent burden was low, as acceptability and feasibility were high. Internal consistency was excellent (0.92) and test-retest reliability good. Distinctive QoL profiles were found for diverse conditions. Musculoskeletal, psychiatric and cardiovascular patients reported the poorest QoL and also improved most during treatment. Overall, QoL was good, and best for healthy groups, supporting discriminant validity. Compared with the SF-36, WHOQOL physical and psychological domains showed good concurrent validity, although social was weak. Small or moderate effect sizes confirmed responsiveness to change in specified domains for certain conditions and interventions. Age had a small impact on reporting QoL. Discussion and conclusion The WHOQOL-BREF is found to be a high quality patient-centred generic tool suited to individual assessment in clinics, for research, and audit. [ABSTRACT FROM AUTHOR]

A longitudinal modelling approach is used to examine the effect of job satisfaction on survey non-response in an applied employee attitude survey. Members of a large electronics company were invited to participate in the survey in each of four consecutive years. Logistic autoregressive modelling revealed a significant effect of prior non-response on subsequent non-response. The odds of responding to the survey in any given year were more than twice as high for individuals who had responded to the same survey 1 year before, as compared with those who did not. Prior job satisfaction was also significantly related to subsequent survey non-response. Participants who were more satisfied on a given occasion were more likely to respond 1 year later than those who were less satisfied. At the facet level, satisfaction with supervisors contributed incrementally to the prediction of survey non-response in subsequent years. Implications for the theoretical and methodological development of non-response research and for the practical implementation of employee attitude surveys are discussed. [ABSTRACT FROM AUTHOR]

Few studies have been conducted on the rationales for using interpretive guidelines for effect size, and most of the previous statistical power surveys have covered broad research domains. The present study aimed to estimate the statistical power and to obtain realistic target effect sizes of depression research in Japan. We systematically reviewed 18 leading journals of psychiatry and psychology in Japan and identified 974 depression studies that were mentioned in 935 articles published between 1990 and 2006. In 392 studies, logistic regression analyses revealed that using clinical populations was independently associated with being a statistical power of <0.80 (odds ratio 5.9, 95% confidence interval 2.9-12.0) and of <0.50 (odds ratio 4.9, 95% confidence interval 2.3-10.5). Of the studies using clinical populations, 80% did not achieve a power of 0.80 or more, and 44% did not achieve a power of 0.50 or more to detect the medium population effect sizes. A predictive model for the proportion of variance explained was developed using a linear mixed-effects model. The model was then used to obtain realistic target effect sizes in defined study characteristics. In the face of a real difference or correlation in population, many depression researchers are less likely to give a valid result than simply tossing a coin. It is important to educate depression researchers in order to enable them to conduct an a priori power analysis. [ABSTRACT FROM AUTHOR]

This study presents a meta-analysis of 25 individual differences proposed to be related to effective leadership, with an emphasis on comparing trait-like (e.g. personality and intelligence) to state-like individual differences (e.g. knowledge and skills). The results indicate that although both trait-like (achievement motivation, energy, dominance, honesty/integrity, self-confidence, creativity, and charisma) and state-like (interpersonal skills, oral communication, written communication, administrative/management skills, problem-solving skills, and decision making) individual differences were consistent predictors of effective leadership, the impact of trait-like and state-like individual differences was modest overall and did not differ substantially (ρ= .27 and .26, respectively). Finally, organizational level of the leader, method of predictor and criterion measurement, and organization type moderated the relationship between individual differences and effective leadership. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how different measurement methods and sampling techniques contribute to the observed variation in prevalence rates of workplace bullying. A total of 102 prevalence estimates of bullying from 86 independent samples (N = 130,973) were accumulated and compared by means of meta-analysis. At an average, the statistically independents samples provided an estimate of 14.6%. Yet, the findings show that methodological moderators influence the estimated rates. As for measurement method, a rate of I 1.3% was found for studies investigating self-labelled victimization from bullying based on a given definition of the concept, whereas a rate of 14.8% was found for behavioural measure studies, and 18.1% for self-labelling studies without a given definition. A difference of 8.7% points was found between randomly sampled and non-randomly sampled studies. When controlling for geographical differences, the findings show that geographical factors also influence findings on bullying. Hence, findings from different studies on workplace bullying cannot be compared without taking moderator variables into account. [ABSTRACT FROM AUTHOR]

Presents the exchanges between authors and reviewers of the periodical "Reading Research Quarterly," concerning statistical significance. Argument among statisticians in education and the behavioral sciences about whether to eliminate significance testing in favor of reporting effect sizes; Use of ordinary least squares analyses instead of possible nestedness; Presentation and interpretation of effect sizes.

Corn Soy Blend (CSB) porridge is commonly prepared with oil for treatment of moderate acute malnutrition (MAM). A recent review recommended that 30 g of oil be used with 100 g of CSB to increase energy density and micronutrient absorption. This study assessed the effectiveness and cost-effectiveness of program changes aimed at achieving that target oil:CSB ratio in prepared porridge. Caregivers of children in MAM supplementary feeding programs were assigned to three groups: a control group received monthly rations of 1 L oil, 8 kg CSB in bulk, and social and behavior change communication (SBCC); intervention groups received 2.6 L oil, 8 kg CSB provided either in bulk (Group 1) or four 2-kg packages with printed messages (Group 2), and enhanced SBCC emphasizing the target oil:CSB ratio. Compared to the control, both intervention groups had higher mean added oil per 100 g CSB (18 g, p < 0.01, and 13 g, p= 0.04, higher in groups 1 and 2, respectively), and greater odds of meeting or exceeding the target ratio (28.4, p< 0.01, and 12.7, p= 0.02, in groups 1 and 2, respectively). Cost per caregiver reaching the target ratio was most favorable in Group 1 ($391 in Group 1, $527 in Group 2, and $1,666 in the control). Enhanced SBCC combined with increased oil ration resulted in increased use of oil in CSB porridge in a supplementary feeding program. Modified packaging did not improve effectiveness. However, both interventions were more cost-effective than standard programming. [ABSTRACT FROM AUTHOR]