Statistical Methods for Health Care Research

Evidence suggests that participation in physical activity may support young people’s current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects. The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2–5 years of age), children (6–11 years of age) and adolescents (12–18 years of age). A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents. A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6–18 years (effect size 0.173, 95% confidence interval 0.106–0.239, p < 0.001, percentage of total variability attributed to between-study heterogeneity [I2] = 11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent. Findings from the meta-analysis suggest that physical activity interventions can improve adolescents’ mental health, but additional studies are needed to confirm the effects of physical activity on children’s mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.

Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta-Analysis.

CONTEXT: Numerous faces scales have been developed for the measurement of pain intensity in children. It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity, reliability, feasibility, and preference. OBJECTIVES: To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility. METHODS: Five major electronic databases were systematically searched for studies that used a faces scale for the self-report measurement of pain intensity in children. Fourteen faces pain scales were identified, of which 4 have undergone extensive psychometric testing: Faces Pain Scale (FPS) (scored 0–6); Faces Pain Scale–Revised (FPS-R) (0–10); Oucher pain scale (0–10); and Wong-Baker Faces Pain Rating Scale (WBFPRS) (0–10). These 4 scales were included in the review. Studies were classified by using psychometric criteria, including construct validity, reliability, and responsiveness, that were established a priori. RESULTS: From a total of 276 articles retrieved, 182 were screened for psychometric evaluation, and 127 were included. All 4 faces pain scales were found to be adequately supported by psychometric data. When given a choice between faces scales, children preferred the WBFPRS. Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS. CONCLUSIONS: For clinical use, we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use. For research use, the FPS-R has been recommended on the basis of utility and psychometric features. Data are sparse for children below the age of 5 years, and future research should focus on simplified measures, instructions, and anchors for these younger children.

A Systematic Review of Faces Scales for the Self-report of Pain Intensity in Children

Background Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development Self-regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts

Aims  This paper reports on a study to explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills

Methods  Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self-regulation and thinking

Findings  Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition This skill acquisition is best accomplished through teaching–learning attention to self-regulation learning theory A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self-regulated learning theory It is apparent that single-minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development Likewise, single-minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self-regulated learning prompts

Conclusions  Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self-regulated learning strategies The self-regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts

Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self‐regulated learning theory

https://cmapsconverted.ihmc.us/rid=1MCY0CLZ4-1HDF60Q-15R8/Case%20Studies.pdf

Promotion of critical thinking by using case studies as teaching method

Background: Hospitalization of a neonate in the neonatal intensive care unit (NICU) can be a stressful event for parents. They need specific information and communication to alleviate their stress, but these parental needs are not met by NICU staff. Exploration of these needs can help health professionals to provide better healthcare services. Objectives: The purpose of this study was to explore the information and communication needs of families in neonatal end-of-life and bereavement in the NICU. Materials and Methods: A qualitative content analysis method was used for this study. Data were collected through single semi-structured interviews with 24 participants. Sampling was conducted based on the purposive sampling method in five NICU environments in Iran. All interviews were taped and transcribed verbatim. Results: Data analysis revealed two main themes: information and communication. For information, there were two subthemes (true information about the infant’s health and true information about the infant’s death), and communication needs also developed two subthemes (communication with healthcare professionals and communication with the infant before, during and after the infant’s death). Conclusions: According to the results, parents need accurate information about the health and the death of their neonates in the NICU. They also need to communicate with healthcare professionals and their babies. Communication is regarded as a channel for obtaining information. Therefore, the healthcare team needs to address these families’ needs and attempt to fulfill their requirements in neonatal end-of-life and bereavement in the NICU.

Information and Communication Needs of Parents in Infant End-of-Life: A Qualitative Study.

Background and Aims: Newborn death is an unexpected outcome for parents. Parents face with several needs in infant end-of-life. The health care team is responsible for meet these needs. This qualitative study aim was to explore of parental needs in infant end-of-life and bereavement. Materials and Methods: For this qualitative study, 24 single semi-structure interviews were done. A qualitative content analysis method was used. Sampling conducted on purposeful with maximum variation in five Neonatal Intensive Care Unit (NICU) environments in Isfahan city. Inclusion criteria for nurses and doctors were having at least one experience of caring for an infant and their family at end-of-life. Inclusion criteria for parents and their families were having at least one infant at end-of-life or had lost their infant for 6 months before in NICU. Results: Data analysis uncovered two main themes. Family's support needs with two subthemes (family's support needs before infant's death and family's support needs after infant's death) and family's preparatory needs upon infant's death with two subthemes (management of the bad news of infant's death by treatment team and management of the bad news of infant's death by family). Discussion: Mourning mother's need for her husband's presence by her side, getting hospitalized in a separate room, and management of infant's death news by father and family were among items rarely pointed out in other studies. Exploration of these needs cab be helpful for the health care team for providing care.

Parental needs in infant's end-of-life and bereavement in NICU: A qualitative study.

Background: Sleep is essential for organizing and maturation of the brain in premature infants; it also plays a role in maintaining the natural balance between different nervous centers. Given the role of nurses in neonatal sleep care, this study aimed at assessing the impact of a training program on the nurses’ knowledge and performance in a Neonatal Intensive Care Unit (NICU). Materials and Methods: In this quasi‑experimental study which structured into three stages, 35 nurses working in an NICU in Isfahan, Iran, were included. The neonatal sleep training program was in the form of a lecture with questions and answers and then placing posters and booklets in the NICU. The data were collected by a questionnaire for nurses’ knowledge and performance assessment which its validity and reliability were determined through content validity and internal consistency, respectively. The nurses’ knowledge was assessed via 40 multiple‑choice questions before, immediately after, and 1 month after the training program, and their performance was evaluated before and 1 month after intervention using 15 multiple‑choice questions. The data were analyzed by descriptive and inferential statistics using the SPSS software version 16. Results: The results showed that the mean score of nurses’ knowledge after training has significantly increased as compared to before training (33.33 (4.4) vs. 19.33 (4.1)) ( P < 0.001); however, the score of performance was slightly improved although it did not reveal any significant differences ( P = 0.07, 42.6 (7.6) vs. 45.1 (7.8)). Conclusions: The results indicated that this method of training program could lead to an increase in nurses’ knowledge, but it did not significantly improve their performance. It may be due to a low number of training sessions; therefore, it is recommended to implement long‑term training programs in this field.

/pdf/the-impact-of-a-neonatal-sleep-care-training-program-on-4krk19wnli.pdf

The Impact of a Neonatal Sleep Care Training Program on Nurses' Knowledge and Performance in Neonatal Intensive Care Units.

Background: Children with cleft lip and/or palate frequently experience feeding difficulties that may place them at risk of malnutrition. Parents' negative response to these problems is associated with development of problematic behaviors in the child. This study aimed to investigate feeding behavior in children with cleft lip and/or palate and parental responses to these problems. Materials and Methods: A total of 120 parents of children (aged 6 months to 6 years) with cleft lip and/or palate were recruited from the Cleft Lip and Palate Clinic in Isfahan University of Medical Sciences, Isfahan, Iran, who gave consent and completed a two-part questionnaire through interviews. Part A of the questionnaire consisted of 25 items that evaluate children's feeding behavior during mealtimes and part B consists of 18 items that assess parental response (strategies, feelings, and anxiety) to these problems. Results: Independent t-test showed a significant difference in the mean score of feeding behavior in mothers (P = 0.020) and parental responses in fathers (P = 0.030). The Pearson correlation coefficient showed an inverse correlation between behavioral feeding score and children's interval (P = 0.008, r = −0.381) and direct correlation between parental response and feeding behavioral difficulties (P = 0.003, r = 0.428). Conclusions: With regards to the results representing appropriate feeding behaviors in children with cleft lip and/or palate, it is suggested that feeding be avioral assessment is an essential nursing and nonmedical intervention for all children.

/pdf/feeding-behavioral-assessment-in-children-with-cleft-lip-and-1ocyldyfcc.pdf

Feeding behavioral assessment in children with cleft lip and/or palate and parental responses to behavior problems

Background: Adolescent is a time of profound biologic, intellectual, psychological, and socioeconomic change that they will face a crisis. Therefore, compatibility may be exposed to many hazards, such as depression, anxiety, and other emotional problems. Nevertheless, a planned regular exercise enhances physical and mental health of adolescent female with diabetes. The aim of this study was to determine the effect of exercise on emotional reactions of female adolescents with type I diabetes. Materials and Methods: This study was a quasi-experimental research conducted in Endocrine and Metabolism Research Centre. A total of 72 patients were randomly allocated in the two groups. The intervention group did aerobic exercise for 45 minutes, while the control group did not aerobic exercise. Data were collected using a Symptom Checklist (SCL)-90 questionnaire. Data were analyzed and using descriptive and inferential statistics methods and SPSS software. Results: The results showed that the mean score for physical symptoms, depression, obsession–compulsion, interpersonal sensitivity, aggression, phobia, paranoid ideation, psychosis, and anxiety in the test group significantly decreased after intervention than before intervention. The average score in the control group did not differ. The average total score of emotional reactions in the test group after the intervention decreased before the intervention significantly ( P = 0.001). However, in the control group, the mean scores did not differ (P = 0.97). Conclusion: The findings showed that regular exercise is effective on affective responses of adolescent females with type I diabetes.

Marzieh Hasanpour

Papers

Information and Communication Needs of Parents in Infant End-of-Life: A Qualitative Study.

Parental needs in infant's end-of-life and bereavement in NICU: A qualitative study.

The Impact of a Neonatal Sleep Care Training Program on Nurses' Knowledge and Performance in Neonatal Intensive Care Units.

Feeding behavioral assessment in children with cleft lip and/or palate and parental responses to behavior problems

Impact of exercise on affective responses in female adolescents with type I diabetes.